Unexpected Death

A sad day at work, today, as I discovered that one of the doctors I work with died suddenly and unexpectedly yesterday. His wife is expecting their third child later this year and my heart aches for what this little family faces over the next while.

Both he and his wife have worked for a number of years in their busy hospital department and are well liked. A memorial service is being planned and I am sure it will be packed.

Instinctively, I imagine what it would be like if my husband died like this. Somehow, I need to personalise the pain to make it more real. In shock, I find myself drawing on connections to establish a sense of reality. Is it not enough that the pain exists? Somehow it needs to touch me, to be close. I do not like the tinge of voyeurism that comes with another's grief, but it speaks of our need to know and be known.

Losing a dear someone brings so much attention, especially when it is in tragic or sudden circumstances. Attention that can be initially overwhelming but fades all too soon as the world moves on. Moving on, as the people whose lives have been blown apart are left reeling and lost.

This broken, broken world where families are bereft, children fatherless, death uncontrollable. We desperately need someone to bring hope and healing. I cannot fix things. We cannot fix things. Despite our competencies, our professionalism, and our independence, our self- reliance is, in fact, baseless in the deep and lasting matters of existence and purpose. Part of my grief is desperation that we are so powerless, in the end, when it really matters.

The message of Easter is that I am powerless, but God is not. Jesus chose to come in innocence and die. God raised him from death to sit beside him in heaven. Relying on God's power and work to rescue us is based on truth. His power to defeat death has passed the burden of proof. He has already done it.

My grief gestates an urge to trust God more.

Then, when our dying bodies have been transformed into bodies that will never die, this Scripture will be fulfilled:

“Death is swallowed up in victory.

O death, where is your victory?

O death, where is your sting?”

For sin is the sting that results in death, and the law gives sin its power.

But thank God! He gives us victory over sin and death through our Lord Jesus Christ.

1 Corinthians 15:54-57.

Please pray that this family will know God's love, comfort and power, now and in the years to come.

What do you think of a doctor who says 'I don't know?'

This week I attended training in how to deal sensitively with families of patients in mental health. We began discussing difficult questions which we sometimes get asked by families. One of the common themes that comes up is concerns about prognosis, the future for the patient and their family, and 'is full recovery possible?'.

Really important, practical questions. Extremely difficult to answer, to really answer what that family are asking. I'm not sure that giving people a list of statistics for prognosis or recovery is all that helpful. They have a place in a really comprehensive answer, but I suspect that we doctors hide behind statistics because questions like this make us uncomfortable. It is hard to tell people that not everyone recovers or that people have relapses or don't return to work.

We need to acknowledge, however, that we do not know the future. We cannot say for a particular individual what is going to happen. We can make educated guesses, based on studies of the natural history of an illness, or on experience with previous patients. But we do not know for sure. In fact, expecting to be able to answer these questions without uncertainty is unrealistic.

What became evident as we talked was a deep reluctance among my colleagues to say 'I don't know'. It was even mentioned that saying those exact words will damage the therapeutic alliance between the doctor and the patient's family, so they should never be said.

But how can we say that we have built a therapeutic alliance if we cannot even acknowledge uncertainty. I think people know that we are fudging and uncomfortable with the question. This damages their trust in us more than admitting we don't know. Saying 'I don't know' opens up a dialogue that includes fears for a bad outcome but also the possibility of a good one. Difficult, confronting questions, with answers that we do not clearly know are an opportunity to talk with the family about what has provoked the question. It gives the chance to educate them about what we do know, to support them in the uncertainty of what we do not know, to ignite in them the hope of recovery.

Where did we get the idea that we are not allowed to be uncertain or not know? I think that our empathy for and alliance with patients is strengthened by admitting that there are some things we do not know. I also suspect that we may couch our reluctance to express not knowing in delicate feelings for the patient or the therapeutic alliance but we are actually protecting ourselves. We are the ones who do not want to hear that we do not know.