Spring
ACADEMIC AFFAIRS COMMITTEE
Mary Claire O’Brien, MD FAAEM
“Do they know?” I asked one of the paramedics. “No,” he said. “They don’t.” Doctors have memory aides to use for how to break bad news—mnemonics, acronyms, little lists devised to help us remember what to say. I can never remember the mnemonics. I always think: there will be so many questions… Questions. That’s my reminder. Who, what, when, where, [pause], why, how?
S
prng in Winston-Salem is glorious to behold. Tiny white snowdrops are the first to appear, then gold and amethyst crocuses, proud trumpeting yellow daffodils, and a dazzling rainbow of tulips. Pansies that have been sleeping in beds of licorice mulch shrug off their thin blanket of snow, rub their faces in the brisk rain, and wake up. The redbud trees comes alive with delicate purple blossoms. Bradford pear trees, then magnolias. Star magnolias with delicate white flowers against dark gray bark. Saucer magnolias—Mulan Trees—enormous pale pink blossoms that look like hands folded upright in prayer. Cherry trees: weeping, Black, and laurel. Exuberant dogwoods. A few deep heady breaths of wisteria… and summer is here. It was drizzly on that beautiful Sunday morning in spring many years ago when a 16-year-old driver lost control of her car and slid over an embankment, flipping upside down into a teeming creek. Her 8-year old-brother managed to scramble out a back window unhurt. The girl was unconscious, buckled fast in her seatbelt. She drowned. Medics found her pulseless but it was too awful to give up on that child at the scene. They did CPR and came lights and sirens to the ED. She was dead. I pronounced her. The nurses put her soggy church clothes in a brown paper bag for the medical examiner, as required by law. They lifted her chin and straightened her arms. They tucked warm white blankets around her. They tilted up the head of the stretcher so that it would look like she was sleeping. She wasn’t sleeping—she was dead. And I had to tell her mother. Everyone was assembled in the waiting room—her mother, her little brother wrapped in a blanket, her aunts and uncles, a few neighbors, her grandmother, and their pastor. I choked with rage. WHAT KIND OF GOD allows a beautiful young girl to drown on a Sunday morning in the BEAUTIFUL SPRING OF HER LIFE while she was driving her little brother to church?! It was impossible to comprehend.
Who are the people in the family room? I introduce myself and offer my hand. I make eye contact with each person and acknowledge their relationship. Without asking directly, I am trying to identify the closest member of kin. I sit down. When your [husband/wife/mom/dad/daughter/son/sister/brother/friend] got here…] I start. I explain what things were like when the patient first arrived. They were lethargic, they were seizing, they had no heartbeat. Then, where things went after that. We gave them medicine, we did CPR, we did a CT scan, we gave them blood, we put them on a breathing machine. Then, a pause.
The emergency department visit is their story, not yours.”
“I’m afraid I have very difficult news.” I brace myself to say the “D” word. “I’m so terribly sorry,” I say. “She died.” No medical jargon. No euphemisms. “She died.” You have to say it.
Sometimes the wheels come off. The mother screams and it hits you like lightening. The aunts wail, grabbing one another’s hands, rocking on their plastic seats. An uncle bangs the plaster wall with his heavy fists, cursing and pounding, rattling the cheap emotionally neutral landscape print hanging there above the mother. A neighbor might throw a chair. And sometimes, someone in the family falls to the ground, shaking uncontrollably—not a seizure, but to everyone there assembled it looks like one—a shocking, horrible, physical outpouring of grief. You sit there, letting it wash over you like battery acid. You try not to cry. Why did it happen, they will want to know. “I don’t know,” I mumble. Sometimes it’s a heart attack or a burst aneurysm, and you can offer this, “I’m sure when he slumped over that was the last thing he knew. I’m sure it was quick. I’m sure he didn’t suffer.”
>> COMMON SENSE MARCH/APRIL 2022
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