Each year, thousands of New Zealanders die unexpectedly. Someone has to tell their loved ones. Mike White meets the people with the worst job in the world.
Someone has to deliver that message, the worst of messages. Someone has to break it to you, and break your world apart.
Every year, more than 30,000 New Zealanders die. For most, there’s some warning: illness, gradual deterioration through age, the evil march of cancer. But for countless others, there’s little or no warning. The 1500 who suffer heart attacks. The 320 road deaths. The 570 suicides. The dozens of murders. The strokes, the stillbirths, the work accidents. And for each devastating death, there’s that essential but distressing task that follows: the job none of us would ever want to do, and are forever indebted that others do for us.
The Police Officer
It’s called a 2A. In police code, it means, “Advise Relatives/Owner”.
“And you know when that comes across, you’re hoping like hell it’s not you that gets assigned, because you know what it is,” says Steve Greally.
He was a first-year cop in South Auckland in 2000 when his sergeant phoned and said, “Hey, we’ve just had a 2A in the system. You can come with me; we’ll go and do that.”
It was a guy who’d been working in Wellington and was driving back home to Auckland overnight. He’d rung his wife on the way, to say he was going to be late, he was just going to have a bit of a sleep. She told him, don’t rush, she was going to work, she’d see him when she got home.
“But he never made it,” says Greally. “He’d fallen asleep. He was just too tired, and he went head-on into a truck and it killed him instantly. That was my job, to go and tell a woman who was expecting her husband to make contact with her during the day – and it never happened.”
When he met his sergeant outside where the woman worked, the sergeant asked Greally if he minded being the one to break the news.
“It wasn’t that he didn’t want to do it, but it’s a development thing. He knows that as a cop you’re going to have to face these things. And I said, ‘Yep, I can do that.’ I was up for it. But it terrified the bejesus out of me and I didn’t know what to expect. I knew it was going to be life-altering for this woman and could only go badly.
“My sergeant said, ‘Look, what you’ve got to do, mate, is just spit it out. Don’t try and coat it, don’t try and overthink it too much, because you’ll end up never getting anything out. What this person needs right now is someone being direct and compassionate.’
“I remember walking up to her work and she answered the door. She wasn’t expecting us and she looked at us and asked how she could help. And I remember thinking, ‘I succeed or I fail right now, because if I delay this any longer it’s going to be even worse.’ So I confirmed who she was and said, ‘I’m so, so sorry, I’m here to tell you that your husband has died.’ I just couldn’t think of any other way of saying it.
“She just looked at me, very stunned. I could see her whole world imploding before me, a stranger. And she dropped to the ground – I couldn’t catch her – she just collapsed.
“You know, as a junior cop, I didn’t know how to deal with that. I’d like to think, now, 17 years on, I would be better at it and more prepared. I thought she might scream, but she didn’t. She was silent and collapsed. It was horrible, absolutely horrible.
“I just sat there on the ground with her; it was all I could think of doing. I didn’t think she was strong enough to stand, so we just sat there for a while, and she tried to come to terms with what I was telling her.
“It’s almost like a cliché or a movie, isn’t it? Two cops walk up and knock on the door and take their hats off, looking solemn. She probably knew exactly what was happening as soon as she opened that door and saw two cops standing there. I don’t know if I helped her or not. But I know that sitting down there with her, and letting her know she’s not alone, was probably the best I could have done, with my limited experience and expertise.”
Often the next job in such cases is to contact other family and friends who can come and give support. “It means you repeat it and repeat it and repeat it,” Greally says. “And, oh god, it does your head in. That first one sort of knocked me round a bit. You get a little bit overcome with the emotion of it all.”
He remembers another time having to tell a young man his wife had died suddenly. Like Greally, they’d just got married. “You could see, when you looked around the house, the photos, the very proud wedding photos. Yeah, hell, why did she have to die in her early 20s? What was that about? It was just horrific, that one.”
Greally was so affected by what he saw and the similarities with his own life that he had to ring his wife while at the scene and talk to her. “Because it made me think of her and how I’d react. This can happen to us. Life’s cruel, mate, at times, I have to say.”
When he started as a cop, there was little awareness of how such events could affect officers, says Greally. “The culture was, ‘Shut up, mate, and get on with it.’ You felt like you were letting the team down or people would think less of you if you said, ‘Hey, I need a break. I’ve got to talk to someone about what I saw or heard or the smell…’ Trust me, all those things get into your brain.”
