The below is a true story. The names have been changed but the story-line has not been altered. It’s my fear that this situation happens all too often. If that’s the case, my heart goes out to families who are treated like a number and a commodity. It only takes a minute to show kindness, empathy and respect.
It was a typical New Year’s Eve. Grace and Tom always stayed in and made a gourmet meal, shared a bottle of wine or two, watched Dick Clark’s Rock‘n New Year’s Eve on the television and somehow managed to stay awake long enough to watch the ball drop in Times Square welcoming the New Year – except this year. They were enjoying their meal which this year consisted of all organic vegetables, grilled filet mignon when Tom looked up at Grace with his eye bulging and his face turning red. Grace realized Tom was choking. She leaped from her chair knocking her plate on the floor as she managed to get behind Tom and place her hand around his sternum, attempting to do the Heimlich maneuver. Tom knew what was happening but was unable to verbally communicate. He knew Grace wasn’t strong enough to help, so he had instinctively picked up his cell phone, dialed 911 and handed it to Grace. The operator heard the confusion and Grace yelling as she frantically was trying to dislodge the object caught in his throat. Thirty minutes later, the attending emergency room doctor pronounced the time of death to be 8:36 p.m. on December 31, 2016. All this had transpired in less than ninety minutes.
Grace was trying to wrap her mind around the fact that less than an hour ago, they were enjoying a quiet meal and now her perfectly healthy, although overweight husband of thirty years was dead at the age of 56. There she stood alone in the emergency room looking at Tom with tubes down his throat, IV lines in his arms, shirt wide open, his skin colorless and eyes lifeless when a nurse approaches her and said that they would have to call the county medical examiner, who in turn would want to know what funeral home to call. Grace replied, “Medical Examiner? Why, I don’t want an autopsy! Funeral home, never thought about it. I can’t answer that right now.” The nurse then said “You may want to think about what organs will you allow us to donate?” “What do you mean organs to donate! We didn’t talk about this. Tom hasn’t even been dead ninety minutes and you expect me to give you an answer! ” Grace shouted. It was that moment Grace realized she had no car as she rode in the ambulance and no support. The only children they had were their two cats who almost 20 years old, she needed to call a friend. She called Derek and Ann, their best friends.
Upon receiving the call, Derek and Ann immediately left their New Year’s Eve party and headed to the hospital. When they got there, the charge nurse lead them back to the emergency room where they met Grace and saw Tom. Derek went over to pay respect to Tom, when the charge nurse briskly walked in told him to step aside as she started placing drops in his eyes and then taped them shut with surgical tape. Grace cried out, “ What are you doing?” . The nurse replied, “Getting him ready for Gift of Life – most people at minimum donate their eyes.” Derek looked at Grace and asked if she approved this. Grace did not. In fact, she didn’t want to donate anything. She felt it was expected by the hospital and that she was being pushed into something she was not comfortable with. Derick asked Grace if she signed any donation authorizations, she answered no. He took her by the hand and they walked up to the nurse’s station and explained to the head nurse that organ donation would not be an option, nor would there be any more discussion about this. The nurse then requested that Grace sign a form stating that “Gift of Life” was explained to her and she declined. Grace signed it, but mumbled something to the effect that “Gift of Life” was not explained and that she felt bullied. Derek put his arm around her and walked her back to Tom’s room.
Derek nor his wife Ann were not new to death care. Derek’s a supervisor for the township cemetery and had also worked for many years on the county’s transport team. He knew the crew well. Ann had worked at a funeral home for the past three years and kept close ties with her past employer. They could clearly see that Grace was being treated benignly. There was no empathy nor explanation, just an attitude of checking things off a list. While this may have been a routine death for the emergency room staff, it was Grace’s first. This was not an expected death, it was a very unexpected and tragic death. Being made to feel like just a number and having Tom’s body being treated like a commodity with vultures circling up above take his body parts was unconscionable. Grace had so many questions and no one from the hospital staff was taking the time to answer them.
The three primary questions that were not addressed were:
- Why did the medical examiner have to be called?
- Why would we need an autopsy, if he died choking on a piece of steak?
- Why do I have to donate Tom’s organs?
