Confronting Deaths in a Hospital

I have often wondered how ill-prepared Indian hospitals are when they are confronted with dying patients. When the inevitability of death looms large over a terminally sick patient, our hospitals tend to pretend that death does not exist. Most folks assigned to take care of a patient who is in terminal decline, find it hard to communicate either with the patient or the grieving relatives. Many including the doctors do not know what to say and inanities such as ”we will keep trying right till the last breath” or a barely muttered ” I am sorry, but his chances are really slim’ escape the lips of the caregivers. For some reason, everyone seems to talk in low hushed tones, when they know that death is around the corner.

Sadly many hospitals do not want the dying to pass away while admitted to the hospital. This is as shameful as it gets, but the fact is that many smaller hospitals will refer the patient to some other facility, hoping all the time that the person will not die in their hospital. You see, a visit by the angel of death is not welcome, after-all there are hospital mortality numbers to be protected. Many hospitals will discharge a terminally ill patient informing their family that it is best that the patient dies at home surrounded by her family members, rather than in the hospital under a mountain of tubes and needles. Sounds altruistic and kind but I do believe that hospitals can handle deaths a lot better.

Here are some suggestions.

It is best not to pussyfoot around the matter of death. The senior most doctor under whose care the patient is admitted to the hospital must have a candid conversation with the patient’s attendants about the possibility of death. Giving false hope when there is a very small possibility of the science of medicine pulling off an improbable outcome is best avoided. A doctor must be honest and forthright in their assessment of the situation. This does not mean they have to be cold- empathy, warmth and honesty should go hand in hand. The hospitals must have designated patient conference rooms, where such discussions can happen. Busy OPD rooms or corridors outside the ICU are hardly the places for such conversations. Delegating this task to a junior doctor on the care team is also not right. I would be very uncomfortable with a doctor who cannot look me in the eye and talk honestly about death, particularly when everyone from the nurses to the ward boys is whispering about it.

Hospitals must employ some counselors who can help patient attendants cope with the bad news. They should be trained in talking with the patient’s loved ones, prepare them for the death in the family, ask them if there is something that the hospital can do to help ease the pain. I recall a grieving husband, who wanted a Sikh priest to spend some time with his young wife dying of breast cancer in one of the hospitals I worked for. Religious ministers of various denominations must be at hand and available, for patients and their attendants who may need them.

Designated rooms for patient’s attendants to mourn their loved ones will be a good idea in a hospital. I remember once when a distant relative of mine passed away in a hospital in Delhi, there was just no place for the immediate family of the deceased to sit down together and share their grief. Eventually, they huddled together in the hospital cafeteria with curious onlookers whispering about the misfortune of the family in having lost a member. Their personal grief was there for everyone to see, which made things a lot worse.

Hospital paperwork after the death and the release of the body by the hospital should be managed with a great deal of sensitivity. While one understands that the bills need to be settled and arrangements need to be made, hospitals should have trained staff handling this part. They should know well in advance that in the eventuality of death, who is it that they should approach for the paperwork to be completed. It would also be good if the hospital could help by recommending an undertaker or a hearse service, which most people will need once the dead body is released from the hospital.

While it may sound macabre, hospitals must have a sound system of delivering a great experience even when the matter may be as grave as a death. In fact, a death would be an occasion, when the hospital must make a big difference.