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Key points
- There are times when you need to tell yourself the truth about death and dying.
- You can tell yourself a realistic appraisal sentence to help cope as someone passes away.
- Healing during grief starts with accepting the reality of the situation.
The unexpected death of my father-in-law 10 years ago was one of the worst days of my life. We had had a late breakfast with him and his wife and we waved goodbye and went back to our home. Two hours later, he was moving groceries from his car to the house when he felt a pain in his upper chest. He staggered over to a patio chair and told my mother-in-law to call 9-1-1. After she called them, she made a hysterical call to us and we drove over as fast as physically possible. When we got there, the firefighters and paramedics were already working on him. They had him hooked up to an AED machine and it was clear it was having no good effect.
We stood by, hoping for his recovery. A sheriff’s deputy had arrived on the scene right after the medical responders and had been watching the event unfold. As my wife and mother-in-law held each other in agony, he pulled me aside and said, “You need to prepare yourself for a bad outcome." He was right; my father-in-law never regained consciousness and was pronounced dead at the scene.
That started several months of horrible pain for our family, beginning with a funeral for a highly reputed and beloved man, all the financial paperwork and hassles that accompany the death of a senior citizen, and those times when you wake up and think, for just the briefest of moments, that it’s going to be a good day, and then you remember that it won’t.
I saw the deputy in our town a few weeks later and I made a point to thank him for what he said. He was honest, direct, and empathic. He didn’t sugarcoat his response. He didn’t suggest that my father-in-law would miraculously rise up and be fine. He told me the truth.
In her August 5, 2023 article in The New Yorker, “The Hidden Harms of CPR,” physician Sunita Puri, who specializes in palliative care, wrote about how hard it is for many emergency room physicians and nurses to stop doing CPR for a patient who has just died, especially when the person’s family is nearby and expects them to continue until it somehow works. She writes about the relative ineffectiveness of CPR — 85 percent of patients don’t survive with its use — even if it starts at a hospital. Like my father-in-law, most people who receive CPR get it at home, at work, after an accident, or in the street. Unlike what we see on a lot of hospital TV shows — “Clear! Zap! Saved!” — it’s not without its limits.
Dr. Puri writes about how hard it was in the early part of her medical career to talk directly with the families of terminally ill, very sick, severely injured, or comatose patients about the pending death of their loved ones. She relates that often her patients already knew about the life-ending seriousness of their conditions and were matter-of-fact about it with her. She recalls feeling relieved that they broached the issue of their pending death as she struggled to find the right words.
For our family members, spouses or partners, in-laws, and dear friends who are at an advanced age and in poor health, most of us have the wish that they pass away peacefully, painlessly, and with dignity, with their loved ones at their home or in the controlled environment of a hospital, not in pain and carefully monitored by healthcare professionals.
In reality, people die on their kitchen floors, in their cars, at work, walking at the mall, in nursing homes, or in hospice care facilities. Their deaths are not gentle or pain-free, which is agonizing to them and us, if we have to bear witness.
We all want the time and the ability to prepare ourselves, to gather our emotions, and our courage, to be able to say goodbye. Deaths that are sudden, accidental, and horrific, especially for people (or children) who seemed so alive not one hour before, are nearly impossible to fully cope with, even after several years of processing our grief.
But I think back to what the deputy told me a decade ago, “You need to prepare yourself for a bad outcome.” It helped me do exactly that. It didn’t make it better, but it made it a little easier because he didn’t create a false hope. If my father-in-law had somehow survived — and he was cyanotic and gray when I saw him on the ground, with oxygen, an IV, and a heart defibrillator attached to him — the deputy would have been glad to have been wrong. But he wasn’t and what he said made it easier to cope with what turned out to be terribly true.
If you ever find yourself in a similar horrible situation, where it’s possible that you may witness the death of someone you care deeply about, you find some small comfort in the phrase, “I need to prepare myself for a bad outcome.” Maybe you’ll be able to say the same thing to a close family member, as you both witness the pending death of someone you both love. “We need to prepare ourselves for a bad outcome” might be the only thing that can be really real at that moment.
We all wish someone we loved who died would have been with us just a little bit longer. Can we give ourselves a coping phrase, a sentence that is direct and even comforting, because it’s honest?
