The crack of a falling tree, the terrible loss – then the silence

Exactly one year ago, my wife was injured while we were enjoying a self guided walking holiday in Sicily. We were walking through a section of national park.

She was hit by a tree, one that was felled by a park worker. The circumstances were freakish. There was no warning or visible indication that it might happen. There was a single short burst of chainsaw activity nearby which completed the cut and the tree came down fast. I was a few feet in front of my wife and managed to avoid being hit. A couple of seconds was the difference between safety and disaster.

‘When I met people who I knew, and with whom I had not had contact since the event, few were actually able to say anything.’Credit:Tamara Voninski

She suffered multiple injuries, largely to her thorax and spine, but also a head injury and a fractured ankle. It took considerable time to transport her by road ambulance to the nearest town from which she was transported by helicopter to a hospital in Palermo.

She spent six and a half weeks in three different hospitals and then died. Many things contributed to her death but the most challenging to manage was infection by a multi resistant bacterium (superbug) which caused failure of her respiratory, renal and blood clotting systems. The mortal event was a bleed in the brain related not so much to her original head injury but more to her systems failure.

Her prolonged hospitalisation in Palermo was a nightmare from many points of view, not the least of which was the experience of being with her after her life support was removed.The outcome was devastating and, like the experiences of many people around the world dealing with unexpected death, very difficult to manage.

There were knowing smiles, occasional touches, uncomfortable questions. One person came up and said "Hi doc”, told me a joke and walked off.

It is hard to not continually reflect on one's experience in this situation and one of the things I was most troubled and distressed by was the way in which we, as a society, communicate about death.

I was very fortunate to have a large group and friends and a few close work colleagues who communicated with, and supported me and my family while I was in Italy. After that time it was much harder, especially as I re-entered my workplace.

For me, the single most important thing about losing Di was to have people acknowledge the loss. When I met people who I knew, and with whom I had not had contact since the event, few were actually able to say anything. There were knowing smiles, occasional touches, uncomfortable "how are you" questions. One person came up and said "Hi doc” then told me a joke and walked off. When I approached him later he said somebody had told him to not say anything as it was “too raw”. Wrong, wrong and wrong. Raw yes but not to be ignored.

It is as simple as saying, “I was very sorry to hear about your wife’s death”. That simple acknowledgement allows a bereaved person to choose where the conversation goes and to move on in some way. Saying nothing puts up a road block to good communication. Verbal communication is one thing but there are other forms of acknowledgement.

The most welcome method is to send a simple handwritten note, saying the same thing. I received quite a few such notes but, to my surprise, only three from work colleagues. One of these from two young doctors I had supervised and two from administrative staff with whom I had worked closely.

Others colleagues communicated verbally and electronically. A number have remained totally silent. I offer the following suggestions for those who wish to communicate with a bereaved friend, colleague or associate, either at the time or later. Often the news travels very slowly. It is true that "better late then never" is applicable here.

Write a note. Hand written is best, email acceptable, texting not so meaningful. Keep it simple.

Consider calling. If you do – acknowledge and keep it simple. A bereaved person may not be inclined to want to talk much but contact is usually appreciated. It is wiser to not make comparisons with your own experiences or try to offer solutions.

Talk about the person who has died. There is a perception that this might be painful but it is more likely to be welcomed. Consider the language used. The terms "passing" or "passed on" are very commonly used. Many would disagree but I find them offensive. In a modern secular world I think best to use the meaningful terms of "death" and "dying".

What about "condolences"? OK for a business or organisation maybe, but not so good for individual use. Consider following up with later contact. Keep in mind that the lives of the bereaved often remain on hold for long periods.

The bereaved understand that the lives of others go on normally while they follow a rather solitary path to acceptance and some form of resolution to allow their life to proceed. Others can't really modify that journey but good communication and friendship can help.

Stephen Rogers-Wilson is a general surgeon in Melbourne.

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