It felt like watching a train go by with no control over its destination and no way to stop it. We simply had to watch our loved one as he made his way towards death. The doctor said he had a traumatic brain injury with herniation. His pupils were fixed and dilated on arrival to the emergency department, which meant that he was not a candidate for any neurosurgical intervention. And that our lives would never be the same. He had been playing on an ATV with his friends, wearing no seatbelt nor helmet at the time of the collision. Although he survived being transported to the hospital, the beginning of the realization that we would never talk with him, walk with him, hug him, or work with him ever again started to become clear. As an internal medicine physician, I recall having hard conversations with families when I needed to let them know that things were not going well with a patient. Over the course of a conversation, the dialogue with family members often revealed to me what information was standing out to them. I have often noticed people letting me know through their questions and comments that they had only grasped the encouraging parts of what I had told them. Usually, they had only held on to the slightest bit of positive information I had given in a sea of bad news. I had never understood this phenomenon quite as well until it was my own loved one who was in critical condition. He was only 16 years old. My wife and I had expected to see him on the upcoming break from school. It’s hard for us to accept the unimaginable in an instant. Some have termed this the “existential slap.” When it hits a patient or loved one that things have changed forever and perhaps death or permanent disability is inevitable. When I am on service, I sometimes remark to families that if the patient was my family member, I would choose a particular treatment, diagnostic test, or palliative measure. However, now I realize that our objective judgment is completely lost when it is your son, your uncle, your brother, or your nephew. As physicians, we can intellectualize these tragic situations and the psychology of this type of response, but the truth is we will all be there ourselves if we live long enough. And experience things differently than if we are the bearer of grave news. My role in this experience as a family member was compounded by the fact that I am the only health care provider in my family. Thus I had to translate the medical jargon for everyone. Because the prognosis was poor, I felt it was my responsibility to relate that prognosis immediately, even though I was still processing all this information and my own emotions at the same time. Though I am a physician, I am only human. Even though I wanted to be objective as teardrops escaped my eyes. At that moment, I did not see myself as a medical professional; my clinical knowledge and experience were almost irrelevant. Just like the family members of my critically ill patients, I relied on the compassionate, honest, and thoughtful extended family of health care professionals treating my nephew to show us — grieving and in disbelief — that not only did they care, but that they were pursuing the best treatment for the patient. This experience reminded me that in our role as health care providers, we must help patients’ family members through the lonely tunnel of disbelief towards the peace which comes in time with acceptance of hard truths. Though difficult at times when we can see the undesirable outcome, we must remain companionate, never losing sight of the fact that every patient is someone’s loved one. In loving memory of Durpree “Man Man” Battiest. Source
