The final hours are a time for truth-telling
For people who have suffered a catastrophic neurological event, artificial ventilation and other kinds of organ support are not only used to buy time to diagnose, provide care, determine prognosis and allow family and loved ones to gather and come to terms with what is going, but also to give them time to discuss organ donation with their families.
Diane, Tavita and Moana had all collapsed suddenly and within seconds lost any chance of recovery. For their families, this was a time of overwhelming shock and disbelief. Their grief is palpable and their emotions raw. It is a time that brings families and friends together to support each other, putting aside many of the things that may have kept them apart before. It is a deep dive into uncharted emotional territory in which great distances are covered in a short space of time. At some stage in this torment, when the winds begin to settle and with the right facilitation, it can become a time for reconciliation of differences, reminiscing and, later, a time for some humour, too.
We, the doctors and nurses, travel that distance alongside families doing what we can to help, inform and comfort them. It is a time for truth-telling because there is no turning the clock back.
Right from the start, the conversations we have set the tone for what’s to follow. Never easy, these need as much care and preparation as if part of a surgical procedure. How we proceed together is determined by how well we connect, and the way we recognise and address the things that really matter.
What you reap is what you sow. Kindness, compassion, expertise and honesty deliver great rewards when it comes to hard conversations. So, too, does time spent to help families better understand what has happened and what the consequences of those things are, especially when a terrible outcome is expected. In practical terms, that may mean we meet formally with families many times in one day and, in between, have more conversations with small groups or individuals to get people to a common understanding. Coming to terms with a terrible truth takes time and it is our job to help that process along.
As we get a better sense of the patient’s condition and prognosis, what we discuss in the more formal family meetings evolves over time. I do my best to be totally transparent when it comes to sharing information to help families come to terms with what has occurred and to better understand what I am saying. If I suspect that a patient might become brain dead, I will usually mention that as a possibility. Commonly families will pick up on this and, if it is appropriate, then we will embark on a more detailed discussion.