Rituals

It's so cliche that you already know how it happens. The doctor walks up to the family member and says, "We need to talk. Please come with me." The person is ushered into a room and asked to sit. If they don't sit, then they are encouraged to sit.

"I have some bad news." Colloquially known as a warning shot, this is the clue to the person that this is bad. There will be no 'good news, bad news' game here. It's only bad. Next comes a formula repeated in every hospital in the country. A recitation of facts about what happened, and at the end, telling the family member that their loved one has died. The doctor says, "We did everything we could, but we couldn't save him, and he died." There are accusations, and shock, and tears. Tissues are provided. Hugs sometimes or a hand on a shoulder.

While it seems like a cliche, it serves a purpose. When people experience a situation they know, then it helps to provide structure to the process. It's no different than a Catholic mass. There are no surprises. You know exactly what is going to happen, what people will say, and when it will end. So when faced with terrible circumstances, it's reassuring to know that there is a structure to it, and a role to play. The doctor knows what they're supposed to do, and the family knows as well. So while reciting the words and gonig through the ritual, a person has for a brief moment the chance to truly grieve, cloaked in the words and actions already predetermined.

If you're looking for advice on breaking bad news, then there are lots of formulas. I think that SPIKES is as good as any. I do have a few tips.

1. Make sure you say that you did everything you could. In fact, use that exact phrase. "We did everything we could."
2. Make sure you say that the patient died in no uncertain terms. Not "passed", not "lost". Something like, "We couldn't save him, and PATIENT died."

You would not believe, despite saying those exact words, how many people will question you on those two points. And that's natural. Don't be defensive. The human creature can only process so much trauma at one time. People want to make sure that everything was done. People want to make sure that their loved one is indeed dead. It's not blame. It's shock.