Morbid Topic

[Cosmo75]

I was curious if anyone has experienced the death of a patient while in training? If so, how did that impact you? Do you feel like your program prepared you for this?

I had a client pass away earlier this year of natural causes, albeit way too prematurely. It was someone I saw while on practicum for 2 years, so I had terminated with them for internship. Needless to say it was quite a shock with a variety of emotions came with it. Not to mention questions about my role in terms of attending the funeral (which actually wasn't an option), corresponding with family, etc. I felt like this wasn't something that I really learned about in my classes.

Would love to hear some perspectives on this.

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[RileyG]

I've never had a client pass away, but I did have a student in one of the classes I was teaching pass away this semester. I too felt unprepared to deal with it and had many of the same questions, plus whether or not to talk to the rest of the class about it (it was a small-ish class of about 30 people). It would have been nice to have known what to do ahead of time.

 

[psychmama]

This is an interesting and difficult topic. I know a student who had a client die of a terminal illness while treating him. I've never asked her much about this, but I think it affected her deeply.

 

[deleted106747]

Several, due to the nature of my practicum site. It does affect me - both sadness and happiness. Gratitude for my life, for what I have, for being healthy. Sadness for them, but happiness for the good that they had in their lives. In some ways, it is not unexpected - again, due to the nature of my site - so I don't have the shock of it happening out of the blue. That seems like it would be extremely difficult.

 

[PhillyPsych]

Several, due to the nature of my practicum site. It does affect me - both sadness and happiness. Gratitude for my life, for what I have, for being healthy. Sadness for them, but happiness for the good that they had in their lives. In some ways, it is not unexpected - again, due to the nature of my site - so I don't have the shock of it happening out of the blue. That seems like it would be extremely difficult.

Though I have never experienced this as I am in the research side of my institution, the other half of the students here work on the Hem-Onc cancer floor conducting therapy with those who are terminally ill and admitted inpatients. I know that through talking to them frequently about this topic (coping with the death of a client) that we as future psychologists will always have to experience this phenomenon (even if it only is once). It is aparent to me, and definately stated much more elgantly in psycycle's post that the parting is often bittersweet. What we can do is talk about our feelings (Hey we ARE humans too!) with our peers, and discuss with a supervisor how to best handle the logistics (Do I get in touch with the family?, Should I attend the funeral?, Do I send a card?, etc...). I know that it all varies greatly on the client, your relationship with them, and the family as well, and it is a very slippery slope at that. I hope this helped a little bit, and I wish you the best in regards to the situation at hand.

 

[Therapist4Chnge]

I've never had a client pass away, but I did have a student in one of the classes I was teaching pass away this semester. I too felt unprepared to deal with it and had many of the same questions, plus whether or not to talk to the rest of the class about it (it was a small-ish class of about 30 people). It would have been nice to have known what to do ahead of time.

Speaking of perspective....when I read "small-ish" I was thinking 6-12 students, as "large" is 30+ for me. There is that liberal arts education creeping in again.

Though I have never experienced this as I am in the research side of my institution, the other half of the students here work on the Hem-Onc cancer floor conducting therapy with those who are terminally ill and admitted inpatients. I know that through talking to them frequently about this topic (coping with the death of a client) that we as future psychologists will always have to experience this phenomenon (even if it only is once).

I've had to have "the death talk" with a number of patients who have had brushes and full on dances with death because of their substance/self abuse. While I am quite comfortable working in this area, the idea of working with terminal cases (particularly those who did nothing to put themselves in that position) makes me take pause. My internship rotations will involve terminal cases, so I guess I will be able to have the experience and see how I do.

What we can do is talk about our feelings (Hey we ARE humans too!) with our peers, and discuss with a supervisor how to best handle the logistics (Do I get in touch with the family?, Should I attend the funeral?, Do I send a card?, etc...).

This is a great example of how consultation, supervision, and personal therapy all can play a positive role in a professional's life. "In Treatment" recently tackled a similar situation, which definitely gave me something to think about.

 

[Prsstnt]

I was curious if anyone has experienced the death of a patient while in training? If so, how did that impact you? Do you feel like your program prepared you for this?

I had a client pass away earlier this year of natural causes, albeit way too prematurely. It was someone I saw while on practicum for 2 years, so I had terminated with them for internship. Needless to say it was quite a shock with a variety of emotions came with it. Not to mention questions about my role in terms of attending the funeral (which actually wasn't an option), corresponding with family, etc. I felt like this wasn't something that I really learned about in my classes.

