How to Tell a Mother Her Child Is Dead
nytimes.com
nytimes.com
I have very little memory of those first few hours. I now know what it is to be insane. I was so disconnected from reality that people have told me that I had long conversations with them that I have zero recollection of. The only thing I clearly remember was telling the officer that I had a gun upstairs and that if he didn't take it, I was going to murder the man responsible for her death within the hour. It was the most matter of fact confession of planning a murder imaginable.
After a couple of hours, I saw a Facebook post of hers and lost it, the insane calm left me and I bawled my eyes out.
It's her birthday tomorrow. I miss her so, so much.
Anyway, the point of this post: my daughter died of an overdose. She was at a party, a man gave her powdered pure fentanyl claiming it was cocaine. I have no idea why. She snorted some and overdosed soon after.
All I want to happen is that someone somewhere reads about what happened to my daughter and reminds their kids that without proper testing kits, they have no idea what the fuck they are taking. Drugs may not be bad, but some people certainly are.
I'm a paramedic in a nice suburban area. I've been doing this a little over a decade now. I managed to make it a good long while without having to deliver life changing news to a parent. In the past two years I've done it way too many times.
I'm so sorry for your loss. I have witnessed your pain in others, and I know that it's beyond my comprehension...
All fentanyl, legal or otherwise, starts out as a powder (generally as the salt, fentanyl citrate, though illicit labs produce a number of variations...). You're right that there is no powdered form sold legally, but most of the illicit sales come from labs in Mexico and China, and is indeed in powdered form.
Far better: "I cannot pretend to understand how you're feeling", "I can't imagine...". Perhaps with "I can only appreciate how difficult it may be", and so on.
One thing remains the same, it's always my least favorite task as a paramedic.
"I feel how weak and fruitless must be any word of mine which should attempt to beguile you from the grief of a loss so overwhelming."
http://www.sirchie.com/nark20033-fentanyl-reagent.html#.V8uE...
The problem is, it's a destructive test, which makes it unattractive to both dealers and users, as it requires wasting at least some of the product.
Seems strange, when tests for other drugs are available.
That will hopefully be changing soon (at least in the US): http://www.wsj.com/articles/u-s-china-reach-agreement-to-ste...
I'm not sure about testing kits, but there is naloxone, which is becoming part of standard operating procedure in reversing overdoses and is even available OTC in some states. If something is learned from your daughter's death, I hope that the availability of naloxone becomes better known and even more widely adopted.
My parents were devastated when my brother died. Coping with his death very nearly killed my mother, and almost certainly killed my father. As cliché as it sounds, there is life after death, and you have loved ones who will help you through this. Not believing that probably worsened my parents' state of mind. I wish you strength, peace, and light in the coming months.
I know it doesn't count for much right now, but I promise that things do get better in time. If you ever need to chat, feel free to message me anytime.
If heroine were legal 100 deaths would have been avoided that weekend.
http://www.esquire.com/news-politics/a46918/heroin-mexico-el...
"American drug and law-enforcement officials, concerned about the dramatic surge in overdose deaths from pharmaceutical opioids (165,000 from 1999 to 2014), cracked down on both legal and illegal distribution, opening the door for Mexican heroin, which sold for five to ten bucks a dose"
A trusted source of a heroine-like drug was removed, so the cartels increase production of heroine. But fentanyl is more profitable, and
"The cartels mix fentanyl with heroin because once an addict has shot that mix, they won't go back to "just heroin," since they can't get high on it anymore."
and we end up with a much more dangerous product.
Sorry to nitpick but this is a fairly delicate subject. Does a typical 'bad' person for whom it would be totally ok to overdose exist?
From the point of view of outcomes and efficiency it's better to approach people as individuals and not as statistics, or even worse, statistics with moral binning into good and bad. The logical argument is that humans are complex and it takes a lot of time to gather sufficient data to be correct.
I can dig out references if you like but medical facilities which focus more on individual-to-individal interactions rather than on factory like throughput work better.
experimenting with drugs which, even if they are what you think they are, can be fatal. Especially when mixed (as they often are) with alcohol and other narcotics.
