Viewpoint: Carers should fall silent after a patient's death


Surgeon and columnist Pauline Chen suggests doctors and nurses should be obliged to pause for silent reflection when someone they are treating dies. It would be good for them, she says, and may make them better carers.

On hospital wards, in the operating room, in clinics and in the intensive care unit, there should be a mandatory five-minute silence when a patient dies.

The doctors, nurses and all who had been caring for the patient at the end would gather around the bedside for those five minutes and reflect in silence on that patient's life and death.

In my experience, there's a moment right after the patient dies when most caregivers, particularly doctors, will scatter - if not in presence then in mind.

We immediately think about going to see the next patient, cleaning the room, getting the body ready to go to the mortuary. Anything to avoid confronting the reality before us because, for those of us who practise in wealthier countries, a patient who dies represents our professional failure.

Several years ago, I took care of a young woman who had had a transplant a decade earlier but who was now hospitalised because of a series of infections.

She was slender and blonde, and I can recall how she loved talking about the novels she had read and the way she raised her right hand to her forehead, palm facing outward, to pat her hair.

But on the night she bled to death from an infection that had eroded into a major artery, none of us stopped to remember the lively conversations about literature.

Instead, as soon as she was pronounced dead, we became preoccupied with seeing the next patient, removing the stains from blood that had gushed up to the ceiling and disposing of the used needles and syringes strewn on her bed.

We did not talk about her, the woman who had just died in the room.

Weighed down

I have often thought back to the fact that I did not stop to remember her or acknowledge her impact on me. There was no closure to our relationship, no acknowledgment of her life or my grief.

Had I lived those moments around her death differently, perhaps the details of her death would not be frozen in my mind as they are now, a few minutes replaying over and over again.

Perhaps by acknowledging her passing I would not be as weighed down by what was lost, even as I continued to care for other patients.

I believe that instituting the five-minute pause for silence after a patient dies will change the way doctors, nurses and other caregivers approach death.

First, it will give closure, as well as respect, to the relationship between that patient and his or her caregivers.

Second, the conscious pause, the act of taking time out, will establish a ritual. And rituals, consistently practised, offer great comfort at difficult moments.

Finally, the five-minute silence will allow caregivers to acknowledge their own feelings.

I am convinced that one of the reasons doctors and other healthcare providers don't do a better job caring for the dying is that we hardly ever take the time to acknowledge our own responses to those who have died. We deny those feelings only to end up constrained by them.

A five-minute pause for silence would allow us to attend to our own grief about a patient who has died and free us to commit ourselves fully to those who will follow.

Pauline Chen is a liver surgeon and author of Final Exam: A Surgeon's Reflection on Mortality. She also writes the Doctor and Patient column for the New York Times.

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