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.
Palliative care with Dr. Evie Marcolini
How do you set up the meeting w/ the family?
Introduce yourself and everyone in the room
Bring the nurse with you and introduce them as well
Wear the white coat – gives you a level of authority
Make sure that everyone can sit down
Make eye contact
Be direct with your comments – your family member has died
Then be quiet and let the family process what you said
Express your grief/sorrow, say that everyone on your team is sorry for the family’s loss
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.
Try to ask them about their family member, this allows the family to tell stories and it is very therapeutic
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
Don’t afraid to be human meaning you can cry if you feel it is truly emotional
What about tactile presence?
Touching families is about pros and cons. Maybe ask are you a hugger?
Human touch is helpful for families, but read the room
Use your ancillary staff
Get your social work involved
Bring your Chaplain to see the family
Try to contact the primary care doctor
They usually know the family well and they will know what the family may need
They generally will reach out to the family themselves
What do you respond when the family asks for a miracle?
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
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
We want families to understand that we are doing everything we can to help their loved ones
What about having the family in the room?
People feel either way
It’s good to have the Chaplain nearby to explain to the family what exactly is going on
It’s a good idea to tell the team you are planning on bringing in the family member
If a team member doesn’t feel ok with the family there, try to swap them out
Generally, it can help the family with closure
How do you help your team process what happened?
Make sure you thank everyone who was involved with the resuscitation
Touch base with team members who seemed to struggle with the recent resuscitation
What can the medical student do to help?
Maybe get chairs for the family members some chairs
Maybe bring some blankets
Try to go to as many family meetings as you can to see others’ styles