Co-grieving With Families Of The Sick: What COVID-19 Has Taught Us

It was a Monday morning. The team’s ritual is a detailed clinical round of patients admitted in the intensive care unit followed by those in the general wards. As I entered the ICU my resident informed me that we had to see five patients. Three of them were on ventilators and of these two were post-COVID, the familiar depressing welcome note that has become default since the start of this pandemic. One of them was a 40-year-old gentleman who had moved down to our locality with his young wife and two kids as part of his job. He was sick. He had been on the ventilator for almost a week now with no signs of improvement. His blood pressure was low, he was unconscious, and his lungs were very bad. After our assessment, there was little doubt about the outcome of this young man in the prime of his life – unlikely to win this unacceptably skewed battle.

While waiting in the counselling room for his wife, I was running a quick rehearsal in my mind.

Wife: “Doctor, how is my husband?”
Me: “I know this is going to be tough, but he is very bad”
Wife: “Wont he get better doctor?”
Me: “Chances are very very slim. He is sinking and we have done everything possible. I don’t think he will make it. Please prepare your mind for the worst”
Wife: “Doctor, isn’t there even a 1% chance?”
Me: “That of course is always there, but in his case even that is a miracle”

My rehearsal was interrupted by her entry into the room. She was alone. The upper half of her face left uncovered by the mask gave me no access to her state of mind. Contrary to the sequence of my rehearsal, she didn’t ask anything. I started by explaining his condition and ended with a very grim note on his chances, almost indicating that he might expire shortly. She looked down for a second and then at me; her eyes were moist. But she didn’t utter a word. She remained silent for about 2-3 minutes. It seemed like 2-3 hours. I had an urge to speak something that might console her. But I resisted and remained silent all the while. She thanked me and left the room.

That very evening, he passed away. I didn’t get a chance to meet his wife. But the silence that we shared earlier kept reverberating in my ears. Sometimes sharing silence with a grieving person is all that we can do as doctors. The pacifying effect of silence during profound grief is often underestimated and underutilized. Remaining silent and respecting the non-reactive detached grieving family member is a sign of maturity and empathy. Long drawn monologues filled with usual words of consolation like “life is cruel, we know your sorrow, it must be very difficult for you” might only serve to multiply the grief while both the griever and the doctor clearly recognize the hollowness of such words.

COVID has made me realize such subtleties of communicating bad news with families because of two reasons. First, it is probably the first time in my professional life (and many other’s) that we have broken bad news at such great pace and numbers. Second, breaking bad news in the pre-COVID era was quite often confined to families of elderly patients with chronic illnesses. But COVID has not spared the young, energetic men and women in the prime of youth. Hence it is easier to step into their shoes, seeing patients of my age suffer and perish.

Healthcare professionals must evolve constantly to cater to the changing needs of the ailing society. Sharing silence after breaking bad news is as important as sharing the news itself. Let us accept it as a way of co-grieving with families of sick patients.

The author, Dr Aneesh Basheer, is a professor in General Medicine.