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Stroger Hospital reaches out to families of dying

Thursday, August 11, 2005
Chicago Sun-Times
by JIM RITTER Health Reporter

The young man was brought to Stroger Hospital with gunshot wounds in his chest, neck, abdomen and legs.

"Am I going to make it?" he asked trauma surgeon Dr. Roxanne Roberts.

"We'll do our best," she answered.

Roberts worked on his abdomen while an orthopedic surgeon stabilized broken leg bones and a vascular surgeon tried to stop the bleeding. When the patient went into cardiac arrest, Roberts opened his chest and tried to jump-start his heart.

But he died on the table. And afterward, Roberts could spare only 10 or 15 minutes to break the news to the man's family and explain everything that happened.

"I'm embarrassed by that, but I had other seriously sick patients," she said.

$175,000 grant

Stroger's famed trauma unit saves the lives of a remarkable 98 percent of the patients who suffer severe injuries from high-speed car crashes, falls, gunshots, etc. and are still alive when they arrive at the hospital.

But officials say trauma units at Stroger and other hospitals could do a better job serving the non-medical needs of dying patients and their families.

"We're overwhelmed medically taking care of sick patients," Roberts said. "I don't have the time or training for bereavement counseling."

That may be changing. On Wednesday, the hospital received a $175,000 grant from Aetna and the Aetna Foundation to develop a hospice-like program for dying patients and their families. The idea is for Stroger to serve as a model for other trauma centers.

Training for doctors, nurses

Such a program likely will include training doctors and nurses on how to talk to dying patients and their families. "Many of us hide behind medicalese and medical technology," Roberts said.

The program also could include social services to help families to, for example, find a funeral home or view the body.

Nurse Susan Avila, who will help design the program, gives an example of what a program could offer. The case involved a woman who was brought to the trauma unit after being run over by a truck in a traffic accident.

She was bleeding to death and in severe pain, but had the presence of mind to plead for someone to pick up her child at school. Moments after the woman was told that such arrangements had been made, she lapsed into a coma and died.

In a traditional hospice, patients and families generally have weeks or months to prepare for death. In a trauma unit, the process can take only minutes or hours. Hospice patients typically are elderly, but at Stroger's trauma unit, the average age of death is 32.

Another difference: In a traditional hospice, doctors stop trying for a cure, and focus instead on making the patient as comfortable and pain-free as possible. In the trauma unit, doctors keep trying to save the patient, even while preparing families for the possibility the patient could die.

'It sucks the life out of you'

Some patients are dead on arrival or die within a few minutes. Some survive a day or two, while others spend two or three months in intensive care, facing life-threatening crises such as infections and emergency surgeries.

Perhaps the hardest part of a trauma surgeon's job is losing a patient and breaking the news to the family. "It sucks the life out of you for the night," said trauma surgeon Dr. Faran Bokhari.

Roberts has had to break the news dozens of times. She usually meets the family in a conference room, often with as many as 20 relatives. After Roberts returns to work, a nurse stays behind to comfort the family and answer questions.

"It's different every time," Roberts said. "And it's heartbreaking every time."

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