Words, Practices, and Pronouncing Death

To the Editor: It was my first time being called to the bedside to pronounce the death of one of my patients. His son was present, and I had no idea what to do. As new interns in our first week of orientation, we practiced “circumcisions” on ballooned pacifiers, delivered babies out of synthetic pelvises, and sutured cow tongues—all in preparation for the real thing. We emerged knowing what to expect (in an elementary sort of way), and that has helped ease the edge of uncertainty when reality arrives. But when I was paged to pronounce death, I had no practice for navigating a moment a family will never forget. Now, because of this, I believe medical trainees should simulate death pronouncement just like we practice for cardiac arrest. First, this preparation would give us time to practice with words. When I first called a death, I did not know what to say. I wanted to protect silence, which is the way I have been morally formed to respond to death. But I knew, as the physician, I would need to speak, and I ended up saying something clumsy and slipshod: “Let’s call it at 8:12.” I remember feeling my heart drop at my own voice, thinking, This man’s father just died, and I’ve responded like someone putting a time limit on a game that has gone on too long. I remember wishing I had more practice. Simulating the moment of a patient’s death might give us learners a chance to prepare for words we have likely never spoken aloud in earnest. Second, well-designed simulations are a launchpad for real-life practices. The logistics of pronouncing death are relatively simple—documenting a lack of pulse, respirations, and heartbeat for several minutes is usually sufficient.1 But also there are the deeper practices. It was the nurses who responded with actions that were at once beautifully human and utterly practical: “Can I get you a cup of coffee?” “May we turn the lights down for you?” My attending asked me to sit with my patient and his son, leaving just the 3 of us in a still room with dimmed lights and muted monitors. We sat in silence, and it seemed deeply right. Perhaps our orientations and trainings should form us to pronounce death with such simple words and practices, naming death clearly before asking, “May I sit with you?” John Brewer Eberly Jr, MD, MAFirst-year resident, Department of Family Medicine, AnMed Health Family Medicine Residency, Anderson, South Carolina; [email protected]; ORCID: http://orcid.org/0000-0002-9815-6243

Aesthetics · Feeling · Psychoanalysis · Silence · Medicine · Palliative Care and End-of-Life Issues · Philosophy · Psychology · Simulation-Based Education in Healthcare · Social Psychology