Taylor Klein, OMS-II, NRAEMT
I’d be surprised to encounter someone working in healthcare who doesn’t remember their first experience with death. We are taught that it’s inevitable; we can’t save everyone. We know that we will eventually encounter patients who are beyond the help of medical intervention. We are told to internalize that it isn’t our fault. Guidelines exist for delivering the sad news to family members. We know how we are supposed to react. But, we don’t really know how we will react.
I can tell you the exact date of the first patient I lost. I can also tell you about how overwhelmingly unprepared I felt. I was an EMT-Basic student on my first shift riding along on the rig and toned out for the second call of that shift. It was my second call ever! We knew we were en route to a pulseless, non-breathing patient. I vividly remember one of my preceptors turning to ask me if I knew CPR. I remember being assigned to chest compressions while my preceptors worked on more advanced interventions. I can still hear the IO drill, see the image of the vocal cords on video laryngoscopy, and remember the unsettling feeling of being relieved from my task by a automated CPR device.
I don’t think I became aware of the patient’s family until my hands were idle, but suddenly there they were. They were asking us repeatedly if their loved one was dead. I don’t remember who eventually answered them, but it certainly wasn’t me. I was shocked to silence, listening to one of our firefighters explaining that we were doing everything possible. I have two other striking recollections of this call. One, sitting in the captain’s chair en route to the hospital watching the capnography reading. I was ventilating the patient when I was struck with the notion that the patient was not going to survive. Next, looking out the garage door of the ambulance bay watching as a family friend brought the patient’s school-aged children. I hadn’t even noticed them at the time; they were in the room during the entire incident. At this point, the patient had already been pronounced dead by the physician. We had continued life-saving efforts long enough for a nurse to bring in the patient’s wife to say goodbye. The patient’s wife was present for the time of death, and I had witnessed the hospital staff counsel her. It wasn’t until seeing those children, at that moment, that the weight of being a part of the story of one of the worst days of that family’s life settled over me.
Unfortunately, this wasn’t the last patient I lost. I can no longer tell each individual story. Each has helped me improve on the skill set necessary to respond to such a situation. I’ve had mentors, colleagues, and experiences to learn from. While I now feel more confident in managing such a situation and my own reactions, I feel like I’ve never reacted perfectly. Now, as a medical student, it has become increasingly common to hear my peers discuss concerns about their own ability to handle such a situation and apprehension about their own possible reactions.
Delivering bad news is a common source of apprehension and different physicians have different preferred methods, but almost all use some components of the “ABCDE” method (Vandekieft , 2001) outlined in Figure 1.
Figure 1. ABCDE Mnemonic for breaking bad news (Vandekieft, 2001)
B-Build a Relationship
D-Deal with Family Reactions
E-Encourage and Validate Emotions
For students learning this method, it provides an excellent outline for communication with families and setting expectations for such an encounter. However, it provides little in the way of how to manage your personal reaction to the loss.
As future or current healthcare professionals, we have a responsibility to manage our own reactions in such a way that we can continue with our daily tasks and provide the best possible care to our other patients. Finding yourself in this situation for the first time can be hard. Especially for those new to healthcare, it is not uncommon to hear how they should not be so affected by a patient’s death as they were neither friend nor family. While perhaps we wish that were true, it fails to consider the compassion that we feel for our patients and their families. It is impossible for me to look at my peers now and predict just how hard it will be for each individual. Grief looks different on every person. The best advice I can give to anyone is to forgive yourself for being human. Your grief does not make you a bad at your job, and it does not mean you are failing. It means that you care. Try not to forget about your responsibility to take care of yourself. Also, don’t underestimate the value of talking and asking questions of your colleagues and mentors if you find yourself needing guidance. Learning how to handle your personal feelings in the way that is best for you can be a challenge but is a necessity in order to continue providing the best care possible to your patients.
Vandekieft, G. K. (2001). Breaking Bad News. American Family Physician, 64(12), 1975–1979. American Academy of Family Physicians. Retrieved July 2, 2018, from https://www.aafp.org/afp/2001/1215/p1975.html