Death: It’s Not the End of Care

I don’t do dead things. I don’t get squeamish at the sight of blood; there’s just something about a dead thing that makes me wholly uncomfortable. They’re both the thing they were when they were alive, and, somehow, they’re not. Roadkill, goldfish, the chicken before it goes into the roaster—all these things existed as their definition, and now they’re just dead.

People? I don’t do dead people. Wrong profession, I know. One part is the “that’s not a person anymore” reason. The other part is that slight possibility that dead person is a zombie, and we aren’t dealing with a corpse but patient zero.

I watch too much TV.

That part of them that’s missing isn’t just their heartbeat—it’s not quantifiable like that. The action of death becomes measurable. The death, not the body, becomes the thing in the room that takes up the most space. It becomes the root of a lot of emotions. It’s here I find most training fails us. My own discomfort aside, what I was taught was to look at someone with a soft face, speak in a soft voice, tell them how sorry I was for their loss, and book it the hell outta there. The problem is, that training leaves a lot of emotion in its wake for both the provider and those for whom they provide.

We are told death is not about us. That allows for commitment to the effort but not the aftermath. Tuck in our capes, bow our heads, and move on. I find it’s the grief of the family that stays with me. It’s the wailing loved ones and my own grief and defeat I can’t express.

I’m not a stranger to the notion that as first responders, our education models fail us in a lot of ways, but in these situations it fails us specifically in humanity. We approach a patient as a number, a burden, something that takes us away from our suppers. We must have a level of detachment, or we’ll drown in the emotion we avoid to be effective. We lose sight of our unique position. The failure happens because we aren’t training providers to consider psychosocial skills as part of their tool set.

We focus on the hard skills more than the soft. We preach about IV catheter placement before we talk about bonding with a patient you’re about to stick with a sharp object. We stress introduction as a means of obtaining vital signs instead of acknowledging a patient’s fear. When it comes to death, the hard skills are easy: Push hard and fast, 30:2, zap it if you can. In a death all that work with no result means we have “failed,” but once a time of death is called, we see the patient and not the world around them. Resuscitation is the hard skill! Death is the soft skill! Mourning starts immediately, and we can be part of that process. We were just never told how.

Let’s clarify: I’m not proposing a lecture on how to make friends with the bereaved. Consider, though, that in our unique positions, we still have the power to help. In an age of provider self-awareness, maybe helping the family helps us too. Death after effort isn’t easy, and we as providers are affected. Notice I didn’t say loss or failed effort. The AHA tells us most of our efforts won’t be effective, so why consider the death of a patient something negative? Sometimes a death is just a death, with nothing we could have done to prevent or reverse it. The goal then is to take away the negative stigma surrounding dying in our own training.

Death is not a failure unless we caused it, and then, well, that’s another blog. Death is an opportunity to use our humanity to touch another person’s humanity. We’ve all had a loved one die, we know what it feels like, and training a provider to access their emotional intelligence is going to help them become a more complete asset.

Social-emotional education feels crunchy. Talking about feelings makes us feel weak and vulnerable. It makes us human, and we can’t be human and heroes, right? Wrong! More than a third (37%) of first responders have at least considered suicide after not being able to deal with their feelings following a heavy job. We always use the phrase “rely on your training” when it comes to complicated calls, so why isn’t emotional intelligence involved in that training too?

Giving our students the tools to interpret emotions, theirs and others, creates safer scenes but also targets that 37%. Essentially we must turn emotion into a procedure. What we are asking is for assessments to start with a human component, allow humanity to be part of your differentials, and let the two work together instead of either being avoided for the sake of detachment.

How do we do it? Glad you asked! We must incorporate the soft skills with the same level of importance as the hard skills. This means including interpersonal skills in the algorithms. Asking our students to consider the emotional fallout from dealing with something like death means we make them aware of their patients and themselves. With my project we started by putting a patient check-in into the assessment as a required step. Even if that doesn’t include talking to the patient, providers should get them a blanket or use that therapeutic touch. Make them perform an action that would give them comfort if the roles were reversed.

It makes the students consider that the people they serve have their own experiences akin to their own. So when that pronouncement happens, instead of mumbling a quick condolence as they run out the door, they can feel comfortable performing that check-in with a devastated family member—maybe even give them the ability to express their feelings about the experience.

I don’t do dead things. Mostly for the irrational fear of the undead, but also because my concern is the living. It’s my job and my human obligation to keep humanity in my care. That means letting the people around a tragedy know they aren’t alone in how they feel. Feelings are uncomfortable, we don’t like them because they set our heroic personae on fire, but addressing them is necessary for ourselves and our patients, especially when our patients turn out not to be the ones we were called to help.

Death is easy. Care is hard.

Anna Ryan is an EMS educator and blogger from New Jersey. She is a regular contributor to The Overrun podcast.