Sudden and unexpected death. The pediatrician's response
F. Mandell, M. McClain and R. M. Reece
When an infant dies suddenly and unexpectedly, the sense of loss and
terrible grief may overwhelm not only the parents but also the physician.
When that sudden death is due to a known cause, the concrete character of
the event can be incorporated into the normal rationalization of mourning.
However, when death is due to an unknown mechanism, as in the sudden infant
death syndrome, feelings of inadequacy in caring for the child are
reinforced. The essential need for support of these families is clear. For
physicians, this kind of loss is disquieting and anxiety-provoking.
Forty-seven physicians responded to a survey exploring the relationship
between the physician and the family after the death of an infant, the
feelings of the physician about the death and his or her own sense of loss,
and the physician's need for personal support and educational preparation
for such an event. While 41 of the physicians indicated they had discussed
the death with the family, six had made no contact with the survivors.
Thirty-six of the respondents indicated that their relationship with the
family continued, and ten physicians stated that their relationship
terminated after the death. Physicians characterized their initial
responses to the death as frustration, sadness, shock, anger, guilt,
regret, hurt, and inadequacy. Most of the physicians believed that they had
"missed" something and feared they might be blamed for the death. The
competence, sincerity, and sensitivity shown to families during this tragic
experience can positively influence the family's mourning and recovery. The
pediatrician can provide a rational voice and a medical understanding of
tragedy without blame.
