bad outcomes

[across the pond]

Esp. for the more experienced members on this forum, how do you deal with bad outcomes personally, esp. if it was unexpected? While generally safe, anaesthesia is ripe with the possibility for poor outcomes (unexpected death, brain injury, MI, etc). How do you cope with this when bad things happen and esp. when unpredicted? Anyone taken time off, developed sleeping problems, etc?

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[coprolalia]

How do you cope with this when bad things happen and esp. when unpredicted? Anyone taken time off, developed sleeping problems, etc?

They are so rare that it's hard to develop chronic mental-health issues from them. Sure, we all have a few cases that we wish had gone better and probably linger with us a little longer than we'd like, but if you are having recurring thoughts that are affecting your pattern of sleep or well-being then you probably need to talk to someone in a long white coat.

-copro

 

[militarymd]

Esp. for the more experienced members on this forum, how do you deal with bad outcomes personally, esp. if it was unexpected? While generally safe, anaesthesia is ripe with the possibility for poor outcomes (unexpected death, brain injury, MI, etc). How do you cope with this when bad things happen and esp. when unpredicted? Anyone taken time off, developed sleeping problems, etc?

s h it happens...

you do enough cases...you'll have them...and the more cases you do...the more you'll have...

So I deal with them the same way I deal with GOOD outcomes....you move on.

 

[urge]

s h it happens...

you do enough cases...you'll have them...and the more cases you do...the more you'll have...

So I deal with them the same way I deal with GOOD outcomes....you move on.

True. Sht happens. Go about your business as usual.

How do you cope with this when bad things happen and esp. when unpredicted? Anyone taken time off, developed sleeping problems, etc?

I don't think you are cut for this business if you are the sentimental kind.

 

[jennyboo]

Esp. for the more experienced members on this forum, how do you deal with bad outcomes personally, esp. if it was unexpected? While generally safe, anaesthesia is ripe with the possibility for poor outcomes (unexpected death, brain injury, MI, etc). How do you cope with this when bad things happen and esp. when unpredicted? Anyone taken time off, developed sleeping problems, etc?

I think as a group we are a fairly resilient specialty (perhaps more so than the GP, paediatrician or psychiatrist) and we don't take bad outcomes to heart for long. We tend to ponder things lightly for a day or two, then move on.

It is after all "critical care" and we have to know before we choose it, whether we're well suited for the "critical" aspects of the job. If this is a great concern then you can mostly avoid these critical events and critical situations by choosing a different specialty.

 

[Fastrach]

I think just talking things over with a fellow resident or a staff whom you respect and trust does as much for me as anything else. Just the catharsis of getting the weight of bad experiences off your chest, mixed with the reassurance from your coworkers that bad sniznit happens to everyone, especially if done around a table of brewskis and nachos at happy hour after work, is usually what eases my soul most in times of turmoil.

 

[CanGas]

I think the original poster should be cut a little slack.

It’s a pretty heavy topic for someone’s 1st post so I can’t help but think this person may have just experienced such an event and may be dealing with some issues related to the experience.

#1 – go talk to someone. I assume you are junior if this is the first time it has happened to you. I would advise you to talk to your program director and get the name of someone who has grief counseling experience. Or call your 1-800 physician help line. These are available in many countries and are anonymous so you don’t have to risk your ability to get life/disability insurance in the future. But if you are struggling that hard, get some outside help.

As for how I deal with it? I’m gonna break it down to the 2 likely scenarios.

1 – Bad thing happens but it’s not your fault.
This class is easier to deal with. We deal with this in our critical care area of medicine a lot. On call we are going to deal with a lot of people who are going to die. Perhaps not on the table but perhaps in recovery or more likely the ICU afterwards (man, we can keep organ donors “alive”, it takes a lot to stop a beating heart and some sort of pressure trace on the art line with levo-epi-vaso-milnirone running. We all know what is going to happen in the ICU but at least it did not officially happen on the table.

My most recent case of this had a thorasic surgeon “hugging” the patient on the table. Left hand grabbing thorasic aorta via left throacotomy. Right hand grabbing thorasic aorta via right throacotomy. Surgeon telling us “I’m not getting much of a pulse here can you do something?” as I am looking at the expanding pool of blood on the floor and quietly signaling the nurse to stop transfusing after our 30th unit of O neg blood so we don’t empty the blood bank on a case that has turned into an autopsy.

My strategy for this situation is to step back a bit and depersonalize the situation. Bad thing was going to happen whether I was involved or not but with my involvement and my people skills I can help the family cope with this when I talk to them before/after. Generally does not affect my sleep though sometime my wife gets a bit of an extra long hug when I get home. As an aside, the OR team asked an outside non-OR basedd porter to come in and help clean up while waiting for the coroner to release the body. That guy was talking to a counselor the next day and had to take time off work – simply a case of exposure – he was not equipped or prepared to deal with what he saw, I was.

