Urgent need to improve organ donation experience for donor families

Many families of organ donors describe feeling alone and abandoned at the moment when their loved one is taken to the operating room for donation. Heather Talbot says she and her family were left on their own as her son was wheeled into the OR. The experience left her thinking, “Well, they got what they wanted and they’ve moved on.”

A qualitative study in CMAJ examined the experiences of donor families. They found that many families felt unsupported at critical transition periods. Authors of The experiences of family members of deceased organ donors and suggestions to improve the donation process conducted 271 in-depth interviews with family members of organ donors.

On this episode, Drs Bigham and Omole speak with the study’s lead author Dr. Aimee Sarti. Dr. Sarti is an ICU physician in Ottawa. But first, they speak with Heather Talbot. Ms. Talbot’s son Jonathan became an organ donor after his death in 2009.

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Transcript

Dr. Blair Bigham:

I'm Blair Bigham.

Dr. Mojola Omole:

I'm Mojola Omole. And this is the CMAJ Podcast.

This episode, we're going to discuss a qualitative study in the CMAJ entitled: The experiences of family members of deceased organ donors and suggestions to improve the donation processes.

Dr. Blair Bigham:

This was a qualitative study that interviewed almost 300 family members of people who had gone through the organ donation process. And it was looking for ways to see if we provide adequate supports to those families as they're going through both the decision making process and after they've made the decision to donate. And we'll get more into this later, but to sum it up, there was a lot of support reported in those moments of trying to decide if donation was the right decision, but once that donation was made, a lot of families felt that the hospital teams and organ donation teams had, to put it bluntly, gotten what they wanted and moved on. And so the study really presented some opportunities for us to improve the entire longitudinal experience that families go through during tragedy when someone has to donate an organ.

Dr. Mojola Omole:

So for me, reading through the article, it seems to be a continual theme that I've been experiencing is that, we're really good at the medicine part, but the people part, the holistic part, is really lacking, when we talk about healthcare. And, honestly, people are definitely grateful for what you do during taking care of their cancer or when they're in the ICU, but it's the aftercare that probably has the most impact on their quality of life…after. And that's the part that we don't do well. So this really resonated with me, because we are good at just the medical part of figuring things out, making diagnosis, and then, “bye”. And just the thought that families just felt abandoned after their loved one has been wheeled away, is really tragic.

Dr. Blair Bigham:

I remember having a couple of brain death cases and the organ donation coordinators were so good with the families. They really are very highly skilled at communicating, but then once the decision was made to donate, I remember how busy they got. They were really busy trying to make sure that tests were done, that allocation was sorted out. And I felt like maybe their bandwidth was just overwhelmed and that then they kind of lose focus on the family, because they're trying to get ready for the organ donation process itself. I wonder if it's just a matter of, like you said, Jola, people have their wheelhouse. They're really good at certain things. And there are just these social and psychosocial aspects of what families go through, where there's just nobody assigned. There's just no one dedicated to helping people through this process. Maybe this study just highlights that those gaps need to be filled.

Dr. Mojola Omole:

But I think that's just like, that's a common theme in medicine, that there's always gaps in terms of actually taking care of people. We know how to take care of illnesses. We are specialists in diseases, but we're not necessarily great specialists in the people aspect. And I often think that that is what turns patients and family members away from things such as organ donation, is that fear of like, "What's going to happen after?"

Dr. Blair Bigham:

Absolutely. And we're really lucky today to be able to not only speak with co-authors of the study that was recently published in CMAJ, but first, really privileged to be able to speak to Heather Talbot. She is a huge advocate for organ donation and we met years ago when she was telling me about the story of her son who died tragically and was an organ donor. That's coming up next on the CMAJ Podcast.

Heather and I spoke five or six years ago. A couple of years after her son, Jonathan, died in a car accident back in 2009. The family was very quickly faced with a decision about organ donation. Heather, thank you so much for joining us. It's great to speak to you again.

