| As
Emergency Physicians, we are often faced with treating
patients in their dying moments. To nonmedical people,
it sounds as though this would be stressful, but
for those who chose Emergency Medicine as a career,
it usually is not. We relish the opportunity to
save a life or rescue a patient from the jaws of
death.
We are very good at performing
the split second yet complex decision-making tasks
during a resuscitation. We are ever ready to utilize
the skills we have honed during the hours in the
Operating Room or procedural labs. Of those patients
who arrive with any signs of life or who suffer
witnessed cardiac arrest in the department, we do
resuscitate a significant number.
Now, before we start patting ourselves
on the back, we must ask, "How do we fare with
our other group of patients?" What other group
of patients, you might ask? I am referring to that
group of patients in the waiting room that are spiritually
and emotionally linked to the patient dying in the
resuscitation room. Sometimes we fail to realize
that the friends and relatives attending are just
as much our patients as the one in the cardiac or
trauma room with all the IVs and tubes.
While the patient in the Emergency
Department may have undergone a transition from
clinical life to clinical death, the loved ones
in the waiting room may be embarking on a path leading
toward emotional and/or spiritual disaster. Usually
the more unexpected the death, the more difficult
it is for family members to receive the news.
Our every interaction with loved
ones must be geared toward directing them up the
path of psychological healing instead of allowing
them to drift down the road of emotional pain and
suffering. This in no way implies attempting to
thwart the grieving process, for this is an important
step toward healing.
I have discovered some things to
be helpful in my encounters with family and friends
during the initial moments following the death of
their loved one.
1. Sit down. This will impart that
you are not in a hurry and that you intend to communicate
on their level.
2. Identify the spokesperson of
the family. This will usually be the spouse but
could be an elder child.
3. Speak directly to the spokesperson
with direct eye contact. It is important to impart
your sincerity and your understanding of the seriousness
of the situation.
4. Make sure to have a nurse or
social worker with you to help comfort the family.
5. Review the events leading up
to the patients demise. (The family will not hear
anything else you say after the announcement of
death.)
6. Make sure friends and family
understand the patients clinical status upon arrival
to the Emergency Department. Many family members
and friends do not understand that if CPR was in
progress, the patients heart had already stopped.
7. Explain what you did in lay
terms. Explain that CPR was done by pumping on the
chest in order to try to circulate blood. Explain
that you put a tube in the wind pipe to help breathe
for the patient. Explain that you gave medication
to try to get the heart to start again.
8. Tell the family clearly that
the heart would not start again, and the patient
died. Do not use terms like "they have left
us" or "they have passed on" or "they
have expired" or "they are no longer with
us." These phrases are too vague and many family
members will not know what you are trying to tell
them. Some family members may even think that you
are trying to be evasive.
9. Find a private room for the
family away from the waiting room where you can
speak candidly and the family can express their
emotions and concerns.
10. Offer clergy and/or counseling
services for all family members and friends.
I believe that with appropriate
effort and education, physicians can become as adept
at psychosocial healing as we are with clinical
entities.
©1999 by The
American Academy of Experts in Traumatic Stress,
Inc. |