2 – Bad thing happens AND it is your fault (or you feel it is your fault)
This is much more difficult. Fortunately, I have not run into it yet but know of some difficult cases. How about being involved in a case where H20 was used instead of an iso-osmotic irrigation fluid in a urology case with predictably REALLY bad outcome. Sure not your fault but should you have done an ABG for a sodium after 1 or 2 hours instead of 3 hrs when you thought about it? This is going to affect you. Even more so if it was actually you who did the wrong thing. You gave Roc instead of Sux on that questionable airway and now the guy has some cognitive deficits because the surgeon could not get the trach in fast enough. You gave the ancef because the cross-reactivity to a penicillin allergy is less than 5% but the patient is now in the ICU ventilated from the severe anaphylactic reaction and the surgeon and family are saying why did you give ancef when “everyone knows” you should have used Vanco. Ect, ect. Any one of us could be in that situation. You are going to relive that moment over and over and wish to God you had a time machine to go back and change what you did. If with time and support from friends/colleagues/family you are still reliving that moment you may need to speak with a professional.

As for the sentimental comment. I think we need to be careful with the “it can’t happen to me”, or “it’s because you are too weak for this specialty”, along the same lines as the couple recent threads on addiction issues.

Dictionary: sentimental (sĕn'tə-mĕn'tl) pronunciation

adj.
1.
1. Characterized or swayed by sentiment.
2. Affectedly or extravagantly emotional.
2. Resulting from or colored by emotion rather than reason or realism.
3. Appealing to the sentiments, especially to romantic feelings: sentimental music.

So I’m doing a palliative care rotation. Every once and a while following the question to the husband of 50 years “And how are you doing”, and seeing the person break down out of the grief of loosing someone they love so much, I get a little teary eyed. Does that make me sentimental? Does it make me a bad doctor? Does it make me a bad anesthesthesist? On the contrary, it makes me human and I think a better doctor. It does not keep me up at night but I damn well guarantee if I did some medication error (wrong med intrathecal, wrong dose, ect – all published in case reports so they do happen) and ended up killing or paralyzing someone or heaven forbid a kid, I guarantee you I would be loosing sleep. I don’t care how “resilient” your personality is. You kill (or think you killed) a kid you are going to be affected by it.

So anyways. To summarize. Some things are easier than others to cope with. Some things will be handled by your personality and personal coping skills but others are going to require professional help and perhaps even medications.

I hope I’m wrong and you were asking out of intellectual curiosity but if not, good luck. And despite all I said, if you are finding that people dying outside of your control is REPEATEDLY affecting you this way perhaps another specialty is more appropriate.

CanGas

 

[Planktonmd]

Excellent post Cangas

 

[Planktonmd]

Esp. for the more experienced members on this forum, how do you deal with bad outcomes personally, esp. if it was unexpected? While generally safe, anaesthesia is ripe with the possibility for poor outcomes (unexpected death, brain injury, MI, etc). How do you cope with this when bad things happen and esp. when unpredicted? Anyone taken time off, developed sleeping problems, etc?

The first step is to accept that you are human and that you are not perfect.
Your job is to do everything you can to help these patients, and most of the times you do, but sometimes you don't, and sometimes you make mistakes.

 

[militarymd]

What the fu ck is up with all this cum bay yah, let's hold hands, and sing a song, bull s hit??????

People die....life goes on....

some times you fuc k up...sometimes...you don't....leither ways...people get fuc ked up.....life goes ON...if you can't hack...quit....I hear AIG and WAMU will probably need some new people.

 

[fakin' the funk]

What the fu ck is up with all this cum bay yah, let's hold hands, and sing a song, bull s hit??????

People die....life goes on....

some times you fuc k up...sometimes...you don't....leither ways...people get fuc ked up.....life goes ON...if you can't hack...quit....I hear AIG and WAMU will probably need some new people.

Wow, another gem among your recent run of curse-filled, 100% negative, oppositional-just-to-be-oppositional posts. Truly great stuff. Just because it's an anonymous internet forum doesn't mean it's OK to be a jerk non-stop.

 

[mille125]

What the fu ck is up with all this cum bay yah, let's hold hands, and sing a song, bull s hit??????

People die....life goes on....

some times you fuc k up...sometimes...you don't....leither ways...people get fuc ked up.....life goes ON...if you can't hack...quit....I hear AIG and WAMU will probably need some new people.

....

 

[mille125]

Esp. for the more experienced members on this forum, how do you deal with bad outcomes personally, esp. if it was unexpected? While generally safe, anaesthesia is ripe with the possibility for poor outcomes (unexpected death, brain injury, MI, etc). How do you cope with this when bad things happen and esp. when unpredicted? Anyone taken time off, developed sleeping problems, etc?

