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Use the ‘d’ word, prepare to lose the conversation by Heather Murphy Woolwine Public Relations It’s considered the last great taboo in modern society. The one thing that most don’t want to discuss in detail, if at all. And while those who work in the health care system must deal with death on a variety of levels, both professionally and personally, fear often keeps those who deal with death from dealing with it correctly. Kenneth Iserson, M.D., University of Arizona’s director of bioethics and a professor of emergency medicine, sought to help interdisciplinary health care workers from MUSC’s campus understand the best ways to deal with patient deaths and survivor notification. Iserson spoke Nov. 20 and 21 in the Medical Center's 2 West Amphitheater. “I’m going to tell you the most important thing about this entire presentation before we even get into it,” Iserson said. “I know it is hard and I know that you don’t want to do it, but when you are engaging in survivor notification, you must use the ‘d’ word. It has to be ‘dead, death, died.’ Then prepare to lose control of the conversation.” Referring to sweeping emotions expected from family members or spouses during the process of survivor notification, Iserson explained if a patient has passed on, health care staff must realize that the survivors then become the patients. “It is essential that you tell and explain what has happened with compassion, thoughtfulness, and in the correct manner,” he said. During his presentation, Iserson provided insight on why he believes health care professionals are sometimes unprepared or insensitive when conducting survivor notifications. Professionals may become uncomfortable, scared of survivors’ reactions, lack feedback concerning their notification performance, and have few role models due to variation in methods of delivery, etc.  After providing a brief look at common myths associated with death, processes related to death (like autopsies, embalming, and organ and tissue donation), and advance directives, he explained the ideal scenarios relating to survivor notification. “First we must realize that expected and unexpected deaths must be handled differently,” he said. “When preparing for a notification, you need to factor in the approach of death, cause of death, nature of the illness or injury, identity of the patient, any autopsy reports, time and place of notification and survivor reactions.” In addition to those guidelines, Iserson mentioned the importance of body movements, eye contact and gestures. He suggested that whenever possible, remain eye level with the survivor and if need be, crouch down if they’re sitting. Refrain from shaking your head back and forth, as if prefacing the difficult thing to be said. Acknowledging that much of what he had to say sounded like common sense, Iserson told the audience how many times he’d seen physicians and nurses represent themselves as insensitive or spit out the facts and run away.  Some phrases to avoid when delivering a survivor notification include: “It was actually a blessing because,” “God has a reason for this,” “It could have been worse,” “Everything is going to be OK,” and “I know how you must feel.” These statements, in most cases, seem to promote ignorance, unhealthy expectations of immediate acceptance, insensitivity, and disempowerment.  Instead, Iserson encouraged staff to use phrases like “I can’t imagine how difficult this is for you,” “I’m so sorry for your loss,” “It’s OK to be angry with God,” “It’s harder than most people think,” “I know this is very painful,” and “It must be hard to accept.” In addition, he asserted the difference that just sitting and listening to a survivor for a few minutes makes in how he or she immediately deals with the loss. Iserson spent the final minutes of his presentation discussing telephone notifications, local versus distant notifications, and ways in which survivors express anger. He also called for staff to remind themselves to consider miscarriages as sudden deaths and mothers’ who’ve lost a child must receive the same kind of survivor notification granted to others. In Arizona, Iserson often allows family members to watch resuscitations, hold or touch the patient, and sometimes helps to create memory boxes that include the patient’s handprint, footprint, and a lock of hair. He tells survivors to add more items when the time is right. In terms of promoting survivor notification practices, Iserson suggested that appropriate materials be integrated into the current curricula through classes, readings, discussions, simulated situations, observations, and supervised experiences in real situations.    Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.