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Doesn’t anyone know what dying looks like? by Monica Williams-Murphy, MD

Sunday, 06 Jul 2014 07:33

About Dr. Monica Williams-Murphy (120 Posts)

Dr. Monica Williams-Murphy is a Board Certified Emergency Medicine Physician, who practices in one of the largest emergency departments in the United States at Huntsville Hospital. Through her writing and speaking, she is devoted to transforming the end of life into a time of peace, closure and healing. Media Page


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I live and work in the house medicine. You would think that those of us who have chosen this profession would actually know what dying looks like. Furthermore, one would hope that if the doctor could identify dying, he or she could share this with the patient and family (given that this is fairly significant medical information!).

I never cease to be amazed that most doctors cannot speak straightforwardly and compassionately about the reality of death and dying.

Case in point: I was just summoned into the room of an actively dying patient who’d been in the ER for several hours. Both the emergency physician had seen her, as well as her admitting doctor. All they told that the family was that she was “very, very, very sick” and that they would put her in hospital to try to treat this.

So where did this leave the family? All they heard was “sick” and”treat”.

Do these words suggest “dying” to you?

Me neither!

Ok, so back to the story: The nurse pulled me aside (because nurses can both recognize and speak of death) and pleaded with me: “I know that the earlier doctor has gone home, but will you please tell this son that his mother is dying? No one has told him yet and I think she may die during the transport up to her hospital room.”

Accepting the job, I looked at the chart and the patient. The patient had a DNR arm band on already. She was 95 years-old and septic, with a blood pressure of 40ish. Still peering through the curtain, I observed that she was completely unresponsive and had shallow breathing.

Yep, my nurse was right. She was dying.

I put my irritation at the apparent irresponsibility of my doctor colleagues aside and stepped into the room. (No, I  am not perfect, but neither am I afraid to call a spade “a spade”.)

I gathered her son to my side and with great respect, I got right to the point.
“Sir, I am Doctor Murphy and I know that I have not been involved in the care of your mother, but your nurse has very kindly asked me to come speak with you. I know your mother is about to be transported upstairs to the room right now and I also know that her wishes are to have a Do Not Resuscitate order in place. But I’m concerned that no one has told you that your mother is actually dying right now and I’m sorry you have to hear this so abruptly and from a stranger.” I grabbed his hand to ease the blow.

Then, I continued, “Furthermore, frankly, I don’t want to move her from this room. I think it would be best if you called any children and family you want to be with her.”

With a gesture of gratitude, he grasped my shoulder and said, “Thank you for telling me…” and he immediately made phone calls and sent text messages.

Within 15 minutes the room was filled with children and grandchildren. One of the children who worked in the hospital came up immediately –he was so grateful that the nurse and I had identified the dying moment so that he could be with his mom.

I did my best to shepherd the family and looked on as a natural vigil unfolded before me. Small grandchildren climbed up on the bed to kiss their grandmother’s cheek while adult children held her hands. A hand-made blanket was draped over her legs. There were sweet whispers and loving goodbyes.

The priest was called in for last rites and he arrived right on time. Her heart
stopped at the end of the sacrament.

It was my honor and privilege to pronounce her time of death after such a beautiful farewell.

Finally, I turned to the family and asked, “What else I can do?”
The son whom I had originally spoken with responded “Thank you so much, doctor, but there is nothing more we could ask of you. After all, we only needed to know that she was dying.”

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As always some details have been changed to protect the privacy of the patient and date of publication has no relevance to the date of the patient encounter.

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"It's OK to Die" is a ground-breaking book filled with graphic stories straight out of the Emergency Room illustrating how most Americans are completely unprepared for death and dying. In response, the authors have created a unique and comprehensive guide urging EVERYONE to prepare in advance, to assure their own peace and to prevent the suffering of their loved ones.
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12 thoughts on “Doesn’t anyone know what dying looks like? by Monica Williams-Murphy, MD

  1. Rea

    Once again, it brought tears. What a beautiful article! The art and science of storytelling belong to you, Dr. Murphy! End of life as “a time of peace, closure and even healing.” It is impossible to imagine work more meaningful than yours. Hopefully, many others will listen to your lessons and grow from your strength.

    Reply
  2. Shery Picker, MSW

    Thank you for your article. A real shame most doctors can’t assist a patient and their family when medical care is no longer appropriate.