There isn't some special shield around newbie drug users to protect them from consequence. I find the whole concept bizarre, they are well within their rights to experiment but then they own the consequences.
That's exactly how "stereotypical bad" people start out. It's just that fentanyl kills them faster, while other drugs leave them time to self destroy until we no longer have any empathy.
The difference is how long the average person can stay a casual user.
And of course punishments deter crime. Not the crime that happens, obviously, but the crime which is never committed. There would be more rape, theft and murder if there were no consequences at all.
What I want to say is that demonizing marijuana can allow a bad comparison in the form "marijuana did nothing bad to me, all the thing they say about drugs are nonsense, so I can move to other drugs and be ok".
Truth is marijuana is harmless, compared to almost all the other drugs, including alcohol and tobacco.
Yeah, it's bad for business. Good consumers must sink all their money and all money of their relatives to drug dealer, drug clinics, etc.
This is definitively wrong. They do not meet the medical criteria for substance use or substance dependence. Nor is it statistically probable that a person eventually will, given that they have taken the drug at least once.
Please do not spread misinformation.
People will do drugs, I accept that. I just want them to know the actual risks of what they are doing. I can't stop adults choosing to take drugs but maybe I can remind a few people to be a lot more careful and to be less trusting of their suppliers.
Also do you realize what you're saying to the author of the root comment? Shame on you.
Even though I'd also like to see such a link, I'd argue that because you're the one making a rather strong (purportedly factual) statement, it's up to you to provide evidence for it.
Don't get me wrong: I don't have a strong conviction on this matter. I really do want to see some evidence to inform my own point of view.
That said, the vast majority of my friends have used cocaine, as have I. Most of them multiple times. None of them have a problem with cocaine.
I'd never encourage someone to experiment with cocaine or heroin because it can be quite dangerous. But misinformation is potentially even more dangerous.
This is demonstrably false, in most cases.
I admire the self control you had in telling the cop about your gun despite knowing what you wanted to do with it.
If you are married, I have seen a pattern where the loss of a child severely impacts the marriage negatively. Try to resist that if possible.
I'm very sorry for your loss.
I think this may have been written for you. https://soundcloud.com/boudwin/the-wall-2
thank you for sharing your humanity with everyone who reads and spreads this profound insight
in the absence of undoing i only wish i could offer relief by sharing the burden of experience with you
whatever solace there is to find, i want you to know your strength is affecting
Some kind of party had been going on when mom and dad were out for the evening. The young woman and assorted friends doing drugs. She passed out, it was hours before anyone thought to check out how she was.
I called in all the docs there were to call. We tried every trick there was known to try. Then heart rate fell to zero. All the effort came to nothing. Everyone was quiet, mumbled their sorrow, and slipped out the private staff access door. That is everyone but me.
That morning was about the hardest I ever faced, even in the decades since. Sure others have died on my watch, one cause or another. But that time was different. I knew I had to say it, give the worst possible news, the unnecessary death of a child, to grieving parents. I truly did not know how such a thing can be said, what phrasing is best, what stings the least?
I don't know how, but summoning the courage I walked out to where they were sitting. I was nearly in a trance, not only from lack of sleep, but stunned by the magnitude of what I had to speak. And I said what happened, the child passed away, never awakened despite the heroic efforts of so many healers sweating all at once.
I sat there for a moment, no more to say, listened to the mournful sobs. Though I felt a failure, more than anything I had no comfort to provide. They didn't find fault, they were not angry that we could not do more.
Seriously, a moment too stark, too profound to ever forget nor would I want to relinquish it. No repeat is necessary, the lesson deeply embedded, the value of life, the meaning of words, the merit of a healer's human voice, these are all worth keeping.
Can't imagine how hard that was, but you did the difficult thing and your best at it in the hardest circumstance I can think of.
Thank you.
So I always did the trip on my own.
The loss hit them like a truck every time, I have a few memories that make me wake up in the middle of the night three days a week but the look on a mother's face when you tell her that her son is dead is something you will never forget as long as you live.
Still, I am glad I went to see every family of everyone I lost in all those years. There was crying and screaming and tears and a lot of blaming, I even got slapped a few times but I always told them I'll be in a hotel nearby for the next days and if they want to talk they can call me any time of the day.
