Like many of you, I suspect, many of my most “educational” experiences haven’t come from sitting in lectures, reading textbooks or even listening to podcasts. They have come simply from living life and all of the ups and downs that can be thrown at you. From witnessing the birth of your children, to a close family member, 0r yourself, being unwell, these events shape who we are as people and how we react in certain situations, whether at home or when working in the Emergency Department.
Much of our training is based on doing all we can to save lives. To investigate potential life threatening diagnoses, and then do all we can to treat these when we find them. Medical technology has advanced so far that we often persist in our aim to achieve this, regardless of the costs involved both to the healthcare system and the patient themselves. Online education is awash we adrenalized procedures, such as the advent of “extracorporeal cardiopulmonary resuscitation”, that would’ve only a few years ago been unheard of and high profile speakers at conferences talk of how we must do all we can to save life, going that one step further, pushing the boundaries. That we must be heroes.
Yet in amongst all of this emergency medicine erotica, one bare fact faces us all. That one day we, and those we care about, will die. If we are lucky this will be a planned, peaceful death, with our loved ones around us, after fulfilling all of our potential and saying our eternal goodbyes. The deaths that we intimately observe in the ED, however, aren’t like this. They are sudden, sometimes violent and often unexpected. We stand at the periphery, unable to explain why someone’s father, mother, brother, or child has died. Families look to us to help, but there is little we can do to lessen their grief. We try to find the words, with a simple “I’m sorry” often being the best we can muster, before leaving them and moving on to our next patient.
My father died ten years ago. He was a “good age” and a lifelong smoker, so it wasn’t really a surprise when I received the call in the middle of the night in Australia to say my mother had found him dead in his favourite chair, early on a Sunday morning, a final cigarette burnt out on the ashtray delicately balanced beside him. I’d had a feeling something like that could happen, I’d even tried to prepare myself, but what happened over the next days, weeks and years shaped me as a doctor more than any other educational experience I’d had before or since. Every time I “break bad news” (a curious phrase we use to mean “change people’s lives forever”) I remember those times. The sleepless night, followed by the dash to the airport to try to get home, the longest plane flight I’ve ever taken, the funeral arrangements, singing his favourite hymn “Dear Lord and Father of Mankind” at the service, clearing his cupboards, the endless paperwork and calls to solicitors. And telling my brother.
My mother doesn’t remember much about that wintery weekend morning, except one thing the call handler said to her when she called 999. After giving his name and address they asked her several “clinical” details, presumably to ascertain the urgency of the call. She vividly remembers being asked “Is he stiff?” and, being of a certain generation, obediently following the request to lift his arm to find out. I don’t ask her about it now, but I know that moment still haunts her.
This very personal experience taught me many things. That the grief, and sheer organisational burden, for families goes on long after we have left that small room and more than anything that what we say really does matter. That many of us won’t be afforded the luxury of a “good death” and as the clinicians we must do all we can to lessen the emotional distress for the families and friends left behind. These patients aren’t the focus of a government enforced target, but if forced to choose between spending an extra few minutes with a dying patient or a grieving relative or preventing a “breach” on majors, I know where I’ll be.
I love my job: trauma calls; high tech resuscitation; diagnostic challenges and the high five from a cheery child, but the time when I feel like I am truly helping isn’t when I save lives, but when I do everything I can to ease the pain of an inevitable or unexpected death. The simple things like holding a relative’s hand or making sure a patient is on a proper bed and painfree (I have a deep seated belief that no one should ever, if at all possible, die on a trolley). Giving families time together and offering whatever support we can.
I know it doesn’t always feel like it, on a busy shift with staff shortages, too many patients, no in patient hospital beds and fighting metaphorical fires at every turn, but doing our job is a privilege. We can take away people’s pain and cure illness, but more than that when the time does come that we can do no more, we can do so much more. We can, and must, be kind ; surely there is no more valuable attribute in anyone who works in an ED. And that when we say “I’m sorry” we couldn’t mean it more.