Randi Hutter Epstein M.D. M.P.H.

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February 16, 2019 By Randi Hutter Epstein Leave a Comment

How To Deliver Bad News

Melissa Thomas, a former Medical Service Corps office in the U.S. Army and a current medical student, wrote a heart-wrenching piece in the New York Times Magazine about the moment she learned of her husband’s death. He was in the army, too, and, like Melissa, served several missions on the front lines in Iraq and Afghanistan. He didn’t die in warfare. He died while snowshoeing in Colorado on New Year’s Eve Day four years ago. An avalanche killed him.

I know Melissa. She’s a compassionate, deep-thinking doctor-in-training. But there’s more to her story than coping with tragic news. There’s a message for future doctors.

As doctors, we like to think that it’s all about saving lives. But we also know that being a caregiver sometimes requires being the one that breaks the news that a loved one is dead.

Melissa has told me that as part of medical training, she’s known that she has to consider carefully which words she’ll use. She had a friend, for instance, who was told by a doctor that her husband’s heart stopped beating after complicated surgery.  We all live in denial when harsh news hits us. So Melissa’s friend didn’t understand what was going on until the doctor finally said, “Your husband is dead.” Then he shot out of the room leaving the woman alone.

Yes, words matter. But Melissa barely remembers the words when she was told that her husband died. What she remembers is the comfort; the way the officers stood by her side. The way they spoke in calm tones, rather than sounding like a computer.

This is a lesson—albeit one learned in such a harsh way—that she is trying to take with her as she becomes a full-fledged physician.

I have a colleague who is a professor at Yale drama school and teaches voice classes. The vast majority of her students are aspiring actors. A few years ago, she was invited to speak to a group of physicians. Someone realized that we, doctors, never learn about how we speak, just what we say.

One of my former professors told me that he had this issue with one of his trainees who spoke in a chipper voice no matter the content. But he thought it was inappropriate to comment on her tone.

Why inappropriate? If we teach medical communication in medical schools these days, shouldn’t voice count too?

Yes words matter but, it’s like that mom-ism “It’s not what you said, it’s your tone.” Doctors could take note of that too.

Filed Under: GENERAL BLOG Tagged With: Bedside Manner, Death, Doctor-Patient Communication, Medical Humanities

September 27, 2012 By rhe_blogadmin Leave a Comment

My Dad, My Dog: The Humanity of Dying

My Dad, Dexter on the right, Charlie, my golden retriever on the left, and Theo, my sister’s shepherd in the middle. Photo credit: Edie Hutter

When my dog deteriorated to the same level as my father (not able to move or eat on his own and appeared to have little cognitive functioning), I knew it was time to put Dexter, our 13-and-a-half year German Shepherd down.
Dexter hadn’t walked the length of a block in about six months despite twice daily painkillers and a host of other pills to get him moving.

When I arrived at the hospital to end it all, two technicians lifted Dexter onto a gurney and into an examining room. As I wrapped my arms around him—wishing he would close his eyes—the vet, held the syringe of euthanol, and asked:    “Are you sure you are ready?”

That was probably the toughest moment of all.

Then she injected him. One huge syringe of a milky-white powerful sedative followed by another syringe filled with phenobarbital that stopped his heart. There was no last cry or yelp. He just dropped his head and peacefully left.

Right away, my dog’s life flashed before my eyes. I pictured him as an 8-week-old puppy with huge floppy ears and then as a rambunctious hulking 5-year-old. That’s when I knew, hard as it was, that we made the right decision.

Then, oddly enough, my dad’s life flashed before my eyes. The man he was before Alzheimer’s struck. When he was chairing a world-renowned pathology department, editing a prominent cancer journal, leading the American Cancer Society, running miles every day, lifting weights, and so on.

My dad was always a good listener and a great decision-maker. I could tell him anything and he seemed to simplify the process, ask key questions that allowed me to come up with “my own” solution. Even now, when I visit him in the Alzheimer’s ward of the assisted living home, I tell him things just the way I used to. Sometimes it’s the teenage me, asking for life advice about whether I should do this or that. Sometimes, it’s kindergarten me, “hey, dad. Look. I wrote a book!” Often it’s proud-mom me, “the boys are playing football, just like you did.” And somehow, I just know what he’d say. I’ve even learned to predict those key questions guiding my decision-making process. And I know that if he could talk even for a moment, he’d beg us to end it all.

For years, I’ve been a huge proponent of death with dignity, insisting that surely, we must “do something” for dad. I’m proud New Jersey, where I grew up, may become the third state to allow near-death patients to self-administer life-ending medication. Still, I think for all my talk, I’m just going to have to wait this one out. I really wish we could respect my father’s wishes. We’ve agreed that we will not be reaching for lifesaving remedies should he take a turn for the worse. And yet, if my father’s doctor asked, the way my dog’s vet had: “Are you sure you are ready now?”

I’m not sure what I’d say.

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Filed Under: Personal Tagged With: Death, Dying with Dignity

Randi Hutter Epstein, MD

Randi Hutter Epstein, M.D., M.P.H. is a medical writer, adjunct professor at Columbia University Graduate School of Journalism and a lecturer at Yale University.

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