How to tell a family that their loved one has died

by Tim Noonan

When a team misses out on an opportunity to go to the Super Bowl, World Series, Final Four, or something similarly trivial, these words may be appropriate. When the person, who has been the center of your life dies, what is more insensitive than, We’re sorry for your loss?

What kind of language is that to use when providing some of the worst news we could imagine? True, we could try to be insensitive and say something like, Sucks to be you, but I am assuming that the goal is not to demonstrate a lack of compassion, or a lack of sympathy. At least not intentionally, still these are lacking.

Compassion and sympathy mean to share feelings with another. In this case, to share suffering with another. We don’t want to suffer and we do not want them to suffer. We’re sorry for your loss is only a way of deflecting a suffering we hope never to know. The death of someone we love may not be the worst experience of our lives, but the unexpected death of someone young has little competition for the worst experience.

When my father died, I had known it was coming for years. He had his defibrillator turned off several weeks before. Apparently an arrhythmia was the cause of his sudden, but expected, death. He could not have planned it much better. My mother called me, and I talked her through confirming that my father really was pulseless. I reassured my mother that this was what he had repeatedly said that he wanted. She could call the funeral home in the morning. By then, even the most aggressively insensitive EMS people should be able to realize that he is beyond treatment. I told her to get one of the many DNR forms that I had placed all over the house, in her pocketbook, and in his wallet.

An ideal death. 82 years old. No signs that his death was painful. No unnecessary treatment was inflicted on him to satisfy any bureaucratic sadism. We should all be so lucky. These are the deaths that are the easiest to deal with. It is difficult to mess up this death notification, since everybody already knows.

However, it is with the unexpected death that we seem to go out of our way to be insensitive. When someone dies, we use words that attempt to hide what happened. We lie. As if that lie will make the suffering go away. We aren’t trying to be insensitive, but that does not keep us from insensitive behavior.

Telling a young mother that her 3 month old has gone to a better place is just telling a lie in order to avoid using the word dead.

Telling a couple of parents that their teenager has passed on is also just telling a lie in order to avoid using the word dead.

What about death brings out this kind of abuse? We can break the news gradually, but giving someone false hope through these lies is cruel.

I like to start by asking if they know what is going on and letting them guide me to the right way to break the news to them. Many will ask directly. They almost never use euphemisms, although they may now be hoping for something that was unthinkable just a little while before – jail, or just an amputation, but not dead. The person may be in a better place, but the word that needs to be used is dead.

We need to make it unmistakably clear. The simplest way to do that is to use the word dead. It is the truth. We need to stop telling lies, just to help us feel better. This isn’t about us.

In medicine, meaning well does not keep us from making a bad situation worse.

Tim Noonan is a paramedic who blogs at Rogue Medic.

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  • http://rk.md Rishi

    Great post! It’s nice to read a straightforward and bold approach to addressing death.

  • http://www.birdsonawireblog.com Paula

    My dad, 89, had been in a New Jersey nursing home more than a year when the nurse in charge called me one night to say she was sending him to the local community hospital for evaluation. This wasn’t an emergency, she stressed, but he was having a little trouble breathing and she thought he should be looked at.
    Almost 90, a biochemical research scientist with many patents to his name, my dad still had most of his faculties, but not a good heart. Although generally upbeat and cooperative, he didn’t want to go to the hospital that night. I told him he should and, if they admitted him, I’d drive down to see him in the morning.

    This was the conversation I had with an ER doc 345 minutes later:
    Me: This is Paula Blah-Blah, Paul Blah-Blah’s daughter. I believe you’ve seen my dad tonight?.
    Doc: Where are you?
    Me: I’m in Massachusetts.
    Doc: What are you doing there?
    Me: That’s where I live. Um, can you tell me what’s going on with my dad? Did you admit him? I can get down there in six hours, if you think I should.
    Doc: He died.
    Me: (gasp) Oh! What happened? I mean, can you tell me what happened? Was he in any pain? Is there anything you can tell me? I’m sorry, I didn’t expect this and don’t know what to do.
    Doc: I have no way of knowing if he had any pain or not. Uh, do you have any other questions, because I have to get back to work.

    And so it went. Next!
    Yes, the man was honest and direct, but I was appalled at this physician’s callousness. I’m not sure what he should have said, but this wasn’t the way I expected my father’s death to be handled.

  • http://roguemedic.blogspot.com/ Rogue Medic

    Rishi,

    Thank you.

  • http://roguemedic.blogspot.com/ Rogue Medic

    Paula,

    What you describe is horrible. I was not suggesting that we be direct at the expense of compassion.

    There probably is no good way to handle this over the phone.

    One way to start telling someone about a death is by asking what the person knows about what is going on. By providing more information, paying attention to the responses, and finishing up with a clear acknowledgment of death, using the word dead.

    Especially over the phone, it is easy to be misunderstood, but that does not make being blunt the right approach either. There are times when the ED is extremely busy and the living meed to take priority, but the doctor should consider asking to call you back at a time when some time can be taken to not be callous.

    There are a couple of very well written posts from other bloggers that provide a slightly different perspective on dealing with death in the hospital.

    Coffee

    and

    The Family Room

  • http://www.mcgath.com GaryM

    “Gone to a better place” is the worst of those. It implies that the survivors share — or had better share — the religious views of the one giving the news.

  • http://roguemedic.blogspot.com/ Rogue Medic

    GaryM,

    I agree. We need to avoid any expression of our beliefs, unless asked by family.

    It is difficult for many of us to realize how we express ourselves in ways that we are not conscious of, because it is so much a part of our lives.

    Family, friends, neighbors, and others may be expected to express these views, but we are there because we were providing medical care.

    Many hospitals have social workers, who can help with this. One of the mistakes we make is calling for social workers only after someone has died.

    A social worker can be a priceless resource in providing information to the family and gathering extra information for the doctors and nurses, while allowing the medical personnel to focus on patient care and keeping the family from feeling like they might as well be on another planet.