dealing with death

[jmart]

After volunteering in the ER for 2 years I finally observed my first gsw. I'd been waiting for this ever since I started but I don't think I was mentally prepared. The patient came in talk and left with a chest tube and intubated. They later died in surgery and I bad knowing I was one of the few people who same the patient conscious. This wasn't even bad because the patient did NOT acutally die in the ER. How do you guys handle the deaths that aren't expected? What was your first experience and do you eventualy become numb to it?

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[deleted109597]

Death is to be expected. However, some just hit closer to home. If you ever get completely numb to it, you stop trying to fight it, so most never get that far.
You can see the differences though, no matter how hard we try. Nobody codes the nursing home patient for an hour. Almost everyone does the 28 year old, or even worse, the 8 year old. It is just because you expect those people to not die.
My first death was my first day in the ED. BLS just doesn't work that often.

 

[Wackie]

My first day as a volunteer in an ED, one of the EM docs who worked there came walking in wearing street clothes. His mother in law was in town visiting and had collapsed in the shower. Earlier that day she had complained of a headache. They did what they could and sent her to ICU to die, basically. It was an inoperable brain bleed. They didn't expect her to live through the night. I felt like I brought bad luck.


The first death I saw where I got to see someone called was a young guy, looked to be in his late twenties, early thirties, who was found unconscious at a park. He looked like he was running. He was overweight, but obviously trying to get healthier. When we got him, he was flat line and that's how he stayed, pretty much. After thirty minutes, the doc called it. We couldn't find any identification until about twenty minutes into it when someone found something on his shoe. We couldn't get ahold of anyone.

Sometimes it's not the patient's death that'll hit me, but their loved ones reactions. I'm sure that when they finally found out, they probably wished they were around the phone, or wished this, or that, maybe wished they said something nicer to him the last time they spoke to him, things like that.

 

[Febrifuge]

The other day, when I got in and was assigned to the trauma room, I got report from the tech who had been on the previous shift. There had been three patients, from two cases: one birth, and one death. This struck me as sort of poetic.

I've been there as patients expired, and I've been there for miraculous saves. Over time, it sort of balances out, and I find that the trade-off for the chance to intervene and save a life is that we will necessarily be around for those times when nothing can be done. I find this to be a fair deal, overall.

You can't get too wrapped up in the idea that "I was one of the last people to see this person talking." Ultimately, in this poor soul's trip through the mortal plane, you were a tiny blip on the radar. It's not as if you could have done anything to make them a better person, or remind them how their family loved them.

Often, we'll try to take on more responsibility than we truly have, because that's a way to control, and thus deal with, the scary monumental nature of death. In my opinion, a more appropriate (and more sane) way is to stop thinking of death as scary and monumental.

 

[ForbiddenComma]

This one time during my first few weeks of volunteering in the ER as a premed, I was busy doing one of my usual scut routines, loading the towel oven. This tech comes up and asks if I could give them a hand in the back (I'm a big guy.) So over in what passed as a trauma room in that smallish ER, there was a guy maybe 50 y/o laying there as if he were taking a nap. They needed my help rolling him into the body bag. Apparently he was out playing soccer with his kids when the MI hit. You could still smell the sweat on him. Naturally, what bugged me was his eyes. I wish they had closed them like they always do in the movies. "I'm sorry, he's gone" the sad doctor says in the movies as he reaches over and closes both eyelids with one hand. I guess real life ER staff are so inured to it that they don't even notice little things like the wide stare of death anymore.

First death as a med student was a 60ish woman having a routine lumpectomy for DCIS. It was a nothing operation, out before we were even in almost. She was throwing some PVCs during the procedure but I figured that it was nothing, and besides it wasn't my place to say anything since med students are about as important and about as respected as the drunk in the ER who likes to pee on the floor. Anyway, she coded out in recovery about 15 minutes later. I kicked myself all day because I felt like I should have brought up the PVC's during surgery but of course that would have accomplished nothing anyway, except maybe to piss off the anesthesiologist. Usually the surgeon likes to have the student along when he talks to the family... that time, of course, he didn't.

It was weird how the simplest operation can end with a code, whereas monster emergent bowel resections following a perf can leave the patient almost looking like nothing happened a week later. Kind of scary how random it is.

