One of the most difficult responsibilities of an emergency room physician (and staff) is dealing with the death - often
sudden and unanticipated - of a patient.
This can happen in someone awake and talking, who rapidly deteriorates despite all efforts. People often are brought in
by ambulance after sudden cardiac events. CPR, cardio-pulmonary resuscitation, is in progress, lights and sirens are
on, and the radio crackles with updates about patient progress.
Time is of the essence. For CPR to be successful, it generally must be initiated within four minutes, and Advance Life
Support (ALS, paramedic level) should be available in eight or so minutes. These are narrow windows for anyone
experiencing cardiac arrest. Most who survive have witnessed events; CPR is initiated by bystanders and advanced care
In most fatal outcomes, it falls upon the ER doctor to inform the family. Some have a good idea of the seriousness of
the emergency, but others are totally unaware. It is far worse if a child is involved or if a trauma patient is unaware
of the death of a friend, relative or spouse, dead at the scene of an accident.
Speaking to a family is one responsibility I never have delegated. I almost always have solicited the help of a nurse,male or female. They are equally (or more) consoling - it can become tearful for all involved. Nurses often remain with
a family, especially if the ER's other demands limit the physician's presence. Clergy also are helpful, especially if
known to the family. Hospitals have come a long way - quiet" rooms and chapels are located near the ER.
One unusual experience comes to mind: an episode of sudden cardiac death and efforts at resuscitation that failed. An
elderly man, who had collapsed, was brought in from a pick-'em-yourself strawberry farm, with CPR and breathing by
bag-valve-mask. He never regained a pulse or spontaneous respiration and remained flatline" on the cardiac monitor.
Before we terminated our efforts, he had vomited copious amounts of strawberries.
Leaving the mess to others and steeling up our courage, a nurse and I left for the quiet room to break the bad news:
We and the rescue folks did everything we could, but your husband didn't make it - we're very sorry. ... "
Sitting beside and across from her, we were stunned and dumbfounded - she began to laugh. Speechless for a time, I
finally asked why she found his death so funny? She replied: We sure crushed a whole lot of strawberries."
She also knew and had recognized that her husband probably was gone before the ambulance arrived. She added that he
probably had eaten several quarts of strawberries.
A little later that afternoon, the rescue people sought me out - Polaroids to share. They had driven the rig all the
way across the strawberry patch, swung around and backed up. The immediate vicinity also was flattened by rescuers and
others - it briefly was very busy in the patch.
No disrespect intended, but funny it was, and I remember her laugh whenever I eat strawberries.
Dr. Fraser Houston is a retired
emergency room physician
who worked at area hospitals
after moving to Southwest Colorado from New Hampshire in 1990.