12 February 2010

Friday Flashback

Each word a hammer

Every ER has a "Quiet Room." Small, drab, windowless little rooms, with a couch and a couple of chairs, a phone and some tissues, all alike. Nothing good ever happens there.

I've walked into the quiet room hundreds of times. Eyes look up to meet me, full of apprehension and dread. Nobody is ever happy to see me. They are afraid of me, I think. They want very much to talk to me, but they are deathly afraid of what I will say.

"My name is Dr. Y. Are you David's wife?"

"Are you her father?"

"Is John your brother?"

"Are you Anne's husband?"

It's a weird conversation. I begin with pleasantries and very concrete small talk. They play along. Always. The stupid little social niceties frame the conversation and allow it to develop in a bizarre but comprehensible manner.

"Did you know your dad had heart problems?"

"You know the accident was pretty serious, right?"

"Was she awake when you saw her last?"

Start with a question. Either rhetorical or very concrete. Sometimes it prompts a long story, but usually the answers are pretty short and direct. But the question sets the stage. Sometimes a subtle shift in tense can presage what's coming. Deep breath.

"I wish I had good news for you."

"I think you know that he was pretty sick."

"Her breathing was pretty bad when she got here."

"You know the paramedics were doing CPR."

Then let it fly.

"I'm sorry to tell you that he died."

Each word a hammer.

"I'm sorry to tell you that she died."

With each hammer blow their faces crumple like so much tin.

"We were not able to restart his heart, and he died."

Each word a hammer.

"The paramedics did everything they could, but she died."

Weeping and wailing. Rage. Questions. Disbelief. Shouting. Quiet acceptance. Silent tears. It's never quite the same, after. I can talk a bit more, but it doesn't matter. They don't hear or remember anything I say from that point on. Perhaps a polite lie that the deceased did not suffer. Who knows? True or not, it seems to be good to hear. Offer more information. Ask some more questions, maybe. Then an awkward departure. That's tough. What do you say to end that particular conversation? "I've got paperwork to do"? "I've got to go take care of the living"? You show up, introduce yourself, devastate a total stranger with eight words, and leave. They tell me I'm pretty good at it. An artist with the hammer. I guess that's good, though a dubious distinction. Lord knows I've had enough practice.

So I promise to come back, I put my hammer back in my pocket, leave them amidst the wreckage of their lives, and move on.

Originally posted 14 May 2006


  1. I'm a long time reader and hardly ever comment.

    The doctor who told my husband that his wife died did it almost exactly like this. It was quick, factual, and he stayed around to answer questions. There weren't many.

    I really appreciate what you and your people do. You're amazing. Thank you.

  2. Wow, what a heavy post, yet, true. I remember the day my mom died. I remember the paramedics saying those exact words. My only response was, 'wow'. It was like the whole world came to crashing halt. Thank you for all that you do. Some days, it must seem like a thankless job. Please know that it isn't, especially to those of us you've treated so kindly. Thank you.

  3. Well said.

    People don't realize the human toll it takes on those that provide care. The care giver, the patient and their loved ones - all linked for a time. It is a hard thing to look those loved ones in the eyes and have to tell them you are sorry for their loss. It is painful.

  4. Everyone at my job was furious when they took away our quiet room and turned into a break room for EMT's; they aren't even employees of the hospital! I'm not saying they're not important to the system but this was not an acceptable trade. We all thought it was so disrespectful to those grieving, to deny them a place to take in the initial shock without being on display.


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