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Hello everyone, I know this is a really personal topic and have been wanting to write this for the past few weeks so here goes... with clinicals starting this topic being something that is part if medicine it could be healthy to share how we deal with death/dying, as I've talked to some friends and realized this is going to be the first time for many of us to be forced to cope with this subject.
When I was training as a paramedic I remember experiencing death pretty frequently in people's homes and bedsides and really struggled to come to terms with it and wanted to open up about some things I learned that might be helpful to those of who are experiencing these things for the first time, and was hoping that some other students/attendings/residents (with way more experience than I have) could share their thoughts on an important and undervalued topic.
For the obligatory anecdote... during undergrad I worked overnights in a busy commercial 911 system and had a really ****ty year. I lost count, but over the span of about a year and a half a number friends and mentors died of suicide, homicide or random weird stochastic health events. I was a few years older than my peers at school, and had moved for college and it was just not great. So for those of you who moved for clinicals and are away from your support systems -- I get it -- it's a super hard burden they put on us. I remember one time in particular when it all just hit me in the undergrad cafeteria and I broke down in uniform one night before heading out to my shift because I just didn't want to do it anymore. The ****ty part was that no one came up to check-in. So I 'manned up' and drove myself to work and ended up really, really burned out. Sharing this to highlight that it can get really, really bad before it gets better, and that getting perspective and support can really help.
When I turned to my doc and paramedic leadership they had some really profound advice that I took to heart and would not be pursuing medicine today without because I found it really made a difference in my ability to perceive events and not be negatively effected by them.
-your patients were strangers when you started your shift.
Callous, but the idea is that if you had not shared a geographic co-location with this individual during their emergency that you wouldn't have known about it and by extension would not have been effected by it. Stranger at the beginning of the day and stranger at the end (applicable only for EM type encounters I guess). Weirdly this gave me a lot of peace.
-bad things happen to good people.
Accepting that the world works the way that it does was really helpful. I wish I had observed this as a truth earlier.
-be committed to the process and not the outcome.
Probably the single best piece of 'resilience' advice that I ever got. The idea was to focus on excellence on my and my team's end and emphasize and be attached to the quality of our actions without being emotionally or personally invested in the final patient outcome. As in facing a really heartbreaking patient (young, viable, no comorbity who got hit by a drunk driver) you realize that you're going to become emotionally invested/attached so focus that attachment/investment towards the quality of your own actions and interventions and emphasize the excellence of your care and teamwork instead of 'hoping for a good outcome.' When something bad happens, acknowledge that bad things happen to good people. This was a subtle difference but really helped.
-keep an eye out for your team.
Call people by name, and if you see something that's not right with how your classmate/teammate is acting go ahead and say something and offer to listen to what they have to say/are struggling with -- even if you don't know them well -- especially for those of us who have to move for our rotations
-it's ok to cry.
I had a male doc who was my idol, ex-military badass who had been there done that kind of individual, probably one of the top 1% of people I've met in my lifetime. Anyway his advice was that it was ok to cry after you've done your job if an event got to you. Can't tell you how cathartic it was at the end of those rare 1/1,000 really really bad calls to take 5 outside the ambulance bay at the side of the hospital in the dark to have a good cry before coming back to work and be able to move on to that next call with a clear mind instead of having all that badness stack up inside of you.
If you're taking the time to read this would love to hear how you deal with death/dying in healthy ways so other students might benefit, cause it's a really hard part of the process that we just don't spend enough time talking about. Anyhoo, was nervous to write this & hope it's well received.
Anyway... wrote this to put it out there that if you're feeling the stress of experiencing these things for the first or 100th time you're not alone and there are people in your life who are there to support you through this journey.
When I was training as a paramedic I remember experiencing death pretty frequently in people's homes and bedsides and really struggled to come to terms with it and wanted to open up about some things I learned that might be helpful to those of who are experiencing these things for the first time, and was hoping that some other students/attendings/residents (with way more experience than I have) could share their thoughts on an important and undervalued topic.
For the obligatory anecdote... during undergrad I worked overnights in a busy commercial 911 system and had a really ****ty year. I lost count, but over the span of about a year and a half a number friends and mentors died of suicide, homicide or random weird stochastic health events. I was a few years older than my peers at school, and had moved for college and it was just not great. So for those of you who moved for clinicals and are away from your support systems -- I get it -- it's a super hard burden they put on us. I remember one time in particular when it all just hit me in the undergrad cafeteria and I broke down in uniform one night before heading out to my shift because I just didn't want to do it anymore. The ****ty part was that no one came up to check-in. So I 'manned up' and drove myself to work and ended up really, really burned out. Sharing this to highlight that it can get really, really bad before it gets better, and that getting perspective and support can really help.
When I turned to my doc and paramedic leadership they had some really profound advice that I took to heart and would not be pursuing medicine today without because I found it really made a difference in my ability to perceive events and not be negatively effected by them.
-your patients were strangers when you started your shift.
Callous, but the idea is that if you had not shared a geographic co-location with this individual during their emergency that you wouldn't have known about it and by extension would not have been effected by it. Stranger at the beginning of the day and stranger at the end (applicable only for EM type encounters I guess). Weirdly this gave me a lot of peace.
-bad things happen to good people.
Accepting that the world works the way that it does was really helpful. I wish I had observed this as a truth earlier.
-be committed to the process and not the outcome.
Probably the single best piece of 'resilience' advice that I ever got. The idea was to focus on excellence on my and my team's end and emphasize and be attached to the quality of our actions without being emotionally or personally invested in the final patient outcome. As in facing a really heartbreaking patient (young, viable, no comorbity who got hit by a drunk driver) you realize that you're going to become emotionally invested/attached so focus that attachment/investment towards the quality of your own actions and interventions and emphasize the excellence of your care and teamwork instead of 'hoping for a good outcome.' When something bad happens, acknowledge that bad things happen to good people. This was a subtle difference but really helped.
-keep an eye out for your team.
Call people by name, and if you see something that's not right with how your classmate/teammate is acting go ahead and say something and offer to listen to what they have to say/are struggling with -- even if you don't know them well -- especially for those of us who have to move for our rotations
-it's ok to cry.
I had a male doc who was my idol, ex-military badass who had been there done that kind of individual, probably one of the top 1% of people I've met in my lifetime. Anyway his advice was that it was ok to cry after you've done your job if an event got to you. Can't tell you how cathartic it was at the end of those rare 1/1,000 really really bad calls to take 5 outside the ambulance bay at the side of the hospital in the dark to have a good cry before coming back to work and be able to move on to that next call with a clear mind instead of having all that badness stack up inside of you.
If you're taking the time to read this would love to hear how you deal with death/dying in healthy ways so other students might benefit, cause it's a really hard part of the process that we just don't spend enough time talking about. Anyhoo, was nervous to write this & hope it's well received.
Anyway... wrote this to put it out there that if you're feeling the stress of experiencing these things for the first or 100th time you're not alone and there are people in your life who are there to support you through this journey.
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