Words: Notifying Survivors about Sudden, Unexpected Deaths
Kenneth V. Iserson, M.D.
Catalog # 018 $38.95 Paper
343 pages, Bibliography, index
death notification is one of the most stressful-and surprisingly
frequent-parts of many professionals' jobs. Only one to seven patients
per 100, on average, are discharged from hospitals alive after medics
have performed out-of-hospital CPR. More than one-fourth of all
in-hospital deaths are unanticipated, rising to two-thirds in the
emergency department setting. These figures mean that many people
can become involved in a death notification. Yet education and training
is often woefully inadequate-with unfortunate consequences for the
Words: Notifying Survivors About Sudden, Unexpected Death is written
to provide all those in the helping professions who must relate
tragic news with in-depth information, protocols, and case studies
tailored to a variety of situations. Potential notifiers will learn:
To be aware of non-verbal communication.
· When to use the "D words": death, died, and dead.
· "Helping" phrases and how to avoid clichés.
· Protocols for long-distance telephone notifications.
· Which resources and referrals survivors need.
· Typical questions of survivors-and answers.
· How to request organ or tissue donation.
· How to tell children, parents, and disaster survivors.
· When survivors should view the body of their loved one.
· How to identify acute grief reactions.
· How to build a Memory Box.
· How and when to follow up with survivors.
· Good course objectives for death notification education.
nurses, emergency department staff, police, ambulance or fire department
personnel, chaplains, social workers, medical examiners or coroners,
and others in helping professions will learn to better help survivors
and to effectively teach those notification skills to others. National
bereavement resources, an educational outline, and in-line-of-duty
notification and airline disaster protocols are included.
Grave Words: Notifying Survivors About Unexpected Deaths begins:
truth, consistency, and clarity are the key factors when delivering
information about a sudden, unexpected death. These points were
driven home for Jennifer Gilbert, a Galen Press editor, while she
was reading this manuscript for the first time. She encountered
sudden death one evening and describes the experience:
Hearing Kathy scream my name, I rushed next door. "My baby
is dead," she moaned in disbelief as she met me at the door.
She had just returned from work to find her 40-year-old fiancée
lying face down on the kitchen floor. It was obvious from his coloration
that he had been dead for hours. I hugged her hard while I tried
to swallow my own mounting panic, fear, and grief. Instinctively,
I knew there was nothing I could say-just being there, hugging her,
"He's asthmatic," she had me relay to the 911 operator
as she leaned over his body, "He'd just discovered that the
inhaler he was using could cause his heart to stop." Within
minutes (it seemed much longer) the room began to fill with paramedics
and policemen. Somehow Kathy was pushed out onto the front porch
as they proceeded to do something to his now lifeless body. "They're
going to take him away from me," she cried. "Why are they
working on him? He's not coming back." A paramedic rushed past
carrying syringes. "Is he breathing?" she asked. "No,
he's not," the young man answered quickly, without pausing
or turning his head.
I rubbed Kathy's back as she crouched by a phone, trying to remember
people to call. I asked if there was someone I could notify and
she had me telephone a nearby relative. "Don't say he's dead,"
she cautioned, "Say there's been an accident and to meet us
at the hospital." I will always remember how clear she was-still
thinking about others in the midst of her terrible shock and sadness.
A couple of men brought in a gurney in preparation for the short
ride to the hospital emergency room. "I want to go with him.
I have to go with my baby," Kathy sobbed. My role had been
to hug her whenever she needed support, inform the professionals
entering the yard that the dogs were harmless. Now I rushed out
to the ambulance and made sure she would be allowed on board. Everyone
seemed extremely busy, absorbed in the tasks they no doubt performed
efficiently several times a day, but they nodded a brief affirmative.
By the time her fiancée's body was placed in the ambulance,
a young policeman, who told her she needed to answer some questions,
had stopped Kathy in the living room. "I have to go with the
ambulance," she pleaded. But three minutes later the ambulance
sped away, carrying his lifeless body and leaving Kathy to follow
behind in my truck. This created a lasting (and unnecessary) memory
of callousness and pain for Kathy, who needed to spend those last
moments with her partner's body. At no time did any of the professionals
involved in the response take a personal interest in the one person
who would remember this evening forever-Kathy, the survivor.
Death has replaced sex as the major taboo topic in Western culture.
Imaginary death-such as cartoon-like violence on television and
in movies-has replaced reality for most people. When death strikes,
as it must, and especially if it strikes suddenly and unexpectedly,
we respond with discomfort, distress, and dismay.
What healthcare professionals say about
Grave Words: Notifying Survivors about Sudden, Unexpected Death:
"I will use this book frequently as a reference when teaching
physicians and others about giving bad news. I've never seen a better
source on the subject. I'm sure your book will be on the shelf of
many care providers who find themselves in the situation of having
to deliver bad news to a family."
Kate Christensen, M.D.
Chief of Bioethics, Kaiser Permanente, Northern California
book is outstanding, both as a text to educate a person in how to
make death notifications and as a guide for the development of policies
for institutions to use in handling death notification. As a pathologist,
I've been involved in both positive and negative experiences related
to death announcements. Dr. Iserson's wealth of information-highlighted
by his diverse anecdotes-makes for wonderful reading.
Anna R. Graham, M.D.
lack of communication skills among health care professionals is
one of the real barriers to improving care at the end-of-life. Grave
Words is the kind of "how to" resource that health care
professionals need to communicate better with dying patients and
their loved ones. . . . Much of what Iserson provides can be of
assistance as health care professionals struggle to "deliver
bad news" in a variety of situations.
Myra Christopher, President and CEO, Midwest Bioethics Center, Director,
Community-State Partnerships to Improve End-of-Life Care
book made the "light go on." I never realized how deficient
I was in providing comfort and information to the survivors of sudden
and unexpected death. I would strongly recommend this book to all
emergency personnel. The survivor information sheet is a wonderful
Gary H.Lambert, M.D.
a terrific resource! Practical, forthright, and sensitive. A critical
resource for every healthcare professional!
Kyle Nash, Center for Clinical Medical Ethics, Pritzker School of
Medicine, Chicago, IL
1-883620-02-3 Softcover, 354 pp.
# 018 $38.95
Sample Advance Directives
Funeral Industry Jargon
ORGAN AND WHOLE-BODY DONATION CARDS
A Sample Protocol to Use When Speaking
versus Sudden, Unexpected Deaths (Table 1-1)
Protocols for Notifying Survivors about Sudden Unexpected Deaths
Slides on Death Notification
The Gravest Words Video