Fatalities?

[blaze1306]

I asked this question in the EM forum and got some very good responses. I know it's a difficult time with the match and all, but I wanted some experianced insight into the subject of losing patients. The EM residents had some great ways of dealing with next of kin and death of patients. But I want to know how soon into residency have you had to deal with losing a patient in the middle of a procedure, or if it happens at all.

I'm under the assumption(I know.. a bad idea to assume..) that residents are only doing minor surgeries and assisting the attending in major ones.Arn't all procedures for general surgery residents under the direct control and supervision of attendings. So if something does go wrong they handle it. Is this true? Or do residents plan, attempt a procedure(under supervision) and if a problem occurs and a death happens does the resident sign the death certificate? I'm trying to determine how I would handle the situation. since surgery or EM are my 1st two loves.

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[Smurfette]

Usually the resident is the MD who signs the death certificate, at least where I am from (I can't remember if there is a separate line for the attending to sign as well...probably. But I have to write cause of death, time of death, etc. etc. and fill out and sign all relavant forms). I'm an intern, and I've had patients die (not mid-procedure for me, but it happens).

While all surgeries are supervised by attendings, it varies a lot as to how much the attending allows the resident to do...sometimes attendings don't even scrub, other times they do the entire case. Afterall, residents need to be able to perform these surgeries on their own once they graduate. As for minor procedures (note I do not mean minor surgeries, although this may be the case as well depending on where you are), rarely are these even physically supervised by attendings. A chest tube or central line gone bad could--or does-- kill a patient. Every resident will hear a story of an older resident who had a patient die from *insert procedure X here*. Chest tubes inserted below the diaphragm, chronic effusions drained too rapidly, etc. etc.

If a patient dies outside of the OR, the resident is the one coding the patient, pronouncing the patient, and in many cases, talking to the family. The attending usually does not even come in from home if it's the middle of the night (depending on the situation of course).

 

[blaze1306]

If a patient dies outside of the OR, the resident is the one coding the patient, pronouncing the patient, and in many cases, talking to the family. The attending usually does not even come in from home if it's the middle of the night (depending on the situation of course).


So if you do a procedure and the patient dies when its over, it's your responsability? I didn't know residents were given so much of the load! I never realized that for minor procedures your on your own?!

 

[DrDawg]

In surgery it happens and you will have to do it early on in your intern year. Sometimes its an immediate postop pt that you didn't even operate on, or someone you have seen in consult but you were the only doc available at 2am. I'm sure medicine residents do this as well especially on the code team . I would expect to do more of this during trauma. Family's just want to know you did all you could.

 

[blaze1306]

I did'nt know it was your responsibility so early in a medical education, I'm a gung-ho guy, I can't wait to get in there and get my hands dirty so to speak, even though I finishing up my undergrad I feel like my life is on hold till I can get into medical school and really help people.But I'm also a pretty emotional guy, i'm not squemish or anything just the finality of death effects me when family members get emotional. I don't want to be the running joke in the hospital ya know...I don't want to be known as the 6-2 big ex- baseball player doctor thats afraid to talk to family because he may cry(Damn I sound like a *****!) I thought once med school got started I'd have more time to prepare myself for someone dying on me. What was the first time like? Even if it's not my patient like you say, that can have a profound impact.

 

[Plastikos]

I did'nt know it was your responsibility so early in a medical education, I'm a gung-ho guy, I can't wait to get in there and get my hands dirty so to speak, even though I finishing up my undergrad I feel like my life is on hold till I can get into medical school and really help people.But I'm also a pretty emotional guy, i'm not squemish or anything just the finality of death effects me when family members get emotional. I don't want to be the running joke in the hospital ya know...I don't want to be known as the 6-2 big ex- baseball player doctor thats afraid to talk to family because he may cry(Damn I sound like a *****!) I thought once med school got started I'd have more time to prepare myself for someone dying on me. What was the first time like? Even if it's not my patient like you say, that can have a profound impact.

Im a somewhat sensitive person myself, and the first death of a pt in 3rd sucked, and i had absolutely no resposibility whatsoever. By the end of the three weeks id be in the trauma bay addressing a pt and someone died in the next bed (12 inches away). The sad part is you kind of get used to it, but i still think it brings you down a bit.

