Inevitably, there will come a time in our medical journeys where we will have to have a difficult conversation with a family about the passing of a loved one. Sometimes, it will be an expected event after a patient has dealt with a long illness at an advanced age; other times, it will be an unexpected event in a person who looked healthy a short time before. These events can be jarring for family and physician alike, since death is the opposite of what people expect with medicine most of the time.
We enter this profession with the desire to improve the lives of patients in spite of their illness. However, the reality of the death of a patient will confront us, and the role of comforting family and friends becomes the primary focus at that moment. I have been reminded of this numerous times during my training, and each time, I gleaned new insights about honoring families in their times of grief.
1. It is OK to be uncomfortable. Most of the time, there is the expectation for physicians to remain professional and to not show our discomfort with certain situations. But we are also human, prone to the same feelings that our patients have, particularly when it comes to someone passing away. I found myself on numerous occasions walking slowly to the family room thinking about what to say and how to say it, and worrying about how the family will take the news. However, I had to remind myself that it was not about me, but it was about the patient and the family. They are feeling uncomfortable too, and it is my responsibility to help improve that discomfort in some way through being there for them. Thankfully, if the discomfort still exists for me after the conversation, usually there is a colleague I can talk to in order to debrief.
2. Tell the truth, with sensitivity. In their times of grief, families want to know what happened. It is also important to consider that their desire to know is surrounded with raw emotions, such as sadness, anger, or denial. We need to understand that what we say to them about what happened to their loved one will be remembered for a long time, as well as how the information is delivered. It is not the time to appear hurried, and it is not the time to use overly medical terms as if we’re presenting a case at grand rounds. It is the time to relate as we would to our own families in situations of grief, surveying the families’ emotions and their comprehension of what is happening as we talk with them. In these difficult times, we can spend a few extra minutes with the families given how sensitive they are with the passing of their loved one. They know that we have time constraints, so anything they can see in our demeanor that lets them know that their situation is important to us will do wonders for them even in their time of grief.
3. Non-verbal cues matter. We talk about the importance of non-verbal cues such as body language and eye contact when it comes to interacting with patients, but they take on a new significance when it comes to meeting with families during times of grief. Anything to show that we are invested in their welfare will be well-received. Sometimes we can say more to the family through our actions even though we are not saying anything in those moments. At times, there may be long periods of silence as people process the information you provide them, and that is OK. Rather than say something to break the silence, let the silence persist naturally. Believe it or not, you’ll know when the right time will be to say something when it comes as you survey the emotions of the room.
4. These conversations become easier the more we have them. As tough as it is to have these conversations, I have found that the conversations become easier the more I have them with families. Hopefully we do not have many of them during our careers, but if they arise, at least we should try to direct these conversations in order to become more comfortable with them down the line. We each have our own style in terms of how to deliver news about the loss of a loved one to families, but we can only discover those styles as we engage in these conversations. As previously mentioned, it is OK to feel uncomfortable, but at least learning how to have these discussions in spite of our discomfort will help us to develop the tools we need to deliver sensitive and compassionate care to families in the midst of grief.
At the end of the day, families are a natural extension of the patients we serve, and as such, we have a role in their lives on a daily basis while we care for their loved ones. That role becomes more important when our patients pass away; families will be looking to us for comfort and we need to be ready when that time comes. We need to be ready to honor these families in their times of grief, and part of that is thinking ahead of time about how to have these difficult conversations when they arise. It is one thing to read an essay like this or have classes in medical school or residency about how to deliver bad news; it is another thing to actually do it while trying to keep our own emotions in check. Death is never a comfortable thing to talk about, but if the conversation is handled with sensitivity and with the realization of what an honor it is to have the responsibility of caring for patients and their families, we will bring more comfort to families than we realize. Ultimately, we will honor these families in their times of grief.
Chiduzie Madubata is an internal medicine physician.
