Dying to Be Honest

Death is part of medicine in a way that few outside professions can truly understand. Not so much for say Fire-fighters or Police officers, but if you're a Dentist and you see a lot of deaths then maybe you need to have a rethink of your skillset.

Unlike funeral directors, who meet the dead after the fact, we’re often there when it happens — or just before. We witness death unfold in real time, and nothing in medical school can fully prepare you for it.  Many hospital doctors experience acute emotional responses to patient death, especially early in their careers — yet formal training to prepare for it remains limited.

Some doctors never actually see someone die during training. You might witness a cardiac arrest, or be around someone who’s palliative, or even be handed the paperwork for someone who’s already passed. But being present at the moment a person’s life ends? That changes you. Memorable patient deaths often become lasting emotional anchors for physicians, shaping their practice and deepening their need for reflective support.

One of the first times I encountered death was on a night shift as an FY1. I was asked to prescribe fluids for a patient. I didn’t realise until later that it was the nurse’s way of subtly prompting me to recognise someone was dying. I didn’t get it. I was too green, too tired, too unsure. I wrote up the fluids, left the room, and was gently taken aside by the FY2 on shift — someone who had clearly been told to have a word with me. I hadn’t recognised the signs. I hadn’t written up anticipatory medications. I hadn’t spoken to the family. She was baffled, speaking to me like I just offered to peel her cat in the tone one uses to offer someone a Custard Cream.

It wasn’t malice that caused it; it was ignorance. Lack of experience. But it stayed with me.

That’s the thing about death — you carry it. Sometimes in your memory. Sometimes in your guilt. Sometimes both. You learn to talk to families. You learn to say, “We’ve done everything we can.” But you never really know how they’ll respond. Some cry. Some scream. Some ask for miracles. Some go silent.

There are mnemonics for breaking bad news — SPIKES, for example. Structure helps. But no formula can prepare you for the unpredictability of grief. It's true that Communication-skills training improves confidence in end-of-life discussions, but that junior doctors often feel unprepared when those moments actually come.

Again, it's because it a bit unethical to kill someone for real in Comms teaching - it's all about fidelity.

I’ve had to tell families that their loved one is dying for the first time, at 2am, when the whole world feels silent except for the buzz of the fluorescent lights and the occasional beep of the flimsy cannula dripstand alarming again. I’ve had to make those calls minutes apart — one to say, “They’re still here,” and another to say, “They’re gone.”

And I’ve seen the full spectrum - sort of a very grim collection of memories in a positive rather than "Dahmer-esque-come-see-the-rotten-meat-in-my-fridge" sort of deal. From patients dying slowly, expectedly, with family around them — to the utterly unexpected, when a phlebotomist goes in to take blood and realises the patient is already stone, cold dead (and only because they failed to draw. True. F***ing. Story)

But the hardest conversation? That comes when someone is dying and nobody’s said it out loud yet. That moment when a person — or their family — needs to hear it spoken, clearly, gently, finally.

Once, I sat with a man in his home. He was fading. Wasting. In pain. Everyone knew, but nobody had said the words. I asked him if he was ready for honesty. He nodded. I said, “Do you know you’re dying?” He exhaled — relief, not fear — and said, “Oh, thank fuck someone finally said it.” His wife cried. He smiled.

Those moments stay with you.

Doctors are often afraid of death conversations. Understandably. They're heavy. But the truth is, you don’t need to say the perfect thing. You just need to be present, honest, and human. As a doctor, your own discomfort with death — your “death anxiety” — can interfere with honest, clear communication at the bedside.

My father died when I was relatively young. He told me over the phone — in his usual blunt tone — that he had pancreatic cancer and it had spread everywhere. He handed the phone to my mum immediately after. It was classic him. No sugar-coating. No time for soft landings. But it was still a conversation that shaped how I talk to families now. Because everyone does death in their own way. There is no “right” way.

And when you’re the doctor in the room, it’s not about knowing the perfect script. It’s about holding space for people in their worst moments — even when you don’t feel ready. Reflecting on death experiences is essential in training, precisely because these encounters are formative and emotionally lasting.

The room where my father died — the hospice, the staff, the smells, the colours — is imprinted on my memory. Not the names of the doctors. Not the paperwork. Just the feeling. Just the moment.

That’s what death does. It stays.

So, to the new doctors who are afraid of getting it wrong — you will. At least the first few times. You’ll miss signs. You’ll fumble your words. You’ll learn. And you’ll get better. Not because it gets easier, but because you understand that death is part of the work — and part of being human.

Be kind. Be real. And when in doubt, stop, sit down, and ask, “What do you need right now?” Often, that’s more than enough.

Stay positive

DW