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Live and learn blog

Time to bury RIP?

‘Rest in peace.’ How many of us write this in patients’ notes when we confirm death? It’s not taught to us at medical school. It’s not in the ‘how to survive foundation year’ textbooks. But frequently I see it, even in notes written by colleagues trained abroad.

I struggled with whether to write this or not.  I felt I needed some way to demonstrate respect, to mark the recording of death as different to all the previous ward round scrawls and ‘ATSP re: constipations’.  But ‘rest in peace’ has religious connotations, Christian at that. I’m not religious.  Most of the time, I don’t know whether my patients are religious.  Would they want that in their last ever note entry?  How else can I show respect?

For a time I wrote out the day, time and date in full: ‘Mr X was confirmed dead at 2.24am on Sunday, May 4, 2010.’  This felt formal, sonorous, without being religious.  But then I started to worry that colleagues might view me as heartless.  Or, worse, soppy.

Why is an entry documenting death any different to an entry regarding any other aspect of a patient’s management?  Grow up, be detached, get on with it.

But I feel it is different.  Of course it is.  I remember the first time I saw someone die, when I was a final year medical student.  It was not a good death.  He had been writhing in pain just previously.  In the room was an F2 (foundation doctor 2), a support worker, another medical student and me.  When the patient stopped breathing, the F2 took us through the confirmation, the surreal calling and shaking (‘unresponsive to voice or pain’), the listening to the weird settling noises of a non-breathing thorax.  Then he left.

My fellow student and I lingered.  Was that it?  What about the guilty relief we felt?  What about — well, about the fact we had just watched someone die?

The support worker took us in hand.  He told us it was his and the nurses’ job to take the lines out, clean the body, tidy the room.  He opened the window ‘to let the soul out’, and told us to go for a cup of tea.

Bizarrely, the opening of the window was what reassured us the most.  We needed the element of ritual to resonate with our feeling that something big had just happened.

The F2 didn’t mention it again.  What was the need?  I suppose Kardexes and fluid charts were more pressing.  But when I was an F1 and had medical students with me when a patient died, I made sure to ask them if they were OK afterwards.

‘Yup,’ they nodded with rigid faces. ‘Absolutely fine.’

True doctors in the making.  Maybe allowing ourselves three words of ritual isn’t so bad after all.

Claudia Fry, core trainee in psychiatry, Scotland