How do you get over it?

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I shadow at a busy emergency room in a teaching hospital. I had the privilege to see many cool trauma cases. Every time I start my shift, I look forward to those adrenalin-releasing experiences. However, last night I witnessed a case that excited me at the beginning, but made me feel miserable for the rest of the night.

A 2-year old boy was brought with a cardiac arrest. The usual CPR, intubation, etc. were per done on him, but he didn't make it. The boy parents and other family members were hysterical. It was very dramatic even some of the female nurses were crying. I almost did. Having a 4-year old son aggravated my pain. I kept thinking about that boy his parents and imagining it was my son. I felt depressed for the entire night.

I understand such unfortunate events are part of physicians' life, especially in emergency medicine. How do you docs cope with these painful experiences? how do you prepare yourselves to carry the life-changing news to family members?

Thanks

.

I find that everyone has their own way--or doesn't--of dealing with these things. I still think about some of the more emotionally intense moments I've come across in my (brief) time in the ED. But I've found throughout med school that one of the best ways to deal with things is find someone who you think deals with them well--whether by the way that they interact with patient families, or the rest of the team, or in what they say to you--and ask them what they do. I've come across really wonderful suggestions using this (journaling, meditation, writing condolence letters). But i agree with the previous poster--while you're at work, some amount of distance is necessary in order to get through the rest of your shift and appropriately pay attention to your other patients. But what you do when you go home to manage those experiences really varies. I think its worth spending some time and energy figuring out what works for you.

We initially strive to be compassionate and humane when dealing with that sh*t but then end up later self-medicating with gallows humor and cold beer. Or, that's what works for me.

Originally Posted by BeanDip4All

We initially strive to be compassionate and humane when dealing with that sh*t but then end up later self-medicating with gallows humor and cold beer. Or, that's what works for me.

That's pretty much me, except wine.

Originally Posted by Ibn Alnafis MD

I shadow at a busy emergency room in a teaching hospital. I had the privilege to see many cool trauma cases. Every time I start my shift, I look forward to those adrenalin-releasing experiences. However, last night I witnessed a case that excited me at the beginning, but made me feel miserable for the rest of the night.

A 2-year old boy was brought with a cardiac arrest. The usual CPR, intubation, etc. were per done on him, but he didn't make it. The boy parents and other family members were hysterical. It was very dramatic even some of the female nurses were crying. I almost did. Having a 4-year old son aggravated my pain. I kept thinking about that boy his parents and imagining it was my son. I felt depressed for the entire night.

I understand such unfortunate events are part of physicians' life, especially in emergency medicine. How do you docs cope with these painful experiences? how do you prepare yourselves to carry the life-changing news to family members?

Thanks

4 years of medical school.

i'm in the icu and 2 people died just today, both very young. it's very very very sad. we code someone almost everyday. a couple we wish would just go ahead and do DNR.

i still go home and sleep 8 hrs. no nightmares.

it's very sad but they did all they can. you didn't put him there. it's part of life.

Originally Posted by BeanDip4All

We initially strive to be compassionate and humane when dealing with that sh*t but then end up later self-medicating with gallows humor and cold beer. Or, that's what works for me.

^^
Heh. Migrated from TGR I see.

As for the OP. Hobbies that you are passionate about and can lose yourself in outside of work are key.

I tend to be of the mindset (especially when someone comes in coding) that they're already dead. You do what you can, and sometimes you get lucky. We had a young guy come in coding a couple of months ago who was resuscitated, went to the cath lab, and walked out of the hospital with no defecits back to his wife and two kids. Those are the ones you hang on to.

Originally Posted by ccfccp

I tend to be of the mindset (especially when someone comes in coding) that they're already dead. You do what you can, and sometimes you get lucky. We had a young guy come in coding a couple of months ago who was resuscitated, went to the cath lab, and walked out of the hospital with no defecits back to his wife and two kids. Those are the ones you hang on to.

+1... right on the money

My mentor was a deeply religious man and would say a silent prayer after every code regardless of the outcome.

Personally I find something positive/fulfilling on every shift. It won't make the hurt go away, but it does seem to keep my spirts up when they need it the most.

Avoid working in a city with a lot of backyard pools. I haven't coded a kid since I moved from Arizona (knock on wood). We did it all the time there.

Agree with gringa. Also agree with comments about humor, wine and beer, just remember to take a step back occasionally to check that youre not crossing from reasonable attempts at coping/stress release to pathologic and that you never do beer after liquor.

