Monday, December 21, 2009

The Family Room

It's in every emergency department.

Empty, it's just another shell of a sparsely decorated hospital room, lacking vibe and energy.

But when you fill it with nervous, hopeful family members awaiting news of their critically-ill family member, it is transformed into a room that can barely contain every possible extreme of human emotion.

It is The Family Room.

So, you ask, why is this room known as The Family Room?

This is the room where the families of the most extremely sick patients are placed while the medical team uses every available effort in their medical arsenal to save a life. It's a place for family to be alone, to comfort themselves in the face of adversity. These may be families of trauma victims, heart attack victims, stroke victims, or any other critical illness. Because the family room is usually situated on the edge of the department, it is usually quieter, more calming, and private. A far cry from the commotion that usually accompanies the room in which resuscitating a patient is happening.

Don't be fooled, though. This is no ordinary room. Physically, it may look like any other decorated hospital room, with a few extra vases and boxes of tissues thrown in, but that's where the similarities end. It is a room that demands and deserves respect. It is a room that I imagine as my friend, absorbing and buffeting and protecting all within it from the swirls of anger and the clouds of desperation. Sometimes, just sometimes, the mood is joyful. More often than not, however, this is a room where dreadful news is delivered to a family not prepared for such news.

Our own family room is just as I described above. It sits in the corner of our department, nestled between our waiting room on one side and the entrance hallway to our department on the other. It's painted beige and coral with a flowery border at the top--comfort colors, I guess. Short shag navy rug. Two of the corners hold lamps, usually lit for better ambiance. The furniture consists of two love seats and two wing-backed chairs, a couple in dark blue floral patterns, the other in pink and coral. Slightly better quality fabric and stuffing than the standard hospital furniture, but not by much.

How do I know these details? It's amazing the small things that I notice when I'm trying to blink back my own tears in sharing a family's misery. Sometimes I'm transported back to tenth grade when I counted Christmas tree ornaments on our church tree during my grandfather's funeral, all in the hopes of distracting my impending tears. 157 ornaments on the tree closest to the Virgin Mary.

I rarely deliver news alone to a family waiting. Either the ER social worker or the supervising nurse accompany me, sometimes both. I wear my long, official white coat to respect the gravity of the situation.

Imagine that moment right before walking into the family room with bad news. I hesitate at the door, take a deep breath, and remember that my words and support will be paramount to the family. I open the door, usually to be greeted by several anxious family members either pacing or sitting well beyond the edge of their chairs. After introductions of myself and my team, I ask them how they are each related to the patient.

Then, the hard part follows. I sit close to the spouse or family. Sometimes, I am offered a hand to hold and I eagerly take it. If the patient has already died, I make it a point to not linger and share the news almost immediately. It is important to be blunt but heartfelt, using the words "dead," "expired," and "we did everything we could." It has been shown that a family needs to hear several variations of the word "dead" so that the news sinks through their despair. Reassurances are given that everything possible was done.

If the patient is still alive, I review with the family everything being done to save their loved one. I explain any prehospital treatment, what we are currently doing for the patient in the ER, and give the family a brief opportunity to ask questions. We sometimes need to review the patient's living will or DNR status and to what level efforts should be pursued. Family members may even be invited to witness the resuscitation.

Through all of this, I don't lose eye contact. I focus on each person in the room, letting my eyes say something different from my words. "I'm so sorry" is the most simple and heartfelt offering.

As an ER doctor, I have a protective shell around me that I can usually maintain. But in the family room, I am different. It is not rare for me to leave with tears in my eyes, and that does not shame me. It is my privilege and blessing, really, to accompany a family through some of their darkest moments. I appreciate their acceptance of my presence during their misery. Who am I to bear witness to their profound loss?

I have been told by several staff members that my greatest gift is how I interact in that family room. But, for whatever I bring to that room, it is but a feather compared to the weight I carry away from it each and every time I meet another family.

I am humbled by this part of my job. And respectful of the family room's role in our ER.

Thank you, as always, for reading. I am grateful...may your week go well. Next post will be Wednesday, December 23.


WrightStuff said...

Your writing never fails to move me. You successfully bring to life what it feels like to be the other side of the Emergency Room to the majority - the patients. Thank you to you and your colleagues around the world for everything you do.

SeaSpray said...

Ditto what Wrightstuff said!

I look forward to your posts.

For 20 years as an ER regisration/patient rep person.. I was familiar with "the room" and it was heart wrenching to hear the wails of extreme grief occasionally coming from the room.

But this year..I had my own experience in "the room" when my mother was dying in the ER. It's certainly a lot different when it's your loved one.

It occurs to me that I never wrote a thank you note and I should have because the ER doc, nurse and hospitalist were so sweet, concerned and sensitive... and even though it was all so distressing ..I DO remember their compassion. Not their names though or even the room.