My solution: Plastics baby!

 

[OMFSCardsFan]

I did'nt know it was your responsibility so early in a medical education, I'm a gung-ho guy, I can't wait to get in there and get my hands dirty so to speak, even though I finishing up my undergrad I feel like my life is on hold till I can get into medical school and really help people.But I'm also a pretty emotional guy, i'm not squemish or anything just the finality of death effects me when family members get emotional. I don't want to be the running joke in the hospital ya know...I don't want to be known as the 6-2 big ex- baseball player doctor thats afraid to talk to family because he may cry(Damn I sound like a *****!) I thought once med school got started I'd have more time to prepare myself for someone dying on me. What was the first time like? Even if it's not my patient like you say, that can have a profound impact.

Despite what we'd all like to think, we're not gods, and most of the time, we can't work miracles. You can be the most skilled, careful, competent surgeon that has ever lived, and you're going to lose patients. It's not a possibility--it's a guarantee. It's part of the job, but no one said that it's an easy part. You WILL, despite what you may think, get used to it fairly quickly. I'm not trying to say that it won't affect you, but it won't affect your work.

 

[scrappy]

I did'nt know it was your responsibility so early in a medical education, I'm a gung-ho guy, I can't wait to get in there and get my hands dirty so to speak, even though I finishing up my undergrad I feel like my life is on hold till I can get into medical school and really help people.But I'm also a pretty emotional guy, i'm not squemish or anything just the finality of death effects me when family members get emotional. I don't want to be the running joke in the hospital ya know...I don't want to be known as the 6-2 big ex- baseball player doctor thats afraid to talk to family because he may cry(Damn I sound like a *****!) I thought once med school got started I'd have more time to prepare myself for someone dying on me. What was the first time like? Even if it's not my patient like you say, that can have a profound impact.

get ready for a couple more years of your life on hold *after* you start medical school. at most places, clinical years don't really start until third year. i don't think it's going to have to be you that breaks the news while you're a med student.

first of all, you won't be a running joke if you cry because of a patient death. i think most people will respect you more.

second of all, by the time you have to do it, you'll have had plenty of role models to follow and have experienced it in the sidelines.

don't worry too much about how you will handle certain things, bc in most cases you won't have to handle anything until you're ready for it.

best of luck!

 

[blaze1306]

Thanks for all the advice I hope I'll be prepared for this when it happens.

 

[fourthyear]

It's strange, when you are in the code-type situation and someone is dying, it's almost like an out-of-body experience - you are just doing things and taking care of the patient and not really feeling that it's you there. It's like the emotional self is not there really, you're just doing what needs to be done to try to save the patient.

When you talk to the family, if you don't know them well yet, it's kinda the same...but I do find it harder to talk to the family of a patient you have been caring for for quite a while and actually know a bit more personally. But like someone else said, all they want to know is you did all you could, and they usaully are pretty content with the care you've given. I've actually gotten thanked quite a lot during these talks, which is kinda weird b/c they're thanking you for taking care of their loved one so well, yet they died despite the care you tried to give.

Mostly, I find I don't get much chance to reflect on the death until I'm heading home much later. It doesnt' really hit you at first, especially if it's not the first one you've dealt with. You will be able to handle it, everyone does.

 

[OMFSCardsFan]

i think most people will respect you more.

Riiiiight...

 

[Plastikos]

Riiiiight...

LOL

 

[PoorMD]

LOL

to be honest, I cried the first time I saw a patient brought in paralyzed after a car hit her. she was 22, struck walking on the sidewalk, and it hit me real hard about how unfair life can be and all that..

'course, we all move on and learn from that experience.

 

[Plastikos]

to be honest, I cried the first time I saw a patient brought in paralyzed after a car hit her. she was 22, struck walking on the sidewalk, and it hit me real hard about how unfair life can be and all that..

'course, we all move on and learn from that experience.

Yes, of course it only matters WHERE you deal with it. If its right there in the hospital, that may not be the best. At home, etc....much bettter.

 

[PoorMD]

Yes, of course it only matters WHERE you deal with it. If its right there in the hospital, that may not be the best. At home, etc....much bettter.

