Would You Want To Be There?

She died unexpectedly. Well, not exactly unexpectedly - she was a middle aged woman who died from undiagnosed heart disease and complications thereof, but the timing and day of her death was unexpected. It was a sad case because it was so sudden, because she was so full of life, and because, of all ironies, she had been in town on vacation.

She had been recovering slowly and had a sudden decompensation on the day of her death. As she died, 7 physicians and numerous nurses were at the bedside in a lengthy resuscitation that was unsuccessful. For those present during the resuscitation, there was no doubt in anyone's mind that every possible thing was being done, and that when we stopped, we had tried our best, and there was nothing more that we could have done. Still, my heart went out to the husband, who sat alone in the intensive care waiting room, periodically updated on his wife's condition. For him, his wife had gone from ill but stable in the morning to dead by noon, and all this was second-hand information.

Should we have allowed him to stand by the bed and watch the resuscitation? If I were him, I probably would chose to be present. There has been some research indicating that family members have more closure when they are present during the resuscitation, and some hospitals have integrated this into patient care. Others claim that having family members present in the controlled chaos of a resuscitation would be detrimental for the patient - family could get in the way and slow down the resuscitation, or they could be overly emotional and distract from patient care... There is also the issue of being able to tolerate what they will see. Will they understand that dying people gasp for air like a fish out of water? Will they know that the electric shocks are a desperate attempt at restarting the heart? Would her husband have been able to watch as the surgeon reopened her ribcage for cardiac massage after all else had failed? But all these issues aside, deep down, I feel that family should have the choice to be present. They can see, with their own eyes, that we cared, and we tried. And perhaps, for some patients, having family present would allow us, physicians entrusted with the care of the patient, to let go more easily. Oftentimes, we become too attached to the patient, too unwillingly to let go even though common sense states that it is time. It is a fine line to walk, to know when to let go, and when a refusal to do so causes more pain for the dying or dead patient. It is much easier when a family member, someone else who has the patient's best interest at heart, knowing that we have done our best, reminds us that it is OK to step back and let go.