BOOSTED BY MEDIUM
When Someone Asks, ‘Doctor, Am I Going to Die?’ What’s the ‘Right’ Answer?
‘Yes’ seems harsh, even though it’s always true
Disclaimer: Lots of ER Docs are at once deadly serious and crazily flippant. Bear with me as you read.
As a now-retired veteran of 33 years in Emergency Medicine’s trench warfare I got the question, “Am I going to die?” … a lot.
Answering the question turns out to be harder … and easier … than one would imagine.
That’s because the honest answer is “it depends.” And, in my opinion, the so-called right answer depends on context.
Here’s a perspective.
1️⃣ “Yes”
That, by far, was my most common answer to the question “Am I going to die?”
Many come to the Emergency Department (ED) with a specific concern in mind. That concern is often buried beneath, or entwined within, layers of other stuff.
Here’s one example of many I could give.
“Doctor, I have chest pain. I think I’m having a heart attack. My uncle died of a heart attack just last week. Am I going to die?”
One of the many ED joys is that ER Docs can get loads of vitally important information immediately - things like EKGs (heart wave tracings), lab tests, critical elements of medical history from the patient, and so forth.
Plus, there’s the matter of the instantaneous gestalt that ER Docs formulate after a time about who’s sick, sick, sick, and fixin’ to die (as we used to say in North Carolina) and who’s simply not that sick, and will likely go home or at worst, be hospitalized in stable condition.
So, while ensuring that my “Am I going to die?” patient was safely tucked in and could reasonably come to no harm whatsoever AND proceeding quickly down the appropriate diagnostic pathway, I would sit, look my patient in the eye, put my hand on their shoulder and say:
“Yes … just not today or anytime soon.”
Yes, I had to choose my audience carefully (another one of those intuitive skills ER Docs acquire) but the “Yes” followed quickly by the rest of the phrase above never failed to bring a smile or a laugh, often a loud one, from almost everyone who heard it.
I can’t remember ever being wrong.
2️⃣ “We are doing everything we can to prevent that from happening”
A much smaller group of individuals come to the ED critically ill or injured and sick enough to die quickly.
For 100% of these people who asked “Am I going to die?” I would answer, “You are seriously ill (injured) because of ______ (and provide a succinct reason). You are ill enough to be considered critical, even ill enough to die soon, but we are doing everything we can to prevent it.”
I can recall many patients clearly in the throes of substantial heart attacks. And heart attacks kill people. So, while openly stating “Yes, you’re having a heart attack. And, yes people die of heart attacks, often suddenly and without warning,” I was able to continue moving forward with medical care while being completely honest with patients.
My experience was that patients appreciated the honesty and found it helpful even during one of the worst moments of their lives.
3️⃣ “No one is going to die while I’m on duty.”
I still remember this kid, and he was my patient over 30 years ago.
Keyon was a skinny, heavily jail-tatted, banger from the miserable streets of Los Angeles, still wearing his “colors” as the paramedics wheeled him into Trauma Room #1.
“GSW to the chest. Stable field vitals” was the essence of the paramedic report.
GSW is gunshot wound. “Stable field vitals” is shorthand for the fact that the basic signs of life, like pulse and blood pressure, are normal and haven’t significantly changed during paramedic transport. And, you guessed it, a GSW to the chest often goes right off the rails, and quickly.
As soon as Keyon hit our gurney he turned slightly, clutched my right hand in both of his, pulled me close, and, with tears streaming down both cheeks, sobbed “Don’t let me die!”
I had an instant to decide the right response.
In far less time than it’ll take to write this, I reasoned. * Keyon is a young healthy kid. * Keyon isn’t dead already even though he’s been shot in the chest. * Keyon is surrounded by experts able to provide some of the best trauma care available to patients anywhere in the country. * Keyon’s basic signs of life are intact and normal, or at least appropriate to the situation.
I said, as I sat Keyon up to listen to his heart and lungs, and the trauma team descended upon him to provide care:
“No one is dying today.”
As it turns out, Keyon had a collapsed lung that was an easy fix, and no other injuries. He did great.
4️⃣ “It’s highly likely”
I could still walk to the precise critical care room where this occurred many years ago.
While on duty as a teaching/supervising physician in the university hospital where I spent the bulk of my career, it was my responsibility to know about every patient in my “zone.” As a consequence, I did a supervisory “drive-by” on every patient either as they entered the zone or shortly after they were settled in bed.
So when I entered critical care room #7 I was struck by this disconnect.
Tom, the senior-level physician trainee was engaged in an unhurried conversation about symptoms with his patient.
His patient, a chubby, 30-something-year-old man was sitting bolt upright in bed panting, while on mask oxygen, soaking his sheets with sweat. A quick glance at the patient’s monitor revealed a crazily rapid heart rate and a marginally low blood pressure. As I grabbed a mask and strode to the patient’s bedside to introduce myself I saw immediately that his skin was marred by what looked like bruises and thousands of pinpoint purple dots.
“Tom,” I said, “come with me now.”
We stepped just outside the patient’s glass door.
“What do you think this patient has?” I asked.
“I don’t know” replied Tom, a little irked. “I was trying to figure it out when you came in.”
“Even though he’s young, he’s sick enough to die soon almost no matter what we do” I went on.
Tom’s eyes widened slightly as he searched my face.
“He almost certainly has meningococcemia” I continued.
“He needs a team around the bedside STAT! (NOW!) to provide immediate critical care with big intravenous lines, antibiotics, and medications for blood pressure support (all explained quietly and rapidly in medical language). His medical evaluation should supersede all others in the ED. Let me know if you hit any roadblocks. Now, let’s get busy” I commanded.
I re-entered the patient’s room.
“Sir, are you able to hear some very difficult news? I said.
“Yes,” he replied.
“I’m virtually certain you have meningococcemia, a life-threatening infection. You are critically ill now and will almost certainly get worse in the next little while. You may even die. I’m sorry to have to tell you this so abruptly. Do you have family here with you or someone you’d like us to call?”
The patient responded “I’m on my own. That’s tough news to hear doc but thank you for being straight with me. I wish I’d come in right when I started feeling bad.”
“Well we’ve got a great team here to care for you” I replied, as nurses and techs elbowed me out of the way.
Within the hour the patient was receiving several different blood pressure support medications to combat shock. He was also on a ventilator.
Shortly thereafter, I got a call from the lab. “Hey Burg,” said the pathologist “I’ve never in life seen more toxic granulations (a lab indication of overwhelming infection) on one patient’s blood smear.” How’s he doing?
“He died a few minutes ago. We just stopped CPR” I answered.