Yes I went to the bathroom for a few minutes

 

[OMFSCardsFan]

to be honest, I cried the first time I saw a patient brought in paralyzed after a car hit her. she was 22, struck walking on the sidewalk, and it hit me real hard about how unfair life can be and all that..

'course, we all move on and learn from that experience.

Are you trying to say that everyone respected you more for it? Don't get me wrong, I'm not criticizing you for being emotional. I just don't think crying necessarily gets you MORE respect...

 

[spo0kman]

I probably shouldn't be posting here, as I'm not a surgical resident, or even a physician yet. However, I am a paramedic/firefighter in a very busy urban area, and I've seen more than my share of death and destruction. You are now working in a field where you will be asked to see and deal with things that normal people aren't supposed to have to absorb.

When I am teaching new EMT students, and the stress chapter comes up, I spend a lot of time there. Working in the streets and working as a surgeon appears to be a similar atmosphere from my observations. Both areas are very egotistical, arrogant, and competitive. No one wants to admit they care, and no one certainly wants to admit they suffer from depression or anxiety from it. This would be viewed as a weakness, and of course, weakness fails.

Let me tell you from personal experience. I shoved it all down deep inside of me for years, the pain, the dead children, the mistakes, the crying family, until it all came out in one terrifying panic attack, during which I was convinced I was going to die within the next 5 minutes (which in hindsight, made me regret ever blowing off a patient who was experiencing a panic attack).

It is normal to cry, it is perfectly acceptable to seek professional help, its absolutely normal to supplement your diet with anti anxiety or anti depressants. I put off addressing my personal demons for years because I was afraid to admit I had a problem, not wanting to be "weak". I'm not here to bible thump, and your faith is your business, but I can also tell you that finding Christ was a huge factor in helping me through this and allowing me to deal with what we see.

Again, I'm sorry if I overstepped my bounds by posting in this forum, I just felt I had something important to add.

 

[Ladd's Band]

I probably shouldn't be posting here, as I'm not a surgical resident, or even a physician yet. However, I am a paramedic/firefighter in a very busy urban area, and I've seen more than my share of death and destruction. You are now working in a field where you will be asked to see and deal with things that normal people aren't supposed to have to absorb.

When I am teaching new EMT students, and the stress chapter comes up, I spend a lot of time there. Working in the streets and working as a surgeon appears to be a similar atmosphere from my observations. Both areas are very egotistical, arrogant, and competitive. No one wants to admit they care, and no one certainly wants to admit they suffer from depression or anxiety from it. This would be viewed as a weakness, and of course, weakness fails.

Let me tell you from personal experience. I shoved it all down deep inside of me for years, the pain, the dead children, the mistakes, the crying family, until it all came out in one terrifying panic attack, during which I was convinced I was going to die within the next 5 minutes (which in hindsight, made me regret ever blowing off a patient who was experiencing a panic attack).

It is normal to cry, it is perfectly acceptable to seek professional help, its absolutely normal to supplement your diet with anti anxiety or anti depressants. I put off addressing my personal demons for years because I was afraid to admit I had a problem, not wanting to be "weak". I'm not here to bible thump, and your faith is your business, but I can also tell you that finding Christ was a huge factor in helping me through this and allowing me to deal with what we see.

Again, I'm sorry if I overstepped my bounds by posting in this forum, I just felt I had something important to add.

The world is a cruel and harsh environment. I commend your story, but at the same time you can not have people holding hands and singing “cumbaya my lord”. Life has to go on, regardless of the weaknesses of few individuals.


“It’s absolutely normal to supplement your diet with anti anxiety or anti depressants” -------------I am not going to “supplement” my diet with anti anxiety or anti depressants. --------------------What is that all about? --------------I can understand if you asked me to go out for a ran or go hiking to deal with life’s stress. (But not pills)

 

[spo0kman]

The world is a cruel and harsh environment. I commend your story, but at the same time you can not have people holding hands and singing “cumbaya my lord”. Life has to go on, regardless of the weaknesses of few individuals.


“It’s absolutely normal to supplement your diet with anti anxiety or anti depressants” -------------I am not going to “supplement” my diet with anti anxiety or anti depressants. --------------------What is that all about? --------------I can understand if you asked me to go out for a ran or go hiking to deal with life’s stress. (But not pills)

I'm not saying they're for everyone, simply put, there are many people in this field who refuse to treat their issues in any manner simply for not wanting to feel weak. Go take a walk, go play paintball, do whatever.. However, if pills are what you need, don't be embarrassed and put it off because of being hard headed.

