End of Life Discussions

In this episode, Mitchell Zekhtser, and Evie Marcolini, MD FAAEM, talk about end of life discussions. Mr. Zekhtser is a student at Western University and Western Regional Representative on the ’18-’19 RSA Medical Student Council. Dr. Marcolini is an Assistant Professor of Emergency Medicine and Neurocritical Care at Yale University, Medical Director of SkyHealth Critical Care, AAEM Scientific Assembly Planning Committee Co-Chair, and an at-large board member on the AAEM Board of Directors.

Show Notes

Palliative care with Dr. Evie Marcolini

1. How do you set up the meeting w/ the family?
   1. Introduce yourself and everyone in the room
   2. Bring the nurse with you and introduce them as well
   3. Wear the white coat – gives you a level of authority
   4. Make sure that everyone can sit down
   5. Make eye contact
   6. Be direct with your comments – your family member has died
      1. Then be quiet and let the family process what you said
   7. Express your grief/sorrow, say that everyone on your team is sorry for the family’s loss
2. Make sure when you are telling the story of their loved one’s death, start it with that your family member has died. Then tell the story.
   1. Try to ask them about their family member, this allows the family to tell stories and it is very therapeutic
   2. Take the family to where their loved one is. Let them know they can stay as long as they want, but just ask them to tell you where the funeral home is located
   3. Don’t afraid to be human meaning you can cry if you feel it is truly emotional
3. What about tactile presence?
   1. Touching families is about pros and cons. Maybe ask are you a hugger?
   2. Human touch is helpful for families, but read the room
4. Use your ancillary staff
   1. Get your social work involved
   2. Bring your Chaplain to see the family
5. Try to contact the primary care doctor
   1. They usually know the family well and they will know what the family may need
   2. They generally will reach out to the family themselves
6. What do you respond when the family asks for a miracle?
   1. Say that you hope that their loved one will get better, but be frank and say that generally people in this condition do not improve
   2. DON’T encourage magical thinking that people will improve, but do not set up antagonism between your evidence-based medicine vs the family’s cultural beliefs
   3. We want families to understand that we are doing everything we can to help their loved ones
7. What about having the family in the room?
   1. People feel either way
   2. It’s good to have the Chaplain nearby to explain to the family what exactly is going on
   3. It’s a good idea to tell the team you are planning on bringing in the family member
      1. If a team member doesn’t feel ok with the family there, try to swap them out
   4. Generally, it can help the family with closure
8. How do you help your team process what happened?
   1. Make sure you thank everyone who was involved with the resuscitation
   2. Touch base with team members who seemed to struggle with the recent resuscitation
9. What can the medical student do to help?
   1. Maybe get chairs for the family members some chairs
   2. Maybe bring some blankets
   3. Try to go to as many family meetings as you can to see others’ styles

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