That’s changed greatly, with cops now encouraged to talk about their experiences, and counselling available. However, Greally says, every day cops as young as 18 or 19 – “with zero life experience when you think about it” – are tested with the most extraordinarily difficult situations, dealing with everything from road deaths to sudden medical events. “That’s part of being a police officer. There’s just no way around it, unfortunately.”
Greally, now a superintendent and the national manager of road policing, says in his career he’s had to inform relatives about sudden deaths four times. “I don’t know if four is a big number. I don’t know if it’s a small number. But I know it’s a bloody haunting number. I remember all of them. I know where they were and I can remember their faces and how they reacted.”
It never got any easier, says Greally. “And it never will, because you know the impact you’re going to have. There was nothing to indicate this person was going to die today when you gave them a kiss goodbye before they went to work or to school or whatever. You certainly expected to see them at the end of the day.
“You’re trying to make things right but you know you can’t make it right, because it’s not going to be okay. I could definitely see in every one of their eyes their life imploding, their hearts breaking, as badly as anyone’s could possibly break. It’s not like a split-up relationship – that’s bad enough. But this is, ‘I’m never going to see my loved one again and I didn’t get to say goodbye.’”
Greally’s advice to young cops who have to tell relatives that someone has died is the same as his sergeant’s all those years ago. “Be concise, show empathy. This is a human being who’s going to go through the worst experience of their lives, and you’re the one giving them that information.
“I hope like hell most people never ever have to do that job. I hope cops don’t have to do it in the future – but they will, because someone has to, and that’s what you sign up for. You’re entering into such an intimate part of someone’s life, not by their invitation. It’s the most incredibly personal thing you’ll do with someone you don’t know.
“There are some really great things about being a cop, moments you’re as proud as... Some really bad things, too, times that just terrify the hell out of you. But as bad as those things are – homicides, drownings, when someone finds a body that’s been decaying for many weeks or whatever – it pales in comparison to the worst job in the world. And there wouldn’t be a cop on the planet who could come up with a worse job than informing a family that their loved one – their mum, their dad, their kids, their partner, husband, wife – is not coming home.”
The Emergency Department Doctor
Often you don’t even know their name. They’ve been rushed in and you’ve done everything you can to save them, to bring them back from the brink. But at some stage you’ve got to call it: they’ve died. And then you need to tell their family.
Several times a year, Andre Cromhout, the head of Wellington Hospital’s emergency department, has this task, and it never gets easier. “The worst part of being an emergency physician, the absolute worst part of your job, is to tell someone their loved one has died.”
When he began as a doctor, 25 years ago, nobody was taught how to break bad news. “There are times I look back on that I’m not necessarily proud of how I did it, because I didn’t know any better.”
So he’s learnt on the job, largely through grim experiences. Here’s what he’s learnt.
First, before you walk out to the family, find out who the patient is. Get a quick history of what’s happened. Find out if the family was present when the accident happened. Find a private area to talk to them. Make sure only the people who need to be there are in the room. Crucially, find out who the family members are. Don’t assume. Don’t talk about a person’s father, when it was actually their partner. “That’s definitely happened. And that’s a situation where everything’s rushed and you just don’t think.”
When you enter the room, don’t delay the inevitable. “Be honest right from the start and say you’ve got bad news. The thing we sometimes forget is that by the time we walk into the room, our body language, our facial expression, even though we try to hide it, has already told the people there’s bad news coming.”
Give a very brief summary of what’s happened: they were brought to hospital by ambulance, their heart had stopped, doctors carried on cardiac compressions and did everything they could. “And then say that, unfortunately, the patient has died. The longer you take, the more hope relatives get that it’s bad news, but maybe not so bad.”
Use the word “death”. Say, the person has “died”. Use their name. “We’re all afraid to say ‘die’. But if I say someone has died, there’s no misunderstanding. I can vividly remember telling a mum her son had passed on, and what she thought is, ‘Oh, he’s in ICU [Intensive Care Unit].’ I’ve given her false hope and now I immediately have to break her down.”
So tell them their loved one has died, and then stop, let it sink in. “Because after that moment, relatives often don’t hear anything,” he says. “By nature, we want to try and explain things and that’s what I often find the hardest thing – to just pause.”
