December 2000 • Volume 7 Number 12
When a child dies
Dealing with survivors of sudden, unexpected deathIn a calm, quiet voice, George Higgins III, M.D., opened his discussion, "Dealing With Survivors of Sudden, Unexpected Death," by telling of his own near-death experience at age 5.
He touched on themes you've probably heard about: leaving his body, seeing a tremendous luminescence, feeling an overwhelming peacefulness -- and being called back.
Higgins, chief of emergency services for Maine Medical Center, Portland, and an associate professor at the University of Vermont College of Medicine, Burlington, spoke during an Oct. 29 workshop at the AAFP Emergency and Urgent Care CME course.
"Not knowing it at the time, at that moment I ceased to be afraid of death," he said of his childhood experience.
Perhaps it was that realization that allowed him to relate another story -- this one with a tragic ending.
Encircled by colleagues bending close to hear each word, Higgins described how he held his 11-year-old son -- a victim of a car accident -- as the ventilator maintaining his son's breathing was turned off.
"I want you to wear two kinds of hats as we go through this," Higgins said, urging participants to consider the sudden death of a child from the perspective of both the physician and the parent.
A SHARED PERSPECTIVE
"Imagine yourself as the physician working to resuscitate that child," said Higgins. "You're trying and trying and trying, but it doesn't work, and you finally have to make the call. Just then the nurse walks in and tells you the child's parents are here. What do you do?"
Now, turn that viewpoint around, Higgins said, and envision yourself in the parents' place.
"If you're the parent, and it's your child, what are you thinking right now? You know I'm in there with your child, and I haven't told you anything yet. What do you expect?" he asked. "You expect a miracle. Every parent believes their child is blessed."
It's a shield parents use to try to ward off the reality of a child's death, he said. Physicians, too, shield their emotions during resuscitation efforts by immersing themselves in the process. But it's a tendency physicians should guard against when delivering that most unwelcome message to parents, he said.
BREAKING THE NEWS
"When you come into the room, you may see the parents sitting together, or they may be apart," said Higgins. "It doesn't matter; it's what works for them."
Higgins said he typically approaches the mother, sits down at her level, and leans forward to touch her hand. "I have tragic news for you" are the words he uses to make that first verbal contact.
"You've read all these books that say use the D-word as soon as possible. 'Dead.' Well, the people who wrote those books don't work where I work. I can't get that word out of my mouth," said Higgins. "The parents will tell you what word works for them."
The steps Higgins next recommended are designed to ease the impact of the news on parents without unduly shielding them from the reality of their child's death:
- Clean the child carefully, removing all tubes, IV lines and other equipment. Don't, however, discard clothing that may have been removed or cut away during resuscitation efforts, regardless of its condition. Often, parents desperately want these reminders of their child's life.
- Invite the parents to spend time with their child in a private, quiet area. Ensure that all staff treat them with respect and compassion.
- Offer them the option of meeting with a spiritual counselor.
- And difficult as it may be, you need to broach the subject of organ and tissue donation.
"Unfortunately," Higgins added, "another part of this is that we often have to treat the death as child abuse. You're looking for a murderer here." Listen for discrepancies in the explanations given by different family members.
Above all, don't delegate the responsibility of breaking the news, Higgins advised. "I encourage you to look on this as not only a duty, but also a profound challenge and privilege that will make you better people and more compassionate physicians."
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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