Giving bad news to patients or their families is always hard… but when they refuse to listen, it makes it even harder.
“Mrs. Smith, when your husband collapsed at work, his heart had stopped beating. We know that his brain went without oxygen for at least 10 minutes, the length of time it took the paramedics to get to him, in addition to the amount of time it took his coworker to find him. While they were able to get his heart restarted, there is no way to repair the damage done to his brain. After 48 hours, he has not woken up or shown any signs of responsiveness. All of the tests we have done to his brain have shown that it is not functioning – he is brain dead.”
After a member of the healthcare team gives grave news like this, the response sometimes goes like this:
“Oh look at that! *points outside at the helicopter pad* When Mr Smith was little, he used to live near a small airport where all of these planes and helicopters used to fly in and out. I’m sure this is a very peaceful sleep for him. He’s always been such a fighter.”
A response like this makes you wonder if they were actually listening to what you were saying, or if they’re just using avoidance as a defense mechanism. I have compassion for people who are dealing with one of the hardest events in their lifetime like this, I really do, but I wish it was easier for people to open up their eyes to reality.
How do you handle these situations?
Wow, do people really do that? I know if someone close to me were injured, I would be listening out for all the info I could get regarding the injury/illness. Could that reaction possibly be denial? Some people just can’t handle major issues like this.
I just continue to bring it up gently. We often give devastating news on a diagnosis and even though it seems to ME that it was obvious your loved one was in the final stages of cancer, etc, it wasn’t to them.
I just continue to talk about where “we” go from here and be supportive.
I have yet to give news about brain death – but I find many families are shocked when you bring up code status about grandma that is obviously here with ESRD, CAD, etc…they are often suprised and that is difficult.
Lately, we have had a few horrific traumas in the area and I have cared for a couple of them in our ICU. One of them happened to be similar to your post here. Regardless of the diagnosis, usually the reactions are the same. I think the denial stage usually happens in the waiting room in my experience. By the time the patient gets up to our unit, the families already have some sense of the gravity of the situation. When they come in to see their loved one for the first time (on the vent, surrounded by pumps, etc..) and they are told that there is no brain activity, I usually see anger believe it or not. It’s odd. The families actually give me looks like I DID this to him/her.
Amy, I know this is an old post, but it hits close to home. I’m fortunate (if you can call it that) enough to work on a unit where the mere sight of my patient is usually (but not always) enough to yank a person right back into reality. When one of my patients is close to death, we’ve either just recieved them in an admission, or we’ve been working for a long time to keep them alive. In the situation where the patient is a new admit, we’ll often leave the dressings off their burns and explain to the family as sensitively as possible, “I’m sorry, Mrs. Johnson. We’ve been working on Sam for the past two hours and feel that we now need guidance from you. When a person has 80% of his body burned, there’s only so much we can do.” Usually, when a mother sees her child with severe burns, she’s likely to understand. IF there’s a situation where they insist we keep on trying, we usually request they stay at the bedside so they can see what that means to the patient (chest compressions, escarotomies, vasopressors, etc). It usually helps.