Some never called but after a day or two most invited me back to their home or came by and we had a few long talks over the next days until I had to go.
I've been in touch with most of those families over the years and I heard a lot of times that it gave them peace to know that I was there when their son / brother / husband / grandson died and that I came by personally to try to comfort them before they got "the letter".
I wish everyone that you will never come into this situation because it's almost as hard and unfair to be the messenger as it is to be the recipient of that message.
When I was young joining the army in my country was an easy decision, the money was good and it was a safe job. Recruiters would tell you that you could make an impact on the world and make it a better place for everyone while making enough money to easily fund your kids future and live a good life if you do the job long enough and are willing to put blood, sweat, and tears in.
But within a few years, I realized that what I did had no impact whatsoever, and the money was only good if you went home in one piece or alive at all.So I quit and specialized in tracking down war criminals in the private sector.
It is a long way before you see some of these people in front of the International Criminal Court for example. Many don't even make it there.
You ask how I could continue the work I did?
I had the chance to talk to these people sometimes for an hour sometimes for days before handing them over and one question I always asked was "What do you think would have been necessary to keep you from doing what you did?" and most of the answers boiled down to "nothing, besides a bullet maybe".
And that is exactly the reason why people like me are necessary. You can't sit down at a table with these guys and talk them out of it. There is real evil in this world. And these people are the living proof.
They think they are invincible and above the law and when you see how long it takes to bring these people to justice you begin to understand why they think that way.
Now I'm retired. So no, I am pretty sure the cause of my death will be natural some day.
As far as I'm concerned I don't need to write a book about what or how I did what I did. And outside those trials, my name will never be mentioned anywhere.
But the families of all the people I worked with that died and all the families and mothers that suffered by losing their sons and daughters and husbands because of the war crimes that person ordered will get a little bit of peace, knowing that no matter how rich or powerful you are there are people coming for you willing to give their lives so you rot in jail for what you did.
Can you say more about clients and rules of operation?
What is the relationship to the multi-billion mercenary sector (Blackwater/Academi etc.) the Bush administration created to make its wars more palatable?
Unfortunately, I don't think I can and this also would do no good for the original topic. I hope you can understand that.
If you are interested in the topic what I would recommend is to try to get a better understanding how the investigation in war crimes is handled, especially after a country pulls all or a large part of its armed forces from a conflict region like Iraq or Bosnia.
You will probably make some interesting discoveries that will satisfy your curiosity . Good luck.
I could easily be wrong though, because I'm having trouble finding precise and dependable information online – if you have some good pointers about the growth and changed role in US politics of mercenaries, I'd be interested in reading them.
Just out of curiosity, not saying any side is good or bad, but did you ever run into someone whose rationale was "Because I was 19, Dude. Because, but for the grace of god, it would have been me in the ditch with a bullet in my head."?
Yes, I heard a lot of excuses, especially in Africa.
But it never really mattered to me in a way that I would have said to even a single one ok I let you go and you disappear and spend the rest of your life doing good to make up for what you did.
Some things these people did are beyond what any normal person can imagine.
If a 20 yrs old is in tears and tells you that he was high and ordered to do what he did three years ago and that he was a child soldier for most of his life, then it's just human to feel bad for what happened to him. No kid on the planet should go through that kind of hell.
But if you make the decision to shoot a man in the stomach and let him bleed out, then behead his kid in front of his eyes and rape his wife in front of a dying man before cutting her throat because you claim you were ordered to do so, that is the end of a chain of bad decisions that you made in the past.
I did not walk a single mile in his shoes, so I can't judge if I would have acted differently in his situation with a past like that and being drugged out and forced to do horrible things even before that. But if you make this decision then you also need to be aware of the consequences.
If he had talked about the military, yes I would have posed the same question. That people in the US seem to be okay with paramilitaristic private companies is beyond my understanding, but I was not criticizing this here. I am honestly interested in his motivation, because I cannot think of anything I would do with these consequences attached. Maybe when not doing it would make it even worse, but I do not think this applies here. There is another thread where a doctor describes the same horrors, but his motivation is clearly that sometimes his actions can actually avoid this. Yes a soldier could save his friends in a battle, too, but to me the most effective way would be to convince his friends to not go to the battle in the first place, maybe even by leading by example.