One rule in the book, The House of God is "the patient is the one with the disease"-- I sometimes think about this to help keep perspective. Its an interesting read, some say a must read during your training.

martial arts, the local watering hole and a firing range (yeah i have a gun licence...wonder what drongo gave me that) i go do some karate for 3-4hrs....go to the pub and have a few then i go shoot some roos or cans or an emu...they wouldn't be missed.

Originally Posted by Ibn Alnafis MD

I shadow at a busy emergency room in a teaching hospital. I had the privilege to see many cool trauma cases. Every time I start my shift, I look forward to those adrenalin-releasing experiences. However, last night I witnessed a case that excited me at the beginning, but made me feel miserable for the rest of the night.

A 2-year old boy was brought with a cardiac arrest. The usual CPR, intubation, etc. were per done on him, but he didn't make it. The boy parents and other family members were hysterical. It was very dramatic even some of the female nurses were crying. I almost did. Having a 4-year old son aggravated my pain. I kept thinking about that boy his parents and imagining it was my son. I felt depressed for the entire night.

I understand such unfortunate events are part of physicians' life, especially in emergency medicine. How do you docs cope with these painful experiences? how do you prepare yourselves to carry the life-changing news to family members?

Thanks

I agree with a lot of the advice that's already been mentioned - if someone comes in coding, they're dead, and if you bring them back, you've performed a miracle, if you don't, no one really expected you to anyway so take solace in the fact that you gave a good effort. The more difficult (or scarier) cases are when people come into the ER looking sick (but still alive), and go from alive to dead while in the ER. Those stick with me more than any DOA code.

Another thing I'd mention is that after a particularly difficult case (pedi code etc.), I always like to take a little time (if able) to just gather all the people involved to thank them for their efforts and to remind everyone that as a team, we did our best. I had a pedi code a few months ago, EMS brought in and they were distraught that they couldn't intubate the baby, and "only" got an IO. When all was said and done, I told them they did the right thing scooping and running for the ER and I think that took a weight off their shoulders. When the code was over, the entire team in the ER (techs, nurses, myself) had a cathartic moment together which I think was good for everyone.

Originally Posted by ToxicChic

that you never do beer after liquor.

"Liquor before beer, all's clear".

Or at least that is the adage.

Liquor before beer, you're in the clear.

Beer before liquor, you've never been sicker.

Originally Posted by Apollyon

"Liquor before beer, all's clear".

Or at least that is the adage.

Whoopsie.

I also prefer wine. Although some days, a long run is better.

You learn distance and detachment with practice, but the kids hit everyone hard. The people who come in talking and die are also really hard. (I really hate the "I'm gonna die, aren't I, doc?" comment that inevitably comes right before they flip into VF)

I remember pretty much every kid I've ever coded, and a couple that came close... the single worst day of my career involved a crashing 6 day old that I couldn't pull out of the tailspin.


There is an art to telling someone bad news, and I understand that they're teaching it more in med school. But it's a weird feeling knowing that you're about to destroy someone's life, and once you open your mouth, they will never be the same.

Sit down. Ask what they know. Fire a warning shot. Warn them that you have bad news.
I often give a quick replay ("When the medics arrived, he wasn't breathing and his heart wasn't beating... and we worked on him... etc... but he died.") It is often easier if you have the family there for the rescus attempt, and I try to do this routinely. When I took my current job, the nurses sort of looked at me funny the first several times, but now they expect it. I think the families do better if they can watch and be with their loved one. Especially kids.

It's a little different with my usual "bad news." I find a lot of cancer (usually lung or abd masses with obvious mets or isolated brain mets), and that talk is slightly different because I don't usually know exactly what I'm dealing with. Also, once you use the "C" word, people don't hear anything else. Getting across DEATH is one thing, getting across CANCER is another. (Especially because without a tissue diagnosis, it's a best guess thing.)

You want some more stories? Go look for the "Medicine Sucks" thread in this forum. That's a venting place.
We develop some pretty black humor, but we are human and it's a coping mechanism.
Sometimes we pour our hearts out. There have been 2 recent cases posted at Sermo (a physician site) of pedi codes, mostly just to talk about them and vent.

Also read a recent blogpost that might interest you - a different sort of twist on it.
http://www.epmonthly.com/whitecoat/2012/04/the-squeeze/

Coping skills are habits that are important long before medical school.

