Viewpoint: How to handle a death in the family and keep going

December 4, 2009

No one educates young physicians on how to tell your own family that someone is dying or how to balance your grief and sadness with your family's request for medical knowledge.

During residency, I informed patients and family members of impending death, and have pronounced and certified the deaths of many. Sometimes I had known the patient long enough to establish a connection with him and the family. Other times, as an intern, I did not know the patient whose silent chest I listened to at 3 a.m., whose eyelids did not dance, whose pupils did not respond, and who, in perhaps the most unnerving measure, did not wince or retract when I intentionally induced pain.

In my limited time practicing medicine, I felt fairly confident in my ability to calmly and quietly discuss end-of-life issues. However, no one educates young physicians on how to tell your own family that someone is dying, or how to balance your grief and sadness with your family's request for medical knowledge and advice.

"Hey, Blythe, Grandpa had his operation today and that went well, but he has been crazy ever since."

Translation: Patient developed post-op delirium.

"He has been thrashing around, yelling, restless, and sweaty. They don't want to give him too much medicine, but he is out of control."

Translation: Delirium worsened, patient now tachycardic, probable 4-point restraints.

"Last night your dad heard him speaking in Cherokee; he was whispering the Death Chant, but that is the only time he talked. Today they tell us he has pneumonia. He is not breathing well without oxygen, and his heart is beating funny."

Translation: Patient now with fever, possible etiologies include pneumonia, sepsis, urinary tract infection, bleeding, and now requiring supplemental O2. Question of pulmonary effusion, fluid overload, heart failure, and/or atelectasis. Still unresponsive. All are poor prognostic indicators. May also be developing an arrhythmia.