Heather Talbot:

You're welcome.

Dr. Blair Bigham:

Heather, can you tell me the story of Jonathan's accident and what happened when you arrived at the hospital that day?

Heather Talbot:

Okay. Yes. So Jonathan was 22 years old. He was a York University student in kinesiology. He went to a party with a friend, who drove him to the party and he never came home. So, that was Saturday night. The next morning, Sunday, the police came to the door and asked, "Do you have a son named Jonathan Talbot?" And I said, "Yes." And they said, "There's been a terrible car crash. You better follow us fast to Sunnybrook Hospital, or you might not see your son alive." My husband drove, me and my daughter, because I would not have been able to drive. When we arrived at the hospital, Dr. Scales met us and told us what was happening. He explained, and he showed us a computer monitor with a scan of my son Jonathan's brain. And it was swollen, totally smooth. There were none of the little folds that a brain usually has.

And he said, "I cannot fix this." And my husband said, "Well, what if there's a miracle?" And he said, "No, there will be no miracle. His optic nerves are severed. He's blind. He's probably deaf. He will never walk or talk or anything again. Everything that was Jonathan, is gone." We were devastated. He then led us into the ICU where Jonathan was hooked up to all kinds of tubes and monitors. And his head was covered with a hood, but the rest of his body was perfect. There wasn't a scratch or a bruise anywhere on him. He was on a ventilator to help him breathe. And it went through my mind, "Well, they're telling me there's no hope, why are they even keeping him alive?" And it did cross my mind that maybe they're going to ask if I would like to donate his organs. And I wondered what I would say. I was a bit squeamish about it.

Anyway, the coordinator asked if he had signed his donor card. And I said, "I don't know." And our daughter, Emily said, "Oh yes, he did. We discussed it." He called her a loser because she didn't sign her donor card. And anyway, it made sense that he would have chosen to be an organ donor, because he was a regular blood donor. He had grown his long blonde curls, long to cut off, to make wigs for children with cancer. So it made sense. And we did consent to donate his organs. And then we were in the hospital for two days, by his side all day, all night, while he was wheeled in and out having tests, I guess, to match him with his organ recipients.

Dr. Mojola Omole:

Heather, you made a comment that everything that was Jonathan was no longer there. Can you tell us a little bit about who Jonathan was and is still to you?

Heather Talbot:

Yes. I'm going to get emotional now. He was amazing. He was gorgeous. I know every mother thinks her child is gorgeous, but he really was. He was smart. He was funny. He loved music. He loved nature. He loved animals. He had snakes. We had a dog, a cat. He was a natural athlete. He won Athlete of the Year, grade nine athlete, grade 10 athlete, every year at high school.

But his superpower was making friends. I remember one time he was going to a friend's house in a kind of sketchy neighborhood. And I said, "Why don't you invite him over here instead? I don't really want you going there." I'd heard about gangs in that area. And he says, "Don't worry, mom, everyone knows me. Everybody loves me." And I thought, how cool is that to feel that way, that everybody loves you.

And at his funeral, he really was loved. He had friends, all ages, all nationalities. There were well over a thousand people at his funeral. During the open eulogies, one after the other, people stood up, "John was my best friend when I moved to Guildwood. John was my best friend at the Y. John was my best friend." And I thought, "How many people would say about me, oh, Heather's my best friend." It was just incredible. So it was so devastating to lose him, but it was such a gift to hear how much he was loved by so many people.

Dr. Blair Bigham:

Heather, you know that today, Jola and I are talking about this article, this study that was done in CMAJ around how supported family members feel during processes, like what you had to go through. Are you able to tell us a little bit about how you felt supported from the time you arrived at Sunnybrook through to the conversations with the organ donation coordinator about the decision to donate?

