Sometimes just our presence is all we can do to comfort a grieving family. It never feels like enough and it never will be, but it is something. Silence is powerful and doesn’t need to be filled with empty words. Sit with suffering and silence.
As I walked the short distance from the MICU to the waiting room, the lump in my throat grew. This was the first time that I, alone, was to tell a family that their loved one was dying. In between dispassionately shouting out orders for aliquots of epinephrine, my resident told me to go give the family “the news.” I tried to rehearse in my head what I would say, but the pounding of my heart and the squeaking of my sneakers on the freshly mopped MICU hallway made it impossible to think, and before I knew it, I was in the in the waiting room.
In an unsteady voice, I told the ten crying eyes in front of me that their mother’s heart had stopped again and that despite our best efforts, I didn’t think we could save her. As the words came out of my mouth they seemed so distant and formulaic. I was disgusted at myself for falling into the pattern for which I had so often criticized my peers and predecessors. Rather than speaking from my heart, I spoke from my brain. I delivered news, not comfort.
They cried as I stood there awkwardly not knowing what to do. There was one empty seat between two of the adult grandchildren and for half a second I thought about sitting down and just being with them, but I couldn’t. The crying had stopped and silence filled the room. The suffering was so real I could taste it and I couldn’t deal with it. I mumbled a barely audible, “I’m sorry,” and hurried back to the unit.
Last week, eleven years later, I again walked from the MICU to the waiting room. The hallways are different now and my coat is longer, but the lump in my throat is the same, and the same squeaky sneakers and pounding heart create a sad soundtrack. I have probably delivered “the news” over a hundred times between that first time as an intern and this most recent time. It never gets easier, but I’ve learned a few things along the way.
This time, I walked quietly into the private waiting room and sat down. I spoke from the heart. My eyes welled with tears as I expressed to them that I wished things were different. Then, I just sat there in silence. I sat with them and with their suffering in silence. Every time I do this, my mind wanders back to that first time when I couldn’t sit with the suffering, and I silently chide myself, but then I remember how much I’ve learned since then:
1. Sit with suffering and silence.
Sometimes just this, our presence, is all we can do to comfort a grieving family. It never feels like enough and it never will be, but it is something. Silence is powerful and doesn’t need to be filled with empty words. Sit with suffering and silence.
2. Use simple language.
I do say the words “death” and “dying,” because euphemisms are confusing. Families aren’t thinking clearly; simple and compassionate words are best.
3. Be present. Speak from your heart, not your brain.
If your eyes well up, let it happen; if the lump rises in your throat, acknowledge it. These moments are sad and difficult.
4. Recognize the significance.
These are moments that will be ingrained in family members’ hearts and minds forever. Moments that we are privileged to bear witness to.
It’s not easy and it never gets easier. It is an honor to sit with suffering. Hippocrates says that our duty is “to cure sometimes, to relieve often, to comfort always.” The best way I know how to do that is to sit with suffering.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.