rashid elhawli

Family Meeting

“…and unfortunately,  Jacqueline,  he is going to die.”

There was silence.  The nurse rested a hand on Jacqueline’s back. Her face was blank, and she stared unblinkingly at the space above the consultant’s head.

Then at once, as if her control had completely snapped, her face crumpled. Her tears were silent. No-one moved. It was as if we were afraid that movement would intrude on her grief.

We were sitting at a round table, yet still there was a divide. The bedside nurse with the devastated wife on one side, and the small panel of doctors (plus my curious self) on the other-sympathetic but serious, a solemn row of doomsayers changing a family’s life forever.

The family meeting was brief, but heavy. We left her in the room alone (by request) and filed out. Once we were back in ICU however, as if the veil of mourning had been whipped off, the senior doctors began speaking earnestly, discussing details of the palliation and the patient’s family situation. The wife was estranged from her in-laws and wished for them to not be present whilst her husband’s support system was being switched off. This meant that the consultant was to inform the parents and sister of his palliation the following morning and allow them only the morning hours to say their goodbyes before the wife was to return in the afternoon.

“This is such a shitty situation,” the senior registrar was saying. “He’s dying.” The nursing manager nodded. “Exactly. The poor man is passing away yet his wife and family can’t set aside their differences for one day just so they can say goodbye together, it’s so sad.”

He sighed and shook his head. “You do see it happen though, sometimes. But I suppose mostly it’s when the patient’s been in here for a long time, and they’ve had time to come together. He only started deteriorating last Friday.”

Meanwhile the consultant turned to me. “See it’s actually really important that you specifically say the ‘d’ word-you’d be amazed to know how many people can walk away from a family meeting thinking something completely different if you don’t explicitly say it.” The junior registrar was nodding in agreement. “People can be really dense when they’re grieving, or they simply just stop listening. Don’t beat around the bush, you have to be straight and honest.” Having seen from my wide-eyed look that I definitely got the message, they began to discuss the patients that needed to be seen first in the afternoon ward rounds.

Thus began my short-lived stint in ICU. We were only rostered on for 1.5 days, my reasoning being that if I were an ICU doctor I probably would not want a clueless third year medical student running around after me for 5 days of the week. It was unfortunate for us but also fair enough-as a medical student in her first year of clinical placement I was probably as useful in ICU as a solar powered torch.

It did make me think however. I’d been warned by one of the registrars beforehand: “Just be aware, Priscilla that this can be very tough, and you just need to stay calm. It doesn’t really help if you start crying.” I had been expecting to feel completely overwhelmed, yet whilst I felt sympathy and compassion I didn’t feel such overflowing emotion. Perhaps it was because I was simply an observer and felt no personal connection. Or perhaps it was because he was not my patient, and I had only seen him once and only very briefly.

It made me wonder what it would be like if I knew the patient, and had made a connection. How would I handle it? Would I struggle? I am a curious mix of stoic and highly emotive. Sometimes I can be surprised by my own reactions.  My desire to attend the family meeting was to not only observe firsthand the proceedings but to also challenge my mental strength. Could I deal with it? It appeared I could, but I was not completely convinced.

I suppose this is something I would find out in the future, and all I can do is be as ready for it as I can.

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