Death in the NICU

1. What are your thoughts and feelings regarding a death of your patient (baby).

I would say that I am always upset and sorry for a family when I lose a patient, but it depends on what was wrong with the patient. If a 23-weeker who weighs 500 grams dies, it is easier to take than a big, hearty full-termer who has MAS or goes into PPHN and dies. In each case, I feel awful for the family. But I am better able to reconcile in my mind the loss of the micropreemie.

2. What are any concerns you see that could smooth the process for staff and families?

I think we do a pretty good job at my hospital. We encourage the family to be with their baby and spend plenty of time with him or her. We try to move them to a private area (we have one large room, with three more private isolation rooms), and we allow them to have as many people come in as they want to. The chaplain is always available, and we call in their own clergy if they prefer. Also, if we are harder hit than usual, there is always opportunity to speak with a chaplain and the social workers. We also serve as a great resource for each other.

3. Do you feel responsible? If so, how do you process the thoughts and find relief?

I don't really feel much responsibility when we lose a baby because of the fact that a team of people were responsible for the baby's care. If I were to make some large error, and that resulted in a loss of a baby, of course I would feel responsible, but that's another topic. I do feel awful when it happens, but I don't feel a sense of responsibility.

4. What suggestions do you have for staff to better prepare for a death?

Hmmmm...don't really have any. Take advantage of your coworkers support to help get through it. Remember that it is about the family first and about you second. Ask for help if you need it.

5. When should ethics committees step in? Do you believe in ethics committees? Your experience with them?

I have not had any experiences with the ethics committee. I guess they should step in when there is real break between what the doctors know to be true (no hope of recovery) and what the family hopes to be true (a miracle in the making). I do believe that there is a place for them, but we have not had to ask them to step in during my time in the NICU.