Administration and Leadership, Cardiac & Resuscitation, Training

Bad News: Choosing your words and saying them well

Issue 2 and Volume 35.

Everybody loves Jerry Westfall. That’s how it seems, anyway, as five of you struggle to resuscitate the 50-year-old engineer on the kitchen floor of his ranch-style, suburban home. Cell phones are ringing all around you, and a weeping audience is growing by the minute.

It’s before dawn, and Jerry’s wife called this morning after she awoke to a sense that something was terribly wrong with him. Sure enough, he was unrousable, and you arrived to find him apneic and pulseless—with a rhythm.

You’ve been through two rounds of drugs, Life-Saver, and you’re tempted to transport, but you know the facts. Transport would subject this family to an ambulance bill, a hospital bill, a senseless delay and the risks of driving to the hospital in a tearful state.

It would also dump a big chunk of your responsibility on the ED staff, who have problems of their own. And it could be deadly dangerous for you, because it would mean futile CPR in a moving ambulance. Finally, there’s that other fact: Jerry’s a goner. You know what dead is, and he’s dead.

But how do you stop working this guy in front of all of these people? What do you say? What do you do? It was never mentioned in any of your training.

Make no mistake: At least some of these folks will remember everything you say and do for the rest of their lives. Never learned? Most of us would echo that, and it’s too bad; this is no time to experiment. Somehow you’d better choose the right words, and you’d better say them well.

Notification of sudden death is a skill, and you can learn to do it, but not from a little how-to column like this in a technical journal. You deserve better, and people like Jerry’s wife and family deserve a whole lot better.

We’ll develop this topic in a much larger article in the future. Meanwhile, you can educate yourself by consulting people who deliver death notification for a living. They include morticians, coroners, hospice workers and ED physicians. Each of them can share their own perspectives and techniques.

Another thing you can do is interview surviving family members. It sounds dicey, but you may be surprised at how willing they are to tell you—say, a year later—how you did, and maybe how you might improve your repertoire. And let’s face it, they’re the experts.

Doug Kupas, MD, is a paramedic and author in central Pennsylvania who’s also a practicing ED physician at Geisinger Medical Center. In fact, he’s the EMS medical director for the Commonwealth of Pennsylvania. Doug has been teaching this topic to people like us for the past 15 years. He highly recommends a book called Grave Words (Kenneth Iserson, Galen Press). It’s easy to find on, and you could read it in a day.

Meanwhile, what can you say to a family like the one in the above example?

Actually, the easiest kind of notification is the kind you do after somebody dies in their sleep, at home in their own bed. Try this: “You know, we’ve been there when some people were born, and we’ve been there when lots of people have died. This was a good way to die. Mr. Westfall went to sleep last night in his own home, in his own bed, in the company of someone who loved him. We can find no evidence to suggest that he suffered or struggled; he just went to sleep and didn’t wake up this morning. We’ve done everything in our power to revive him, but to no avail. We’re very sorry to tell you that he has clearly died.”

One more thing: After the call, send a card. Not one of those sappy, condescending cards you find when you’re in a hurry. (Who writes that crap, anyway?) Not one that speculates about what God thinks or what the angels are doing. But a nice one you’ve taken the time to browse for, maybe at a card store, that says the kind of stuff you’d actually want to say to someone.

Next time you find a card like that, buy several and save them. When somebody dies, send one to the family. Don’t put your agency’s name or return address on it. Just write, “Sorry we couldn’t have helped you more. Your friends, the EMTs” (or something like that).

They’ll love it. I promise. JEMS

Thom Dickhas been involved in EMS for 39 years, 23 of them as a full-time EMT and paramedic in San Diego County. He’s currently the quality care coordinator for Platte Valley Ambulance, a hospital-based 9-1-1 system in Brighton, Colo. Contact him at [email protected]

For more on delivering bad news: