3 minute read
Disclosing Death from Behind a Mask
By Anita Chary, MD, PhD
“I am so sorry to tell you that your mother has died.” I stand six feet away from my patient’s children in the far hallway of the emergency department waiting room, wearing a mask, goggles, and a blue gown as I deliver the news. My patient’s son holds his head in his hands in disbelief; my patient’s daughter begins to wail. I suppress my urge to step forward, reach out, and place my hands on their shoulders. This is a pandemic, and I am a surface, a potential vector for fomites.
Death is a part of life, and death is a part of emergency medicine. Physicians who work in the emergency department come to accept that at times, despite all of our efforts, critically ill patients die. Each of us learns to navigate the difficult task of disclosing to our patients’ loved ones that they have passed. As physicians, we do our best to read the situation and choose the right words and the right ways to convey sympathy, but the pandemic has uprooted what I have learned about disclosing tragic news.
Before COVID-19, when our patients died in the emergency department — of heart attacks, serious car accidents, gun violence — their family members were often at the bedside, or we would call them to come to the hospital. We would escort them into a family room, designated for these types of conversations, and speak with them face to face about what happened and how their loved one died, with tissues at the ready. Sometimes, when it seemed appropriate, I held family members’ hands, shoulders, or offered them an embrace, and we all grieved together.
Now, with rare exception, visitors are not allowed to enter the emergency department while we care for their relatives. Family members are asked to remain masked in the department waiting room as we treat and resuscitate patients. We try to bring family members into the clinical space if their loved one’s death is imminent, and family members are permitted to see a loved one who has died. This already traumatic experience can be even harder to process as visitors of the dead are limited to one, sometimes two at a time, in line with social distancing. Some, in that darkest moment, must face their grief alone.
And simultaneously, grief enters the public domain. Now, we no longer have a family room. The small space which used to house a couch and a chair cannot safely accommodate social distancing between a clinician and a patient’s family members. When I tell people their loved one has died in the emergency department, they are in the quietest and least populated section of the waiting room that I can find. I measure my voice so that only the family can hear me, but I do not feel as soft or gentle as I used to when delivering bad news, as I must now be heard from six feet away.
As we disclose death, our faces are hidden behind masks and our eyes behind goggles. Where my sympathy used to be tangible, I now wonder if patients’ family members sense my shared devastation. Telling someone that their sibling, parent, or child has died, with layers of plastic covering my eyes and a respirator muffling the sorrow in my voice, I wonder if the news seems devoid of feeling.
These rituals around disclosing death initially seemed cruel but necessary to protect our patients’ loved ones from infection. Hauntingly, now more than one year into the pandemic, they feel like more of the same.
ABOUT THE AUTHORS
Dr. Chary is chief resident, Harvard Affiliated Emergency Medicine Residency.
