Even during challenging circumstances, doctors find ways to communicate with patients and their families

 

BY AMBER SMITH

As they learn to perfect the practice of medicine, doctors also learn how to communicate during stressful situations, such as when a patient is near the end of life.

Sometimes families are estranged. They may not speak English. Some might not understand much about diseases and medical interventions. Emotions may be particularly raw if the patient who is dying is young. During the pandemic, the protective measures of masking and distancing complicated communications even more.

No matter the challenge, doctors learn how to help vulnerable families make vital decisions.

One neurosurgery resident at Upstate fielded all of these challenges, all at once, in caring for a patient during the pandemic. George Koutsouras, DO, reflects on what helped him help his patient in a paper he wrote for the American Journal of Bioethics Neuroscience with Upstate mentors Gregory Eastwood, MD, and Satish Krishnamurthy, MD. Eastwood is a professor of bioethics and humanities who teaches about medical ethics and has written about end-of-life issues, and Krishnamurthy is a professor and interim chair of neurosurgery.

The patient was a middle-aged man with an impaired blood clotting ability, who had profound bleeding in his brain. He became more confused as doctors worked to save him. The man was an immigrant and did not speak English. His wife was deaf and spoke only in the sign language of their native country.

As the man’s condition deteriorated, nurse manager Jessica Urtz and the palliative care team obtained permission for an in-person meeting with the wife and the patient’s oldest son, a teenager who spoke a little English.

To facilitate communication, Koutsouras explains, the staff located a sign language interpreter who knew the sign language of the patient’s native country as well as American sign language.

Because this interpreter was deaf, a second interpreter who knew American sign language was called in who could also speak in English.

The conversation between Koutsouras and the patient’s wife moved slowly because of the translations.

“I described the natural history of her husband’s disease and that, despite our greatest attempts, his condition was irreversible,” Koutsouras says. The wife signed an emotional reply. “Just by observing her body language, I could see clearly the sadness and fear of losing her husband.”

To help the wife make decisions about whether to prolong her husband’s time on ventilator support, the hospital staff contacted another relative who worked in health care. They communicated through a video chat.

At one point, the son spoke, to make sure his father was not in pain.

Koutsouras admits feeling anxious throughout the family meeting. “I found myself also relying on my own life experiences to provide an added sense of empathy and relieve my anxiety. I, too, have been on the receiving end of terrible news of a family member’s health condition and have had to make end-of-life decisions for a dear loved one.”

He knew the importance of being with loved ones near the end of life. The pandemic made that impossible for so many families, which meant doctors and nurses were there to help relieve fear and suffering. In this case, he worried that important points would get lost through the multiple translations.

Koutsouras soon realized that his major points were getting through to the family.

They understood that their patriarch would likely not survive his injury. Even if he did, he would not be the person they knew before.

The wife asked that her husband be made comfortable until he died.

“To appreciate the significance of this moment for this family,” Koutsouras says, “I realized that we did not need to understand the language to appreciate their grief and anguish.”