How do you deal with death?

[Rollo]

How do you deal with a patient on your service who dies? I mean, sure a 90 year old hospice patient is not going to affect you much.

But I'm talking about relatively young patients who get a terminal diagnosis or who just crash in the ICU?

What about kids?

Won't go into details but recently saw a series of young patients dying on the rotation I'm on now. A 2 year old from CO poisoning, a 18 year old from MVA, a 39 year old from sarcoma with mets to brain, a 47 year old from inhalation injury, and a 53 year old from heart failure (forget the exact reason but his pressures were out of whack and was pretty much screaming in pain the whole time).

I figured we could have a discussion about how since most of us have rarely experienced death on a personal level...sure a good number of us have lost older family members like a dear grandmother but it was easy to deal with their deaths because they were simply old and it was their time.

I don't know about you guys but my medical school doesn't really lecture us on how to deal with death and/or dying patients. Before starting clinical years, I never would have thought that this topic was important. But now I realize that this topic is as important to teach in pre-clinical years as pharmacology.

Anyway, how do you guys navigate through this stuff? Chalk it up as "well we're fighting a losing battle against death, the ultimate enemy, anyway"?

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[barn4]

Death is nothing to us; for that which has been dissolved into its elements experiences no sensations, and that which has no sensation is nothing to us. -Epicurus

 

[officedepot]

.

 

[RySerr21]

I don't know about you guys but my medical school doesn't really lecture us on how to deal with death and/or dying patients.

I felt this way as well, which i think is a shame. Even more so I felt that attendings/residents in thte 3rd year tried to shield students from the more serious cases (when possible). So I signed up for a two week elective in palliative care. I'm currently on it right now and would highly recommend. You also deal a lot with chronic pain management, which is also not really covered at my school at all.

 

[mmmcdowe]

By comforting the family and acknowledging the loss of life.

 

[Bacchus]

I had a patient code hours before discharge. It was awful. I had taken care of the patient and bonded well with the family over the 4-day hospital visit. This was the first week of my rotation. It was my 3rd rotation. The patient was placed on a vent, brain-dead. It was an awful feeling, especially when I went to the code. I got through it. I don't know what else to say.

The most helpful thing for me was the patient's family. I listened to them, they offered kind words to me. It made it a lot more bearable than it could have been. I didn't really get any positive support from my intern, resident, or others on my team. I guess you get numb? They often sent me to console the family, obviously refraining from medical discussion.

That's the only time I've experienced death of a patient I've had. You get through it. If you're attached or have an excellent rapport, its ok to feel grief. You'll get over it.

 

[RySerr21]

I had a patient code hours before discharge. It was awful. I had taken care of the patient and bonded well with the family over the 4-day hospital visit. This was the first week of my rotation. It was my 3rd rotation. The patient was placed on a vent, brain-dead. It was an awful feeling, especially when I went to the code. I got through it. I don't know what else to say.

The most helpful thing for me was the patient's family. I listened to them, they offered kind words to me. It made it a lot more bearable than it could have been. I didn't really get any positive support from my intern, resident, or others on my team. I guess you get numb? They often sent me to console the family, obviously refraining from medical discussion.

That's the only time I've experienced death of a patient I've had. You get through it. If you're attached or have an excellent rapport, its ok to feel grief. You'll get over it.

one of the main reasons i hated medicine.....i didnt like the attitudes many of the residents/attendings had adopted. its a defense mechanism i'm sure. death happens so frequently you just have to shell yourself off at some point so you can keep doing your job. Which is fine, just not the person I want to become.

 

[nitemagi]

This is a generally undertaught skill in medical training. Most often trainees end up associating death with failure in their work, and then either feel guilt or end up suppressing the emotions or detaching and ending up apathetic. The other end of the spectrum involves getting overwhelmed with grief and losing yourself in the emotion, which isn't helpful for others and is a tough place to be in in a field that can have a lot of death.

First off, recognize the limitations of modern medicine. We cure very little. We mostly manage chronic disease. Inevitably death happens. Your job is to do the best you can in alleviating suffering, and improving the quality of life of the individual.

