Blythe Sanders Winchester, MD, MPH
|
I always thought I was good at delivering difficult news. I even had an exercise in medical school which simulated breaking
the news of someone's death to a loved one. Since then, I have been in many situations where my words changed lives.
During residency, I informed patients and family members of impending death, and have pronounced and certified the deaths
of many. Sometimes I had known the patient long enough to establish a connection with him and the family. Other times, as
an intern, I did not know the patient whose silent chest I listened to at 3 a.m., whose eyelids did not dance, whose pupils
did not respond, and who, in perhaps the most unnerving measure, did not wince or retract when I intentionally induced pain.
In my limited time practicing medicine, I felt fairly confident in my ability to calmly and quietly discuss end-of-life issues.
However, no one educates young physicians on how to tell your own family that someone is dying, or how to balance your grief
and sadness with your family's request for medical knowledge and advice.
My grandfather, Soldier Edward Sanders, was a full-blooded member of the Cherokee Nation and a former World War II POW. He
had struggled with Alzheimer's disease and multi-infarct dementia for several years. Grandpa had progressively gotten weaker,
but took a turn for the worse and fractured his femur. When my mother told me, I began to understand how much vocabulary we
take for granted as physicians. I take pride in how well I translate "doctor language" into what my husband calls "normal
people talk." But during this conversation I found myself, for the first time, depending on my mother to summarize a medical
situation. Grandpa had fractured his greater trochanter and had an operative repair, and I called my mom for an update. "Hey, Blythe, Grandpa had his operation today and that went well, but he has been crazy ever since."
Translation: Patient developed post-op delirium.
"He has been thrashing around, yelling, restless, and sweaty. They don't want to give him too much medicine, but he is out
of control."
Translation: Delirium worsened, patient now tachycardic, probable 4-point restraints.
"Last night your dad heard him speaking in Cherokee; he was whispering the Death Chant, but that is the only time he talked.
Today they tell us he has pneumonia. He is not breathing well without oxygen, and his heart is beating funny."
Translation: Patient now with fever, possible etiologies include pneumonia, sepsis, urinary tract infection, bleeding, and
now requiring supplemental O2. Question of pulmonary effusion, fluid overload, heart failure, and/or atelectasis. Still unresponsive. All are poor prognostic
indicators. May also be developing an arrhythmia.
Practice Tools