Would love to hear some perspectives on this.

We had one suicide this past year. This is atypical despite the population we work with. As a group, we had all worked with this client at some point (role of outreach services). So the entire group was provided with a group session moderated by the Employee Services wing. The counselor who worked with the client was recommended for individual sessions through the same department.

It took a while to get over it. Moreover the rest of the team was available to discuss since we were going through it together. Personally I drew upon my religious and spiritual beliefs. Once again, it did take a while.

The family had a private funeral. All the same, the message we got from our supervisors was that it was fine for us to attend, especially if it would help with our closure (family willing).

 

[Cosmo75]

Thanks for sharing your perspectives. I did speak with my supervisor from practicum about it, as well as some people on my internship. I suppose being a health psychologist, this will be something I need to come to expect. I think because this client was one of my first and I saw them for so long, not to mention some of the transference issues that came up, it's been a potpourri of thoughts and feelings.

 

[Ollie123]

Little training in how to deal with it, but still early on and have limited training in general so that's not surprising.

I'm in health psych, so realistically, this is going to come up, especially if I do a behavioral medicine internship. Most of my work has been with smokers...obviously not the healthiest population as a whole, but I haven't had any issues come up so far. Though I feel like there is something very qualitatively different about behavioral medicine relative to say...losing a client to an accident, or suicide, since with behavioral medicine you are typically going into it realizing they are having major surgery or suffering from a serious illness and that death is not only a possible, but often the most likely outcome regardless of anything you do. Doesn't make it easy, but I think it at least allows more time to prepare.

 

[Cosmo75]

Though I feel like there is something very qualitatively different about behavioral medicine relative to say...losing a client to an accident, or suicide, since with behavioral medicine you are typically going into it realizing they are having major surgery or suffering from a serious illness and that death is not only a possible, but often the most likely outcome regardless of anything you do. Doesn't make it easy, but I think it at least allows more time to prepare.

I agree. My client had Hep C and developed liver cancer. I knew once the cancer showed up they would probably not make it, but they went pretty quickly after the diagnosis. This has certainly made me reflect on more sudden losses, especially if a client were to commit suicide.

 

[WannaBeDrMe]

This has certainly made me reflect on more sudden losses, especially if a client were to commit suicide.

I lost someone to suicide during my internship. There were 2 other interns (one a year ahead, one a year behind) on site as well. I think we all knew it was a possibility but once you are so settled into something, it seems much less potentially tragic.

As for how we were prepared, I can't speak to those two interns (other universities). I know my classes didn't cover it or if we did, it was so brief that it doesn't stand out. For me, during a placement meeting with the director of field, I had mentioned my worry about patients choosing suicide. She was pretty blunt when she told me that if I was truly going to approach my practice with a value for each individual then that included respecting their ultimate choices, even if their choice was death.

How the site handled it... we had a lot of debriefings and trainings led by the medical director. We had a lot of subsequent issues/investigations led by risk management. To say it was stressful was an understatement... Not only from the loss of the individual but from the fall out as well.

The interns were advised not to speak about the incident off hospital grounds. The current contract had allowed them to take our journals, our notes, any assignments related to the practicum setting, etc and maintain them as part of their records and restrict our use of them for class. Which meant a lot of double work for us re-creating the whole semester without mention of the incident. It was a poorly constructed agreement that left the students vulnerable and without a safety net. I urged the clinical director to get it written into the next contract that the hospital site could not prohibit discussion of site events relating to student progress.

The intern who had been the individual's primary clinical support while inpatient left the field a few months later and transitioned into a school support setting. The rest of us just sort of kept it in as if that were the professional courtesy.

Specifically about me... I did want to know what happened. I think from a little bit of survivor guilt since I was not there at the time it happened (late evening). Not from the actual individual... but from not being there that day with my staff. I wanted to know more just so I could share that experience in a way that allowed me to be supportive. Of course, I know now that's a silly idea but at the time, I felt like the last thing they needed was another outsider in their ranks.

 

[psychmama]

WannaBe - Wow, that is quite a sobering story. I hope this does not happen to me, but then again, it always might. THanks for sharing this with us. It helps to hear what others have gone through.