Monday, January 16, 2012

Unanswerable Questions

At a recent call, I was asked that simple question that most family members want to know. Simple questions should have simple answers, but this one rarely does. "Will he be okay?"

The answer I could not say was "How on earth should I know?"
Unfortunately, that is always the answer, because no one ever knows. Not me, and not the doctors, either. The answer I give to that question varies with the situation.

It reminded me of various times I've been asked questions that were difficult to answer, for one reason or another.

Like the first time a patient asked me if they were going to die.
Or the time one asked me- begged, really- to help her die, right then.

What kind of answer am I supposed to give them? There isn't one, and yet, I can't just ignore the question.

I've heard a variety of the "will he be okay" questions, in circumstances that ranged from almost silly (no real injury at all) to not silly at all (where the answer was closer to "I really don't think so.")

I've been asked a few times if a patient was, in fact, dead. Usually when it was pretty obviously so, but clearly they were hoping for a different answer, one I wished I could give them, but could not.

In my original EMT-B class, we were told not to lie when asked these questions, but we weren't really told what to say. We were encouraged not to use euphemisms, so that people would clearly understand what we meant. I get that.

But saying "Yep, grandma's deader'n a doornail" probably isn't the best choice.

It finally occurred to me to look at what all these people were really saying, really asking.

When the patient was dead, they pretty much knew that, so they couldn't really be asking me if it was so. They also ought to know that I can't predict the future, and can't make any guarantees, so they can't really be expecting me to know, for sure, whether someone will "be okay." Hoping, maybe. Expecting, no.

What they all have in common is fear.  Fear of death, and fear of the unknown and unknowable. In addition to any actual answer, such as there might be, they are looking for, asking for, acknowledgment of that fear. For the most part, they are in a situation they did not plan on, probably did not expect, and can't control. With that level of stress, people say things that don't necessarily make logical sense- and that's okay. What comes out is what comes out.

So I try to answer questions when I can. When I can't, I explain why I can't, and express an understanding of their wanting to know.

For the one begging to die?
The best I could manage at the time was "I'm sorry you are in so much pain. We're doing the best we can to make it less."
And I really WAS sorry. I had never seen anyone in such pain before, and it was quite unnerving. It took me a while to learn to separate myself from a patient's pain. Almost as if I got confused, and didn't remember I was not the one in pain. This is a topic I'd love to see a class or conference session on, working with patients in extreme pain.

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