 

[drpectin]

I'm not saying they're for everyone, simply put, there are many people in this field who refuse to treat their issues in any manner simply for not wanting to feel weak. Go take a walk, go play paintball, do whatever.. However, if pills are what you need, don't be embarrassed and put it off because of being hard headed.

Spookman's right... If you are clinically depressed and require medication, not seeking help just because you don't like "pills" is no reason to avoid treatment.

If its good for your patients, its good for you.

Alternatively, I second Spookman's call for a healthy stress outlet, be it physical activity, recreation, Faith, whatever. Bottling things up and repeating "Serenity now," produces insanity later.

(Please forgive the Seinfeld reference)

 

[Ladd's Band]

I am probably the only doctor who does not believe that pills solve problems (special psychiatric pills). One of the reasons I went into surgery; cutting it out or mechanical changing the body is the only real medicine.

I see to many people popping pills like it is the only solution. Life is the only pill worth swallowing. If you are depressed or “psychological” affected move-on to a different environment, different job, and so on. Life is to short to be suffering and masking the pain and injury with pills.

 

[spo0kman]

I am probably the only doctor who does not believe that pills solve problems (special psychiatric pills). One of the reasons I went into surgery; cutting it out or mechanical changing the body is the only real medicine.

I see to many people popping pills like it is the only solution. Life is the only pill worth swallowing. If you are depressed or “psychological” affected move-on to a different environment, different job, and so on. Life is to short to be suffering and masking the pain and injury with pills.

I think the whole point of my post is being overshadowed by the mention of meds. The point is to admit that we (surgeons, physicians, street medics) are human and not god. We're not designed to deal with what we deal with, and we need to stop pretending that burying our feelings inside of ourselves is healthy.

I'm also not endorcing "pills" as the "only solution". However, there are people that need that as a suplement to other outlets. Unfortunatly, attitudes as you display only solidify the position that its either "get over it or go home", which leads to many people in medicine becoming completely screwed up.

I don't know what the suicide rate is like for doctors, I know that for fire/police/street medics, its frightening. If someone would have taken the time to really show these people from the beginning that feelings of sadness, depression, anxiety, were normal and a part of our profession, perhaps we could have avoided some needless death. As stated when I teach the stress chapter, I make sure that people understand fully what they are getting into, what they can expect, and how they can fix it.

 

[Ladd's Band]

I think the whole point of my post is being overshadowed by the mention of meds. The point is to admit that we (surgeons, physicians, street medics) are human and not god. We're not designed to deal with what we deal with, and we need to stop pretending that burying our feelings inside of ourselves is healthy.

I'm also not endorcing "pills" as the "only solution". However, there are people that need that as a suplement to other outlets. Unfortunatly, attitudes as you display only solidify the position that its either "get over it or go home", which leads to many people in medicine becoming completely screwed up.

I don't know what the suicide rate is like for doctors, I know that for fire/police/street medics, its frightening. If someone would have taken the time to really show these people from the beginning that feelings of sadness, depression, anxiety, were normal and a part of our profession, perhaps we could have avoided some needless death. As stated when I teach the stress chapter, I make sure that people understand fully what they are getting into, what they can expect, and how they can fix it.

Ok. You Won.

Let me jump on the sofa and you can solve and fix all my problems ... Dr. Phil.

 

[spo0kman]

*sigh*

 

[mysophobe]

I am probably the only doctor who does not believe that pills solve problems (special psychiatric pills). One of the reasons I went into surgery; cutting it out or mechanical changing the body is the only real medicine.

I see to many people popping pills like it is the only solution. Life is the only pill worth swallowing. If you are depressed or “psychological” affected move-on to a different environment, different job, and so on. Life is to short to be suffering and masking the pain and injury with pills.

Not true. I agree with you wholeheartedly. I used to be clinically depressed and had bad anxiety/panic disorder. I tried Zoloft for a few months, but I hated the idea of taking a pill to fix things, so I worked it out on my own, and I have never felt better.