Dealing with tough days

[brk81144]

2nd year resident here. Wondering if some of you could give insight into how you cope with the really hard days. Had multiple Peds trauma and deaths recently and am having a hard time not bringing the work home to my wife and children. Does it get easier?

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[Birdstrike]

There is a myth in EM that "when you're off, you're off." Not so. Exhibit A: brk81144's post, above.

You definitely don't want bring it home to your kids, but your spouse is going to feel it. There's no way around it, and they need to understand the stuff you deal with, isn't what people with regular jobs deal with. Some of the unspeakable tragedy we see can't be "shaken off" like a bump to the knee. Though I'm sure banking, lawyering and accounting can be very stressful, it's not the same as what we, police officers, coroners, or soldiers see. You cope with it the same way you try to cope with any other inexplicable tragedy. You talk about it with your significant other (HIPAA details removed, of course), friends and co-workers that were also involved, or with spiritual beliefs, if you have any. There's a certain amount of pain, mourning, or greiving that's going to have to happen, especially with Peds cases that hit close to home, even if it's only a short time. (Why do you think I post cases that are from years back, yet seem as vivid as the present and still haunt me, ie "Those Shoes"?) I call it "PTSEDD" or "post traumatic stress emergency department disorder," only half tongue in cheek.

Does it get easier? To some extent yes, because you build up some emotional armor to it all. But you can't be totally detached, and every once in a while one will find that weak spot in the armor and draw blood. So you go home, you give your spouse and kids (and dog and cat) an extra kiss and hug and remind yourself how thankful you are for what you have, and that it wasn't you, or them. You also remind yourself how great of a job you're are doing by just being there to help when able and even when unable, because most others couldn't even stomach what you're doing or seeing for one minute. Also, I think it helps to let families see your pain a little during death notifications and see that it hits home with you, too. There's nothing worse than a doctor who doesn't seem to care that the tragic news he just dropped, amounts to a nuclear bomb on their life. What you are going through, everyone goes through. It's normal. It'll get better.

 

[Apollyon]

You talk about it with your significant other (HIPAA details removed, of course)

Actually, in the United States and Australia (which got it from the UK, which, strangely, now, does NOT have it anymore), spousal privilege attaches, so communication between legally married spouses are confidential and privileged. You can freely vent to your spouse, as long as your spouse doesn't tell anyone else.

 

[primadonna22274]

I participated in a particularly awful code several years ago of a 13-wk infant who we soon found out that his mother used him like a swinging bat to hit her boyfriend, bashing his skull (this is public record, mom is now in prison). I did 2-finger compressions on that tiny guy's chest for 45 minutes. When we finally got a rhythm and pulse back my attending doc had to tell me to stop compressions--it was all a daze. I struggled with that one for several weeks. I was pissed off beyond words. I kept seeing mom standing at the foot of the bed while we were working to get her baby back. All the while she's asking "why does his head look like that?" Honestly we hadn't noticed until she asked...all of a sudden we all knew what we were dealing with. I kept reliving this experience for weeks until I finally met with my priest. You know what he told me? "**** happens." Yes, he really did. Then he gave me something I could use. He said that I could continue to be angry and have it affect me permanently, or I could let it go and have a better chance of helping those in front of me to be fully used as a healer. Somehow that helped me. And yes, **** still happens...but somehow it's a little easier to deal with.

 

[doctorFred]

my wife and i both see a lot of critically ill patients as part of our daily routine.. it's difficult, but we also consider it a blessing. we come home to each other, our beautiful family, and reflect on the fact that we live relatively charmed, comfortable, happy lives. every day in the ED, or up in the unit, is a reminder of how many people out there are doing a whole lot worse than you, and would trade places with you in an instant.

 

[dchristismi]

Also, I think it helps to let families see your pain a little during death notifications and see that it hits home with you, too. There's nothing worse than a doctor who doesn't seem to care that the tragic news he just dropped, amounts to a nuclear bomb on their life. What you are going through, everyone goes through. It's normal. It'll get better.

Bingo.
Aside from the fact that Birdstrike is wise in his advise, this is a pearl.
I recently had to deliver the widely-metatatic-probably-colon-cancer news to a colleague at work. A friend who I sat on committees with. Shared hospital gossip. Someone with the organization almost as long as I'd been alive and pretty much loved by everyone.
Someone who went on to tell all her nurses, both on Oncology and in the SICU, that she was so impressed and honored that I'd teared up and cried when I told her the news. She told me that she would have preferred it come from me.
She went into multiorgan failure and died a week later.
I had several different people from different parts of the hospital touch base with me in the following week to tell me what she'd said.

