You are FY2 in in respiratory medicine department.
A 65 year old man has been admitted 4 days back with SOB, unfortunately he dies yesterday
His cause of death has been found acute respiratory failure due to chest infection
His wife wants to talk to you as she wants to be sure about his husband’s cause of death
She heard about post-mortem, she is willing to conduct that.
She is happy to receive the bereavement offer by the hospital.
She will buried his husband not cremation.
She knows very little about the post mortem process.
Task:
Talk to the patient’s wife and address her concerns
Concern:
Will postmortem disfigure his body?
How much time will it take?
Management:
Greet and confirm identity.
Introduce yourself, build good rapport and show empathy towards her for her loss (How are you coping Do you think that we can do anything from our side to overcome that difficult time? I appreciate that you come to talk to me in this difficult time).
Take history of the incident and concern (how muchdoes she know, from where she got to know, has she discussed with anyone else, funeral plan, bereavement offer etc and take history of husband’s medical condition in a brief) and check for understanding.
Explain the post mortem procedure shortly and signpost.
Address concern post ported will not disfigure the body and it won’t delay the funeral.
Usually post mortem takes 3days , but she can do the funeral arrangements since the paper works are released.
A 65 yo man who was admitted 4 days ago with SOB died yesterday.
The cause of death has been found to be acute respiratory failure chest infection.
Death certificate can be issued with a diagnosis of respiratory failure but has not yet been issued.
The cause of death was found to be respiratory failure secondary to chest infection.
He was having COPD for last 10 years.
His wife wants to be sure of cause of death.
Her wife is planning for a burial and not a cremation.
She has a friend who is a nurse in another hospital, and she advised her to ask for a post-mortem.
She didn’t need any help with funeral arrangements.
She was not sure when they would be conducting the funeral now.
Simulator was teary but was calm
Task:
Talk to his wife Anna and address her concerns.
Concern:
Can I request for postmortem as I want to know the cause of death?
He was doing fine. How can someone die only because of chest infection?
How long will the procedure be?
Will the stitches be visible? Will his face get distorted?
When can we prepare for the funeral?
Management:
Greet, introduce yourself and confirm identity.
Explore in short history what happened so far.
Any risk factor for the condition.
Appreciate to come with the concern to you.
Express enough empathy.
Ask concern.
Explain: though he was admitted here with a chest infection. Unfortunately, he developed respiratory failure which means his lungs could not work because of the infection and that is what he died from.
Assess understanding about post-mortem:
We do this procedure to find out the reason of the death and understand the circumstances of death.
We need to take consent from you that you are agreeing to go through this procedure. Usually 24 hours are given to take the decision.
It is done by the specialists in a room like operating theatre.
It starts off as an external inspection and then it proceeds to internal examination.
During the internal examination the incisions are made but kept to the minimum to make sure we don’t disfigure the body
If specialist needs to examine the organs of the body are carefully removed and inspected before they are returned with caution not to disfigure the body.
Assure her that we deal with deceased body with dignity and respect, we do small cuts on the body and it will be sutured again by nice stitches and we don’t do cuts on visible parts of his body like face or arms.
Procedure takes couple of hours to get finished but examination results may take 3 days to come and you can do funeral arrangement since the paper works are released.
Offer support: Bereavement support as talking and sharing your feelings with someone can also help. Also, we can offer funeral services.