Falling silent after a patient’s death

Written by Suraj Shah.

I feel like when my patients die, I definitely do spend a moment reflecting on the patient but mostly thinking of the families and those moments always truly humble me, because it reminds me that in a few days I will likely not think of that moment, but those families will never forget.

In a recent BBC news article, surgeon Pauline Chen suggests that 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.

In summary, the article highlights:

  • there should be a mandatory 5 minutes silence when a patient dies.
  • all carers would gather round the bedside and reflect in silence on that person’s life and death.
  • most caregivers, particularly doctors in the west avoid confronting the reality because a patient who dies represents a professional failure.
  • having a five minute pause for silence will give closure.
  • the conscious pause will also establish a ritual, which leads to offering great comfort at difficult moments.
  • also the five minute pause will allow caregivers to acknowledge their own feelings.
  • by denying the acknowledgement of feelings, doctors and other caregivers end up being restrained by them.

I asked a bunch of friends who are in the medical profession what they thought about it.

One friend wrote:

“What a heartfelt story. I think that a moment of silence for patients who have passed is actually something that is not only good for that person but for the families and the medical doctors and registered nurses.

I feel like when my patients die, I definitely do spend a moment reflecting on the patient but mostly thinking of the families, and those moments always truly humble me, because it reminds me that in a few days I will likely not think of that moment, but those families will never forget. Thank you for sharing this with me. I think I will be more conscious in those moments to come.”

Another friend wrote:

“Interesting article. I do think that we could do more to respect a patient who has died. We as doctors could also do a lot better to respect the woes of patients who are living.

From the point of view of an ER doctor, I think that 5 minutes is not possible in that environment. Also, it would be nice to have some tradition that reflects and acknowledges the death of a patient, but it would be better if it came from a tradition of spirituality or compassion (universal spirituality is better than any particular religion in our society, mostly) rather than one of hospital policy. The culture in the ER that I see is that some people would like this very much, and others would just scoff at it.

Overall, a tradition of some moments of silence, and then a protocol of supporting family, etc, would be good. I sort of do that in my own way, but it would be nice to have more of a protocol that gets people on the same page, and also has room for exceptions (i.e. it is not appropriate to have a moment of silence if a family member is freaking out … you have to support them first and do what is right for them, silence otherwise).

Perhaps that protocol would also one day become tradition and influence us a bit deeper. There are many medical professionals who are compassionate, and there are many that are not (maybe selectively compassionate depending on mood etc.) We are a pretty diverse and intense bunch of people.

I think that our society has to be more compassionate in general. That is the real issue. Compassionate and intelligent in conjunction with each other. We are way too materialistic and not compassionate enough.”

Are you a carer of some form where you face death more often than most other people? If so, how do you feel about observing silence after a patient’s death?

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