Dying With Dignity: Instituting a Moment of Silence in the ER

A little over a year ago, my father died in his sleep. He ate dinner in his assistant living facility one night, told his fellow residents he was tired and went to sleep. The next morning, he was found lifeless in his bed. He must have passed away in his sleep, most likely peacefully and without pain.

When I share this story, I usually get the same response.

“What a great way to die.”

“That is how I want to go”

Why do they say that? When I ask, most say that they want to die without pain, not hooked up to machines and tubes.

But if we delve deeper into people’s death preferences, comfort is only one part of the equation. In fact, most people also do not want to die alone. Instead, they want to die with family around, having the opportunity to say goodbye.

My father was not found until the next day. My siblings and I are thankful he died without pain but we remain uncomfortable with the notion of him dying alone.

In contrast, my father-in-law knew he was dying. On his last night on earth, he said goodbye to his family and blew them a farewell kiss. He died with family around speaking to him and about him. He did not die alone.

Dying with dignity. Not dying alone. That is what we all want.

Typically, a patient arrives in the ED with CPR -in-progress at least once per day. Despite our best efforts, nearly 90% of these patients are pronounced dead in the ED, usually without their family.

Do these patients suffer? Usually not. Do they die alone? Technically no. There are doctors, nurses, techs all around the bedside supporting the patient. However, as soon as the patient is pronounced,  the providers and support staff move on. In a busy ED, there are other patients to save and focus must quickly shift to them.

We are trained to give full attention to the body. Is there a pulse? Blood pressure? We certainly don’t have time to reflect on the person. The patient becomes a body and we detach. Shortly after a physician pronounces the patient dead, everyone scatters to take care of the next patient. So, yes, technically the body does not die alone but the person does.

Working in a busy ED, we often forget that we are caring for people with meaningful relationships and accomplished lives. Instead, due to the complex environment of the ED, we identify our patients based on their disease process rather than accomplishments and personality traits.

“The Kidney stone in 11 wants more pain meds.

Where should we put the septic patient?

Is that the cp that was called in?”

I recently pronounced an 88-year-old male who had arrived with CPR-in-progress. We performed the ACLS protocol until the team agreed that further resuscitation attempts were futile. As usual, after he was pronounced dead, we scattered to take care of the other patients as the primary nurse and tech remained to diligently prepare the body for the morgue.

One hour later, the family arrived. Speaking with the family transformed the patient from body or disease back into a person. I learned that this elderly man was a father of five, grandfather of fifteen, loving spouse and dilligent and successful accountant.

He had accomplished a great deal in his life. But what stuck with me was that he landed on Normandy on D-Day. He fought at the Battle of the Bulge. He was part of the liberation of Europe.

Learning this information earlier would not have changed the care he received from our team. However, it would have personalized the experience. Had we taken a moment to consider this man’s accomplishments, we could have helped transform the body back into a person – a person deserving our acknowledgment and thanks.

After that encounter, I continued to think about ways we could add more humanity into the care we provide each day. I recently came across and have introduce into my practice The Moment of Silence as a way to help our fellow humans leave this earth with dignity.

The Moment of Silence: How does it work?

After someone is pronounced, the leader of the code should say some words resembling the following:

I would like to ask everyone here to stay for a moment of silence. Let us reflect on how we tried to save [Patient’s Name]. Let us reflect on why we are proud of what we do and of the team here. We were present during [Patient’s] last moment on earth. [Patient] was important to someone else as a child, spouse, father or friend [Patient] was likely loved by others. [Patient] helped many and experienced challenges and frustrations. Our time on earth is finite. [Patient] was a human being and we hope he/she will rest in peace.

I have done this 3 times and received very positive feedback.

In fact, a few of our EDs are instituting this practice already. There have been podcasts and articles written on this practice as well. I encourage you all to share experiences and thoughts and please feel free to reach out if you would like help in setting up a program at your ED.

Let’s bring a little humanity back to what we do.

Let’s treat a body as a human one last time.