On How To Tell A Mother Her Child Is Dead
[guest post by Dana]
Naomi Rosenberg is an emergency room doctor at Temple University Hospital in Philadelphia. This weekend, the New York Times published her eloquent and powerful tutorial, How to Tell a Mother Her Child is Dead. One can only imagine what Rosenberg sees in one shift of work considering that this is a city where last year “…there were only 22 days when someone wasn’t shot in Philadelphia and [n]early 1 in 5 victims died”. One can surmise the manner in which any number of Rosenberg’s patients, including the one in the essay, have met their death. And given the high volume of gun-related deaths in the nation’s inner-cities like Philadelphia, there is the distinct possibility that they may have also had a hand, whether directly or indirectly, in the death of another young person. This is the madness.
First you get your coat. I don’t care if you don’t remember where you left it, you find it. If there was a lot of blood you ask someone to go quickly to the basement to get you a new set of scrubs. You put on your coat and you go into the bathroom. You look in the mirror and you say it. You use the mother’s name and you use her child’s name. You may not adjust this part in any way.
I will show you: If it were my mother you would say, “Mrs. Rosenberg. I have terrible, terrible news. Naomi died today.” You say it out loud until you can say it clearly and loudly. How loudly? Loudly enough. If it takes you fewer than five tries you are rushing it and you will not do it right. You take your time.
After the bathroom you do nothing before you go to her. You don’t make a phone call, you do not talk to the medical student, you do not put in an order. You never make her wait. She is his mother.
…
If she asks you, you will tell her what you know. You do not lie. But do not say he was murdered or he was killed. Yes, I know that he was, but that is not what you say. You say that he died; that is the part that you saw and that you know. When she asks if he felt any pain, you must be very careful. If he did not, you assure her quickly. If he did, you do not lie. But his pain is over now. Do not ever say he was lucky that he did not feel pain. He was not lucky. She is not lucky. Don’t make that face. The depth of the stupidity of the things you will say sometimes is unimaginable.
Before you leave you break her heart one more time. “No, I’m so sorry, but you cannot see him. There are strict rules when a person dies this way and the police have to take him first. We cannot let you in. I’m so sorry.” You do not ever say “the body.” It is not a body. It is her son. You want to tell her that you know that he was hers. But she knows that and she does not need for you to tell her. Instead you tell her you will give her time and come back in case she has questions. More questions, or questions for the first time. If she has no questions you do not give her the answers to the questions she has not asked.
When you leave the room, do not yell at the medical student who has a question. When you get home, do not yell at your husband. If he left his socks on the floor again today, it is all right.
I would like to think that we can set politics aside for a moment, and listen to Rosenberg’s straightforward step-by-step narrative of the most respectful way for a doctor to light the fuse on a stick of dynamite and hand it to a fearful parent, and then wait and watch as a mother’s world explodes into unspeakable grief, anger and sorrow. All of this culminating in enormous frustration at the seeming unfairness of life. I’ve never been that parent. I can only project how I think it might feel. And I’m guessing it would be something akin to a sledge hammer shattering my heart into a million tiny splinters of vicious shards that mercilessly pierce my soul with every breath. That kind of pain. Rosenberg’s instructions of this necessary evil have nothing to do with the politics and pathology of the inner-city struggles and its attendant problems. She is giving readers a glimpse into her world of that one single, solitary moment in which she alone must confirm to a parent that the nightmare in which they find themselves is very real, and in just a short moment, will become far worse than ever imagined.
But by extension, how can this not be about politics at some level, and the moral collapse of the family structure in certain communities? Surely it is the inevitable outcome of something gone terribly wrong. However, at the end of the day, no matter the socio-economic status of the families involved, or even if their own offspring set this tragedy in motion, there still remains a parent who must be told that their child is dead.
As I read Rosenberg’s essay, I was reminded of Patterico’s recent post in which the Los Angeles Times intentionally buried the fact that a 14-year old boy, killed by the LAPD, was first “suspected of writing gang-style graffiti before leading officers on a foot chase and firing a gun at them[.]” The gun having been found later. A commenter cynically said:
The Darwin effect is alive and well.
The blacks are basically self-exterminating. Barry’s home town, Chicago, is a great example.
Thugs offing one another, or shooting at police and being taken out…. yes..more please.
This also shrinks the Democrat’s voting base.
To which our host replied:
When I say “all lives matter” that includes gang members. I deal with a lot of families of murdered gang members. They hurt just like everyone else. And not every gang member is the same.
