I think that all doctors would agree that of all of the moments we get trained for, the one that can be the most difficult is when telling a family member that their loved one has passed away. It’s hard to find the right words, especially when speaking to someone that, in many cases, you have known for less than a few hours at best.
Not so long ago though, I had accepted an assignment at a new hospital and was still getting my bearings. I had become used to the culture of the South where usually I made sure my back was covered before I informed families of bad news as they were known to sometimes attack me in their misguided grief (they usually apologized later). This though was a different part of the US.
Enter Mr. W from the nursing home. This patient was 66 years old and had suffered through many medical problems in his life. He was a double above the knee amputee who was coming because of lethargy and abdominal pain. When I went in to see the patient, he looked ashen and was very lethargic. His abdomen was very distended and had the distinctive tin sound of a bowel obstruction when I listened. So, I ordered blood tests and an x-ray. He didn’t last long in x-ray as when they tried to lay him down he groaned and started retching. So, the x-ray staff brought him back and requested we maybe put a tube in his belly (NG) to prevent him from barfing all over the place when he got flat.
“Reasonable enough”, I thought, so I asked the nurse who was taking care of this patient to come with me and we would get this done together and hopefully soon because he wasn’t looking so good. The nurse passed the tube as I tried to coach the patient and when it was hooked up to suction, suddenly the patient stopped moving and his color paled a little bit. I almost wondered if we had passed it into his lungs, but it sounded like it was in the right place. We stood there for a moment considering whether the old timer had just taken his last breath. It was an interesting moment in my career – no urgency, no fear on my part for some reason.
Then I said to the nurse, “Hey, if this guy’s not a DNR (do not resuscitate) then we should probably call a code.” Some of you may be thinking, “Wow, that’s kind of a nonchalant attitude isn’t it”, and I wouldn’t blame you because it really did seem as if time was passing a little slow. We went out and were told that he did in fact have a medical directive and so we had done the right thing. That’s when things began to get interesting …
A call was promptly put out to family. A message was left for his wife, but we did succeed in getting a hold of his son. We told him that he should probably come to the hospital immediately as his father was very sick and may not survive. His answer?
“Well, there’ll be no love lost there I tell ya.” And then he hung up. Hmmm.
I then asked the nurses where they usually have the doctor tell the family the bad news. They said that there was indeed a family room and they would go ahead and getting the grieving tray ready. “Grieving tray?”, I asked. The grieving tray was a special at this kind hospital – loaded with cookies, fruits, pie, tea and soft drinks – to help grieving families with their overwhelming emotions. I thought that was nice, but then one of the nurses told me, “Yeah, they usually never touch it, so then we get it after they’re gone and can snack on it.” Ahhh, the ever practical mind of the ER staff.
So, I got busy with some other patients and about 45 minutes later, I’m called out to the nurse’s station to meet with the deceased man’s wife. I ask the nurses where I can go (assuming they understood that I meant I wanted to go to the family room) and they told me to go to the end of the ER in the last room. As I’m walking with the woman, I’m at a loss of what to say and just trying to get her to where we can sit down so that I can break the news to her. I get to the last room and pull open the curtain only to find the dead man lying there! Doh!
The woman pushes past me to go to his side – still not knowing if he’s dead. Meanwhile, I’m desperately thinking what to say to her and how to handle this awkward situation (and how much I wanted to strangle the nurse who sent me down here!). As the woman stands – oddly enough at a distance – by the bed, she asks in a confused voice,
“Is he dead?”
Damn it! Have to think fast …
“Yes ma’am, actually your husband did pass away just before you arrived. I’m sorry that you had to learn this way, but we did try everything we possibly could …”
She didn’t seem to be listening though. I was thinking that maybe I should get her a chair or something. Was she going to pass out? Suddenly, the single most amazing thing I have ever seen in a dead patient’s room happened next.
The woman leaned over her husband’s face, looked at him directly and then asked out loud,
“I wonder if he’s in Hell right now.”
Overwhelmed with relief that she wasn’t pissed at the lack of a proper introduction, and at the same time by my disbelief at what I had just witnessed, I blurted out anything I could to keep from laughing. “Ma’am, there seemed to have been some confusion over his medical directive. Did he in fact have one?”
The disbelief continued in her next statement.
“You know, I have no idea. But if you woulda asked me, I woulda told ya to let the bastard die.”
Ok, what do you say to that? Before things got any stranger, I excused myself and told her that I would give her some time alone and that if she wanted anything to drink that the grieving tray was there for her – although in her case, I guess it may have been more appropriately called a party platter. As I stepped out, I silently wondered if she was going to slap him, spit on him or even worse, get out a knife and carve her initials into his chest.
Turns out, after some further research, that this man had been a wife-beater and a terrible father to his children. He had lived a life of hurting everyone in his family which explained the interesting reaction of his whole family to his death. For me though, it is a case I will never forget,
And by the way, the cookies were good.