Heather Talbot:

Yes. During the process, I really did feel very supported. I felt like everybody was all around us. They were telling us we're going here. We're doing this. We're doing that. They showed me another scan of Jonathan's brain the next day, so I could see it was even worse. The fracture was even bigger. So I felt like, "Yeah, they're right. It's not getting better." The nurse from the ER had come upstairs. She said, "I don't usually do this, but I just wanted to come up and check up on him and see how he was doing." And that really warmed my heart. The doctor said, "Oh, tomorrow's my day off. So you won't probably see me again." And I said, "Well, that's understandable. It's your day off." And then the next day he came back and I said, "Oh, I thought it was your day off." And he said, "No, I couldn't leave you."

And one of the nurses offered to cut a curl of Jonathan's hair, which I wouldn't have thought about. And so she cut a curl, she pinned it with a green ribbon, which has become a big part of our lives, the whole green ribbon thing. And I kept it in a little frame, which is on my dresser. And so I really felt like everybody was very thoughtful, sensitive, considerate of what we were going through. Very, very helpful. The social worker, I had to ask her for help a couple of times. She was great. The driver of the car, who was Jonathan's friend, but crashed the car. He was in the hospital too, but he had very minimal injuries, just scratches. And he wanted to come and say goodbye to Jonathan. All of Jonathan's friends poured into that room to come say their goodbyes, especially the people who had been at the party the night before. I guess they all texted each other. Everybody knew.

And they all came in and we allowed them to come and say goodbye. And my husband did not want to let the driver of the car come and say goodbye. So I went to speak to the social worker and she managed it. She got my husband out of the room, got Tyler into the room, then got Tyler out, got my husband back in, so that Tyler could say goodbye to his friend, Jonathan. So that was very, very helpful. So I mean, yeah, they were great. They really were great.

Dr. Blair Bigham:

How did that support wax and wane or change as the process continued towards Jonathan going to the operating room to donate his organs? Did you feel that that support was strong from the beginning to the end? Or were there areas where you thought it could have been a little bit enhanced?

Heather Talbot:

Well, I mean, they explained what was going to happen ahead of the Tuesday morning. They said, "At 6:00 AM, we're going to take the ventilator out. This is probably what's going to happen. This is probably how long it's going to take for it to happen." And they were right on and they said, "Then we have to wait five minutes and then we will take him to the operating room." And then my family was just all alone there at about 6:10 in the morning. And we had a feeling of abandonment and it's like, "Well now what?" And we were on our own and it was a little bit scary. And if I had to drive home, I would not have been able to drive home. I was really out of it. And luckily my husband could drive home. So I think there were definitely ways that we, as a donor family, could have been supported, once Jonathan left for the operating room. And so there was really nothing. There was a feeling of, "Oh, okay, you got what you want and now we're on our own. So.

Dr. Mojola Omole:

Basically if you just explaining, just for me to kind of picture it is that, they do the walk towards the operating room to do the organ part of it and then you guys are just left in the room?

Heather Talbot:

Yes, we were all alone. Nobody kicked us out of the room, but it's like, "Well I guess we just go home now." And that's what happened. So there was no hand-holding.

Dr. Mojola Omole:

What could we, as a healthcare group of people, what could we have done differently that day that Jonathan went to the operating room, to provide more support? Even small little things? What could we have done differently?

Heather Talbot:

Yes. Well, I thought that there could be kind of a support team. For example, I thought there could be three possible people. The social worker could be in the room with us and check on us, "Are you okay? Are you all right to go home?" Possibly give us a pamphlet with who to contact for grief support. I mean, we found grief support on our own, through Grief Families of Ontario. So hook us up. Just give us kind of a hint, a direction where to go to find grief support. Because grief has been huge in my life. It's 13 and a half years later and I realize this is my life's journey now, grieving my son. It's not as sharp as it was in the beginning, but I still do grieve. I get triggered even now, going back to thinking about the ICU, it takes me right back there and it's like it was yesterday for me. So the social worker could have helped.

