How To Say It
I know what happens after you die.
I take your family to a quiet room, with Kleenex. Then I say the word “dead.” Not expired, because you were a person, not milk. And not passed on, because families always want to believe you were just transferred to another hospital. “Dead.” I have to say it.
That's all they really taught us in medical school about how to deliver bad news. A one-hour lecture. So we learned by watching our teaching physicians. We were their constant audience in a sort of theater of the bereaved: lurking near doorways and family rooms and the hospital’s ER, noting how soft they made their voices, when they patted someone on the back, how much technical jargon did they use before getting to the word “dead.”
When you train to become a doctor, they don’t really teach you about death. They tell you how to prevent it, how to fight it, how to say it—but not how to face it. So during one of my first nights as a teaching physician in the ER, as we worked on the body of a sixteen-year-old boy with eight bullet holes in his abdomen and chest, we feel almost angry at his body.
Is he breathing? Bleeding? Is his heart beating?
I plunge a breathing tube down his throat. A large-bore I.V. goes into each arm and an even larger one into the groin. We start running two units of Type O negative blood, trying to replace what he’s lost. We put tubes everywhere. I call for another unit of blood, but no matter how fast we work, we can’t work fast enough.
The monitor begins to sound the shrill, insect whine meant to alert us when a patient is crashing. Which we already know. So it feels less like a warning and more like a rebuke.
We lose his blood pressure. Then his pulse. But he’s sixteen, so I perform a trauma Hail Mary: With a fifteen blade, I slice deeply from his nipple all the way down to the bed. I grab the scissors, cut through his intercostal muscles, take the rib-spreaders, put them between his ribs, and crack his chest open. There’s a huge gush of blood. And then a moment of stillness, like the second after a lightning strike. Even his blood smells metallic, like ozone. I reach into his chest and put my hands around his still heart and begin pumping it for him, feeling for damage.
Then I slip my fingers down the length of his aorta and it is so riddled with holes that the frayed pieces disintegrate in my hands.
The first time I had to be the one to break bad news to a family, I was in my last year of residency training. I remember having to do it in the patient’s room, because his adult daughter refused to leave his bedside. So I said, “I’m sorry. He’s dead. We did everything we could.” Then I was supposed to give her a few moments alone, but I was paralyzed. Rooted to the spot by a feeling of failure and loss. When I looked at the bed, I was imagining what it would be like if that was my father. My supervisor must have realized what was happening, because she grabbed me by the arm and dragged me out the door.
“Don’t you ever do that again,” she said. “Don’t pretend that grief is yours when it’s not. One day, you’ll be where she is. But if it’s not the person you love on the table, say you’re sorry, mean it, and then you have to walk away.”
I look up from the boy’s chest and see that my own audience has formed. They watch to see what I’ll do next. I realize that the boy’s family will be here soon, and in front of me is a gaping hole.
I turn to the surgery resident and say, “As fast as you can, you have to close this guy up.”
Not ten minutes later, we hear a woman’s voice demanding to be let in. We are not ready. Security tries to keep her out of the trauma bay as we shove sheets and gauze and surgical supplies into giant trash bags. But she is a tsunamic force. We barely have the boy closed up and half covered with a white sheet when I see her in the doorway. Clearly his mother. And she goes absolutely still.
“I’m sorry,” I say, “he’s dead, we did everything we could.”
She takes a running leap towards the body. The nurse at the head of the bed sees a large needle, still attached to the thread holding him together, and plucks it off just before his mother lands on top of his body, trying to protect it with her own.
She starts keening. It’s a terrible sound.
“I’m sorry,” I repeat. “He’s dead. We did everything we could.”
She slides off his body and presses the dead boy’s fingers to her mouth for a brief moment before holding them against her cheek. I start to leave as soon as the social worker enters, motioning for the crowd to follow. Maybe that’s what they learn from watching me. How to walk away.
And without a moments break, I go to see the next patient. Because there are forty people in the waiting room who all want immediate attention, and they can’t know that I still feel the dead boy’s heart in my hands like an anchor. But I know that if I don’t put it down now, I may never remember that this loss doesn’t belong to me. One day, grief will be mine. But not tonight.