I dont think that anesthesiology has a monopoly on bad outcomes. Bad outcomes can happen in nearly any specialty (maybe with the exception of pathology). It is best to talk to a friend or collegue and then quickly move on. If you get too personally involved in either good or bad outcomes, you are setting yourself up for unneeded emotional distress.

 

[mille125]

What the fu ck is up with all this cum bay yah, let's hold hands, and sing a song, bull s hit??????

People die....life goes on....

some times you fuc k up...sometimes...you don't....leither ways...people get fuc ked up.....life goes ON...if you can't hack...quit....I hear AIG and WAMU will probably need some new people.

You seem very irascible these days. Is it time for introspection? A long sit on the "couch" maybe.

 

[militarymd]

You seem very irascible these days. Is it time for introspection? A long sit on the "couch" maybe.

Nope, just tired of all this "let's hold hands"...."you're a ******, but you still can be an anesthesiologist"..... bull sh it.

This whole "you can be anything...have anything attitude" is part of the problem underlying our economic crisis right now...

That's right...I'm not a milllionaire anymore....and I'm pissed.

 

[mille125]

Nope, just tired of all this "let's hold hands"...."you're a ******, but you still can be an anesthesiologist"..... bull sh it.

This whole "you can be anything...have anything attitude" is part of the problem underlying our economic crisis right now...

That's right...I'm not a milllionaire anymore....and I'm pissed.

1) You will be a millionaire again before the end of 2009 so dont make any irrational decisions.

2) Everyone (even you military) has had difficulty with that first death/bad outcome. It does not make you less of a man or an incapable failure if you have some brief difficulty in this situation. It simply makes you human.

 

[CanGas]

Is this seriously what you would say to a med 3 or med 4 who just saw something traumatic? Or to a R1 who thinks they just killed someone?

Suck it up. Don't be a pansy. Grow some balls. Move on. Get over it.

Sorry dude. Perhaps you have a pair of giant brass balls and a stone heart but thankfully I like to think most of us are still human. Sometimes something will impact us in a way we weren't expecting and weren't prepared to deal with. Happens in the military (tough guy accidentally shoots a kid, sees a buddy blown to bits), happens in the police force (thinks it's a gun, shoots a kid, finds out its a cell phone or MP3 player), happens in EHS (generally traumas involving kids, abuse) so why do you think it should be any different in medicine.

I'm all pissed about my nest egg too but this is a forum for all levels of training and is a great anonymous source of anesthesia and non-anesthesia related advice. I thought it was a great question. At least it wasn't another one of those "Do you think I can get into X, Y or Z program with a Step 1 of ..."

I like to think I'm a bloody good anesthetist, a great doctor and an even better human being. If I think I killed a kid I'm gonna be shook up and its not going to be "business as usual" for a while.

Perhaps you're made of tougher stuff.

CanGas

What the fu ck is up with all this cum bay yah, let's hold hands, and sing a song, bull s hit??????

People die....life goes on....

some times you fuc k up...sometimes...you don't....leither ways...people get fuc ked up.....life goes ON...if you can't hack...quit....I hear AIG and WAMU will probably need some new people.

 

[jennyboo]

I thought the original poster was a medical student (?) from the UK who is thinking about career choices. In such context, the question asked is a good and legitimate one.

Perhaps we anaesthetists cannot offer a fully thought out or truly insightful answer compared to physicians in other specialties who have thought about this a lot more. A GP could probably wax eloquent about this topic. The truth is that I (and you have to know that I am a US practitioner, whatever differences that brings to the table if any) and probably most others here are not fazed by bad outcomes. Whether a psychologist would find this to be reality or denial, most of us don't feel that we need to do much "coping" at all. We tend to recover quickly from such events.

 

[militarymd]

Is this seriously what you would say to a med 3 or med 4 who just saw something traumatic? Or to a R1 who thinks they just killed someone?

Suck it up. Don't be a pansy. Grow some balls. Move on. Get over it.

Sorry dude. Perhaps you have a pair of giant brass balls and a stone heart but thankfully I like to think most of us are still human. Sometimes something will impact us in a way we weren't expecting and weren't prepared to deal with. Happens in the military (tough guy accidentally shoots a kid, sees a buddy blown to bits), happens in the police force (thinks it's a gun, shoots a kid, finds out its a cell phone or MP3 player), happens in EHS (generally traumas involving kids, abuse) so why do you think it should be any different in medicine.

I'm all pissed about my nest egg too but this is a forum for all levels of training and is a great anonymous source of anesthesia and non-anesthesia related advice. I thought it was a great question. At least it wasn't another one of those "Do you think I can get into X, Y or Z program with a Step 1 of ..."

I like to think I'm a bloody good anesthetist, a great doctor and an even better human being. If I think I killed a kid I'm gonna be shook up and its not going to be "business as usual" for a while.

