Death

[Cerberus]

Just wondering how others deal with the aftermath of death in the ED. I'm generally quite good at not letting it phase me but I've had a tough week involving a peds death and at least 3 other young deaths and a family member assaulting me after delivering bad news. None of the deaths were due to negligence on my part and I know the outcome would have been the same regardless of who was on. Still I'm feeling a little beat down and just wondering how others deal with those unavoidable periods where you just have bad outcomes no matter what you do.

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[Birdstrike]

It's hard. It's really hard. Some of it, most of it, just rolls off like Teflon, and then some hit you in the gut when you least expect it. There's no way to predict it. Cops understand it. Doctors and nurses "get it." Soldiers get it. I think a lot of others don't get it. Because we have to deal with death in life and at work. It's a heavy burden.

I think it helps to talk about it. It might help to write about it (HIPAA-compliant, of course). But some of this is hard to shake. It's what makes being an Emergency Physician very different from being a radiologist, dermatologist, accountant, or librarian. You have to stare tragedy and death in the face. Even if only for a split second, somethings we see, we can never un-see.

You tell yourself you did the best you could. That you gave that person, a little bit better shot than they would have had otherwise, even if it was only 1 in a million, by virtue of you simply being there. At the very least you were brave enough and cared enough to make the very big sacrifice of simply being there when you could have been asleep, at a football game or celebrating a holiday. This is while others chose less heart-wrenching work. Time will heal but there will be scars (one of my scars: don't read if you want dry eyes). If you're like me all of them will fade, but however faint or rarely noticed, some may last a lifetime. It's heroic work you're doing for this very reason. I feel your pain. It will get better.

 

[dotcb]

Yeah - talk about it with peers, or whoever seems right for you. We've all been there and will go there again many times over.

 

[TooMuchResearch]

Sigh. SDN mobile crashed and ate my lengthy response.

I've been struggling with this lately. My residency does a great job letting us take primary on very sick patients in first year (with appropriate senior backup), but I haven't identified our support network to discuss the emotional baggage that comes with these sick/dying patients and their families.

SO is stressed enough with me gone all the time, so clearly I can't discuss at home. Other residents have the appropriate EM sarcasm shield, making it difficult to identify those that may be good company on this. Haven't yet identified an appropriate faculty member with which to discuss things.

Really enjoying residency. Learning a lot. Having fun in the ED. Taking care of people. But getting a bit beat down by the morbidity and mortality.

 

[n2b8me]

Talking with a therapist or psychologist can be really helpful when dealing with grief and stress. We ER docs have a lot of both.

 

[Arcan57]

Sigh. SDN mobile crashed and ate my lengthy response.

I've been struggling with this lately. My residency does a great job letting us take primary on very sick patients in first year (with appropriate senior backup), but I haven't identified our support network to discuss the emotional baggage that comes with these sick/dying patients and their families.

SO is stressed enough with me gone all the time, so clearly I can't discuss at home. Other residents have the appropriate EM sarcasm shield, making it difficult to identify those that may be good company on this. Haven't yet identified an appropriate faculty member with which to discuss things.

Really enjoying residency. Learning a lot. Having fun in the ED. Taking care of people. But getting a bit beat down by the morbidity and mortality.

Sharing with SO is important. Unless they've made it clear they dont want to be emotionally supportive I think you'll find that it brings you closer and helps close the distance.

 

[Birdstrike]

Sharing with SO is important. Unless they've made it clear they dont want to be emotionally supportive I think you'll find that it brings you closer and helps close the distance.

I agree. If I didn't have mine to vent to about my day, and vice versa, things would be a lot tougher. It also helps to share the positives (life saved, funny incident, etc) for balance. Everyone relationship has to find what works for them, I suppose.

 

[Promethean]

My experience is OR, not ED, and mostly peds, so we deal with death a lot less than many. But it happens... almost always trauma related.

Strange things will get to you, ya know? I thought everything was going fine, I was performing my function and not being bothered by the 16 year old self inflicted gunshot wound to the head that I was circulating, as we desperately tried to save the kid's life. The thing that punched me in the gut was seeing the wrong side of the young man's cranium sitting briefly unattended on the back table. Nothing we don't see every day, really, like in a craniosynostosis repair. But knowing that this one was probably never going to be reconstructed hit me, hard. Weeks of nightmares and hypervigilance about my friends' kids who are that age.

It helps to talk about it, some, but not so much that you are perseverating on it and making yourself worse. If there is someone you can decompress to, a counsellor or someone, go see them. Check to see if your hospital has a defined service, or ask to speak to a chaplain, even if not religious.

Then, do things that are life-affirming for you. Spend time with people you love, take care of a pet, plant a tree, go for a hike. Remember that the fleeting nature of life means that you can't afford to waste it. Go live. And help others do the same. Find ways to be helpful to other people that don't expose you to traumatic, high stress, life or death situations. Something you enjoy, that is useful but lighthearted. I like walking the dogs at the no-kill shelter. Or sorting medical supplies for distribution in the third world through a local charity. Being helpful to others, being able to do good that isn't tempered with sadness, especially if it involves physical exertion makes it hard to sit around and think morbid thoughts.

You are showing that you do have good coping skills by reaching out for advice. Keep taking care of yourself, so that you can have the resources to keep caring for others.

 

[NotAnOperator]

Working in an Air Force ED (as an EMT, not a doctor), and seeing death as a combat medic on deployments, my experience may be a little different since I'm more so following orders than giving them regarding the patient, but I've seen an enormous amount of death at a young age. Death in the ED doesn't seem to bother me much, even peds death, but I had one incident where a marine who was my age died in front of me and that hit me hard. I couldn't find support with coworkers or family so I dipped into depression for a while. Without getting into a discussion of theology and religion, I found peace by speaking with my chaplain. I always considered myself a Christian but never really attended church or practiced religion at all. However, speaking with my Christian chaplain helped me get through a tough time dealing with death so I would definitely recommend talking with a religious leader of your faith. And even if you don't have a specific faith, speaking with a religious leader could help. I've never spoken with a therapist or psychologist but that may be very beneficial for some. Ultimately, even the most introvert among us are still very social creatures so find someone you can openly speak with, just to get it off your chest. If you let it bottle up, it will all come out one way or another.
You ER docs are true heroes and I thank you for what you do. Don't carry all that weight alone.

 

[styphon]

Find people to talk...Family members, loved ones, spiritual advisors... Or if there is an attending/nurse/resident that you respect and know is supportive..

The worst is to not address the issue if it bothers you as things will quickly start to pile up.