Survivors: Our Newest Patients

Posted on November 5, 2013 by

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Sudden death. We see it every day in the emergency room, the ICU, on the trauma service. A patient comes in and no matter what we do we are going to lose him within minutes or maybe hours. What we do next could have a lifelong impact on that patient’s survivors.

But why? Our patient is in the process of dying no matter what we do. We can’t change that fact. What can we possibly to to help the family?

Sudden death, the unforeseen and unexpected demise of a loved one makes a mess of survivors.  Five minutes ago we were a family with three kids, now we have two. A moment ago I was happily married, now I am a widow. Sudden death is disruptive. Lives are transformed in an instant, reality rearranged and the future reimagined.  The experience of sudden death is profoundly disorienting. Survivors are lost.

What can we do to help them?

It turns out we can do a lot if we exercise the four principles of breaking bad news. First we need to prepare survivors for the ultimate bad news. If there is an opportunity to bring them into the trauma room during a resuscitation or into the ICU during CPR we should. The family needs to witness the heroic efforts to save their loved one. Failing that, we should “fire a warning shot,” i.e. use our words and tone to convey that things have taken a turn for the worse. Families will follow our cues if we provide them.

When the patient dies we need to communicate clearly using a simple narrative if possible. Your mother grabbed her chest and collapsed. Her heart stopped beating. We performed CPR.  Despite our best efforts she died. We need to take our time, allow for silence and questions but more than anything we need to convey that we care. We need to show empathy: the feeling that we understand and share another person’s experiences and emotions. Showing empathy validates a person’s expression of grief. We get this. We’d be a mess too.

Next we need to be prepared to manage the survivors’ emotions – denial, anger, sobbing or acceptance. We need to listen with a nonjudgmental attitude as people react to the news. The reaction might make us uncomfortable but we have to hang in there and let it fly.

And finally we need to help plan the next steps. People don’t know what to do when their loved one dies. We have to walk them through it. Do they want to come see the body. Is there anyone else we should notify? Could we call the funeral home for them? We need to do whatever we can to be of assistance.

Survivors are victims too, our newest patients. And like any other patient, they deserve our best.

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