Second, I recommend trying a midway point emotionally, in dealing with death. One of the most helpful things I ever did in learning this was a training at the Zen Hospice Project in SF. Learn to neither push away the feelings, nor get lost in them. But sit with them. Recognize they're there. Allow them to be there. You can carry a lot more than you think you can. And process things when you can.

Cultivate a sense of detached compassion with your patients. Feel for them. Work for them. But don't lose yourself in them. Don't be attached emotionally to the outcome of their medical condition. Care about the person, not the outcome. And act from that place.

Sometimes you can give a gift to a person just by sitting with them and giving them your presence, rather than giving into that internal need to "fix" something.

 

[Deepa100]

Let the death experiences teach you how temporary and yet valuable life is. Use it to better yourself as a person and as a doctor. Let it humble you, make you realize you are not all that important, there are bigger things in life than ourselves.
This is what I do, every day.

 

[carrigallen]

This is a superb thread with some thoughtful and detailed replies. As an internal med resident followed by oncology fellow, I have cared for a number of the dying. I have to say that, it still can be emotionally draining. Death by itself is a natural process that, not rarely, can be a relief or even a blessing. Nonetheless, it can take a subtle toll on a provider, particularly when counseling the distressed or grieving. Sometimes it can even evoke the worst in family: anger, histrionics, vitriol, in-fighting - all of which the provider may need to mitigate during their interaction.

 

[Valadi]

My first patient death was one of the few times that I felt the need to tell my friends and family about my day at work. I usually like to play things close to my chest, but I felt a lot better talking about this with other people, both colleagues and friends/family. It was very emotional for me. That being said, in this situation I generally act professional and sympathetic while at work, and process emotionally on my own time at home.

I would suggest some method of active processing for anyone, instead of just suppression.

 

[Bacchus]

This is a superb thread with some thoughtful and detailed replies. As an internal med resident followed by oncology fellow, I have cared for a number of the dying. I have to say that, it still can be emotionally draining. Death by itself is a natural process that, not rarely, can be a relief or even a blessing. Nonetheless, it can take a subtle toll on a provider, particularly when counseling the distressed or grieving. Sometimes it can even evoke the worst in family: anger, histrionics, vitriol, in-fighting - all of which the provider may need to mitigate during their interaction.

I'd imagine in oncology its particularly devastating or has the potential to be. I know there's zebras and random cases in all fields that have poor outcomes, but I'd think you'd see more of this on ocology: 30 y/o mom with Stage IV breast cancer, brain tumors in kids, etc.

 

[Rendar5]

You cry if you need to, then pick yourself up and see the next patient, and at some point that day or the next, you talk to someone about it, whether it's a coworker or a loved one.

It never gets "easy" (and if you think it does, you're just burying it where it'll bite you back someday, or you're losing your ability to connect to humanity), but it does get much less painful after the first couple deaths you deal with.

 

[oldiebutgoodie]

You sit and listen, say you're sorry, maybe hold a hand, get a cup of coffee, listen, give a hug. You can't fix it, but you would be surprised at what the family of the deceased will remember at the time of bad news-- that's often what they remember. I know, I was there. I remembered the simple gestures of sympathy and comfort.

Oldiebutgoodie

 

[wannabeOBGYN]

How do you deal with a patient on your service who dies? I mean, sure a 90 year old hospice patient is not going to affect you much.

But I'm talking about relatively young patients who get a terminal diagnosis or who just crash in the ICU?

What about kids?

Won't go into details but recently saw a series of young patients dying on the rotation I'm on now. A 2 year old from CO poisoning, a 18 year old from MVA, a 39 year old from sarcoma with mets to brain, a 47 year old from inhalation injury, and a 53 year old from heart failure (forget the exact reason but his pressures were out of whack and was pretty much screaming in pain the whole time).

I figured we could have a discussion about how since most of us have rarely experienced death on a personal level...sure a good number of us have lost older family members like a dear grandmother but it was easy to deal with their deaths because they were simply old and it was their time.

I don't know about you guys but my medical school doesn't really lecture us on how to deal with death and/or dying patients. Before starting clinical years, I never would have thought that this topic was important. But now I realize that this topic is as important to teach in pre-clinical years as pharmacology.

Anyway, how do you guys navigate through this stuff? Chalk it up as "well we're fighting a losing battle against death, the ultimate enemy, anyway"?

