Bess Stillman - How to Say It

 

I know what happens after you die. I take your family into a quiet room with Kleenex, and 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, that means I just transferred you to another hospital. Dead, I have to say it. And that's really all they taught us about how to break bad news in medical school. One-hour lecture. 

 

So, we learnt by watching our teaching physicians. We were their constant companions in this theater of the bereaved lurking in doorways and bedsides, and the hospital's ER waiting to see how soft they made their voices. When did they touch someone on the shoulder? How much medical 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 teach you how to prevent it, how to fight it, how to say it, not how to face it. So, on one of my first nights as a teaching physician in the emergency room, as we worked on the body of a 16-year-old boy with eight bullet holes in his chest and abdomen, we were almost angry at his body. Is he breathing? Is he bleeding? Is his heart beating? I go to the head of the bed, and I plunge a breathing tube down his airway, and I hook him up to the respirator that breathes for him. 

 

vWe put a large bore IV in each arm, an even larger one in his groin, and through that we start pressure bagging type O negative blood, just 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 starts to sound this shrill insect whine that's meant to alert us the patient is crashing, which we already know. So, it feels less like a warning and more like a rebuke. And then, we lose his blood pressure and his pulse. But he's 16. 

 

So, I perform a trauma Hail Mary. I grab a 15-blade scalpel, and I make an incision from the nipple all the way down to the bed. I take the scissors, I cut through the intercostal membranes. We take the rib spreaders, put them between the ribs and we crank his chest open. There's this 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 my hands into his chest, and I put them on his still heart, and I begin squeezing it for him, feeling for damage. Then I take my right hand and I sweep it down the length of his aorta. It is so riddled with holes that the frayed pieces just disintegrate in my hands.

 

The first time I had to be the one to break bad news to a patient, I was in my last year of residency training. I remember I had 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." And then, I was supposed to step out of the room, give her a few moments of privacy. But I was paralyzed, rooted to the spot by this sense of failure and loss. 

 

When I looked in the bed, I couldn't stop imagining my own father in it. My supervisor must have seen what was going on, because she grabbed me by the arm, dragged me outside and said, "Don't you ever do that again. Don't ever pretend that grief belongs to you when it doesn't. One day, the person you love is going to be in that stretcher. But if today is not the day. You say you're sorry, you mean it, but then you have to walk away."

 

I look up from the boy and see that my own audience has formed. They wait to see what I do next. I realize in front of me is a gaping hole, and the boy's family will probably be here very soon. So, I turn to the surgery resident and I say, "Listen, as fast as you can, you just have to get this kid closed up." Not 10 minutes go by when we hear the sound of a woman demanding to be let in. We are not ready. Security tries to keep her out. We are shoving gauze, and surgical supplies, and tubing into giant trash bags, but she is a tsunamic force. We barely have this boy closed up and half covered in a sheet. 

 

When I see her standing in the doorway, clearly his mother. She goes absolutely quiet. "I'm sorry, he's dead. We did everything we could." She takes a running leap towards the body. A nurse at the head of the bed notices a large needle still attached to the suture holding him together, and she plucks it off the table 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, he's dead. We did everything we could.” 

 

She slides off his body. I see her put the boy's fingers to her mouth just briefly before holding them against her cheek. I start to leave as soon as the social worker enters, motioning for the rest of the crowd to follow me out. I think that's what they can learn from watching me, is how to walk away. And without a moment's break, I go to see the next patient, because there are 40 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 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. Thank you.