If they’re silent for a long time, ask if there’s anything they want to know. “Speak human.” Avoid medical language. “Words like, ‘We intubated the person.’ What does that mean? ‘We put a breathing tube down their mouth into the lungs to help them breathe,’ makes more sense to someone.”
Take another staff member with you, someone as backup for the family and you. Because it will be tough for you, too, especially if it’s a child who’s died. “There’s been more than one time I just had to walk out or I was going to completely lose it emotionally. My excuse has always been to give the family time to recover, but sometimes I just need to go and recompose myself.”
It’s fine to show emotion, but you can’t get too emotionally involved. The family needs you. Their reactions will vary hugely. Sometimes there’s just silence. Others will want to know what to do next: do they need to contact a funeral director? Others will want lots of details. And sometimes there’ll be an overwhelming outpouring of grief and heartbreak, the whole tragedy of what’s happened given howling voice.
If they ask if their loved one suffered or was in pain, be honest, says Cromhout. Tell them they were given pain relief, but that you really don’t know how much pain they might have been in. “We think everyone wants to be appeased and think it’s all good, but if I was a patient or a patient’s relative, I’d want to know the truth.”
Occasionally people will get angry and blame you. It’s just part of the grieving process, it’s not personal. Take it on the chin, be professional. Never, ever argue with them, even if you know they’re wrong. Let them vent. Say, “I know you’ve got lots of questions, maybe we’ll talk about it later.”
Then ask if they’d like to see their dad/mum/son/daughter/friend. That’s really important, that they get to spend time with them. But first you have to make sure that the victim is presented appropriately, with tubes removed if possible. “Because this is the last image the relative is ever going to have of them. So we have to do what we can to make that, under the circumstances, a good image.”
Most meetings will only last five to 10 minutes. Then you’ve got to move on. It’s an emergency department, there are other patients to go to. Sometimes they might be someone else involved in the same car crash, maybe the other driver – maybe the person who caused it. “And you have to dislodge yourself and your own feelings from this and give your full attention to the next person. It may sound easy, but it’s not.”
And when your shift is over, leave what’s happened during that day at the hospital. That’s not easy, either, especially when you’ve dealt with a child the same age as your own and you can’t help thinking, “It could have been them.”
“But work stays at work, and you just go home and you have to be a parent and you have to be a husband or wife.”
Talk about it with your colleagues. You can tell yourself that you’re hardened to death, “but I’m not sure if we really are. We’re all human.”
What Cromhout wishes is that we’d all be more open about death. “We’re all going to die, yet we’re scared to talk about it.” He says we should talk about how much intervention we want if we’re ill. “At the same time, let’s talk about organ donation and say, ‘This is my wish.’ We unfairly, sometimes, put relatives in a position and say, ‘What do you want?’ It’s actually not about what they want, it’s about what this patient wants – but we don’t know because the discussion’s never been had.”
Despite everything, the shock, the grief, the loss, Cromhout says most people understand what an unenviable job doctors have and are truly appreciative.
“We try and take the chaos out of it, calm it all down. I move on, I go and do other work. But that person is going to grieve for hours, days, weeks, months, years.
“We know it’s a difficult situation – we’re not going to change that. The tragedy has already happened, we can’t turn back the clock. But we can have an influence on how the relatives remember that day or remember that person, and I think that’s really important. We can actually make a difference.”
The Intensive Care Unit Doctor
Ninety per cent of people who come to an Intensive Care Unit don’t die, says Peter Hicks, who heads Wellington Hospital’s ICU. The country’s largest stand-alone unit, it deals with about 1700 patients each year, and 150-170 deaths – around three a week.
Every time someone is admitted, there has to be a careful discussion with family members. In the beginning, says Hicks, “you often tell them the patient might die. Then, if you see a decline, you might tell them it’s most likely they will die. And the next day, you might come back and say, ‘I’m very sorry, it’s clear they are going to die.’ The hardest ones are where the first conversation is to say, ‘I’m sorry, they’re going to die.’ Or even worse is, ‘I’m very sorry, they have died.’
“That’s the absolute worst, where someone rushes to hospital and the patient’s arrived and they’re already dead. There’s no way of softening that. You’re taking away any hope at the start and there’s nowhere for the family to go. At least if you say they are going to die soon, there’s an hour or two between, so the first news isn’t as catastrophic.”
