Unexpected Intraoperative Patient Death The Imperatives of Family- and Surgeon-Centered Care

Conveying to family members that their loved one has unexpectedly died during an operation is perhaps the most stressful task a surgeon must perform. The loss of a patient’s life precipitates enormous personal and professional anxiety and stress on a surgeon: profound grief, damage to self-esteem, loss of self-confidence and reputation, and the specter of litigation. Most surgeons feel unskilled in such a setting, yet how they communicate—what they say and how they say it—is extremely important for everyone involved. Two distinct, but interactive, phases of response are relevant when communicating with a family before and after an unexpected death of their loved one: a proactive phase (“CARE”) intended to establish a positive therapeutic relationship, and a reactive phase (“SHARE”) intended to respond to the crisis in a compassionate and respectful manner and to ensure self-care for the physician. Arch Surg. 2008;143(1):87-92 It is every surgeon’s nightmare. An otherwise healthy patient was scheduled for an outpatient operation under general anesthesia. The patient had no discernible underlying risk factors, and recovery was expected to be routine. Early postoperative discharge was anticipated after the patient’s condition stabilized. The preoperativeinterrogation,physicalexamination,and laboratory analyses were all unremarkable. Intraoperatively, however, something unexpectedly went dramatically and terribly wrong and the patient died. We believe that the process of communicatingwithfamilymembersaboutanunexpected death of their loved one can be considered in 2 distinct phases: proactive and reactive. The arguments and perspectives herein are predicated on our individualandcollaborativeprofessionalexperiencesandourreviewandcriticalanalysis of the relevant published literature.