I think that the coordinator from the organ donation organization, which was Trillium in Ontario, maybe could have stayed to answer any questions. Maybe also have a pamphlet about what are the next steps. Well, for one thing, when will the body be released? That was an issue actually, because normally in my religion, in Judaism, we like to bury the next day. Well, no, Jonathan had to have an autopsy of his brain to prove brain death, because they couldn't take the regular brain death test, because of his optic nerves being severed. So I had to wait an extra day and I wanted to plan the funeral and I had to know this ahead of time. And also, when will Trillium contact us to let us know who got the organs, which organs were used, when will the writing of letters be able to start? When can I write letters?

And it actually, it was great. I did write letters. I received letters back from three of Jonathan's four organ recipients, from each kidney recipient, his lung recipient, but not his liver recipient. And his heart valves went to sick kids' hospital and I don't think there's any letter-writing for tissue. That counts as tissue, not whole organs. So just to know that. And there was a ceremony to honor donors that Trillium does every year. I don't know now during COVID if they still do it. So we were invited. So it would've been nice to know, "Oh, there will be a ceremony and you will be invited and it will be in such and such month, at such and such a place. Just a little heads up." I think also Trillium and all of the donor organizations in every province, should let the donor families know about the Canadian Transplant Association, because that has been huge in my healing, my involvement with the Canadian Transplant Association. Attending the Transplant Games, volunteering there, helping to organize the Toronto Games six years ago.

Anyway, so I just think that they can do a lot more on the spot. And the third person, I think that would be help, would be a peer mentor. Another person from a donor family who has already been through the process and who could just be there to listen, to answer questions, to offer contact information for later, when the family is ready to speak and wants to hear someone else's organ donor story and feel that, "Oh, I'm not crazy. Somebody else has gone through this too." And I can share, and they can listen and share. And just to have somebody else who's been through the same experience. And I don't know if the organ donor organizations can train a person, a mentor, like different mentors, to be that person at that time in the hospital, or even to have their contact information for after the hospital experience is over.

Dr. Blair Bigham:

Heather, you have been such a champion for organ donation and for Jonathan's legacy. Thank you so much for speaking to us today.

Heather Talbot:

Oh, it was my pleasure. Thank you for this opportunity to share this amazing message of organ donation.

Dr. Blair Bigham:

Heather Talbot is an advocate for organ donation, whose son Jonathan gave the gift of life after a car accident 13 years ago. She spoke to us from Toronto. Coming up after the break, we're going to talk to one of the co-authors of the study.

Dr. Mojola Omole:

Dr. Aimee Sarti is the lead author of the qualitative study in the CMAJ, entitled: The experiences of family members of deceased organ donors and suggestions to improve the donation process. Thank you so much for joining us today.

Dr. Aimee Sarti:

Thanks for having me.

Dr. Mojola Omole:

So we will go through Heather's specific recommendations in a moment, but let's just start. What was your initial reaction to what she said?

Dr. Aimee Sarti:

I think first of all, I am very thankful and grateful to Heather for sharing her story so openly and to all of the family members in our study, who've really taken the time to tell us about their experiences and what we can do to improve. And I think listening to Heather, and Heather wasn't a part of our study, she wasn't one of the family members that we had interviewed or in our family member committee. And what she said resonated, was so much of what we heard from family members and is summarized in the various themes that we've captured in this study on the different areas that we can do to enhance the support that we're providing family members. So I think that it really encapsulated those messages.

Dr. Mojola Omole:

What really hits you as you listen to her recount the process, is that, that image of the family that's left alone in the room after the deceased member has been taken for the organ donation process. How typical is that from what you heard in your study?

Dr. Aimee Sarti:

Yeah, unfortunately it's not uncommon. So, that is one of the themes that came across, is that this specific moment family members have shared with us. It does happen and we have heard many stories from family members where they have felt like they've been left alone in that moment, as the body's been taken to the operating room. And it's really heartbreaking and it's really hard to hear that there was this moment for people that we could have provided more support and that they're left with this long lasting memory of feeling alone during that time.