Perhaps you're made of tougher stuff.

CanGas

yes....and I have .....AFTER I reamed them a new ass hole.....back in days when I used to teach.

 

[urge]

I'm on Mil's camp.

Anesthesia is different to other fields in terms of situation.

Ped, IM, ED.... deal with a lot more bad outcomes than we do. That's their daily work. But, the situation is different. They deal with pts that are already sick and a bunch of them die. We do that too. But, we also deal with totally healthy pts that die unexpectedly. Sooner or later is bound to happen. If you already think you will need psycotherapy before it has even happened, then you are making a poor career choice. Chances are everybody will need some catharsis, even Mil. But if you starting point is already so low, nothing will be able to help you.

I'm just saying people know themselves. The OP knows if he/she has a bad outcome he/she will have a hard time dealing with it. I'm saying it's going to happen and it will be a 100% your fault. If you have a hard time getting used to the idea, better stay away. I'm not saying that you will be a bad anesthesiologist. I'm saying you most likely will be a miserable one.

 

[urge]

1) You will be a millionaire again before the end of 2009 so dont make any irrational decisions.

Don't be naive. It will take a good 30 yrs to recover from this mess. By that time we will be too old to make up for it.

 

[militarymd]

I'm on Mil's camp.

Anesthesia is different to other fields in terms of situation.

Ped, IM, ED.... deal with a lot more bad outcomes than we do. That's their daily work. But, the situation is different. They deal with pts that are already sick and a bunch of them die. We do that too. But, we also deal with totally healthy pts that die unexpectedly. Sooner or later is bound to happen. If you already think you will need psycotherapy before it has even happened, then you are making a poor career choice. Chances are everybody will need some catharsis, even Mil. But if you starting point is already so low, nothing will be able to help you.

I'm just saying people know themselves. The OP knows if he/she has a bad outcome he/she will have a hard time dealing with it. I'm saying it's going to happen and it will be a 100% your fault. If you have a hard time getting used to the idea, better stay away. I'm not saying that you will be a bad anesthesiologist. I'm saying you most likely will be a miserable one.

not because he agrees with me....but that's a good post.

 

[numbmd]

This topic has been covered recently in A&A (august 2008). It mentions some good things that we as professionals should consider going forward in this profession.

Has anyone ever ever been doing chest compressions while the charge nurse comes up and asks if she can bring the next patient into the room? Don't laugh, it's happened.

If you think you are the same right after coding your last patient, you ain't. You don't deliver the same care, period. i know you need to get back on the proverbial horse again, but I wouldn't want to be your next patient.

And if you truly don't give a sheet wether I live or die, I wouldn't ever want you as an anesthesiologist. However I am not implying that that is the case with anyone posting here, at least I hope not.

 

[numbmd]

Sorry, forgot the link.
www.anesthesia-analgesia.org/cgi/content/abstract/107/2/591

 

[militarymd]

Sorry, forgot the link.
www.anesthesia-analgesia.org/cgi/content/abstract/107/2/591

funny...I guess not funny...but interesting that you posted that link. I did some of my training there.....That's where I picked up this saying...

"make sure to sprinkle dirt on that patient"..

Residents will ask "why"..

Answer...

" so that they will get used to being 6 feet under it".

 

[mille125]

Don't be naive. It will take a good 30 yrs to recover from this mess. By that time we will be too old to make up for it.

It will not take 30 years. It will take two or three max. Look at the market over the long run. It returns 11 percent over the long haul. It needed a correction and we should welcome it. Overvalued commodities are not in our best interest.

 

[mille125]

Don't be naive. It will take a good 30 yrs to recover from this mess. By that time we will be too old to make up for it.

Naive....give me a break. You lack historical prospective....

 

[dhb]

Naive....give me a break. You lack historical prospective....

After the crash in 1927 stocks only got to pre-crash level in the 50s...

 

[mille125]

After the crash in 1927 stocks only got to pre-crash level in the 50s...

yes and the precrash levels were overvalued (tremendously)...the crash caused stocks to be undervalued (tremendously)....just look at any stock market curve and this becomes evident....it is unreasonable to expect the market to return to a precrash level that is overvalued.....


However, all of our holding will adjust to an appropriate level in 3-5 years and Mil will still be a millionaire....that is all that i am saying..

 

[dhb]

However, all of our holding will adjust to an appropriate level in 3-5 years and Mil will still be a millionaire....that is all that i am saying..

Adjusted for inflation...? i doubt it

 

[mille125]

Adjusted for inflation...? i doubt it

I dont know what else to say

 

[dfk]

after a while, you just become hardened to emotions and letting things get to you. i don't know if it's a desensitizing thing or not, or if it is an individual thing, but it happens. to me anyway. and, it doesn't mean one doesn't care, but, as previously stated, you have to just move on. otherwise, your career will be short-lived. IMO.