–Dana
Read Rosenberg’s essay in its entirety.
Dana (995455) — 9/5/2016 @ 8:20 pmGood post, Dana.
Dustin (ba94b2) — 9/5/2016 @ 8:26 pmhow can there be a right way to say it, and what does it mean when dysfunctional behavior that often results in death or greivous injury is extolled, or at least not severely censured,
narciso (732bc0) — 9/5/2016 @ 8:27 pmnarciso, there’s a right way because there are so many wrong ways to say something like that. Most of them with the best intentions.
Dustin (ba94b2) — 9/5/2016 @ 8:39 pmis there really, or just a less ghastly one,
narciso (732bc0) — 9/5/2016 @ 8:42 pmThis is so devastating, and so moving, Dana.
Please do us a favor: when trolls decide to do their squirrely work here, please remove it. It’s not appropriate.
Thank you for writing this. It should give everyone pause.
Simon Jester (cff76b) — 9/5/2016 @ 8:48 pmThat moment sounds like a nightmare, and I am glad that the people who have to do it have the skill to do it well.
aphrael (3f0569) — 9/5/2016 @ 9:30 pmI teach a lot of students who want to become physicians, and this should be required reading.
Simon Jester (cff76b) — 9/5/2016 @ 9:35 pmI have had to do this many times. The most bizarre example is in my second book. The patient was a 15 year old boy who had taken his mother’s car and hit another car head on. His heart was beating on EKG coming in but I could not revive him in the ER in spite of opening his chest and massaging his heart. When it was over, I went to see if any family had come in. The lazy nursing supervisor had not even tried to call the family to let them know the boy was injured. I had to find his driver’s license and call information to get a phone number. I was hoping they could not find one but they did. I called and a woman answered. I asked if this was Paul’s home and she said it was. I asked if she was his mother and she said she was.
I told her I was calling from the hospital and that he had been in an accident. For the only time in my career, she did not believe me ! She thought it was some sort of prank. I finally convinced her I was a doctor and the call was real. She then questioned me until, completely against my wishes and principles, I had to tell her he was dead.
She was angry and after she found out I had opened his chest to try to save his life, she accused me of doing so for money. It was the worst experience of my life.
One of many stories I have.
Mike K (71d37f) — 9/5/2016 @ 10:16 pmMike, I’m sorry you went through that after what you went through to try to save the boy.
Dustin (ba94b2) — 9/5/2016 @ 10:26 pmI remember reading that comment by our host, and I was most impressed at the time. He works in an environment that can be incredibly frustrating and dehumanizing, and yet he can still see the folks he’s dealing with as people, even the ones who are “part of the problem.”
Kevin M (25bbee) — 9/6/2016 @ 12:10 amI read this article in the paper. It;s designed to a make you feel bad, and it should. Bad about the fact that these murders occur.
I don’t think that’s the right approach:
This bothers me. It’s a meaningless statement. It is overdoing it. And strikes me as really phony.
At least maybe: “I’m afraid something happened.” Rehearse what to say? Please.
The fact that bad news is coming can, and should, be indicated non-verbally. Maybe there are better ideas. Maybe the best would be to take the mother through the sequence of events as encountered by the physician.
And also, in that case, the doctor also wouldn’t have to think, and prepare.
Maybe an important point. But I feel this should never be said under any circumstances, whatsoever. If a person did not feel pain, and if that is comforting, a person could figure that out for themselves, and if they can’t, how do you know it is true?
Or – is it not true, and you’d like people to think so??
As she said, do not lie. The parent is entitled to more respect than that.
And in any case, is this important? And when does a person feel a prolonged period of pain? Maybe only with certain diseases.
Where does this idea of saying such a thing come from in the first place?
You couldn’t make it easier. And crying and screaming is exactly what should happen. That makes it easier. But actually you don’t want it to be easy. It is not supposed to be, and it would a terrible thing if people took it easy.
Sammy Finkelman (337057) — 9/6/2016 @ 2:56 amWhy is that not the case? Don’t they need somebody to identify him? When someone is killed in an accident I guess it doesn’t work that way.
What’s the reason for this? In some cases it might be that the closest kin is the killer, and then – what – they’re going to destroy evidence? How? What kind? Or what?
Is it aybe that they are going to touch the body and contaminate it with their own DNA? Somebody put in this rule, and it is far too strict. Maybe criminal defense attorneys are responsible for that strict rule, by raising objections and concocting fanciful theories. Maybe she doesn’t the reason for this rule, but we ought to learn it.
