There is no right way to tell a family their loved one is dead or dying. Before you speak they know. There is a weight, an air that you carry when you enter the room with that knowledge.
By the beginning of my second year of residency, I had pronounced three people dead. Two of them had slow deaths, which made it no easier to perform the piece of somber theater that is the death exam. Walking into the room of the first patient I pronounced remains the scariest thing I’ve ever done.
She died from multi-organ failure a week after we prophylactically intubated her in the ICU. Her last words were to me, as was her last smile. The week after her intubation she became exponentially sicker, each day a new organ system shutting down. Each day I met a new family member, explaining as best I could that we did not know what was going on. We did not know why she was not getting better. We knew that she was going to die.
I met her mother, her many brothers. I met her daughters. Together her eldest brother and I decided to place her on comfort care, keeping her comfortable while her family assembled to say goodbye before we turned off the medicines keeping her alive.
The nurse’s message buzzed its way through my pager: 6W48 HAS PASSED, COME EVALUATE. My senior resident asked if I wanted her to come with me. I declined.
Outside 6W48 I took a moment to choke down the lump in my throat. I rehearsed in my head how I would say it. How I would look around the room at her mother, her many brothers, her daughters. I nervously recalled the different necessary steps of the death exam. Check for pulses. Listen for heart and lung sounds. Check for pupil response. I told myself that it would be like acting in plays in college: go in, say my lines, play the character, exit stage right. I was terrified of crying in front of them.
I walked into silence, checked for pulses, listened for heart and lung sounds, checked for pupil response. “I’m so sorry,” I managed to choke out. “She’s gone.” I looked around the room slowly, trying to make eye contact, my mouth a thin line, my brow slightly furrowed. “I’m sorry.”
I left her room expecting to break down, to have to go outside and get some air. But the lump in my throat was gone. I felt no need to rush outside. I went back to the workroom and back to work. That night I wondered why I didn’t cry…. To Be Continued
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This is part 1 of a 2 part series written by Dr. Garrett. Part 2 will be published in the next edition of the Physician Grind.
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Alexander Garrett MD
Alex Garrett is a PGY-4 Emergency Medicine resident at the Harbor-UCLA Medical Center in Los Angeles. He is originally from Maine but moved to California for his education. He is a proud graduate of Stanford University, and he received his MD from the David Geffen School of Medicine at UCLA. He is deeply interested in medical education and social emergency medicine