Derek and Ann knew the answers, only because they are familiar with end of life protocols due to their professions. Together they explained to Grace the following:
- Unless a person is under hospice care or has a terminal disease that’s on record, its standard operating procedure – even if death occurs in a hospital, to call the medical examiner. The medical examiner’s (ME) role is to ensure there was no foul play and to sign the death certificate. If the ME suspects, there is something beyond the obvious they will request an autopsy. Things aren’t always what they appear. The cause of death may be a heart attack that triggered Tom choking. Sometimes there is foul play is involved. Regardless of the “why” Michigan’s law states the ME must review the situation.
- Once the ME has conducted an investigation, a decision will be made regarding an autopsy. If the ME decides to conduct an autopsy, the deceased is taken to a local hospital for it to be performed by a pathologist. Once it’s completed the deceased will be transported to the funeral home the family selected. If the ME makes the decision not to conduct an autopsy, the county’s care team will transport the deceased from place of death to the family’s funeral home of choice.
- Organ donation is something the medical community supports. By no means is it a requirement. From a medical viewpoint, if organs or body parts are going to be harvested, the sooner the decision is made after death and the faster this process is conducted the better chance of success. Long story short, time becomes a critical factor.
After listening to the explanations, Grace blurted out, “ I don’t want an autopsy performed! It doesn’t matter how he died, he’s dead. Nothing will bring him back.” The thought of him being dismembered and studied like a science project physically was making her shake. Derek looked her in the eye and told her that by law she didn’t get to make that decision. He went on to further share that medical examiners don’t always require an autopsy to determine the cause of death. Bottom line, she needed to understand the role of the ME and respect the decision. While she didn’t like what was happening, at least it was beginning to make sense. She couldn’t understand why the head nurse didn’t take the time to explain this to her, she would have been less angry and anxious. If the truth be told, she would have felt like the hospital cared that her husband died, versus feeling like she was just another case file.
Fifteen minutes later the head nurse came back into the room and said, “The county removal team is here, you’re going to want to leave the room. You don’t need to see this.” Just then, the county’s care team walked in the room. They had heard what the nurse said and acknowledged Derek. The lead care team member Brent introduced everyone to Grace. He immediately stated that she did not have to leave. In fact, they would prefer if she stayed. Brent began his conversation by asking if Tom was a Veteran. Grace shared that he was not. She asked why. Brent explained that if he was, they would honor him by placing a flag over his body as they wheeled him from the emergency room to their vehicle. Grace let them know that although he wasn’t a veteran, he loved the military and was active in politics. She asked if he could still have a flag draped over him. “Absolutely,” Brent responded. He then further explained what the transport team was going to do, how they were going to do it and asked if she would like to participate. Grace responded no, but Derek jumped in and said he wanted too. At that moment, the head nurse became visually upset and stormed out the room. Everyone looked at each other with dismay. Brent turned to Grace and said, “Please don’t let her lack of empathy ruin this moment. Together we are going to honor your husband the best we can. We will treat him with the dignity and respect he deserves. There is nothing to be afraid of. Would you like to walk with us down the hall and to the van to see him off?” Grace replied yes. Together Derek and Brent placed Tom on the gurney, draped a flag over his body and walked down the hallway to the transport van. Grace kissed the top of his head as watched as his body was loaded into the vehicle.
So what’s the lesson? The fact that Tom died couldn’t be changed. What could have been avoided was the lack of empathy from the head nurse. Grace had no idea what the head nurse had been dealing with prior to Tom’s arrival. Frankly, nor should she care. The head nurse is paid to handle stressful situations. It doesn’t matter if Tom was the first or tenth death that day, it was the first for Grace. If the head nurse had taken the time to set the expectation of what must happen over the next few minutes and why, Grace would have felt a little more in control and much anxiety would have been eliminated. A little bit of empathy would have gone a long way. When death happens in an emergency room, the first thing that should be addressed is educating the survivors of the next steps and decisions that must need to be made – including the why. Organ donation can be a part of the discussion but should never be the focal point. One should not assume nor openly have the family feel like their loved one is a commodity with vultures circling up above for their next meal.
Regardless if you are a business or a person, you only get one chance to make a good first impression. In this case, the first impression is an experience. Regardless of the message, it can be delivered with professionalism and respect. As a person experiencing this, it’s important that you keep in mind, you have rights. If you are not comfortable with what’s happening, ask. It’s imperative that you or a family member are your own advocate.