CHANGE OF SHIFT
The Card Leana S. Wen, MD, MSc 0196-0644/$-see front matter Copyright © 2014 by the American College of Emergency Physicians. http://dx.doi.org/10.1016/j.annemergmed.2013.07.010
[Ann Emerg Med. 2014;63:367.] I never imagined that a simple card could cause so much controversy. “Never tell me you did something like that again,” a colleague whispered to me. “We’re both going to get sued.” “Wow, you’re selfish,” another sneered. “All you want is for them to write back to you and thank you.” “You’re a doctor, not a nurse,” said a third. “Let nurses deal with that psychosocial crap.” Perhaps I should start at the beginning. My patient was a man in his fifties, a first-generation Polish immigrant who had metastatic melanoma. Cancer had filled his lungs, and he came into the ED struggling to breathe. After a long and painful conversation, he and his wife decided on comfort measures. His teenage children were at his bedside until he passed away several hours later. That week, I sent a note to his family, asking after them and expressing my condolences at their loss. Why did I do it? After all, I don’t send cards to families of every patient who dies under my care; as an emergency physician taking care of critically ill patients, I would be sending out cards after nearly every shift. So why this case and not every other? I’m not sure. Maybe it was something about this particular family that made me think they would appreciate this gesture. Maybe it was own experience that compelled me. When my mother was dying of terminal cancer, I couldn’t let go. I will always remember her ICU nurse who talked to me for hours about honoring his late wife’s wishes to give her the dignity she deserved. His words allowed me to do the right thing. After my mother passed away, this nurse sent our family a card, and to this day I cherish it—I like to think that my mother made an impact on someone in her last days, just as this nurse made a lasting impact on me. So I sent the card, a simple one, saying that I was sorry for their loss and was thinking of their family. Weeks passed, and I mentioned it in passing to a group of my colleagues, fellow
Volume 63, no. 3 : March 2014
residents, and some attendings. Without exception, their reaction was that I had done something wrong. Some were afraid that I would get sued; some claimed I was selfish and wrote the letter only for me; some implied that I was somehow less of a doctor because of it. Perhaps they’re right; perhaps the family could misinterpret my message. Perhaps, in this demanding and often emotionally draining field that is emergency medicine, we have to protect ourselves and not allow one another to get close to our patients. Perhaps, if we are to be good doctors, we have to focus on the medicine, and leave the psychosocial care to someone else. But I don’t think so. We have a duty not just to the patients who register in our ED, but to their families and loved ones as well. The family conversations that seem so routine to us are ones that they will take with them for the rest of their lives. I know that I will always remember my mother’s passing and the words that her doctors chose. I will always remember what that one nurse said and did. It’s been 2 years since I sent the card. Did I get sued? No. Did I get a response back? No. I didn’t write it because I wanted one. My discussions with colleagues made me think harder about writing another card, but if I feel that I connected with the family and that I want to express my condolences, I will—and I do. Just the other day, I wrote a card to the children of an elderly gentleman who came in with a devastating stroke. This time, there was a response. Thank you for thinking of us, it said. We are doing fine. Our father died with dignity. Author affiliations: Department of Emergency Medicine, George Washington University, Washington, DC Address for correspondence: Leana S. Wen, MD, MSc, E-mail [email protected].
Annals of Emergency Medicine 367
The Card Leana S. Wen, MD, MSc 0196-0644/$-see front matter Copyright © 2014 by the American College of Emergency Physicians. http://dx.doi.org/10.1016/j.annemergmed.2013.07.010
[Ann Emerg Med. 2014;63:367.] I never imagined that a simple card could cause so much controversy. “Never tell me you did something like that again,” a colleague whispered to me. “We’re both going to get sued.” “Wow, you’re selfish,” another sneered. “All you want is for them to write back to you and thank you.” “You’re a doctor, not a nurse,” said a third. “Let nurses deal with that psychosocial crap.” Perhaps I should start at the beginning. My patient was a man in his fifties, a first-generation Polish immigrant who had metastatic melanoma. Cancer had filled his lungs, and he came into the ED struggling to breathe. After a long and painful conversation, he and his wife decided on comfort measures. His teenage children were at his bedside until he passed away several hours later. That week, I sent a note to his family, asking after them and expressing my condolences at their loss. Why did I do it? After all, I don’t send cards to families of every patient who dies under my care; as an emergency physician taking care of critically ill patients, I would be sending out cards after nearly every shift. So why this case and not every other? I’m not sure. Maybe it was something about this particular family that made me think they would appreciate this gesture. Maybe it was own experience that compelled me. When my mother was dying of terminal cancer, I couldn’t let go. I will always remember her ICU nurse who talked to me for hours about honoring his late wife’s wishes to give her the dignity she deserved. His words allowed me to do the right thing. After my mother passed away, this nurse sent our family a card, and to this day I cherish it—I like to think that my mother made an impact on someone in her last days, just as this nurse made a lasting impact on me. So I sent the card, a simple one, saying that I was sorry for their loss and was thinking of their family. Weeks passed, and I mentioned it in passing to a group of my colleagues, fellow
Volume 63, no. 3 : March 2014
residents, and some attendings. Without exception, their reaction was that I had done something wrong. Some were afraid that I would get sued; some claimed I was selfish and wrote the letter only for me; some implied that I was somehow less of a doctor because of it. Perhaps they’re right; perhaps the family could misinterpret my message. Perhaps, in this demanding and often emotionally draining field that is emergency medicine, we have to protect ourselves and not allow one another to get close to our patients. Perhaps, if we are to be good doctors, we have to focus on the medicine, and leave the psychosocial care to someone else. But I don’t think so. We have a duty not just to the patients who register in our ED, but to their families and loved ones as well. The family conversations that seem so routine to us are ones that they will take with them for the rest of their lives. I know that I will always remember my mother’s passing and the words that her doctors chose. I will always remember what that one nurse said and did. It’s been 2 years since I sent the card. Did I get sued? No. Did I get a response back? No. I didn’t write it because I wanted one. My discussions with colleagues made me think harder about writing another card, but if I feel that I connected with the family and that I want to express my condolences, I will—and I do. Just the other day, I wrote a card to the children of an elderly gentleman who came in with a devastating stroke. This time, there was a response. Thank you for thinking of us, it said. We are doing fine. Our father died with dignity. Author affiliations: Department of Emergency Medicine, George Washington University, Washington, DC Address for correspondence: Leana S. Wen, MD, MSc, E-mail [email protected].
Annals of Emergency Medicine 367