 

[dlung]

This one time during my first few weeks of volunteering in the ER as a premed, I was busy doing one of my usual scut routines, loading the towel oven. This tech comes up and asks if I could give them a hand in the back (I'm a big guy.) So over in what passed as a trauma room in that smallish ER, there was a guy maybe 50 y/o laying there as if he were taking a nap. They needed my help rolling him into the body bag. Apparently he was out playing soccer with his kids when the MI hit. You could still smell the sweat on him. Naturally, what bugged me was his eyes. I wish they had closed them like they always do in the movies. "I'm sorry, he's gone" the sad doctor says in the movies as he reaches over and closes both eyelids with one hand. I guess real life ER staff are so inured to it that they don't even notice little things like the wide stare of death anymore.

First death as a med student was a 60ish woman having a routine lumpectomy for DCIS. It was a nothing operation, out before we were even in almost. She was throwing some PVCs during the procedure but I figured that it was nothing, and besides it wasn't my place to say anything since med students are about as important and about as respected as the drunk in the ER who likes to pee on the floor. Anyway, she coded out in recovery about 15 minutes later. I kicked myself all day because I felt like I should have brought up the PVC's during surgery but of course that would have accomplished nothing anyway, except maybe to piss off the anesthesiologist. Usually the surgeon likes to have the student along when he talks to the family... that time, of course, he didn't.

It was weird how the simplest operation can end with a code, whereas monster emergent bowel resections following a perf can leave the patient almost looking like nothing happened a week later. Kind of scary how random it is.

don't stress about it... PVCs truly don't mean much. She probably had underlying heart disease and the cardiac stress of anesthesia/intubation might have been too much... it happens...

the more responsibility you gain in training, the harder deaths hit... you'll just get better coping...

 

[deleted109597]

I fear the first code I have to run as a resident.

 

[DropkickMurphy]

My first trauma death where I had some responsibility for the case was a high school classmate of mine. We were both on our way to class that morning and she crashed her car and I responded for the fire department. As the first person on scene, I bent down to check her (the car was upside down and she was pinned inside). The thought that ran through my head was "Why is she trying to look in back seat?" Then I realized her neck was broken and her head was so angulated that there was no way she was alive. No pulse, no respirations....I turned around and found another EMT standing beside me. I told him she was dead and that I needed to go. Walking into school that day was the hardest thing I'd done to that point in my life....I was the one who let everyone know Carrie was dead. I can still see the look on her face. That was 10 years ago last month....... :-\

To the OP, you get used to it. Death no longer bothers me unless it's a kid or someone I know.

 

[DropkickMurphy]

I guess real life ER staff are so inured to it that they don't even notice little things like the wide stare of death anymore.

You can close them, but they normally pop back open because of the inside of the eyelids sticking to the eyeball as they dry out (normally within 20 minutes to an hour of clinical death) In the funeral business they use a thing called an "eye cap".....'contact lenses from hell' as I called them.....basically flesh colored contact lenses with barbs to hold the eyelids closed. In a pinch (for a family wanting to view a body), you can put vaseline in the eyes to help "stick" them shut. Just random trivia too.....if you want to impart a peaceful look, you don't want the eyelids to meet in the middle, but 2/3 of the way down. Ah, the crap you learn in a funeral home.......

 

[deleted87716]

Everything you ever wanted to know about embalming and funerals, but were afraid to ask: http://www.wyfda.org/basics.html

 

[Hard24Get]

Everything you ever wanted to know about embalming and funerals, but were afraid to ask: http://www.wyfda.org/basics.html

You, see, and people look at me cray when I say the whole process is grotesque. I hate funerals with open caskets

What's wrong with just burying the body without preservatives or a casket so it can fertilize the earth. Does seeing the body really help anyone>

 

[deleted77919]

You, see, and people look at me cray when I say the whole process is grotesque. I hate funerals with open caskets

What's wrong with just burying the body without preservatives or a casket so it can fertilize the earth. Does seeing the body really help anyone>

Personally, I want my body permenantly on display in an open forum, preferably a public square of some variety . . . people could journey to visit me . . .

Only kidding.

