Spring

Mary Claire O’Brien, MD FAAEM

Sprng 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. “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?

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.

“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.”

The emergency department visit is their story, not yours.”

Finally. This is how the body will look. ‘I’ll go in with you. I’ll help you.” What questions do you have for me? Here is the telephone number for Decedent Affairs. This is Diane, our Patient Family Coordinator. She will explain what you need to do. We will help you. It is always awful. This Sunday morning in spring, this family was quiet. They silently put their heads in their hands. They covered their eyes. They wept. “Do you want to see her?” I asked, when the news was done. “You don’t have to. But I’ll go with you, if you do.” They all wanted to come, first the patient’s mother with her own sisters, then the rest of the family, then the neighbors and the pastor. They made a circle around the bed. I always touch the dead person in front of the family. I smoothed the girl’s hair and turned to leave the room. “Let us pray,” said the pastor. The people in the room extended their hands to one another, leaning in around the dead girl’s body. They bowed their heads and waited. My own hand was already on the doorknob. Something stopped me. “May I stay?” I asked. They were strangers with a different faith tradition. Without looking up, they opened their circle and took my hands. “Lord,” the pastor began. “Oh Lord, hear the cries of your people. We are hurting, Lord, we are suffering. Lord, we are broken. If ever before we needed you, we need you now.” “Yes, Lord,” they murmured. “Lift up this mother, Lord, lift up this boy, her son, and lift up this family. Lift up your church community. Lord, we beseech you. We need you, Lord. Help us today and this week and ever after. We’re gonna need your help, Lord.” “Yes.” “Welcome your loving servant home, Lord. Help us, Lord, to bear the agony of this separation. Give us strength to wait upon her Lord, just as we wait upon You. Carry us, until we see You, and until we see her again in Glory.” Silently, they wept, swaying together like fragile trees in a violent storm, and the very strength of their pastor’s words kept them from uprooting and crashing to the ground. I had a daughter the age of the dead girl and my heart was breaking for them. “Bless this doctor, Lord, these nurses, this hospital. Bless them, Lord. We thank you for their skill and for their compassion, Lord,

She wasn’t for what they have given to your servant and to all her family. Bless sleeping—she was them, Lord. Give them strength to continue their important work.” dead. And I had to tell The strangers on either side of me her mother.” squeezed my hands. “Amen,” they whispered. A friend asked me once: Does your faith enter into your practice of medicine? This is an important question. Yes and no, is the answer. We have to be careful. You can’t impose your beliefs, whatever they are—or your lack of them—on people who are sick or on families who have had a sudden loss. The emergency department visit is their story, not yours. But I say this: whether or not you believe in God, in the emergency department you will be a witness to unbelievable Grace. You will SEE, and you will BELIEVE, in Grace.