> Well, you do seem judgemental.
As seen above, I am a bit, at least I might have a different view on things. Still you can talk to each other and my question is not political but emotional: Just how can you keep going?
If he had talked about the police with this number of losses, I would also ask how you can keep going and not become either depressed or politically active. While there are police deaths, that many OP is describing here are not normal if you look at international statistics, since OP does not seem to be some sort of national police chief, who has to visit every relative of a dead officer and I guess would already be a kind of politician trying to solve the issue.
Does that change your view in any way?
His post perfectly answers my question. I can see why this is a huge motivation.
Very sad, but very well written.
I don't know how people lose a child and come back from it. I say I can't imagine, but I do, and it terrifies me.
Then the first child came and I can't stand more than a passing glance of kids in war torn areas or have to shut off a news clip where some monster did something awful to a child. My blood boils and my heart shatters nearly instantly.
1 second after my first child was born I realized I had only two fears for the rest of my life: not being a good enough dad and living longer than any of my children.
When my wife went into labor at 26w with #2, it hit like a ton of bricks. I remember vividly sitting in the atrium at LPCH after being told she was going to deliver within the day, and we didn't know what her issues were ("any handful of genetic disorders are likely") I lost it. That moment, seared in my memory. I had an hour alone to digest before I had to go back and be strong for her, and to this day, she hasn't asked me what I did, what I thought. She can look at me and tell by the tears in my eyes what I went through.
And then the NICU director came to visit us, and reminded us, "take the long perspective, there will be ups, there will be downs. But for every down, she's still here fighting to be just like any other normal baby. Thrive on the fact that she wants that more than you'll ever know or the other kids will ever know, and we're going to do our damnedest to deliver that."
Now 18m later, she's doing better than any of them would have predicted. And not a day goes by that I can't see a LPCH commercial without losing it...
To the author and all other doctors...my full admiration for what they go through, the miracles they work, and the strength they confer to families in their most vulnerable times...
Having kids of my own I can't even imagine how fucking insane it would be. Don't even want to think about it.
What a heartbreaking essay. And how tragic that death by gun violence is apparently routine in North Philadelphia.
I remember reading an anecdote somewhere that when it's hot out (temperature wise) that physical altercations increase.
This is actually a joke among New Yorkers. Random slashing in the news in May? "Well, it's getting warmer out..."
1. http://wgntv.com/2016/09/01/police-union-tells-cops-to-avoid...
http://www.citylab.com/politics/2013/01/gun-violence-us-citi...
The 'build up' to the wet monsoonal season where I am in tropical Australia is well known as 'Mango Madness' season (it coincides with the mango fruiting season).
I have two sisters in the police force, my dad was a doctor and my wife is a psychologist. They all concur that the rate of murders, assaults, domestic violence, divorces, street violence, car accidents etc. all dramatically increase during these couple of months.
Looks like being cool-headed is more than a metaphor.
The police called her and told her that her son had overdosed and was on the way to the hospital. In the middle of the call they all of a sudden say "actually, he's dead!" like it was nothing special. His mother of course screamed out loud, which made the police upset (they said "hey, it's not my fault" or something like that, I don't remember exactly).
I normally have great respect for the police but I think this was handled catastrophically. They showed very little sympathy.
Of the three of us who remained, only two of us remained cancer free and she wasn't one of them.
A week earlier, there had been five of us.
I knew this. I didn't know if she did.
I didn't know what I would say if she mentioned them. It was possible she had the same problem in her head.
After we caught up, she asked if I had seen one of them.
Telling her the truth wasn't nearly as hard as answering her next question -- what about the other girl?
When my friend died, I saw his parents quite a few times in the following year. Every single one of those times weighed heavier on my mind than any of those three funerals, despite those having been for family members who I knew quite well. When comparing these early life tragedies to older people passing, the only similarity is death.
From a teaching point of view, I'm really glad this article by Dr. Rosenberg is available. For two reasons...
