As physicians, we have been well trained to understand the pathophysiological processes that bring about death and how to best manage them. We know very well the scientific language of death: organ failure, sepsis, cardiac arrest, etc.
Explore This IssueACEP News: Vol 32 – No 01 – January 2013
But we are arguably ill-equipped to deal with some of its social and personal consequences. Informing a family member of a loved one’s death is perhaps the most difficult and uncomfortable conversation that we have in the emergency department, especially for those of us who are early in our careers.
We have all attended the funerals of loved ones and friends. Condolences are exchanged. Brief words. We know, having been in those situations, it is a person’s presence or past relationship that gives weight to those words, not the words themselves. But in the ED there is frequently no past relationship. We are not the family physician who talked a mother through the anxiety of her husband’s job loss. Nor are we the pediatrician that observed the child pick up two blocks one year and three blocks at the next visit.
We were not “there” for them before. Our first encounter with the patient and or family may, in fact, be at the time of the death. Without any past relationship, words by default take on great importance.
The day my grandfather passed away, my uncle got a call from a health care provider informing him that his father had “expired.” The matter-of-factness and apathy in the man’s tone was akin to the automated voice that lets you know your prescriptions are ready to be picked up from the pharmacy. It did not sound like an empathetic human being who had ever been on the receiving end of such a call.
Humans probably should not “expire.” While “expire” would certainly qualify as a synonym for death, it connotes a fixed, unavoidable end. In a way, it negates or ignores the possibility of afterlife, something I am sure the health care provider did not consider with his choice of words. Just think about what happens when milk expires: it goes bad and you throw it out.
“Breaking bad news” is by no means easy. The language of death is admittedly very nuanced and difficult to navigate. The weight of the circumstances greatly magnifies small differences in gesture, tone of voice, and connotation. The conversation will constitute a meaningful part of how the family views and comes to terms with their loved one’s death. There are no metrics for how much these discussions matter, but some studies have looked into what exactly is important for surviving family members.