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?

Making the most of a sunny day

Written by Suraj Shah.

Things change.
Day to day, things change.
Moment to moment, things change.

It’s almost the end of June, but recently the days have been mostly cold and wet.

Today’s an exception. It’s gorgeous. The sun is shining strong, the air is warm, and yet there is a slight cool breeze. Perfect.

Some say that Britain is experiencing a mini heatwave this weekend, and by Tuesday it will be cold and wet again. They say the forecast does not look good.

Perhaps that’s why, rather than hearing so many complaints about the heat, almost everyone is outdoors and making the most of this sunny Sunday:

  • birds are chirping.
  • flies are having a field day in the garden.
  • the occasional butterfly if fluttering by.
  • kids are riding their bikes.
  • neighbours are painting fences and moving lawns.

It seems that everyone is making the most of this sunny day, perhaps because they know it will not last.

Neighbours have washed and hung out their clothes and sheets since the early morning, capitalising on the warmth from the sun to dry their clothes.

Friends on Facebook report loading their cars up with their families and heading to Brighton to enjoy time at the beach, or the local park, or to meet their brothers and sisters who have invited them over for a barbecue.

You just can’t ask for better weather on a Sunday.

But it won’t last – the sun will go, the rains will come, happiness and fun will be replaced with misery and complaints.  It’s what the forecast says, and they never get it wrong, do they?

Even now as I sit here to write at the dining table, with the patio doors wide open to enjoy the bright sun and the warm air blended with the cool breeze, a jet aeroplane thunders through the skies above my head, making it’s way over to the local RAF base.  The peaceful sound of the birds chirping has been rocked by the roar of the jet.

Things change.  Day to day, things change.  Moment to moment, things change.

Knowing this is perhaps the reason we make the most of a sunny day.

(Photo courtesy of kooklanekookla)

Interview: Premal Shah on the loss of his cousin brother

Written by Suraj Shah.

“We talked at home openly about him, shared memories of him, laughed at the things he used to say and do.”

Premal Shah is a 37 year old Chartered Physiotherapist, married with two children aged 9 and 6. He is currently preparing to participate in the Everest Basecamp Trek in 2012, in memory of his cousin brother who recently passed away due to a brain tumour.

In this interview, Premal talks about the loss of his cousin brother, how he discussed the topic with his own children, and preparation for his trek to the Everest Basecamp.

You recently lost your cousin brother. Tell us about him.

Amit was 45. He ran his own very successful pharmacy business in Hackney, and also did a lot on work with the NHS in improving the lives of local people. He was married with two boys.

What were the last few months and days of his life like for him, for you, how did he die, and how was that for you?

Amit died because of a brain tumour that was diagnosed last year after a sudden downturn in his health. The family was devastated, but somehow he always managed to look at the funnier side of life. After his diagnosis, he committed his remaining time for his wife and children. We didn’t really see him, but communicated via phone and email. Time was precious to him, so it was important that he spent his time with those closest to him.

What were some of the biggest challenges for you, and how did you manage to deal with them?

For me personally, the biggest challenge was dealing with the idea that his life was soon to end, and that the treatment he was undergoing was unlikely to help him. I had no problem in explaining to my children what was happening. Honesty and frankness is vital. Sometimes the truth is painful.

What did you do to bring about peace within yourself at the time of Amit’s declining health and eventual death?

We talked at home openly about him, shared memories of him, laughed at the things he used to say and do. He was an amazing character, and one that should be celebrated.

What are the most important lessons you have learnt from his life, his illness, and his death?

Life is precious, time can be short. Family and close friends should be valued.

You are planning a trek to Everest next year – tell us a bit about that.

In February 2012, I am going to trek up to the base camp on Mount Everest. I will be reaching an altitude of around 18,000 feet and trekking 8 hours a day for 10 days. I will be sleeping at times in temperatures close to -15. This is all in aid of raising money for Brainstrust, the charity Amit wanted to be supported. Amit was an amazing person. I want to do something amazing to honour him. I am out of shape and lazy, so the challenge will be that much more for someone like me.

Editor’s note: If you wish to support Premal’s trek in memory of his cousin, and through him donate to Brainstrust, Amit’s chosen charity, please visit http://www.justgiving.com/premshah

(Photo caption: Premal Shah proudly supporting the charity Brainstrust)