In another instance, in the pediatric realm, I remember interviewing a man and he told me that his wife wanted him to do the interview and she herself wasn't ready. She was bereaving the loss of their son. And he shared with me, them being told that their son had been declared brain dead, them consenting to organ donation, them going through the process. And he recalls this moment of walking their boy to the operating room and the whole team going into the operating room and him and his wife being left outside, standing there, alone. And his words will never leave my mind of this moment. And I asked what he did and similar to Heather, he said, "We went back to the ICU. We gathered our things and we left."

And it is this moment where we can have someone there and this is feasible for us to do. And it can be different team members in that moment. And it doesn't always happen, but I can see how it happens. We're busy in our clinical practice. All of the team members there have multiple different roles that they're fulfilling. So you can see how that instance can occur, but you can also see very reasonable solutions to that with checklists and making sure that, at the beginning, we've decided who's going to be dedicated to the family member in that moment.

Dr. Blair Bigham:

How surprised were you and your team of co-authors by the responses you heard in the study?

Dr. Aimee Sarti:

I think that there were multiple different things that we heard that certainly did strike us again. I'd like to just talk about another moment. So in that case that we talked about the body going to the operating room. That is one moment. The other moment that I found very striking is when organ donation cannot occur and a family member's gone through this entire process and they're waiting there. Waiting to find out if organ donation can occur after the withdrawal of life support, because there's a time period where if the person does not die in time, then organ donation can't occur. And that transition back into the ICU or learning that organ donations not occur, is another moment where family members have told us that they need more support. And what we've heard from people, is that sometimes they're quietly going through much more in their grieving process than I think that we've recognized and different forms of loss.

So while losing a loved one and the tragedy and the grief of losing a loved one, when people consent to and go through the process of organ donation, often there's a feeling of hope and hope that this is going to occur. And when it doesn't occur, people can describe other losses. And I recall a woman that I interviewed and she described waiting and hoping for organ donation and when learning that it wasn't going to occur, she said silently in her head, she was trying to stay really calm in the room, but she was feeling that she had failed the world, were her words. That she had failed all of the recipients that were waiting. And she said failed all of those people who are waiting for an organ. So the added support that people need when donation doesn't occur is another instance that I think that we really need to work on.

Dr. Mojola Omole:

How feasible is it to do that? We all know what the constraints are on the healthcare system right now. How feasible is it to have those extra steps?

Dr. Aimee Sarti:

Yeah, I think that's a really important question and one that I don't fully have the answer to, but I do worry about the feasibility of implementing many of the suggestions that are here. And I think that there's some, as we talked about, having someone dedicated at the moment when the body's being taken to the operating room. There is a team there. We can add that to a checklist. I think that is very feasible and can be very quickly implemented. The added support, for example, when donation cannot occur, may be very much a challenge. And if they need someone to sit with them for an hour after, or half an hour, or to talk about that and to have the skills and expertise, to create a space where they can share these different feelings that they're having, takes a certain kind of expertise as well. And I think there are real challenges with that.

And in our intensive care unit, the unit that I work in, even before the pandemic, our social worker had been cut down to only three days a week. So, you heard the importance of that to Heather of having access and she had to find the social worker. Well, on certain days, they're not available in our ICU. And we also have a lot of turnover in our intensive care unit, as many are experiencing right now with more junior nurses coming through, more demands on our nurses, more demands on the physicians to see more patients. And so I do worry that in the current situation, it's going to be very difficult to provide those extra supports in hospital. And also the organ tissue donation coordinators, they have multiple different roles and they're a pivotal person on the team and they also may be pulled in different directions or across multiple hospitals or sites. So we really need to sit down and see, what can we do with what we have and do we potentially need more resources, which I think would be a real challenge right now.

