At noon, a car suddenly parked in front of the Emergency Department, Hospital 103 (Hanoi), inside carrying a 30-year-old man whose life was hanging by a thread after a headache.
“One second at this time is more precious than gold, we must coordinate rescue as quickly as possible,” Dr. Dr. Do Duc Thuan, Deputy Head of the Stroke Department, Military Hospital 103, recalled, April 24.
A 30-year-old male patient was admitted to the hospital when he was in a coma and lost consciousness. Before that, he and his wife went to practice driving a car and suddenly had a headache but tried their best. A moment later, he continued to have severe headaches and then fell into a coma, and was taken to the emergency room amid his wife’s panic.
According to Dr. Thuan, the patient had a headache due to a ruptured aneurysm leading to a stroke, and the prognosis was “little healing, much worse”. Taking a deep breath, he decided to go see his wife, saying the patient’s condition was very serious but the doctors were putting all their efforts into treating her, even if the success rate was low.
This is a skill that Dr. Thuan is equipped with in situations where he must report a sudden death to a patient’s family. Accordingly, the reaction of relatives to this news is often very intense, going through stages such as shock, anger, tormented regret… so medical staff have to prepare many different scenarios. One of the ways to calm nerves and prepare family members for bad news is to inform them of the efforts doctors are making to save the victim’s life, even if hope is slim.
On the other hand, in a short conversation, Dr. Thuan tried to explain the patient’s condition and the possible reasons why the prognosis suddenly worsened. “This will help family members have more confidence in our treatment work, and at the same time create a sense of trust between doctors and families,” Mr. Thuan said.
The battle lasted for more than an hour, but the patient did not survive. “How should I break the bad news to the patient’s family?”, is a question Dr. Thuan has repeatedly been unable to find an answer to because each family has a different situation. The patient was still young, from the time he was admitted to the hospital to his death in just three hours, the wife was devastated when she saw her husband collapse.
“As a doctor, I am disappointed and tormented because I could not save the patient. As a human being, I cannot be indifferent to the pain of the patient’s family,” Mr. Thuan said.
Finally, the doctor decided to step forward, informing the wife that “her husband had passed away despite the medical staff’s best efforts.” Being mentally prepared in advance seems to have prevented the wife from falling into agitated situations, crying or screaming. She tried to cling to the doctor and asked to go into the recovery room (ICU) to see her partner’s face one last time.
Dr. Thuan is performing cerebrovascular intervention for stroke patients. Image:Thúy An
In addition to deaths after being hospitalized, many patients with a positive prognosis suddenly become seriously ill, making it difficult for doctors to immediately soothe their families’ minds. For example, a 35-year-old man was treated at the emergency room at Military Hospital 175 (HCMC) due to acute cerebral infarction. He underwent vascular intervention to remove blood clots and had a positive prognosis. On day 8, the patient had abnormalities in pulse, blood pressure, and breathing followed by cardiovascular collapse and death. The cause is late-appearing malignant cerebral edema, which causes pressure on the areas of the brain that control the cardiovascular and respiratory systems.
Hearing the news, Doctor Hoang Tien Trong Nghia, Head of the Department of Internal Medicine, was speechless, because the team had closely monitored the patient and still could not control this unexpected condition. In addition, this is the stage where the majority of ischemic stroke patients are considered temporarily stable.
“It’s difficult to ease this pain, but we try to take the time to explain the illness in detail and listen to what the family has to say to encourage them as much as possible,” the doctor said.
Over the years in his profession, Dr. Nghia has had to face the sudden death of patients countless times, especially in “head of the wave, wind” departments such as emergency medicine. In addition to professional skills, he must learn how to deliver bad news to family members. At this time, he told himself to put aside his sadness, find a suitable space to discuss and analyze with his family, and alleviate their pain.
“Loss is inevitable, but any mitigation is more humane,” the doctor said.
Patients are examined and treated for post-stroke pain with a transcranial magnetic field machine at the Clinical Neurophysiology Unit, Military Hospital 175. Photo: Chinh Tran
The World Health Organization (WHO) defines sudden death as a non-violent and unexplained death that occurs within 24 hours of the onset of symptoms. Some other documents define sudden death as including death under one hour or 6 hours, caused by sudden cardiac death or brain stroke, which doctors tried to cure but failed.
Doctor Tran Quang Thang, Head of the Department of Emergency Medicine and Stroke, Central Geriatric Hospital, said that when death occurs unexpectedly and suddenly, it is very difficult for relatives to cope with the bad news. They do not believe the truth that their loved one has passed away, and their psychology becomes very sensitive, emotional, and easily agitated. Many people also tend to get angry, destroy, curse, and even try to commit suicide. In this situation, if the health care team does not have the communication skills, compassion and empathy, there is a risk of an intense grief reaction with anger and violence directed towards the hospital staff.
Therefore, all trained physicians must explain each step, starting from the cause, prognosis, and risks encountered. When the patient is seriously ill and at risk of death, the doctor will notify family members as soon as possible so that everyone can mentally prepare. Usually, doctors choose to talk to someone who is mentally stronger or notify all relatives present so that everyone can encourage each other.
In case a family member is in shock, crying, screaming or fainting, the doctor will provide medical support, and comfort them that “both the doctor and the family have tried their best to cure the patient”, avoiding death. they feel guilty or blame themselves. In some situations, doctors do not respond or argue with relatives if they blame or criticize the hospital, because this is an emotional outburst during times of grief, Mr. Thang said.
Finally, family members often ask to see the person who has passed away. “This is a very difficult moment, but the medical staff always prepares the best so that the family can achieve their wishes,” the doctor said. At that time, the patient is changed into new clothes, the ICU bed is tidied up, and life support equipment such as endotracheal tubes, ventilators, and heart rate monitors are turned off to restore a peaceful space for the moment of farewell. special.