I always find some amusement (not in a funny way, either) in perusing the student forum. If you can't deal w/ disappointment or failure and haven't found the appropriate coping skills, then seeing death up close and personal will be very difficult.

As for what is appropriate, that is very person-specific.

I've had to code a little girl whose brain was bashed in by her absentee father. Weeks later, the father came in for syncope and I was the treating physician. Talk about compartmentalizing.

A colleague of mine was working when his children were brought in from a MVA. He witnessed his own child's traumatic code.

One memorable time was telling my colleague that he was having an MI.

The most recent having was to tell my child's teacher about the brain malignancy.

I seek solace inwardly and outwardly. I realize life is short. Treat all with respect. It will be me on the stretcher one day. Til then, do what you can.

.

Originally Posted by BeanDip4All

We initially strive to be compassionate and humane when dealing with that sh*t but then end up later self-medicating with gallows humor and cold beer. Or, that's what works for me.

This is what works best for me. The next best thing is working in a community where I do not know the patients, it makes stuff like a peds code a little less hard.

While working in my small town as an EMT, we coded the doctor (my personal physician) who was on call that night for the hospital. They called him for an ER patient, he starts talking gibberish as his AICD was firing, we get there, he was talking to us, and he codes. Sucky.

Originally Posted by Ibn Alnafis MD

I shadow at a busy emergency room in a teaching hospital. I had the privilege to see many cool trauma cases. Every time I start my shift, I look forward to those adrenalin-releasing experiences. However, last night I witnessed a case that excited me at the beginning, but made me feel miserable for the rest of the night.

A 2-year old boy was brought with a cardiac arrest. The usual CPR, intubation, etc. were per done on him, but he didn't make it. The boy parents and other family members were hysterical. It was very dramatic even some of the female nurses were crying. I almost did. Having a 4-year old son aggravated my pain. I kept thinking about that boy his parents and imagining it was my son. I felt depressed for the entire night.

I understand such unfortunate events are part of physicians' life, especially in emergency medicine. How do you docs cope with these painful experiences? how do you prepare yourselves to carry the life-changing news to family members?

Thanks

You do your best. You recognize that, while you weren't able to successfully resuscitate the patient, you can still provide essential care... for the family. As cliched as this sounds, this is part of the *art* of medicine.

I agree with BirdStrike - when it doesn't affect you (especially a kid), you're toast. But, it shouldn't prevent you from caring for the patient even after his/her death. Being able to give a family closure, as crazy as it sometimes gets (I recall an incident when my resuscitation bay was absolutely destroyed - no joke - by a very emotional family), is essential and is the last bit of care you will have for the patient.

Afterwards, you process as best you can. Sometimes you drown your sorrows in the bottom of a glass, sometimes you beat the crap out of a punching bag at the gym, sometimes you just need to talk to your significant other. It all depends on the situation and how close it hits to home.

But, we're emergency physicians; in a way more Janus than Apollo, as we stand on the precipice of life & death and do our damndest to haul people back from the brink. It's in our psychological makeup to be able to perform this, admittedly sucky, part of our job.

-d

Originally Posted by Daiphon

You do your best. You recognize that, while you weren't able to successfully resuscitate the patient, you can still provide essential care... for the family. As cliched as this sounds, this is part of the *art* of medicine.

I agree with BirdStrike - when it doesn't affect you (especially a kid), you're toast. But, it shouldn't prevent you from caring for the patient even after his/her death. Being able to give a family closure, as crazy as it sometimes gets (I recall an incident when my resuscitation bay was absolutely destroyed - no joke - by a very emotional family), is essential and is the last bit of care you will have for the patient.

Afterwards, you process as best you can. Sometimes you drown your sorrows in the bottom of a glass, sometimes you beat the crap out of a punching bag at the gym, sometimes you just need to talk to your significant other. It all depends on the situation and how close it hits to home.

But, we're emergency physicians; in a way more Janus than Apollo, as we stand on the precipice of life & death and do our damndest to haul people back from the brink. It's in our psychological makeup to be able to perform this, admittedly sucky, part of our job.

-d

Thank you, everyone, your responses have been very educational and insightful. I was deeply touched by that incident and was afraid that my vulnerably to such experiences may hinder my objectivity as a future physician. I am relieved to learn that even seasoned doctors can still be shaken by such unfortunate events.

Daiphon, I enjoyed reading your post. It was quite poetic. Thank you for sharing your wisdom.