Of course maybe closed coffins etc are better anyway.
Sammy Finkelman (337057) — 9/6/2016 @ 3:00 amDana:
She’s not the only doctor and this is not the only hospital in Philadelphia. On the other hand, these killings are not randomly distributed and are heavily concentrated in certain precinct and in maybe one or a very few hospitals. I know that without even checking because different cities are not all that different. We live in the same era.
But she’s telling this, or at least it is published, for a reason.
I would not talk about the collapse of family structure – which has anyway only a very indirect effect – or the collapse of moral values.
I would talk about the collapse of law enforcemnt. Law enforcement is the ultimate backup, and if that doesn’t exist, everything else will collapse eventually. Theer has to be asstem of courts and law and justice. The book “Ghettoside” says that in actually some form of law exists in even the worst communiies – at least out west – only it is rule by criminals.
You knwo, I want to say one thing about the collapse of family structure. People blame that for crime. I think the causation goes the other way. Family structure collapses because of crime.
At least it’s not like Syria where deaths elicit no reaction at all, and hospitals get bombed by the government – a new tactic in civil wars. That is not, quite, openly admitted.
There is no UN resolution condeming that, because everyone knows Russia, and probably China, would veto it, and maybe the Obama Administration doesn’t even propose it because it thinks will get in the way of a ceasefire, which has no chance whatsoever anyway except they’re too foolish to realize it.
Yes, at least 1 and half million refugees will have to be resettled in the west – but that’s justa fraction of teh problem. Syria has, or had about 20 million people, and they ALL must be evacuated from the country. There will be no safe zones.
Sammy Finkelman (337057) — 9/6/2016 @ 3:13 am14. On the other hand, these killings are not randomly distributed and are heavily concentrated in certain precinct and in maybe one or a very few hospitals. I know that without even checking because different cities are not all that different.
Wrong. You should have checked. It’s not as if Philadelphia has a hospital on every corner, and crime is pretty well spread across the city. The hospitals at the University of Pennsylvania and Temple University may receive a significant number of crime-related trauma cases from West and North Philadelphia, but the other hospitals like Lankenau (West), Hahnemann (Center City and North), Einstein (North), and Frankford (Lower Northeast) receive a significant share of shooting and other crime-related injuries.
As the Northeast section of the city, a huge, once steady, working/middle class neighborhood, has “diversified” the police districts and emergency units of hospitals like Nazareth and Frankford Torresdale have been overwhelmed not just by crime victims but by a growing number of heroin casualties.
Jack Klompus (f1f212) — 9/6/2016 @ 3:45 amThank you for this post. Being an adult is not a slam dunk and it never gets easier.
DNF (ffe548) — 9/6/2016 @ 4:12 am6. “Please do us a favor: when trolls decide to do their squirrely work here, please remove it. It’s not appropriate.”
One such.
DNF (ffe548) — 9/6/2016 @ 4:15 amhttp://www.navy.mil/submit/display.asp?story_id=3590
Casualty Assistance Calls Officer. Not fun. I once had to work to get the word that one of our guys, who had far as I was concerned, deserted, died in Istanbul because of carbon dioxide poisoning. He and his new girl friend was using a charcoal grill to heat his room.
Still, he was one of our guys. And he was their son. And I was Squadron Duty Officer.
Steve57 (747e61) — 9/6/2016 @ 4:33 amI didn’t actually make the personal call on the family. Still, the whole thing was heartbreaking.
Steve57 (747e61) — 9/6/2016 @ 4:35 amIt’s why I remember it.
Steve57 (747e61) — 9/6/2016 @ 4:42 amhttp://www.imdb.com/title/tt1019454/
Steve57 (747e61) — 9/6/2016 @ 4:46 amThoughtful post,
MD in Philly (f9371b) — 9/6/2016 @ 5:23 amGood to see you Mike K.
(Yes, doing your best in a tough situation and then criticized for it is a particularly painful experience…)
Jack, you have a lot of knowledge of Philly, are you around here or just have contacts?
Back in the day, I notified next of kin a couple of times. In fact, I ran the duty roster for that job. Nobody liked seeing me coming around with The Look that meant I’d just heard from Casualty Branch.
Richard Aubrey (472a6f) — 9/6/2016 @ 5:33 amI know of one mother who tried to commit suicide. Another did, I found out forty years later, five years after her son was killed.
The guys weren’t hauled off to emergency with the family in the waiting room. They were in Viet Nam. And every time the family saw a guy in uniform, they froze.
