Rural pearls

Gordon Brock, MD, CCFP

Robert Esquerra, MD, CCFP

Vydas Gurekas, MD, CCFP

Staff physicians, Centre de santé de Temiscaming, Temiscaming, Que.

Can J Rural Med vol 2 (2):139

© 1997 Society of Rural Physicians of Canada


Breaking the news of unexpected death

"I have a rendezvous with Death, at some disputed barricade."
--Alan Seeger, killed in action, World War I, 1917

We all have a rendezvous, somewhere, sometime, with death. Knowing this makes it no easier to inform the next-of-kin, often our own patients and friends, that a loved one has died. It is one of our more distressful tasks as physicians. It is a reminder of our ultimate failure as physicians and also a reminder that someday our own families will be informed of our deaths.

This task is especially difficult when the death is sudden or unexpected. As rural physicians, we, the authors, have learned (sometimes the hard way) that there are good ways and bad ways to communicate this news. Over the years, we have developed a procedure for informing family members that a loved one has died suddenly.

Contacting the next-of-kin

Unless the death was clearly expected, people should not be given the news over the telephone. It is best if someone telephones the next-of-kin and says to them, depending on the circumstances: "We'd like you to come in now" or "Your wife has had a car accident. We'd like you to come down now to the hospital."

This call is best made by a nurse, not the physician: if the family member asks at this time if the patient is dead, the nurse can simply state that s/he was asked by the physician to call with that message; s/he need not divulge anything more. If the next-of-kin live too far away to come to the hospital, our usual practice is to ask the local police to phone the family's local police and ask that an officer go to the home to break the news. The physician involved supplies his or her name and telephone number to the police, so that the next-of-kin can make contact if they so wish. We have always found other police forces very helpful and cooperative in such cases.

Meeting the family upon arrival

The physician or a delegate should wait for the family members at the entrance to the patient's room, or at the ward or hospital entrance, to avoid having the next-of-kin walk in unexpectedly on the deceased. If the medical and nursing staff are going to be occupied with other patients, as may occur during disasters, call in a social worker or the administrator on call, so that someone can be devoted to the needs of the family of the deceased. When the family arrives, take them to a private setting, usually an office. Ask the family members to sit down and, if possible, sit down yourself, to introduce an element of calm.

Breaking the news

Give the family members a chance to reach the correct conclusion by themselves. State that you have some very sad news and explain why the person who has died was brought to the hospital. At this time, many family members ask immediately, "Is s/he dead?" Confirm this conclusion clearly: state that the person is dead or has died. If the family does not ask within a few seconds, clearly state that the person is dead.

In view of the frequency of denial on the part of the next-of-kin when faced with the sudden death of a loved one, we feel that the physician should use the words "died" or "dead" and not euphemisms such as "passed away" or "couldn't be brought back to life."

Reactions to news of sudden death

The reaction is usually (and appropriately) grief, often denial and disbelief. However, be prepared for anything. There may be anger directed at another family member or at the medical staff. There may be threats and even violence. Be prepared to leave the room quickly.

Ask the family if they wish to have a few minutes alone, and then leave them in the room to grieve in private if they so desire.

Avoid statements such as "I wish we could have done more" or "We did everything possible." Such statements may suggest to the family that you feel you did not handle the medical aspects of the case well enough or that you have something to hide. A better way to express your sympathy or to end the visit is to suggest that the family contact you later, by saying "Please let me know if you need anything in the next few days." If the family has any questions about the medical care that the deceased received, it is best to discuss these questions openly a week or so later, when everyone, both family and physician, is calmer.

Viewing the deceased

Ask the family if they would like to see the person who has died. Most families wish to do so and find it a therapeutic experience. It is a last visit to the family member they knew, it confirms death as a normal and open part of life and, we feel, it counteracts denial. A clergyman may be called to be present at that time, if the family wishes. Dignified and proper handling of their deaths is the final act that we perform for our patients.

"The Democracy of Death, It comes equally to us all and makes us all equal when it comes."
--John Donne (1572-1631)


Table of contents: Volume 2, Issue 3