
How to Tell a Mother Her Child Is Dead - niyazpk
http://www.nytimes.com/2016/09/04/opinion/sunday/how-to-tell-a-mother-her-child-is-dead.html
======
alasdair_
My twenty one year old daughter died two months ago. A young policeman came to
my door. It was the first time he had to do the job mentioned in the article
and he did it very well.

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.

~~~
JshWright
I've come to hate fentanyl... In the past couple years it has become
significantly more widespread, and in the completely insidious way you
describe. People think they're buying heroin (or worse, cocaine, at least if
they're a heroin user, they have some tolerance to opioids), and it's laced
(or completely replaced) with fentanyl.

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...

~~~
Darwizzle
Please do not hate Fentynal, hate the people choosing to use it. As a person
who suffers from chronic severe pain due to a near fatal illness, I can tell
you that For people like us Fentynal is a life saver as far as the quality of
life it provides to those who need it. It is one of the few medications I can
take as it does not metabolize in the liver, if any does it is a tiny amount.
Fentynal also does not come in a powdered form they are taking a liquid
version and mixing it into powders, other then that one form all other
preparations are majorly tamper resistant being either in a matrix that almost
makes it impossible to even be affective in the system or on a patch which
breaks down over time to slowly release in the body. Of course there are
exceptions, but please do not hate the drug, hate this sick bastards that are
using it to increase their illegal sales! (my apologies to the OP for
hijacking their question.)

~~~
JshWright
When I say I hate fentanyl, I mean I hate the illicit and recreational use of
fentanyl. I'm well aware of its legitimate uses (it's my go-to analgesic in
the back of the ambulance). The drug itself isn't 'good' or 'bad', it's just a
chemical... it's amoral.

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.

------
jrapdx3
A subject I understand more than I can put into words. It's a duty I have had.
A 17 year girl died of an overdose. It was my responsibility to tell the
mother, father, pastor, brothers, sister. They were there all night in the
tiny, chilly waiting room, after notified their comatose child was brought in.

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.

~~~
secfirstmd
You Sir/Mam/Other, make me feel better about the human race.

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.

------
Jamesbeam
I've been a private military contractor for more than thirty years. Some of
the companies I was working for had very impersonal procedures to handle
deaths. I offered a few times to personally inform the family / next of kin
for the guys that were working with me directly but that request was always
denied because it was not "cost efficient".

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.

~~~
allendoerfer
This comment will be unpopular. When you have gone through something like
that, how can you continue to do the work you do? How can it still be worth
it? I do not know what exactly you do, but could it someday be someoneelse
telling this to your family?

~~~
Jamesbeam
I don't see why your comment would be unpopular. These are valid
questions.There is no easy answer to them tho without understanding the bigger
picture.

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.

~~~
patrec
I was completely unaware that there is a long established market for
mercenaries to catch war criminals.

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?

~~~
ptaipale
I don't see how the "mercenary sector" was created by Bush administration. For
instance, Blackwater got its first government contract after the USS Cole
bombing, from the Clinton administration.

~~~
patrec
I should have phrased this better. There have always been mercenaries of
course, and I believe there has been an uptick in US government use after the
end of the cold war under Clinton. I'm however under the impression that the
growth since 2001 has been unprecedented, as is the fact that the number of
private sector employees deployed to war zones by the US government
outstripped military deployments. So a qualitative change seems to have taken
place during that time, even if it was just the continuation of an earlier
development.

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.

~~~
ptaipale
I have no numbers, but I'd agree the use of contractor forces has expanded.
However, it clearly was an emerging trend already during the Clinton era, and
even before that.

------
bennettfeely
I just want to say the style of the article and it's direct, terse language
really captures the gravity of the situation and seriousness of the subject.

Very sad, but very well written.

~~~
themartorana
Two years ago and a day, I could read this and understand the gravity. Two
years ago my daughter was born, and now I can't read this, or see commercials
from CHOP, or anything else similar without my eyes filling with tears.

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.

~~~
alasdair_
They don't. They are different people. Their old life ended the day their
child died.

~~~
spydum
Indeed this is pretty close to it. It's funny the things which can throw you
off too. Striking up a conversation with someone and they ask how many kids
you have, or if you are going to try again for that boy or girl. Sometimes
it's easy, but Some days it will tip your emotional canoe more than you were
expecting.

------
helloworld
_Security is already outside the room and when they hear the first loud noise
they will know to come in. No, you will not have to tell them. They know about
the family room in the emergency department in summer in North Philadelphia._

What a heartbreaking essay. And how tragic that death by gun violence is
apparently routine in North Philadelphia.

~~~
yial
"We have money for new chairs every summer." Really feels to me like it drives
that point home...

I remember reading an anecdote somewhere that when it's hot out (temperature
wise) that physical altercations increase.

~~~
danielvf
There's actual data on this. The correlation between summer and increased
violent crime is real.
[http://www.bjs.gov/content/pub/pdf/spcvt.pdf](http://www.bjs.gov/content/pub/pdf/spcvt.pdf)

~~~
tamana
Spike Lee's first famous movie was about this.

~~~
mturmon
And it captures the feeling of heat putting everyone on a hair trigger very
well.

------
hopfog
One of my best friends died of an overdose a few years ago. His mother was
informed in a horrible way.

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.

------
mindfulgeek
When I was a year out of cancer treatment, I ran into a fellow patient. She
and I had a rare cancer and were treated with a handful of others.

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?

------
toopersonal
My father died younger than 50 years old when I was a child. My mother was
left behind with several small children and financial struggles. On the day of
his funeral there was a funeral of an 18 year old boy afterwards. She has told
me she consoled his girlfriend and when she saw the young girl standing there
crying, she thought that even though her own situation was as bad as it could
possibly get, this was even worse. Must have been a strange moment for her.
Maybe even a bit uplifting, as perverse as this sounds.

