We read dozens of articles, spoke with several physicians, and found a singular article that best encompassed the conversation you are about to encounter. We have annotated and broken Dr. Rosenberg’s article into steps to help you more readily absorb the information to have one of the hardest discussions of your career.
NY Times September 3rd, 2016
Naomi Rosenberg, MD is an Emergency Medicine physician at Temple University Hospital.
The 10 minute mental pause – you’ll need this more than you anticipate:
Philadelphia — First you get your coat. I don’t care if you don’t remember where you left it, you find it. If there was a lot of blood you ask someone to go quickly to the basement to get you a new set of scrubs. You put on your coat and you go into the bathroom. You look in the mirror and you say it. You use the mother’s name and you use her child’s name. You may not adjust this part in any way.
I will show you: If it were my mother you would say, “Mrs. Rosenberg. I have terrible, terrible news. Naomi died today.” You say it out loud until you can say it clearly and loudly. How loudly? Loudly enough. If it takes you fewer than five tries you are rushing it and you will not do it right. You take your time.
After the bathroom you do nothing before you go to her. You don’t make a phone call, you do not talk to the medical student, you do not put in an order. You never make her wait. She is his mother.
In these circumstances, you will most likely not know the family as this is almost always a traumatic and unexpected event:
When you get inside the room you will know who the mother is. Yes, I’m very sure. Shake her hand and tell her who you are. If there is time you shake everyone’s hand. Yes, you will know if there is time. You never stand. If there are no seats left, the couches have arms on them.
Actually breaking the news to family of their child’s death:
You will have to make a decision about whether you will ask what she already knows. If you were the one to call her and tell her that her son had been shot then you have already done part of it, but you have not done it yet. You are about to do it now. You never make her wait. She is his mother. Now you explode the world. Yes, you have to. You say something like: “Mrs. Booker. I have terrible, terrible news. Ernest died today.”
The power of implementing silence in your conversations is invaluable in the delivery of bad news. Just as calculating complex arrhythmic takes time for an individual to process, new information that impacts the past, present, and future of an individual, let alone a parent to that individual, can take infinitely longer. Be patient:
Then you wait.
You will not stand up. You may leave yourself in the heaviness of your breath or the racing of your pulse or the sight of your shoelaces on your shoe, but you will not stand up. You are here for her. She is his mother.
If the mother has another son with her and he has punched the wall or broken the chair, do not be worried. The one that punched the wall or broke the chair will be better than the one who looks down and refuses to cry. The one who punched the wall or broke the chair will be much easier than the sister who looks up and closes her eyes as they fill.
Security is already outside the room and when they hear the first loud noise they will know to come in. No, you will not have to tell them. They know about the family room in the emergency department in summer in North Philadelphia. It is all right. They will be kind. If the chair cannot be sat in again that is all right. We have money for new chairs every summer. If he does not break your chair you stay in your chair. If he does you find a new place to sit. You are here for the mother and you have more to do.
Using concrete, simple terms with the information you have, your verbiage and context in which you use it is equally important as the actual news you deliver and the events you unfold for the family. Do not hide behind your medical jargon in these moments:
If she asks you, you will tell her what you know. You do not lie. But do not say he was murdered or he was killed. Yes, I know that he was, but that is not what you say. You say that he died; that is the part that you saw and that you know. When she asks if he felt any pain, you must be very careful. If he did not, you assure her quickly. If he did, you do not lie. But his pain is over now. Do not ever say he was lucky that he did not feel pain. He was not lucky. She is not lucky. Don’t make that face. The depth of the stupidity of the things you will say sometimes is unimaginable.
Before you leave you break her heart one more time. “No, I’m so sorry, but you cannot see him. There are strict rules when a person dies this way and the police have to take him first. We cannot let you in. I’m so sorry.” You do not ever say “the body.” It is not a body. It is her son. You want to tell her that you know that he was hers. But she knows that and she does not need for you to tell her. Instead you tell her you will give her time and come back in case she has questions. More questions, or questions for the first time. If she has no questions you do not give her the answers to the questions she has not asked.
This event, in and of itself, will be ingrained in your mind for the rest of your career. It is ok to cry. It is ok to be angry. It is ok to question why. Talk with your colleagues about what happened. Work through the events and process what unfolded. It will take time, but you will adjust:
When you leave the room, do not yell at the medical student who has a question. When you get home, do not yell at your husband. If he left his socks on the floor again today, it is all right.