How do you think student should deal with patient dying on the OR table?

I think you may need to go into more detail as your question is so broad it may get all kinds of comments.

I think in general you help close, scrub out, help clean up and transfer the body where ever it is going.

If you mean emotionally, well, it can be unusual and weird but it always is when someone dies.

If you mean like the resident ut the aorta thinking it was bowel well then keep your mouth shut until asked to open it.

Explain more and you may get more useful comments.

watermen said:

How do you think student should deal with patient dying on the OR table? What is the most appropriate thing for the student to do?

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Agree with above.

Patients dying will become more and more common as you go through your clinical years. You will see death in all ways...the 90 year old who passes in the ICU to the child in a car accident. I dont suppose its ever "Easy" but a certain amount of distance is needed while respect and compassion are given.

Sometimes the patient is brought to the OR as a trauma and you do what you can, often as fast as you can, and it doesnt always work.

Sometimes the patient is really sick and you open only to find no viable bowel.

And sometimes there are things that happen in the OR that shouldnt happen...mistakes...that can result in the patients death.

As the student its probably best to hold back any comment until the case is done, or unless you are asked a specific question.

Sometimes the mood of the OR is a very peaceful one, almost jovial, as people deal with death in different ways. Just remain respectful and realize that this is a person on the table, and they dont become a "body" until they are in the morgue...at least thats how I think of it.

I only had one experience regarding a patients death that was negative. We opened an elderly gentleman, unfortunately too late, and found a significant amount of dead bowel. The surgeon asked for someone to bring a camera so it could be documented. When the orderly brought the camera he said with a smirk "is this to take pictures of the smelly belly sausage?" I was pretty mad at that. One of the nurses tried to tell me that humor was his "coping mechanism" for death. I found it innapropriate, especially because the patient was intubated and still alive, although unconscious for several days.

I guess my point is dont say anything that can upset anyone. As a student your only role is that of quiet observer. You are there to watch and learn.

watermen said:

How do you think student should deal with patient dying on the OR table? What is the most appropriate thing for the student to do?

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You get used to it, but if it disturbs you, talk to someone, for example the good folks at SDN (cos your mates might think that you're a wimp) but we'll need details.

Some deaths will be harder than others, thus, try not to get too close to your patients.

With all these said, never be so numb until you loose your humanity.

watermen said:

How do you think student should deal with patient dying on the OR table? What is the most appropriate thing for the student to do?

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I was with the anesthesiologist one time in a thoracic aneurysm repair. It was elective in the sense it was not immediately life threatening but still a serious problem. The patient crashed as we were coming off pump and eventually died. The resuscitation process was long and intense as this was not a trauma patient who had little chance of survival to begin with but an otherwise fairly healthy 50-something year old patient. As a student, I did what I was told, period. I hung up and prepped tons of blood products and fluids and squeezed them in as fast as possible, pushed/adjusted drugs when instructed to do so, ran out of the room to find another doc to help, documented when I could, and tried to throw away trash (last part sounds silly but when things get crazy and everyone just throws everything on the floor, it gets pretty dangerous because people are running around so fast.)

As far as the emotional part? It sucks when you talked to a nervous patient pre-op and then they didn't ever come back out of the OR alive. It's definitely a weird feeling and very distinct from trauma cases when someone dies on the table but you never saw them "normal" to begin with. You'll feel lousy the rest of the day and when you do another similar case, it may be difficult at first but you just proceed. You should always talk to someone if you feel really bad. We had a patient die unexpectedly on my medicine team once and I thought the attending handled it really well by calling everyone together in a quiet room (tough to find in a county hospital) and spending five minutes talking about it before rounds to make sure any feelings were dealt with out in the open.