William is a 68 year old man who has just died in hospital.
He could be your friend. He could be your spouse. He could be a close family member.
This is the story of what will happen to William next.
Immediately after William has died.
William’s death might be expected: he has been receiving palliative care, nurses ensuring he has been comfortable and experiencing as little pain as possible.
You may have been there when he died.
Williams death may have been unexpected.
He has a cardiac arrest in the coronary care unit.
Or he dies in the emergency department after being hit by a car whilst riding his bike.
If this is the case, he will usually have had many emergency procedures and interventions performed in a short period of time.
You may have been in the room during his attempted resuscitation or you may have arrived afterwards.
Informing you of Williams death.
If you were not present at the time of death. Staff will contact you as soon as is practically possible.
They will take you and any other immediate family members to a private place to do this.
There will usually be a doctor and a nurse with you at this time (there may also be a social worker). These staff will always have been directly involved with Williams medical care, and will have been actively caring for him during the time of his death.
Breaking news of a family members death is a very important conversation. There will be no beating around the bush or use of euphemisms such as ‘passed’ or ‘slipped away’. You will be told quickly that William has died and then given some brief details of events leading up to this point.
This information may be repeated several times.
This is not the time to overwhelm you with complex information, and much of what is said may not be remembered anyway.
Staff will give you physical & emotional support and encourage you to ask questions, to react naturally, and to begin grieving in whatever way arises.
Reactions and responses will unfold in their own good time. There is no hurry for anything to happen.
At some point you may be asked if William has a preferred religious denomination or spiritual belief (usually this information is already known to staff from Williams medical records). Any religious rights that need to be performed can be organised with the hospitals Pastoral Care Service at this time.
Some cultural/religious observations involve special rituals such as washing and draping of the body. This is usually performed in a special area of the mortuary or other hospital area as it may take some time (up to 2 hours in some cases).
Time with William to say goodbye.
There is no pressure to go and see William at this time. The decision is completely up to you 1
Many people who have been bereaved by a sudden death felt that it was an important part of their grieving process to see the body of their loved one at this time.
Some people who decided not to, later expressed regret at not doing so.
But there is no right answer here.
Even within one family, there may be different attitudes and reactions. Some might find it helpful, others distressing.
Don’t worry, there will usually be more opportunities to see William later in a more formal and calmer setting when you have had greater time to process the situation.
Before you go into the room to see William, the staff will prepare you.
They will let you know if there are any tubes or wounds or other equipment present.
If William’s death is going to be a coroners case (see below) there are strict rules around removing any medical equipment that was being used at the time of his death.
If it is not a coroners case, nursing staff will wash him, dress him in a clean hospital gown or pyjamas, and place fresh sheets on his bed.
Preparing William for you to see him is known as laying out the body, or last offices. It is a ritual that has taken place in society for at least 50,000 years.
This is an important and privileged time for nursing staff. It gives them their own opportunity to ‘say goodbye’ (and, if they have gotten to know William, to grieve). Williams body will be moved gently and with great care as he is washed and prepared for you to see. Often, nurses will continue to talk to him during this time.
William may have been moved to a single room for privacy or in some cases you may be given the opportunity to see him whilst he is still in a resuscitation area.
There will always be a member of the nursing staff with you at this time. They will answer any questions and provide explanations about the things that you are seeing.
There will usually be a chair or chairs next to Williams bed to sit in, and it is perfectly OK to hold his hand or even hug him if you want to.
At some point depending on the situation, the nurse may withdraw to the ‘background’ or step outside the room to give you some alone time. But there will always be immediately available should you need them.
If required, the hospital chaplain or or other pastoral care giver may also arrive around this time.
Williams valuables will have been collected and documented and will be handed over to his nominated next of kin. Items that he was wearing such as his wedding ring are usually left in place.
What do I do now?
Nursing staff and or a social worker will support you with some of the practical things that might need to happen now such as contacting family members who do not yet know. They will also provide information on how to begin funeral arrangements and provide support for your own immediate care.
If William has consented to donate his organs after he has died, you may be visited by the hospitals organ and tissue donation coordinator who will talk to you about this very specialised process (one that is beyond the scope of this short article).
Transport to the mortuary.
Whilst this is happening, William is being made ready to be transported to the mortuary.
A group of nurses will remove any clothing and dress him in a special paper gown known as a hospital shroud. A set of mortuary tags is completed with Williams identification details. He is then carefully rolled onto his side and a special plastic body bag placed under him. Rolling him back, the bag is then pulled up over him. A tag is tied to him (usually around his ankle) with a cotton tie, and the bag is zipped closed around him. A second tag is applied to the outside of the bag.
William will be transported to the mortuary by a wardsman and a nurse on a special purpose built trolley. Again, this entire process is done gently and respectfully. Caregiving does not cease at the time of death.
Different hospitals have slightly differing mortuary set-ups.
When William arrives he will be signed in and then transferred across onto a stainless steel tray that slides into the large mortuary fridge.
He will remain there until he is collected by the nominated funeral directors or the coroners representative. It is usually possible to arrange another viewing of William during this time if needed.
As mentioned above, Williams death may meet the criteria for a coroners case which will mean that his body will be managed slightly differently.
Coroners inquest may be required to be held into the manner and cause of death in cases including:
- A person who is killed.
- A person who is found drowned.
- A sudden death of unknown cause.
- Death under suspicious circumstances.
- Death following some accidents.
- Death within 72hrs of an invasive medical or surgical procedure.
- Has not been seen by any doctor within last 3 months.
- Dies in custody.
So, if William is a coroners case he will not be washed, wounds will not be cleaned, any jewellery or medical equipment will not be removed and he will be left in the clothes he is wearing. You will be notified of this and the process will be explained to you carefully.
Questions and concerns may not arise for quite some time following the death of a loved one.
It is important to let you know that you can contact the hospital to discuss your feelings or ask questions at any time after you have left.
The exception to this is when the death is a coroners case. As part of this process, police may attend and will require a close family member to make a formal identification of the body. The police officers in attendance are trained to do this and the identification is done with sensitivity and care. ↩︎