Death: Learning to Say the D Word

By: Peju Simoyan (MD, MPH)

In a recent essay published in Pulse, Dr. Charlotte Grinberg reflected on some of her experiences as a medical intern related to how doctors tend to communicate about the end of life, avoiding the words like “death” or “dying”. She noted the importance of using direct language when discussing death with colleagues, patients and family members (1).

As an intern several years ago, I received a handbook prepared by the senior residents in our residency program. The handbook contained advice about many things we needed to know as freshly minted physicians, including the need to communicate clearly with family members when patients die. The instructions were clear: avoid statements like “no longer with us”, make sure you say the word “dead”.  For some reason, that stands out as the one thing I remember from that handbook, more than a decade later.

In religious circles, we frequently say a deceased person “has gone to be with the Lord”, or “gone to rest”, “transitioned to glory”, or something along those lines. A colleague who is also a long- term friend was on the phone with me several years ago, discussing something totally unrelated, and then casually mentioned that her ex-husband had “gone to heaven” a few months prior. I was taken aback that she would inform me of his death in such a casual, if spiritual manner. She might as well have been telling me that he had gone to the store.

When my own father passed away unexpectedly last fall, I found myself doing the same thing when I informed a few friends via text messages that my Dad had “gone to see Jesus”. One of my siblings wrote an informal announcement which stated, among other things, that our Dad had “decided to call it a day”. I believe that was appropriate for the context. When it was time for a more formal newspaper announcement, I took it upon myself to provide the text. This time, I used the “D” word, stating that we were announcing our father’s death. I remember wondering if I should have replaced “death” with something that sounded more “spiritual”. One of my siblings, without my discussing it with him suggested that perhaps we should avoid the word “death” and use a phrase like “transition to glory”. (That phrase had already been used as the heading for the announcement). Somehow, the advice I had received in my first year of residency must have stayed with me. I spoke with another sibling about this and added, “At some point, we have to use the word “death”.  This sibling agreed, responding “because that is what it is”.

I believe there is something comforting about the spiritual terminology many of us have grown accustomed to when it comes to discussing death, but this should not keep us from acknowledging its reality.  When my mother died over a decade ago, I remember cringing internally when people would talk to me and casually say things like “when your mother died”. It was almost as if I mentally accepted that she was gone but didn’t want to hear other people acknowledge it so directly. In order to discuss death and dying in the appropriate manner with our patients, we need to recognize our own reservations and find healthy ways of dealing with them. Being caring, compassionate healthcare providers at times involves having honest but difficult conversations. We need to overcome our own internal barriers in order to do this effectively.   I can’t help wondering why that one statement in the intern’s handbook has stayed with me till this day, but it turned out to be a very valuable piece of advice.

  1. Grinberg, C. Saying the D-word.

Peju Simoyan is a Medical Doctor. She lives and works in the United States of America.

Posted by Deji Yesufu

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