 

[DropkickMurphy]

You, see, and people look at me cray when I say the whole process is grotesque. I hate funerals with open caskets

What's wrong with just burying the body without preservatives or a casket so it can fertilize the earth. Does seeing the body really help anyone>

Actually you can do that......most states don't require embalming, nor do they require you be buried in a designated cemetery. We buried a lady in her back yard in a (literal) pine box.

And yes, there have been studies done that show benefit to the surviving family members to see the body in many cases, particularly if the death was after a lingering illness or horrific trauma.

Personally, I want to cremated, mainly because I don't like the idea of having an embalming trocar rammed through my belly. To quote my supervisor on the first embalming I did as a student: "Woot! Heart tap.....nice work Steve!"

 

[DropkickMurphy]

Personally, I want my body permenantly on display in an open forum, preferably a public square of some variety . . . people could journey to visit me . . .

Only kidding.

If you want a really interesting read, you should check out the story behind the embalming of Lenin.

 

[igcgnerd]

When I worked on a rig I never was in the room of a code when it was called and the only death I had seen were the stiff doa's. On my second day as an e.d. tech a 45 y/o guy w/ hx of heart disease and mi's comes in full arrest and I helped work on him for thirty minutes. I was always either doing compressions, bagging him, or prepping for a procedure. Well the doc called it and by then the family had arrived an brought them in just as he was about to call it to show them what we were doing for him (not the brightest idea). The family was histerical. I just looked at his mother, father, wife, and son and was amazed. I thought about how precious life is if a 45 y/o can go like this.
It has gotten easier to deal with death but i think remembering the things patients have taught me make me a better person and will make me a better doctor because of it.

 

[evansmd911]

Hey im 18 and wheww...I just responded to a car wreck where 3 people including a 2yr old little boy died. We had to pick parts of his skull and brain matter up off the side of the road. For some reason I was ok with it..I really dont know why but im equipped for it. I mean imagine seeing a child his grandmother and his mother all DOA with massive trauma to the whole body.Then imagine having to put all three bodies into body bags. I guess after a while you get used to death. Just remember no one can escape the inevitable.

 

[iatrosB]

Hey im 18 and wheww...I just responded to a car wreck where 3 people including a 2yr old little boy died. We had to pick parts of his skull and brain matter up off the side of the road. For some reason I was ok with it..I really dont know why but im equipped for it. I mean imagine seeing a child his grandmother and his mother all DOA with massive trauma to the whole body.Then imagine having to put all three bodies into body bags. I guess after a while you get used to death. Just remember no one can escape the inevitable.

I promise you that dealing with the 2 year old death will be MUCH harder when you have one of your own, can't explain it, just something you have to experience for yourself.

 

[DropkickMurphy]

Agreed.......it is a whole lot harder once you become a parent because you no longer see the child in question, but rather your own child. *shudders*

 

[DropkickMurphy]

Hey im 18 and wheww...I just responded to a car wreck where 3 people including a 2yr old little boy died. We had to pick parts of his skull and brain matter up off the side of the road. For some reason I was ok with it..I really dont know why but im equipped for it. I mean imagine seeing a child his grandmother and his mother all DOA with massive trauma to the whole body.Then imagine having to put all three bodies into body bags. I guess after a while you get used to death. Just remember no one can escape the inevitable.

You might be "equipped" to deal with it, but trust me, there will come a point in time where all of this will catch up with you. Be sure to deal with the emotions involved with what you see at the time and not to let them bottle up and then overwhelm later on......I've been in EMS for 10 years now, since I was in high school, and if you need to talk about this case or any case you have, I'm as close as a PM.

 

[Croooz]

You might be "equipped" to deal with it, but trust me, there will come a point in time where all of this will catch up with you. Be sure to deal with the emotions involved with what you see at the time and not to let them bottle up and then overwhelm later on......I've been in EMS for 10 years now, since I was in high school, and if you need to talk about this case or any case you have, I'm as close as a PM.

Very true. I had my father, uncle, great uncle, good friend, coworker, all die within 16 months. Then I join the military as a corpsman and experience more and one night out of the blue, right smack in the middle of the witching hour, I was dealing with all kinds of demons. There's a time to be macho but not ever dealing with death doesnt' make it go away. It will spring up. Send Murphy a PM. You can send me one as well.