2 CASES: Situations that stun
Your postop patient suffers acute chest pain and dyspnea on the second hospital day, becomes moribund, and dies. Her family, agitated and upset, has gathered in her hospital room. The unit nurse telephones you and asks you to come to the hospital.
Your brother calls to tell you that his teenaged daughter has just been killed in an automobile crash. He is at the emergency room of your local hospital and asks you to join him there.
In both cases, how can you prepare yourself for what you will face, and what you will say, when you arrive at the hospital?
Like all ObGyns, you have experience telling parents about an expected, or unexpected, perinatal death, and bringing news to a family when death comes finally to a patient who has metastatic cancer. But how well are you prepared to handle the two hypothetical scenarios above? Granted, they represent infrequent, if not rare, occurrences for most of us, in or outside our practices—but they happen.
In this article, we offer suggestions—based on extensive experience we’ve gained working with a national organization, the Trauma Intervention Program (TIP)—on how you can provide emotional first aid to family and other loved ones in the hours after your patient has died unexpectedly. We also briefly explain how TIP citizen volunteers can extend the comfort and counsel that you and other hospital team members provide immediately after the death.
Be present in a caring manner. Caregivers often believe that they must do something. But survivors have repeatedly reported that what they appreciated most was just the person’s caring presence. This includes reaching out physically and emotionally: positioning one’s self at the survivor’s physical level of standing or sitting; a gentle touch; use of the person’s name; a soft voice; and acknowledging the reality of the experience.
Protect the survivors from unnecessary and inappropriate emotional and physical intrusions and behaviors. This skill includes redirecting survivors from making impulsive and, in particular, major decisions—most of which can wait. It also involves paying attention to the person’s physical needs, such as food, water, prescription medicine, and rest. Last, it means helping survivors find a safe place, where they can be protected from being pressured or victimized by others who may not have their best interests in mind.
Provide survivors with timely, clear, valid, and understandable information about what is happening; convey it in an affirming and useful manner. Doing so can be greatly reassuring to loved ones because there is often an urgent need to have answers to questions such as “What happened?” and “Why did this happen?” Preferably, this task falls to medical personnel but, at times, it’s necessary for another member of the team to act as the information advocate and to focus on what the survivors specifically want to know. The more accurate the information that survivors have, the less apt they are to blame themselves for the death of the patient or the circumstances of that death.
Help organize a simple plan that will facilitate survivors’ regaining a sense of control of the situation. Focusing on what needs to be done now mitigates the paralysis that causes a person to lose the capacity to deal with the novel demands created by tragedy.
Reinforce survivors’ source of strength. This is an essential step. Survivors will seek to find something or someone to hold onto in the first hours in an effort to survive emotionally and regain a sense of control. The task of the caregiver is to help them find that source of strength and then support its value once found.
After a death, a window opens briefly for crucial action and care
When a patient dies, your role is usually limited to the notification of death and whatever comfort you can provide in the short time you spend with the family and other loved ones (we’ll simply call them all “survivors” here). Most of us have not interacted with grieving survivors beyond that—in the several hours after the immediate time of the death.
But what does, or does not, happen during that subsequent interval has the potential to be healing for survivors or to cause them pain (and, it’s worth noting, to have a positive or a negative impact on your emotional health). In those hours, many thoughts crowd in for survivors: What happened to their loved one; what they were doing and how they were informed; the attitude, behavior, language, and tone of first responders and health care professionals. And all these thoughts become everlasting memories.