Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative



Sometimes patients and caregivers feel overwhelmed when clinicians provide too much information. When you sense this to be the case, offering clear recommendations can be helpful.

“I don’t know what to do,” my patient’s wife perseverated with melancholy. Her husband of 49 years had been connected to a breathing machine for two weeks. For the past four days his wife had been having daily conversations with doctors who explained and then explained some more. Her husband was in critical condition and had brain damage due lack of oxygen, even though his circulation had been restored by the EMTs when he had cardiac arrest due to heart attack. 


The wife had told me that on a Sunday morning as they were getting ready to go to church, her husband collapsed on the bedroom floor while buttoning his shirt. She was sipping tea and admiring the blooming orchids on the side table near the window and the sunrise. Her husband’s knees buckled. 


“What is your decision?” the doctors asked. 


The wife said she didn’t understand.  So, the doctors explained some more.  Sometimes in medical jargon and sometimes in plain English. “I don’t know what to do!” she said. This time, the palliative medicine resident just waited in silence. 


“We just celebrated our 49th wedding anniversary,” the wife said. “My best friend was there and our son. My husband played guitar and sang Bob Dylan. He’ll never be able to do that again.” 


“No, he won’t,” the resident said. 


“I don’t know what to do.” There was a plea and ask in her voice. 


“Would you like to know what the doctors suggest?” the resident asked. 


“Yes,” said the son, listening in from the speaker phone. “And I think Mom needs to sign a Do Not Resuscitate.” 


The resident had encouraged the wife to get their son on the phone. We had assessed that her repetition of words could be due to emotional freezing and that supportive family on the phone could help. 


“Yes,” the resident responded. “We recommend that we stop the machines and allow him to die naturally.” 


Here’s what I was reminded of from this experience: we can be “explainaholics.” Often our reaction to distress is to give more information with the belief that if the family just understood it better, they would be able to decide. We’re asking families to make very hard end-of-life decisions for loved ones. Sometimes offering direct and concise recommendations can help lighten the load of loved ones. 


The wife decided not to say goodbye and not to be there when he died. She wanted to hold on to the memory of him playing guitar and singing at their wedding anniversary. 


How many roads must a man walk down

Before you call him a man?

And how many ears must one man have

Before he can hear people cry?

The answer, my friend, is blowin’ in the wind

The answer is blowin’ in the wind.





This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.