1. I wish I had seen it during training. It's spot on in every respect. Dr. Rosenberg's advice to stay with the bereaved, and enter with them into their grief, is good advice. There's no way to do it without simply doing it.
2. It's good that Dr. Rosenberg is teaching doctors to do this work. Often enough in the past, the Saturday night emergency department staff just said "page the chaplain" when they needed to deliver bad news. We chaplains don't mind doing our jobs, but that leaves the frightened family hanging while we scramble to get to the ED and figure out who / what before sitting with the family. And, there's always some practical decision-making that takes time. For example, a Roman Catholic patient needs a Roman Catholic clergy person. So, "page the chaplain" keeps people waiting.
If you ever have to do this, do everything you can to avoid physically looking down at the bereaved people. Don't stand over them. Sit on the floor if you must. Some waiting rooms have low coffee tables or side tables. That's a good place to sit.
In teaching hospitals, the new residents (fresh-out-of-school doctors) start July 1st every year. And, they staff the ED on weekend nights. So they are getting their first sustained taste of violence, right at the top of the summer heat. They went into medicine to heal people, not to pronounce them. So this is a big shock for them. The ED unit clerk should still page the chaplain, even if the doctor delivers the bad news.
This epidemic of violence is awful. For my part, I count strong narcotics with guns, knives, and cars as instruments of that violence. It's horrible that doctors and other hospital folks have to learn how to do this. But they do. It's horrible that families have to hear this bad news. But they do.
This article should be posted on the wall of every toilet stall in every high school in the country. Why there? Simply because everybody will see it and have a chance to read it in private.
http://www.nytimes.com/newsgraphics/2014/01/05/poverty-map/
The hospital is in census tract 016300 with poverty level 58.5%
So while I can respect the stoicism and clear focus on the emotions of the mothers of victims, I hope the author and other ER doctors also take some time for themselves to deal with the trauma they experience.
I am a father of three. Were I in those horrible shoes, I'm quite certain I would feel that my wife was the one "being told". Maybe that's just some misplaced "macho" attitude on my part, but it's always been true, in my experience.
So, I am very sensitive to your point, and I think it's an important one, but i don't think it's the primary motivator for the use of "mother" in the article.
I suspect the reasons are (at least) twofold. The primary demographic served by this ER doc has a very high rate of single mothers. I'm not making commentary on that beyond the simple fact that it is the reality. My guess is most of the time she's talking to the mother because the mother _is_ the only parent present.
When the father is there though, I studied he feels as I do... In that awful moment, I would want the doctor's attention on my wife. I would want as much support as possible for her in that time. I'll make do on my own for now... Like I said, that's likely misguided chivalry or a 'macho' attitude on my part, but it's my honest take on the situation, and I suspect I'm in the majority.
I normally wouldn't bother with a follow comment about a typo, but I think it seriously impacts the readability (like I said... feeding twins in the wee hours of the morning...)
It's abstractly difficult to inform a person that their close family member has died, potentially from violent causes, possibly very suddenly.
But come down this hallway, now, to tell this woman that her child is dead; this is what it will be like. You'll need to change your clothes first; you'll need to practice first; and this is what it will do to her, and what it will do to you.
I (obviously) found this very powerful, and while there's some compromise involved in adding in these carefully-selected specifics, it's worth it.
It was crushing. The mother never recovered any of her joy in her own life and only lived another 2 years.
I've shoehorned it into my rationalization for being here as advice on how to have an extremely difficult conversation, but it still feel a bit macabre to have this here.
Seriously people, if your spouse is not cheating on you, beating you, or throwing the family money to the casino, lighten up about the little stuff.
End of public service announcement.
Quick comment about how your it's instead of its caused an English parsing error in my brain:
I read until the comma and because I saw it's, I assumed I missed a word in the first part of the sentence - I though it may have been something like "I just want to say I evaluated the style of the article and it's direct, it's frank, it's spot on!", but re-reading it didn't reveal anything I missed. I then considered some less common writing styles/expressions. None of that worked out, so I read past the comma and figured out what happened. All this happened in the span of a second or so. Not sure what it was about this particular sentence that caused me to stop at the comma, I don't think it happens often.