First, you turn off your phone. You can’t have any interruptions. As you walk to your patient’s room where the family is waiting for you, pick up a box of tissues and put it in your back pocket. Don’t hold it in your hand as you meet them. It’ll betray their new reality.

When you enter the room, you introduce yourself to everyone as the doctor. You find a seat to sit in. No, you can’t stand. There’s always the arm of a chair if you need it.

Then you ask them what they know.

William, a 65-year-old father of two, was fighting metastatic lung cancer, and he started developing a bad cough the last few days. He was having a hard time breathing before he fell unconscious. One of his daughters was diagnosed with COVID a few days earlier.

Kevin was a 15-year-old boy who was playing outside in the street when his mother heard gunshots.

These patients and their families are fictionalized here, but represent reality for so many people every day.

You look at them in the eyes, and you say, “I have some terrible news to share.” And you pause. This is the warning shot. The moment when time freezes, the moment before the freefall.

“He died a few moments ago.”

You don’t say, “He passed away” or “He is no longer with us.” You are direct, without any hesitation in your voice. And then you wait. You wait as you watch their lives get upended. You wait as the fabric of their life is torn. As their reality shifts. As a wife loses her husband, a mother loses her child.

Rachel, William’s wife, breathes a sigh of relief. “He was struggling for a while, and I am happy that he’s in a better place.”

Kevin’s mother cries, she curses, she pleads with you. She begs you to bring her baby boy back. Her baby boy was playing on the street earlier that day.

You’re silent. You look at the ground in deference, but you don’t say a single word. Nothing you say will be heard. Nothing you say now is as important as the words you just uttered. You take out the box of tissues, and you hand it to her wordlessly. And you wait. It might feel like a long time for you, but it is an eternity for them.

Some time passes, and you answer any questions that they have, knowing full well that they are still grappling with their new reality.

Next, you ask, “Tell me about him.”

William and Rachel were married for 35 years and he left behind two children. He was an accountant who would host large family parties where he would make his world-famous stew. His smile was infectious and he was always the star of the party.

Kevin was in high school and he wanted to go into environmental science at the local college. His younger sister was still asleep in bed while the situation unfolded.

You ask them this because your life intersected with theirs for only a few minutes, and you know nothing about who they were, despite your attempts to coax their heart into beating again. You ask them this as a way to carry forward their legacy with you. You ask them this because maybe you can honor something they learned in this unfair life. It’s your weak attempt to ensure they didn’t have to die in vain.

Afterward, you stand up to leave and tell the family you will be available if they have any more questions. As you slowly walk through the hallway back to the emergency department, you end up taking a moment for yourself. Whether it is a sip of water, a misplaced footstep, or a deep breath. You know that this is not the last time this will happen. With COVID raging and the increase in violence and trauma – this is just the first of many more conversations.

You turn your phone back on. After all, there’s always more people that need your help.

Neil A. Ray is an emergency medicine physician.

Image credit: Shutterstock.com