One tear can make a huge difference. And I'm not talking pouring-down-the-face sobbing, just a little water. Just enough. Just enough to let them know you are feeling it too, and hurting along with them.



And obviously, this whole thing has affected me more than I was admitting, hence I pour it out to you.


There is a thread here, buried somewhere, entitled "Medicine Sucks." It's a compilation of the worst cases, the most wrenching, horrible things we have collectively ever seen. Go write about it there (in vague, nonspecific terms, of course.) It's cathartic. I reread that every so often, usually when I have a really horrible case, and it helps get it out. No, you're not alone. We all feel it. We all carry these wounds, they just scab over eventually.

 

[KarlPilkington]

I don't think it ever really gets easier.
After a while, you've seen enough that you things are a little less shocking, no less sad, but I've found after the third death notification in a week and the 2nd metastatic cancer talk in a shift, you learn to just shove it deep down inside and move on, and this transition becomes a little easier.
Find a way to let these feelings out that doesn't involve, booze, drugs, or any other blatantly self destructive behaviors. Figure out what you do to help process these really crappy cases.
I have about 4 cases that still really stick with me, despite my efforts to forget and move on. I think this is near universal for anyone working in this field who has any type of soul.
I had 5 patients die on Christmas day a few years ago, including someone my age who looked me in the eyes and asked if they were going to be ok. I don't think that holiday will ever be the same for me; but you'll find a way to carry on.
Always remember what you do truly matters, if what we were doing on a daily basis wasn't so important, I'd quit tomorrow.

 

[RustedFox]

Bingo.
Aside from the fact that Birdstrike is wise in his advise, this is a pearl.
I recently had to deliver the widely-metatatic-probably-colon-cancer news to a colleague at work. A friend who I sat on committees with. Shared hospital gossip. Someone with the organization almost as long as I'd been alive and pretty much loved by everyone.
Someone who went on to tell all her nurses, both on Oncology and in the SICU, that she was so impressed and honored that I'd teared up and cried when I told her the news. She told me that she would have preferred it come from me.
She went into multiorgan failure and died a week later.
I had several different people from different parts of the hospital touch base with me in the following week to tell me what she'd said.

One tear can make a huge difference. And I'm not talking pouring-down-the-face sobbing, just a little water. Just enough. Just enough to let them know you are feeling it too, and hurting along with them.



And obviously, this whole thing has affected me more than I was admitting, hence I pour it out to you.


There is a thread here, buried somewhere, entitled "Medicine Sucks." It's a compilation of the worst cases, the most wrenching, horrible things we have collectively ever seen. Go write about it there (in vague, nonspecific terms, of course.) It's cathartic. I reread that every so often, usually when I have a really horrible case, and it helps get it out. No, you're not alone. We all feel it. We all carry these wounds, they just scab over eventually.

Yep.

This and this again.

I frequently say to patients/family during those tough talks that - "I cannot always cure; but I can always care." Sometimes I say - "Its not the first time I've had to have a tough talk with family, and I know it wont be the last, but that doesn't meant that it gets any easier."

They (the patients/family/friends)... they get it.

I came home about 2 weeks ago and the wifey looked at me and said - "Jeez, you okay? You look sad." Without thinking, I spat out: "I'm getting pretty tired of hugging widows and orphans for this week."

Its a bummer. People say - "Well, you knew this was going to be a part of it when you signed up for the job." Sure, that's true - but it still sucks. You still feel it.

 

[Greenbbs]

You're human. You're not a machine. It's normal to feel miserable after a terrible case.

In the past few weeks, I've had some terrible cases. I also am not afraid to let my emotions show. I had an adult daughter of a patient cry on my shoulder today as her mom died after a terrible head injury. It's hard to just be a robot in those situations......and being human is what helps you get through things.

The minute you stop being human is when you know you've reached your limit. If you've burnt out to the point where you can't open your soul, then it's time to take a break.

 

[Old_Mil]

2nd year resident here. Wondering if some of you could give insight into how you cope with the really hard days. Had multiple Peds trauma and deaths recently and am having a hard time not bringing the work home to my wife and children. Does it get easier?

I don't know that Peds trauma and death ever do. Still remember the first one I was a fly on the wall for as a medical student...and every one since.

Sent from my Z10 using Tapatalk

 

[HLxDrummer]

I just wanted to say thanks to everyone who has posted in here. It isn't a "good" thread... but it is. I took my time reading it and it really helps remind me what all this studying is for and what the field of medicine/EM entails.

 

[roguetwelve12]

Agree with HLxDrummer and all of the above. While clearly terrible subject, very valuable to read and remind.