Dr. Blair Bigham:

Heather had mentioned the role of having a mentor or maybe a family member who had gone through this before, who might be able to provide peer support in a way. Has that been looked at? Is that an option?

Dr. Aimee Sarti:

Yeah, I think Heather sharing that is also something that resonates with what family members were telling us. We heard from many family members wanting to connect with someone who has a shared experience. So they would tell us, "Not a doctor, not a nurse, not the coordinator, but somebody who knows what I've been through or has an idea of what I've been through. And that I can talk to about that." This is something that we're now talking about and meeting with different groups and stakeholders to see what's possible, what's feasible? I think one of the other things that surprised me, was the want of family members to contribute and to do that role and sharing with us through their interviews, that they wished there was an opportunity for them to do something, to help someone, to connect, to connect with people. And I thought that was really incredible. And people also shared with us that can be healing for them to be able to be in that role.

So I think that there's opportunities here, but how to actually enact that and to create that, are really big questions. And as we're working towards creating these types of resources, I think it's also really important for us to have a system in place for ongoing evaluation and hearing from family members. Did it work? Did it not work? Because these suggestions, sometimes in practice, they don't turn out quite the way that's anticipated at the beginning. So we really need to evaluate it as we go through.

Dr. Blair Bigham:

What's next in terms of how to start implementing these changes?

Dr. Aimee Sarti:

I think there's a number of things as far as what's next and there's already things happening across the country to work on implementing some of these suggestions and work on trying to improve the care being provided to family members during this time. For example, in Nova Scotia, they've developed a position of a family support liaison as their legislative changes were moving through. So there is a position now there, and we are researching how that position is impacting family members' experiences. So there is already changes happening across the country.

The next thing that we have coming through, as I mentioned, there's the importance of critical care physicians having access to appropriate training, so that we learn how to best communicate. And we learn about where these moments are that we can enhance the support that we're providing as well. So we've developed a communication and patient family centered care module as part of a national curriculum on organ donation with CBS. So that's going to be available very soon.

And then the other part, I think is, we need to really sit down and work on developing the different resources that family members are asking for. So we're coming together with key stakeholder groups, with the organ donation organizations and with different researchers and experts and family members themselves, to talk about how we best implement solutions. And I think it's important to know that and to recognize that education alone is not enough. We've got to look at tools that can be helpful, adding to checklists or new checklists, communication tools, system level changes. And we also need to look at those resources and advocate for resources for family members in and out of the hospital. Because it's not just the organ donations, the hospital, all of these clinicians who have very important pieces to play, but I think other groups also. We need to make sure there's access to mental health resources following being in the hospital. Bereavement counseling, bereavement resources. And we've heard from family members that it's a struggle to find these resources.

And also even where resources do exist, often family members don't know and they're searching and they're trying to find that. So putting this together so that family members have access to, whether it be a website or a booklet or a hotline that they can call and talk to somebody, so that they don't have to go searching for those things during the period of time when they've left the hospital.

Dr. Mojola Omole:

Thank you so much, Aimee. This has been really enlightening and there's a lot of food for thought for all of us as clinicians.

Dr. Aimee Sarti:

I really appreciate the opportunity. Thank you.

Dr. Blair Bigham:

Jola, this was a bit heartbreaking to hear that scene of people being seemingly sort of abandoned or feeling abandoned as their loved one is whisked away for the doctors to have their win with organ retrieval. Really hit me hard as someone who's spent a lot of time in the ICU and has seen this process go down and I can totally picture this happening, probably, where I'm focused on popping into the operating room to see what goes on and the family is just left alone. It's exciting that Aimee and her colleagues are taking that extra step of doing qualitative work. It's so often underappreciated qualitative work that gives us such rich information. And 271 interviews, that is so much work.

Dr. Mojola Omole:

It is.

Dr. Blair Bigham:

I'm so glad they've done this. So what hit you hard? What was the big takeaway for you?

