Giving Bad News Gently

The hard truth of medicine, in particular my job in emergency medicine, is that not merely that people die. It is that we have to tell people that people die.

I don’t mind resuscitations, although they can be emotionally and physically exhausting.  I don’t mind managing the airways, putting in the central lines.  I don’t mind thinking through the algorithms and wondering what might work to keep the person before me alive.

What I mind is going out into some waiting room, or to some alcove or some tiny chapel where someone waits.  Their mind and heart racing, their prayers flying up.  Often that someone knows that I’m bringing bad news.  They had a call about a loved one who had a cardiac arrest.  Or they were notified of a car crash.  Maybe they were there.  Maybe they started CPR.  Maybe they tried to get their husband or wife to come to the doctor for that chest pain, but that person refused.

People aren’t stupid. They can sense tragedy and death.

And so I learned in medical school, and residency, how to talk to those who had lost loved ones. I learned to break the news. Over the years I think my delivery has improved.  Furthermore, as often as I can, I do something to make the crash of horrible news less abrupt. To give a stricken human heart a few moments to assimilate a life-changing event.

When someone is receiving CPR and all the medications and other interventions we apply to the dying, I try as often as I can to go to their waiting loved one and explain what happened and what we are doing (including chest compressions).  So much of this work is algorithm driven. CPR continues, medications given on time intervals, etc.  This gives me a moment to talk while nurses and paramedics keep things on track.  After I talk to them I’ll sometimes go back to the resuscitation room to see how things are going.

If it looks as if we are not going to succeed, I’ll go back to the loved one and say “I’m so sorry but your husband (son, wife, daughter, grandmother, grandfather, etc.) is not going to survive.  But I was wondering if you’d like to be in the room when we stop doing CPR.  Do you want to come with me?”  In the case of children, I will bring the parents in early so that they can be with their child and know without question that we did all we could.

Although things are sometimes different in the age of COVID, and of course this varies by locale, in general I have found it to be a very compassionate way to allow loved ones to see the moment that all of our efforts stopped.  They typically consider that the time their dear one died.

It’s horrible to give news cold.  To say to someone who has no idea what’s going on, ‘she died.’  But by carefully, gently introducing the concept, we can offer comfort to the living in a time of personal cataclysm.

Edwin