I can't tell you what the room looked like..not furniture, floor or even color. I just remember faces in the room.

Recently..I have been thinking of death. No doubt because It's Christmas and Mom died and also I've lost other close people and know a lot more people who have died these last few years. I miss the people that've died and feel vulnerable and realize how easily it can all change.

Just this I was thinking about this again..I wondered how medical professionals handle it. Death. I assume as physicians from the beginning of your training... you have all encountered a lot of death.

I want to ask.."How do you forget?" But then I know from med bloggers don't forget.

But... how do you go on and NOT let it effect you, unnerve you or pull you down... because you all know better than most ..just how fragile life is and that each breath..each heartbeat is a gift?

Your patients ... are extremely blessed to have you for their physician and so are the people in the "family room".

mommy-medic said...

Very humbling. I am familiar with the "family room". I think they are ALL coral with loveseats and single chairs too. And blue floors. It must be standard. What isn't standard is how each family can be completely shattered but the news delivered there. How the floor always falls out from underneath them. I have never delivered news in the family room, that's for the higher-ups. I have, however, done it more times than I could begin to count on scenes. My approach is usually dictated by the situation. I try to be as compassionate as possible, and often do cry with the families, but there are also times when short, honest answers are called for. (Once had a woman in cardiac arrest laying on her living room floor. Her daughter was in her late 20's, but didn't realize blue mom wasn't breathing. As we began CPR, daughter asks " she ok?". My coworkers all look to me and as sensitively as I can, I tell her that no, she's not ok. But we are doing everything we can.)

Wow, sorry, got off on a tangent there. Just deleted a bunch. Turned my "comment" into my own post. Sorry! Great post- thanks Doc!

J-Quell'n said...

I hate that room so much...the last time I was there was when my uncle was dying. Our family physician was called in on the case, and I will never forget the kindness and reverence of him, the ER staff (nurses, doctors, etc.), and the very special RN in the ICU who helped us let go of my uncle. It will always mean the world to me how they did what they could to give him a chance and how comforting they were when we all realized that it was hopeless. The special nurse was so gentle with my uncle and so in tune to our emotions. I will never forget his tenderness or that of our family doctor and the rest of the staff. They made that day in hell so much easier than it would have been otherwise.

Thank-you for what you do, for caring, for having a heart and for not being ashamed of those tears. It makes such a difference.

Amanda said...

when my daughter spent 4 months in the PedsICU (complex congenital heart defects), the other parents and I called that room the "your child is going to die" room. We were all there long enough to know what it was. I was escorted to that room exactly twice. I hope never to be there again. I was lucky. My daughter is 9 now. I know we were lucky.

merinz said...

We have had the long wait in the family room while our daughter had open heart surgery (atrial myxoma). We were lucky, the news at the end of surgery was good, but the three hours was a long wait.

I remember that room well.

Maha said...

As usual your writing manages to precisely capture the emotion of the moment. Yet another great post. One of the docs asked me to go into the family room with him but I couldn't - it was too much. I am truly in awe of those docs that can deliver the bad news day after day and do it in a way that truly manages to recognize and empathize with the family's pain.

Cal said...

Kudos to you for writing this piece so well, you really know how to convey emotion. Kudos too for being the compassionate doctor you describe and not fearing the tears (although I still don't know how you can then switch off and leave work behind at the end of the day... maybe fodder for another post?). It is a pleasure to read you.
I hadn't understood the significance of the family room, and it was not until I read this entry that a flashback came back to my mind, and made me appreciate life; Appropriately tomorrow is my birthday.

June Cleaver said...

Having been there before, I think a more appropriate name would be the "Oh Sh@t" room, because that's exactly what you're thinking when you're led into it. Anyone who has had any experience in the ER knows what that room really is and why it's there.

When my father was in the hospital, dying, we got a call in the early morning and, when we arrived at the hospital, were led to the "family room". It's funny that you mentioned wearing your white coat, and the details you remember later, because it made me flash back to the doctor who was treating my father. He came in wearing just his scrubs. I dind't find it disrespectful or inappropriate at all and, looking back, it made him much easier to relate to. Not saying you shoudl change what you do. Just that that's what I noticed.

Definitely a room I hope I never have to be in again.

ERP said...

I remember not too long ago I told a family about a death of a loved on in our "family room". A woman in her 70's screamed, got up, and literally smashed apart the book case that was in the room with her bare fists.

Rogue Medic said...

Wonderfully written.

Anonymous said...

Thank you, nicely done. It is good to hear a physician's perspective.

Thanks also to the Erlanger Medical Staff, especially the ICU nursing staff, who helped my family so much when my mother was hospitalized suddenly in November 1996.

I wish some of the physicians could read this post.

Anonymous said...

That's meant to say "Erlanger Medical Center" staff...