~~~
tbihl
I've been blessed to be very inexperienced with funerals. Two grandparents, an
aunt, and a high school classmate. With my grandparents, we knew it was coming
and had lots of chances to visit in the preceding year. Granted you always
wish you'd done so more, but those ones are relatively easy to handle and feel
like family reunions mostly. My aunt, who committed suicide around age 50, was
much harder, despite her having dealt with mental illness all her life such
that it wasn't out of nowhere. My grandfather, who outlived her by three
years, was devastated (his wife, my grandmother, not being around as she'd
passed away 45 years earlier).

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.

------
emptybits
When I occasionally start to think my work in technology is overly important
or that the woes of my startup projects are unbearably heavy, I'm glad I can
be humbled by something like this. This doctor has responsibilities and
gravity I will never know. Great article and great doctor. Wow.

~~~
tamana
Heyif, making fun stuff is important. If we didn't have any fun stuff, our
lives wouldn't matter and the serious stuff wouldn't be serious.

------
CapitalistCartr
I had to tell that to my own mother. It was 5 years ago this week. There are
no good ways. There are no good outcomes. This is a good article about how bad
it is.

------
OliverJones
I've worked as a hospital chaplain in a big and well-respected urban teaching
hospital.

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.

------
drauh
For some context, here is a map of poverty in Philly:

[http://www.nytimes.com/newsgraphics/2014/01/05/poverty-
map/](http://www.nytimes.com/newsgraphics/2014/01/05/poverty-map/)

The hospital is in census tract 016300 with poverty level 58.5%

------
sndean
Somewhat related - One of the reasons my significant other decided to not go
into emergency medicine was the high rates of PTSD in ER physicians and
nurses: "We don't have good numbers, but the incidence of PTSD in emergency
physicians is probably around 17%" [1].

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.

[1]
[http://www.medscape.com/viewarticle/840980](http://www.medscape.com/viewarticle/840980)

------
ghufran_syed
"The depth of the stupidity of the things you will say sometimes is
unimaginable." -I'm pretty sure everyone who has ever had to do this has felt
the same way.

------
hoodoof
I had to tell friends that one of our closest friends had passed away. The
only thing I would add to this article is to invite the recipients of the news
to sit down first because there's a good chance they'll fall down.

~~~
JshWright
That's why you, as the person delivering the news, sit down. It invites the
family member to sit down without the awkward "Why don't you sit down..."

------
FT_intern
Why is this "how to tell a mother her child is dead" instead of "how to tell
parents that their child is dead"?

~~~
JshWright
I have told parents their child has died. It may not be 'right', but in every
case, even when both parents are present, I'm talking to the mother.

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.

~~~
cperciva
It is certainly a general rule that fathers are not seen as being equal
parents; I think FT_intern's point is that they _should_ be treated as equal
parents. The headline's casual dismissal of fathers is symptomatic of a
societal failing.

~~~
JshWright
It's not so much an 'equal parent' thing, in my opinion. Like I said above,
I'm a father of three (I'm up feeding our 4 month old twins right now
actually...), and we're absolutely 'equal' parents. My wife handles a larger
share of the childcare duties, just like I handle a larger share of the
landscaping... It's just the division of labor that works best for us. We're
both very aware of, and quick to correct, attitudes that she's somehow more of
'parent' than I am (e.g. when she goes out in the evening, I am not
"babysitting"...)

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.

~~~
cperciva
I have no doubt that you're in the majority; stereotypes very often exist for
reasons of statistical predictive power. But that doesn't mean that we
shouldn't recognize and push back against the stereotypes, for the sake of
those who aren't (or even more importantly _don 't want to be_) part of that
majority.

------
cmmn_nighthawk
this makes all debates about software seem trivial. i agree--it's very well
written.

------
rhyselsmore
As an ex-paramedic this really hits home.

------
fnj
It doesn't have to be a child in the sense of being young. No parent should
have to outlive their offspring, especially when they are very close daily. I
witnessed the effect on a 90+ year old mother of the sudden unexpected death
during sleep (natural causes) of her daughter who was almost 60 but very
vibrant.

It was crushing. The mother never recovered any of her joy in her own life and
only lived another 2 years.

------
known
Really painful.

------
andrewvijay
Absolutely terrifying! "If he left his socks on the floor again today, it is
all right." \- the only sentence I could relate to. I hate my life.

~~~
xapata
Why hate the absence of tragedy?

~~~
andrewvijay
I don't hate the absence of tragedy but the things I do at home that bother
other people like this socks example.

------
Kenji
Wow, that was surprisingly moving. For some reason, I expected one of those
dry hacker essays.

------
milesf
I know this will sound cold, but why is this story here? Does it really fit
the guideline of "anything that gratifies one's intellectual curiosity"?

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.

~~~
kctess5
I would say that this does in some way gratify my intellectual curiosity. I
hope to never find myself in this situation, but it's good to have some
guidelines if I ever do.

------
epicureanideal
The article is basically saying not to flip out, but "When you get home, do
not yell at your husband. If he left his socks on the floor again today, it is
all right." We all know that this doesn't just happen after someone dies on
the operating room table.

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.

------
mastre_
> I just want to say the style of the article and it's direct, terse language
> really captures the gravity of the situation and seriousness of the subject.

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.

~~~
sctb
We detached this comment from
[https://news.ycombinator.com/item?id=12421811](https://news.ycombinator.com/item?id=12421811)
and marked it off-topic.