There are two rooms at Wellington’s ICU where such discussions occur. They’re reasonably bare and bland, with space for about 15 people, a few boxes of tissues, a couple of peaceful prints on the wall. The truth is, most families realise that if someone is in ICU, it’s not good.
“What we often forget is what the families are thinking while they’re rushing to hospital,” Hicks says. “They always think the worst. And when they first meet you, you can say what you like for five minutes but all they want to know is, is the [family member] going to die or not. You can waffle on about the CT scan, and what happened in ED, and all that sort of stuff, but they’re still waiting to hear that one thing.”
And when someone has died, Hicks says you have to get to the point quickly. He then stops and says nothing; he doesn’t fill the space, no matter how uncomfortable the silence may seem. “Sometimes, the whole family is completely paralysed… Other times, people are able to go and comfort somebody else. You find adolescents are the ones who cope least.”
Once the family has been given the news, they’re allowed to stay in the room, their distress isolated from others in the waiting area.
The only time Hicks might not be upfront immediately is when someone has died before family members arrive. In that case, he’ll contact the family, tell them there’s been a severe deterioration in the patient and ask them to get to the hospital quickly. When they arrive, they’re told the news face to face. “It just seems wrong to do it over the phone. It’s a bit too brutal.”
At times like this, he says, people – men in particular – show feelings they never usually display in public.
“So you’re part of a very intimate group, of people expressing their raw emotions. And you create a little emotional connection because of that. You can’t not be affected by the emotion of the family.”
Over time, Hicks has learnt that for a day or two after such events he’ll feel like he does after a long night shift, or when he’s jetlagged, “a bit shitty, a bit short with people – you just feel out of sorts. Some of the circumstances are more tragic than others. But someone dying is always awful for the family.”
The Hospice Doctor and Nurse
“There are,” Ian Gwynne-Robson says, “a million potential euphemisms for death.”
The medical director for Te Omanga Hospice in Lower Hutt doesn’t deal in the currency of genteelism, the “time is short” or “things don’t look good” evasions. When he’s assessed a patient, he’ll ask them what they want to know.
“And 99 times out of 100, they’ll say, ‘Everything. I like it straight up.’ Worse than telling someone they are going to die is not telling someone they are going to die.”
Most people who come to the hospice know their condition is terminal, but few have been told how imminent their death might be. “‘How long have I got?’ is often the first question,” says Te Omanga’s director of nursing, Mary Death. “The old adage was, ‘How long is a piece of string?’ Doctors and nurses used to say that. ‘I don’t know, I’m not God… I can’t tell you.’ Well, we don’t say that any more. Now we say things like, ‘I think it could be days to weeks’, or ‘weeks to months’. It could be months to a year.”
Gwynne-Robson says he doesn’t dread patients asking how long they’ve got. “I know it’s coming. I often address it upfront before someone asks. I’ll say, ‘I don’t know how long you have to live, but if there’s stuff you need to do, do it now. If there are people you need to see, now’s the time.’”
If you’re too specific, “people are living till that date and they see it coming, like a freight train in front of them”. And he always puts caveats on any estimate: he could be wrong, or the condition they have means that they could die at any time.
Once he tells them that, “their priority bubbles to the top. ‘Oh my god, my son lives in Australia.’ Or, ‘I haven’t done my will.’ Or ‘I need to see the priest.’ What’s important to that person, for that minute, is going to be different.”
“People want honesty,” says Death. “We’re not blunt, we’re not in your face, but we will answer questions honestly. We’re all counsellors in our own way. But it can be the cleaning lady who cops the big question, because they’ve built up a relationship with her – she’s gone in every morning and wiped their table and had a chat with them. And they’ll say, ‘Do you think I’m dying? Do you think it’s happening?’”
Gwynne-Robson says you never become blasé, or unmoved by death’s impact. “If you did become inured to it, that’d be the time to leave the job. There are times when it’s very difficult emotionally. There are patients you identify with more than others. Some circumstances are very, very tragic – when you look after children, for example. That’s very, very hard.
“But the role of the clinician is, you have to hold yourself together, to be able to support that patient and that family. If, after it’s all over, you go down the corridor and burst into tears, well, that’s okay too.”
This was published in the March 2018 issue of North & South.