THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Thursday, July 11, 1996 TAG: 9607110389
SECTION: LOCAL PAGE: B1 EDITION: FINAL
SOURCE: BY DIANE TENNANT, STAFF WRITER
DATELINE: NORFOLK LENGTH: 112 lines
Death had met Michelle Murday many times.
Suicides, accidents, old age - its terms were never known in advance, but the 26-year-old medical student thought the passing of a few close relatives and friends had prepared her for handling death.
Until Murday had to tell a pregnant woman that her husband had died in a car wreck.
Nothing had prepared her for the hysterics, the withdrawal, the utter aloneness of the woman sobbing in the emergency room.
``Time out,'' Murday said. ``I'm stuck.''
The tension in the classroom broke. The ``pregnant woman,'' actually a local actress who plays the role of patient for Eastern Virginia Medical School, froze in place.
For an instant, death was on hold, while six third-year medical students grappled with learning how to break bad news to the living. Only five of 126 medical schools nationwide require courses in life, death and dying, and this week EVMS offered its first seminar on the topic.
When is it OK to hug a patient? How do you get the tissue from the box into the patient's hand? What if the doctor wants to cry, too?
Murday was unsure. Medicine, which had taught objectivity and neutrality, suddenly needed compassion.
Empathy, urged the instructor. How do you feel?
Murday, who had felt confident about this role-playing, found herself at a loss for words.
And the students who sat facing the bereaved ``widow'' suddenly understood what more experienced doctors had been telling them: Physician, know thyself.
We're all in the process of dying,'' said organizer Angela Stroupe. ``A patient's death is a reminder of our own mortality and the limitations of medical science.''
Listening to the opening minutes of the four-day seminar, the 100 student doctors oozed confidence.
``Telling someone bad news is probably one of the most important medical procedures you'll have to do,'' Stroupe told them. ``It's a procedure that you deserve to be adequately prepared for.''
The seminar was intended to move the students from curing to caring, Stroupe explained, to teach them how to handle their own stress and grief as they deal with dying patients, to offer hope to terminal patients even as they cope with reality.
The students are halfway through their four years of classroom learning. That will be followed in most cases by three years of hands-on training in a specialty.
They heard a panel of doctors, chaplains and hospice workers. Dr. Rebecca Byrd, a cancer specialist at Children's Hospital of The King's Daughters, spoke of bereavement.
``I grieve for every child I take care of that dies,'' she told them. ``You have to know yourself first. You have to be confident with what your beliefs are, your religious beliefs . . . but keep that separate from the patient. Know when you need help.''
Do not neglect the spiritual, urged Sentara Norfolk General Hospital chaplain Ditawa Nianda. ``Our patients do not only suffer in the body, they suffer in the mind and in the spirit,'' he said.
But suffering was so distant for most of the students. They met in small groups to talk about their own experiences with death. Some had none to share.
A few weeks from her birthday, a few days from her first rotation in internal medicine, Murday said she was feeling immortal. It would, she said, be hard to function day-to-day if she didn't.
``I think knowing that I've dealt with death through all stages of my life that I'm a little more aware of the impact that death has on people's lives, and that will help me deal with patients,'' she said. ``And internal medicine deals with death. I know within the next 12 weeks I'm going to deal with somebody who is dying or somebody who dies while I am there.''
Still, she wasn't the first to volunteer for the role-playing, which was performed in front of the group with a coach offering guidance. Alesia Wright stepped forward, offering to tell a ``patient'' that her breast cancer had come out of remission and spread to her bones.
Wright did it, calmly and with cliches. She even located the tissue box on the first help-me glance over her shoulder.
Good for a first effort. Wright sat on her hands and confessed: ``I'm not good with tears. I want to reach in and fix it and I can't. Really, the whole thing is difficult.''
Next.
Murday met the ``pregnant woman'' at the door. Please, sit down, she invited. But the woman refused.
Murday held out the tissue box. The woman didn't see it. ``Oh, God, my baby,'' the woman moaned, clutching her abdomen.
``Please,'' Murday urged. ``Sit down. Is there someone you'd like me to call?''
Sobbing, the woman whispered no. Murday called for a time out.
``Are there support people in a hospital to help plan for funerals?'' she asked Stroupe, who was coaching her.
Bad idea. So Murday waded back in. ``Are you pregnant?'' she asked. ``Where is your family?''
``She doesn't have family in the area, she doesn't have friends,'' Murday said. ``This is so devastating. I don't want to leave her alone.''
``What about touching her?'' Stroupe asked, but Murday was uncomfortable with the idea. ``How about putting a tissue right in her hand?'' the instructor suggested.
Murday tried, and the patient clasped her hand a long, long time.
``Would you like a hug?'' Murday ventured, and the woman clenched her. ``Thank you,'' the victim whispered through her tears.
Stroupe was pleased with Murday's effort. ``You were great,'' she told her student. ``This is not easy. Your first objective: Minimize that sense of aloneness. If you tear up when you tell someone this news, it makes that connection. This is real.''
``Wow,'' Murday said afterward. ``I think it's easy to rehearse things in your head. At what point do you offer to give someone a hug? At what point do you just let them be quiet and grieve? I feel better prepared, but I don't think it will be easy.
``The whole subject is . . . '' she paused. ``Overwhelming.'' ILLUSTRATION: CHRISTOPHER REDDICK COLOR PHOTOS/The Virginian-Pilot
Michelle Murday, a medical student at Eastern Virginia Medical
School, comforts Glorial Franklin, an actress playing a woman who
has just lost her husband in a crash. by CNB