What Have You Learned About Death?

[whoRyou]

Are you ones of those few PAs that seem to be able to handle it? Death is very difficult to deal with and the amount of grief and anger that comes from having a terminal illness can be insurmountable. What have you done to help yourself in times like these with your own pts and/or their family members?

 

I know when I was working with people who had ALS (Amyotrophic Lateral Sclerosis), often referred to as Lou Gehrig's Disease taught me a lot about the medical industry as a whole, and has taught me about my capacity to care as well. Palliative medicine offers treatment not only to the patients, but to their families as well. This form embodies both the medical, and spiritual care that people need to overcome great pain and distress. Their families may not be physically afflicted, but they are certainly emotionally afflicted. We have to be able to communicate without being condescending, and always relay care and calm when dealing with friends and family members.

[True Anomaly]

I've always been able to handle it, but it is mostly because of my past.  The only time I had a family member with a somewhat terminal illness was when I was still just an EMT, and went to visit said family member and I helped my other family members understand what was going on (with what little I was able to ascertain- had mostly to do with explaining vital signs and such).

 

For me, I'm more familiar personally with the sudden and unexpected loss of a family member.  My father collapsed at the wheel of his car while driving in our neighborhood and crashed into someone's backyard- when he was delivered to the hospital, he was pronounced.  A year after that, my sister ran away from home with two other friends- she was driving and fell asleep behind the wheel- was ejected out the front in a rollover accident and killed immediately.  A week after that, I graduated high school.

 

The doctor who pronounced my father came into the family room and told my sister and I what happened- he clearly was experienced and knew how to explain things to a couple of scared teenagers.  As you might expect, I vividly remember every part of this interaction- the way the doctor looked, his name, the words he said, the tone in how he delivered it.  It was this example that I used and still use in talking to patients and/or family during grave times, because I've been there.  People want answers, and when the answers aren't there they want to know you actually care.

 

A rather interesting twist to this- the very doctor who pronounced my father and told me he died is now one of the attendings I work with on a daily basis.  I will likely never tell him about this, but realizing he was one of my new attendings when I started my new job this past summer made me very cautious around him initially- I've since relaxed quite a bit.

[EMEDPA]

I learned a great phrase from seeing one of my attendings explain to a family about the death of their husband/father:

"It was very quick and painless, like getting struck by lightning" and I still use that phrase if it applies.

[whoRyou]

... A rather interesting twist to this- the very doctor who pronounced my father and told me he died is now one of the attendings I work with on a daily basis.  I will likely never tell him about this, but realizing he was one of my new attendings when I started my new job this past summer made me very cautious around him initially- I've since relaxed quite a bit.

TA: If you don't mind sharing (I assume it's OK to ask you this since you brought it up here in public) and please forgive me if this is inappropriate isn't my intent, more curiosity than anything, how come you haven't said anything to the attending?

[True Anomaly]

TA: If you don't mind sharing (I assume it's OK to ask you this since you brought it up here in public) and please forgive if this is inappropriate it isn't my intent, more curiousity than anything, how come you haven't said anything to the attending?

 

Because I'd rather it not be awkward for him, out of respect to him.  It was already awkward enough for me- I chose not to spread some of that awkwardness onto him.  Very likely, he'd be okay with it as he's a very practical and intelligent guy, but why chance it?

[whoRyou]

Thank you for sharing TA

[Guest Paula]

At some point, TA, if you ever leave the job or the attending retires or moves on, tell him.  It will impact him and might be one of the few positive things he hears about his style of practice. 

[True Anomaly]

At some point, TA, if you ever leave the job or the attending retires or moves on, tell him.  It will impact him and might be one of the few positive things he hears about his style of practice. 

 

I've definitely considered that, and if we become actual friends or something like you laid out happens then it'd be much more appropriate.  It just certainly wasn't the right time to surprise the guy when I start working there and trying to establish myself as a PA at that ER

[whoRyou]

At some point, TA, if you ever leave the job or the attending retires or moves on, tell him.  It will impact him and might be one of the few positive things he hears about his style of practice. 

[jdenning]

I see patients with chronic degenerative neurologic disease every day and I've learned to talk about death in very practical terms. We talk well ahead of time about making end of life decisions and what may or may not happen. Patients appreciate when it is a practical and straight forward discussion. It's still sad when it happens. There are some weeks where I might make 2 or 3 condolence calls and families appreciate those calls tremendously.

 

As a profession and as a group we need to talk more about having a "good death" and not shy away from the discussion

[rev ronin]

Patients who are dying, often know they're dying before a medical provider tells them.  They're more likely to open up about their treatment goals than they are to get hysterical denial fits if you talk to them honestly but sensitively.