We do the sorting. You do the medicine.
OSCE: actor and procedure stations · Core01 / 22

Telling a wife her husband died during ruptured aneurysm repairActor: the wife of a 78-year-old man taken to theatre for emergency open repair of his ruptured AAA; he arrived collapsed, systolic BP below 80

Actor: breaking bad news of an intraoperative death

From memory: the diagnosis and the notes are hidden. Answer each question aloud, then press Show.

Know this first

  • SPIKES: private setting, check perception, invitation, give knowledge, empathy, agree sequelae.
  • NURSE for emotion: name it, understand, respect, support, explore.
  • With anger: stay calm, don't take it personally, listen, keep everyone safe.
  • Unstable ruptured aneurysm: in-hospital mortality 62% after open repair in a meta-analysis.

The patient

Actor: the wife of a 78-year-old man taken to theatre for emergency open repair of his ruptured AAA; he arrived collapsed, systolic BP below 80. He died in theatre despite resuscitation. She came alone and knows only that the operation was urgent. She is anxious and asks for news as you walk in. Task: tell her he has died, and support her.

The examiner asks

Answer aloud, then press Show.

  1. Open

    You are in the relatives' room. How do you begin?

    Show the answerHide the answer
    • I'm speaking with his wife after his emergency aneurysm operation, to tell her he has died. Patient
    • My bleep is with a colleague, a nurse is with me, and we are sitting down in private. Communication
    • Can I check you are his wife? I'm the anaesthetist who looked after him today.
    • Before we go on, how much have you been told about why he needed surgery?
    • I'm afraid I have very serious news about your husband.

  2. Explain

    Tell her what happened.

    Show the answerHide the answer
    • The big blood vessel in his belly had burst, and he was bleeding heavily inside before he reached us. (Communication)
    • We operated at once and gave him a lot of blood, but his heart stopped.
    • We worked to restart it for a long time. I'm so sorry. Your husband died.
    • I'll stop there for a moment. Take all the time you need.

  3. Respond

    She is silent for a long time, then says: 'No. He was talking to me this morning.'

    Show the answerHide the answer
    • It's a terrible shock. He was talking with you this morning, and now this. (Communication)
    • I'm sorry, it is true. He died in theatre this afternoon; we could not save him.
    • I'll stay here with you. There's no rush.
    • Is there someone we can call to come and be with you?

  4. Respond

    She becomes angry: 'Why did they operate at all if he was going to die?'

    Show the answerHide the answer
    • I can see you're angry. That is completely understandable after losing him so suddenly. (Communication)
    • Stopping that bleeding needed an operation; the team saw surgery as his only chance.
    • Even with surgery, most people whose aneurysm bursts the way his did don't survive.
    • I won't guess at anything I'm unsure of. The surgeon and I will go through any question honestly.

  5. Close

    She asks to see him. How do you close?

    Show the answerHide the answer
    • Yes, of course. A nurse will take you to him once he's ready. Communication
    • Would you like the chaplain or a relative with you when you see him?
    • The nurse will explain the death certificate and what happens over the next few days.
    • Here are my name and number. I'd like to meet again, with the surgeon, whenever you're ready.
    • I record who was present, what she was told and the support arranged in his notes. After surgery

Fatal mistakes

  • Saying 'passed away' or 'we lost him' instead of 'died'.
  • Blaming the surgeon or any colleague, or speculating about errors.
  • Leaving her alone with no support person and no follow-up.

Checked against: Miller 10e · ESVS clinical practice guidelines on abdominal aorto-iliac artery aneurysms (2024)

Report a problem with this case

Mark Got it only if you said every point. Again brings the case back tomorrow; Got it brings it back in 3, then 7, 14 and 30 days.

All OSCE: actor and procedure stations casesBack to today