Dr. Mojola Omole:

I think for me, it was that doctors and medical training is really good at teaching us how to deal with disease, but not how to deal with people. Because I also recently had patients who've passed away and I do all the work I have to do, blah, blah, blah, blah.

And honestly, as I'm looking back and I'm like, "Was there any support for them?" Their loved one passed away and then what's next? They just go home? And so I think one thing that really struck me, was that what people are asking for is not necessarily any newer technology and all these things that the government wants to spend money on, but just taking care of the people that we have. And having a grief doula, because I've read up a lot about those just in other aspects of my life. And I think that having something like that within the hospital system, where it's easily accessible to people. And they know where to get these services and the cost is not a barrier to it and that they can have that access. I mean, if you're going through the process of organ donation, the least we can do, as an appreciation for such an incredible gift, is provide you these services free of charge.

Dr. Blair Bigham:

I think it really highlights the lack of those social supports in the hospital. I mean social workers, it seems like they're always getting cut back. And I know my emergency department doesn't even have a social worker. It's just-

Dr. Mojola Omole:

That's bizarre.

Dr. Blair Bigham:

It's bizarre. I mean, I get that everyone's trying to save money right now, but I think social workers or people who specialize in attending to suffering and attending to the human condition, they're just so good at it. And I've learned so much from social workers over the last couple of years and I just wish we had more of them.

I used to think when I first started, I thought, "Oh, social workers, they have the best gig in the ICU because they're Monday to Friday and everyone else does shift work." But it's actually super hard because they're the constant. They're there Monday to Friday, week after week after week, they really get to know families involved in these cases where people are in the ICU for a while. And they're just so good at connecting with families and providing them the support that they need in ways that myself and even some of my nursing colleagues, I think, we're just not trained in that art, in that skill. I just wish we had more social workers. But that's just one part of this, I'm sure.

Dr. Mojola Omole:

Yeah. I think actually it's probably the main part of it, right? Like us that are within the healthcare system really need to start advocating for our patients and their family. And I think that starts with, these cutbacks need to stop and we need to really invest in the people in the system. I think without that, the system is already crumbling. It's going to crumble a lot faster.

Dr. Blair Bigham:

The low hanging fruit here, I think the immediate stop gap is for, I mean, I know that house staff are super busy, but residents and fellows can just maybe also step up a little bit into that role. I know that house staff are so busy, but just to be able to take that extra moment to connect with people, might just be one way that physicians can try to alleviate a little bit of the suffering.

Dr. Mojola Omole:

I'm going to be a little bit controversial. I don't think some of us are good at it. I think some of us are shitty at it, to be quite honest. I think there's some people who shouldn't do it. Because if you're not trained to do it, you will say the wrong thing and you can make a situation feel worse. And so in a way it's like, I would never ask for a nurse to do it, mainly because I feel like they're underappreciated and overworked. Physicians, a little bit too, but I also don't think we have the skill set to do it, right?

Dr. Blair Bigham:

I mean, we're all human. I think just by being in the room, you're contributing.

Dr. Mojola Omole:

We're doctors first, humans second.

Dr. Blair Bigham:

Cyborgs. I mean, I don't know. I think just being in the room means something so that people aren't alone, even if you don't know what to say or you don't have that skill set of necessarily attending to suffering. But I mean, it's a statement right there that a lot of physicians, maybe aren't good at attending to suffering. I mean that goes back to deeper roots and we have time to discuss today, but that should be our primary focus. We can't always cure people, but we can certainly just be present.

That's it for this week on the CMAJ Podcast. Thanks very much for joining us. Please be sure to share or like our podcast, wherever you download your audio. It would really help us get our messages out. And this week's message is certainly important and touching for both Jola and I. So we do appreciate any type of sharing that you can do for us to get our podcast out there. Until then, we'll see you two weeks from now with another episode. I'm Blair Bigham.

Dr. Mojola Omole:

I'm Mojola Omole. Until next time, be well.