When you knock on the door, everybody knows, everybody on the block, and they’re there in moments. Somebody, trying to light a cigarette, will say, “Hell of a job they gave you.” Somebody in the family will ask, “Was it quick?” The parents were all of the WW II generation back then and knew directly or from their loved one’s nightmares that it frequently wasn’t quick. That’s why there was morphine. As everybody knew.
It’s like the time when the ship rolled and the hatch came down on this poor schmuck’s grape.
It just shouldn’t have happened. But it did.
Steve57 (747e61) — 9/6/2016 @ 5:38 amPregnant woman among those wounded in Labor Day weekend shootings
At least 11 people were killed over Labor Day weekend in Chicago and 37 others were wounded.
happyfeet (28a91b) — 9/6/2016 @ 5:39 amHours. Days, maybe. And the sharks.
Steve57 (747e61) — 9/6/2016 @ 5:45 amThe sharks made it easier.
Steve57 (747e61) — 9/6/2016 @ 5:45 amhttp://www.findagrave.com/cgi-bin/fg.cgi?page=gr&GRid=59895479
Steve57 (747e61) — 9/6/2016 @ 6:13 am“Please do us a favor: when trolls decide to do their squirrely work here, please remove it. It’s not appropriate.”
In other words, this post was a convenient excuse and uncharacteristically emotional subject change for people who can’t win in normal debates like everybody else.
“I deal with a lot of families of murdered gang members. They hurt just like everyone else.”
No they don’t. Certainly not enough to dissuade their sons from joining gangs. Certainly not enough to care about maintaining good communities and good relationships with the police officers who have to deal with them. Certainly not enough to avoid inciting riots or taking large amounts of cash. You’re projecting your own feelings on to them as surely and as uselessly as the “lucky that he did not feel pain” crowd.
As long as we’re doing that, I’ll say that I guarantee you that innocent and law-abiding people killed by gang members feel it a LOT worse.
“And not every gang member is the same.”
Yes, for example: Our online alt-right gangs are actually all about rebuilding communities and employing otherwise unemployed (yet often quite talented and unjustly denied proper housing and employment due to structural racism) males in socially conscious activities via digital performance art.
Dystopia Max (76803a) — 9/6/2016 @ 7:28 amDana,
This hits you right in the feels.
I have twin boys who are just over 2 years old and have complicated medical histories and have been anesthetized multiple times. Luckily, no doctor has had to deliver news like this to us, but each time they go under, I can’t help but think about it. I’m the dad and supposed to be the strong, unemotional type, but each time I whisper to them that it’ll be okay and I say a little prayer.
The closest we’ve come is the news that our infant would need brain surgery. It was shocking and terrifying, but we were also still holding a happy little boy when we got the news. That combined with having to take care of his twin bro and their sister, made it a little easier as we had a built in distraction! Nevertheless, it looked difficult for the doctor and surely was difficult for us. I can’t even imagine the situation of this ER doctor. Thanks for the link. It was a great read.
RS (8243d6) — 9/6/2016 @ 8:03 amRS, I couldn’t be happier.
Steve57 (747e61) — 9/6/2016 @ 9:33 amI take it it all worked out?
Steve57 (747e61) — 9/6/2016 @ 9:59 amMD in Philly:
Philly born, raised, educated and back again after a Texas hiatus for a few years. Also did a couple of overseas stints including a deployment in good ol’ Kandahar.
Jack Klompus (0d1bec) — 9/6/2016 @ 11:04 amHeartbreaking to read. America is so fortunate to have physicians who are outstanding human beings and practitioners.
But the author tells us so much of why this happens by a simple, repeated omission: telling the father. He is not in the family room with the mom and siblings. She doesn’t have a different script for him, or any script, in fact.
bridget (37b281) — 9/7/2016 @ 7:37 pmJack,
MD in Philly (f9371b) — 9/7/2016 @ 8:18 pmAre you in law enforcement?
My oldest is a Philly detective.
I mean no disrespect, Bridget, but there is no script.
Steve57 (747e61) — 9/7/2016 @ 8:32 pmSteve, the author of the article described a script. I mean no disrespect, but shouldn’t the collision of two brain cells been more than sufficient to make my meaning plain?
bridget (37b281) — 9/7/2016 @ 9:29 pmI’m just an idiot. Sorry.
Steve57 (747e61) — 9/7/2016 @ 9:35 pmIf you mean the author of the article in the NYT, they’re wrong.
Steve57 (747e61) — 9/7/2016 @ 9:40 pm