Communicating News Of A Patient’s Death To A Spouse

Case Scenario: A 40-year-old man, is admitted from work with a large anterior myocardial infarct, which is treated with thrombolysis. Unfortunately he arrests and, despite prolonged attempts at resuscitation, he dies. His wife arrives 5 minutes after he dies. You are a junior doctor on a coronary care unit and your task is to inform the wife that his husband is dead.

How will you approach this case?

Key issues to explore: 
What does the patient’s wife know already?
She will be more prepared for bad news if she knows he is gravely ill than if she doesn’t know why he is in hospital. Explaining an unexpected death is one of the most difficult communication tasks that a medical professional has to perform: if it is done with compassion and sensitivity it can ease the inevitable distress that family and friends will go through.

Key points to establish And Steps In Communicating : 

1. Find a quiet room, if possible a relatives’ room, and ask the nurse looking after the patient to accompany you. 
2. Leave your pager with someone else so that you are free of interruptions. 
3. There is no hiding from the fact that you must inform the wife that her husband has had a heart attack and unfortunately has not survived. 
4. State that you and the team did what you could, and say how sorry the whole team is. 
5. Demonstrate empathy: if it feels appropriate hold her hand or touch a non-threatening area, such as the arm or the shoulder. 
6. Wait until asked to explain details, but keep it simple. 
7. Allow her to cry with dignity, such as by handing her some tissues. 
8. Do not be afraid of silence, but if this becomes uncomfortable it is often helpful to make an open statement, such as ‘This must have come as a shock’.
9. In finishing the discussion, explain that should further questions arise you will be happy to answer them.
10. Also say that you will have to notify the coroner, which is routine following any unexpected death, and that the nursing staff will provide her with information about practical matters such as death certification.

Appropriate responses to likely questions
Wife: what’s happened?
Doctor: [After ascertaining that she knows that her husband was brought into hospital as an emergency, but not that he has died; and speaking quietly, slowly and deliberately to let the information sink in.] Your husband was brought to the hospital as an emergency. He was very unwell: he had suffered a big heart attack. We gave him the best treatment we could – an injection of a drug designed to open up the artery that had blocked off – but I’m afraid that things did not go well. The damage to his heart was too great, it couldn’t beat properly and, despite us doing everything we could, he passed away.

Wife: you mean he’s dead?
Doctor: yes. I’m very sorry, but I’m afraid he’s dead.

Wife: why did this happen?
Doctor: I don’t know why it happened, but he had a big heart attack. This must mean that the blood vessels going to his heart muscle were narrowed, and that one of them blocked off and gave him a heart attack.

Wife: but people can survive heart attacks, why didn’t he?
Doctor: you’re right, many people do survive heart attacks, but I’m afraid that many also don’t. Sometimes the heart attack is so big that it damages too much of the heart muscle for the heart to work at all; and sometimes the heart attack affects the wiring mechanism that makes the heart beat in a regular manner, so that instead of pumping in a normal way the heart can’t pump at all. I’m sorry to say that both of these things happened in your husband’s case.

Wife: why couldn’t you bring him back to life?
Doctor: we did absolutely everything we could to restart his heart, but he had suffered such a large heart attack that this wasn’t possible. We tried everything we could to resuscitate him, but I’m afraid
that it didn’t work.

Wife: did he suffer?
Doctor: no – it was very quick and he was unconscious throughout, so he wasn’t aware of what was
going on and he would not have suffered.

Wife: will he have a post-mortem?
Doctor: it is unlikely that he will have to have a post-mortem. We will need to inform the coroner, which is something that we have to do after any unexpected death, and very occasionally they will insist on a post-mortem. However, I think this is very unlikely in this case, because we know why your husband died. If you would like further information about his health and how he died then we can request a hospital post-mortem, but it may be difficult for you to discuss this now. We can talk about this again later if you want to.