I have to express sincere thanks for the candor many of you have shown in talking about the hard cases and appropriately managing the emotions that come with them.
I was recently rotating through the ICU, and we had a larger than usual amount of mortality, largely due to increasing quantity of sick patients (lots of VV ECMO for ARDS and VA ECMO for numerous reasons). When these patients died, I felt bad that they died, but very emotionally disconnected due to the grave nature of their cases from the start. I've been trying to process why these deaths aren't as emotionally draining and I think it's like those above have said; from the moment the interaction starts, you realize their chances are slim and you're doing your best to buy them time to heal, or at least have their family say goodbye.
This is in stark contrast to a 5yo girl who came in with a fatal injury that had been caused intentionally by a family member last fall. In the OR I managed to just focus and get things done (what's the alternative?) while everything inside of me wanted nothing more than to just RUN out of the OR. She had experienced an anoxic brain injury prior to arrival, so despite our resuscitation and intervention, her family withdrew care the following day. The whole thing had me wrecked for weeks. I could hardly sleep, I had nightmares pretty much every night (either reliving that experience or things happening to my kids). Broke into tears several time when alone in the car. Talking pretty openly to my wife, some co-residents, and a couple attendings about it was a big help.
My exposure to this sort of badness was very limited in medical school. At that time I rarely saw anything of high acuity. Residency has been filled with a lot of new experiences and emotions.
Thanks again for sharing everyone. You've put into words a lot of things I've been trying to process and come to terms with. It's sometimes nice to know you're not alone.