The Two Tragedy Speech: how to counsel the family of a dying patient in the intensive care unit

“There are two tragedies in life. One is to lose your heart’s desire. The other is to gain it.” -George Bernard Shaw


More than half the time in the ICU, I often spend my time talking to families about goals of care.

We had a young 56-year-old woman who came in with a subarachnoid hemorrhage (brain bleed). Overnight, she needed to be connected to a breathing machine due to respiratory failure. She was unresponsive even though she was on no sedation or pain medications. Although she still had her primitive “brainstem” reflexes, her EEG (machine that measures brain electrical activity) showed a flat line. Her wheelchair-bound father wanted to know what her prognosis was. This event was sudden. It was only last week when she was out buying him groceries and cooking him dinner, he said.

Our consulting neurologist put it best when he said, “Let’s try to prevent two tragedies today. The first tragedy is what happened to your daughter. Let’s prevent the second by not trying to prolong her life.”

I think that discussing end of life with patients’ families may be the hardest thing about practicing medicine. Sure, technology has come a long way and we now have all these complex procedures and new medications these days. But these things have rules or guidelines that as doctors we can easily follow. Now, telling a father to let his daughter die… That’s a tragedy that must be done to prevent another.

Key Points

  • Educating families of patients on death is important.
  • Acknowledging the facts can help families see the bigger picture.
  • Telling family that their loved one will die is never easy. And if you’re doing it right, it never will be.

How do you counsel your friends and family on death of a loved one? Please leave comments below!

3 thoughts on “The Two Tragedy Speech: how to counsel the family of a dying patient in the intensive care unit

  1. Jessica says:

    There are many ways to go about telling someone that their loved one is dying. Many ways. It takes finesse, and unfortunately some people are really quite terrible at it. I have found that if I build a rapport with the family with as much, or more often than not, as little time that is left- it makes a huge difference in how they will handle your tragic news. Introduce yourself- this gives you a chance to test the waters (what is their emotional state?). Ask what they already know and understand about the situation (here is where you should assess their medical knowledge). Listen! Then share your knowledge and use language that they will understand but do not dumb things down too much- people don’t like to be talked down to. Be frank. Be honest. Draw a picture of what is to come. Allow this to sink in. Don’t be pushy with the withdrawal of care. Re assess understanding hours later. Don’t be pushy! Put yourself in their shoes. Give hugs.
    That’s all I have doc!

    Liked by 2 people

    • doctormikesblog says:

      Wow, you have some great tips! I agree, introducing yourself should be the first step, and it’s such an easy step to forget. Have you had experience in telling a family member their loved one is dying? What was your story?

      Liked by 1 person

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