    The nightshift nurses let me know my father would not recover from a massive heart attack… barring a miracle, which didn’t materialize

    I hope one day SOON, MDs, surgeons, medical teams can see that helping a patient die, and their family absorb the information is part of their duty. Wouldn’t they want the same for themselves and their loved one/parent …. the opportunity to gather the family, clergy, say good bye and help the person pass?

    I’ll bet most terminal folks know they are terminal. I strongly believe people deserve the right to know their own health or illness condition and do what they wish with that information.

    You aren’t protecting anyone, just not being brave either. I was left having to practically console my father’s doctor on the loss of his patient— wasted time I needed for myself and family.

    Death happens, even to the best of doctors…. please learn to deal with it better!!!

    Reply
  3. Lynda Sparrow

    Another compelling piece. It’s wonderful that you were able to help and comfort a family but there is a question here that needs answering. Why aren’t other doctors doing the same?

    Reply
  4. Pingback: Doesn’t anyone know what dying looks like? by Monica Williams-Murphy, MD | It’s OK to Die | Loss, Grief, Transitions and Relationship Support

  5. Lise Arseneau Lee

    I appreciate your article, Dr. Monica Williams – Murphy. I completed a palliative care certificate program from Lakehead University, Thunder Bay ON, Canada several years ago and was surprised back then at the reluctance of physicians to speak about death and dying. It is unfortunate that this continues to be the case today. Open communications about death and dying truly will determine the perception of a good or bad death for both families and professionals.
    I am praying that the curriculum for med students, nurses, and continuing ed will change in a positive way to have more classes specific to death and dying – signs, symptoms and communicating with families.
    Keep up your fantastic work and kudos to the nurse who spoke up and asked for you to speak to the son!

    Reply
  6. Pingback: Doesn’t anyone know what dying looks like? by Monica Williams-Murphy, MD | It’s OK to Die | All Things Palliative - Article Feed

  7. Stephanie Kimball-Amis

    Great read. My father in law passed away this spring and it was announced to all of us that he was dying by the Hospice nurse. We thanked her profusely for truly being transparent with us and allowing us to contact family and friends so we could all truly say goodbye to such a great man. Family and friends need to be told, they know but truly place a thin veil of denial on and trust the physician in whatever they say. Thank you again for this article.

    Reply
  8. Carol Cruden

    It was nice to read this. I have worked in hospitals and observed doctors who struggle with the dying process. This a situation where the nurses always seem more comfortable with. If the doctor is uncomfortable use the nurses that you have available to support you. Death is a part of life. It has been so removed from families and made more clinical. We need to bring death back to the families and support them. A good experience for everyone it to talk about the process.

    Reply
  9. Kathryn Speed Revis

    Dr. Williams-Murphy:

    Being a nurse of 40 years, I say thank God for the Nurse who spoke up; and, I say God Bless You, Dr. William- Murphy for such a brave and compassionate act. The time you took to spend with that family is “very, very, very“, rarely seen today. No modern day medicine could have taken the place of being surrounded by loved ones when she took her last breath on this earth. This act may be the shining moment of your career. Thank You.

    Reply
  10. Bernardo

    Gracias por el artículo, trabajo en mi tesis en bioetica y el tema es” la misericordia una respuesta ética al sufrimiento del enfermo terminal” por lo que el articulo reafirma mi convencimiento de que la misericordia va de la mano del reconocimiento del sufriente como persona .que la relación que podemos tener con un paciente en el ámbito clinico, es un reflejo directo de la visión que los protagonistas tienen de si mismos .creo además que ante las enfermedades graves la información adquiere una connotación especial cuando el pronostico es adverso y el grado de incertidumbre es muy altot,.es. Es. Un tema complejo ya que la persona que atiende a un enfermo terminal tendrá que asumir esta responsabilidad, porque todo paciente o familiar tienen derecho desde mi punto vista a saber su situación real ,es el derecho a prepararse, el derecho a planear sus últimos dias y la familia y amigos a despedirse de quien han amado.

    Reply
  11. Suzy Mulka, Geriatric Care Manager

    Thank you so much for this article and for writing this book; I have just purchased one and will be sharing it with many of my colleagues!!

    Reply

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