Death is never easy. Even if it's a family member who was simply old, it is still hard. You [supposedly] love and care for that person, and miss them when they're gone, whether they died at 42, 72, or 102. Maybe it was easy for you to deal with family members' deaths, but don't make the same assumption about everyone else.

In terms of patients, I think you learn to separate yourself from the situation. You see it as a case of, "I did everything I could" and let the guilt go. And you learn from it. I haven' seen many deaths, but this is the advice I received from an emergency physician I worked with last month.

 

[jdh71]

I don't know how people deal with the death of children. I don't think I could, which is which I don't deal with kids, god bless those who do and can.

My first overnight call as an upper level resident in the ICU was July 1. Three patient's died. I felt like crap, but later, laying in my call room, it occurred to me: You know what happens to really, really, really sick patients? They die. We do the best we can but they die. That's what happens. It may sound pretty simplistic, but it was profound to me the time. Though jumping off from there, what has really helped me with the death of my patients, is involving myself in the dying process as much as possible, mostly through interaction, and not avoiding the family, and paying close attention to the comfort/palliative care my dying patients need. If I can't save you, you will pass with as much comfort as my medications can aid. Sometimes, you get a little caught up in all the love for the patient in the room, and sometimes you just have to weep a little. It's powerful.

Bottom line for me, just being present as much as possible for all of it is the best way to deal with the death of a patient. Don't enmesh and don't be distant, just BE.

That's all I got. Hope it helps someone.

 

[Bacchus]

I don't know how people deal with the death of children. I don't think I could, which is which I don't deal with kids, god bless those who do and can.

My first overnight call as an upper level resident in the ICU was July 1. Three patient's died. I felt like crap, but later, laying in my call room, it occurred to me: You know what happens to really, really, really sick patients? They die. We do the best we can but they die. That's what happens. It may sound pretty simplistic, but it was profound to me the time. Though jumping off from there, what has really helped me with the death of my patients, is involving myself in the dying process as much as possible, mostly through interaction, and not avoiding the family, and paying close attention to the comfort/palliative care my dying patients need. If I can't save you, you will pass with as much comfort as my medications can aid. Sometimes, you get a little caught up in all the love for the patient in the room, and sometimes you just have to weep a little. It's powerful.

Bottom line for me, just being present as much as possible for all of it is the best way to deal with the death of a patient. Don't enmesh and don't be distant, just BE.

That's all I got. Hope it helps someone.

I'm glad you don't avoid it. Like I said above, I didn't get much support from my intern or resident. Besides explaining the specifics of medicine (I was a fresh 3rd year, although I still don't know much), I was sent by my intern to comfort the patient's sister. I had to explain to her what she was going to see when they transferred the patient. I went and talked to the family to see if they needed anything. My medicine team wasn't in charge of the patient's care after leaving our floor, but we often went by the waiting room for the ICU and he couldn't muster enough courage to talk to anyone. He can't be numb yet.

 

[OveractiveBrain]

How do you deal with a patient on your service who dies? I mean, sure a 90 year old hospice patient is not going to affect you much.

But I'm talking about relatively young patients who get a terminal diagnosis or who just crash in the ICU?

What about kids?

Won't go into details but recently saw a series of young patients dying on the rotation I'm on now. A 2 year old from CO poisoning, a 18 year old from MVA, a 39 year old from sarcoma with mets to brain, a 47 year old from inhalation injury, and a 53 year old from heart failure (forget the exact reason but his pressures were out of whack and was pretty much screaming in pain the whole time).

I figured we could have a discussion about how since most of us have rarely experienced death on a personal level...sure a good number of us have lost older family members like a dear grandmother but it was easy to deal with their deaths because they were simply old and it was their time.

I don't know about you guys but my medical school doesn't really lecture us on how to deal with death and/or dying patients. Before starting clinical years, I never would have thought that this topic was important. But now I realize that this topic is as important to teach in pre-clinical years as pharmacology.

Anyway, how do you guys navigate through this stuff? Chalk it up as "well we're fighting a losing battle against death, the ultimate enemy, anyway"?

I am mildly antisocial, generally sociopathic. I turn on the empathy for patients and their families when they need it, but I generally don't connect with my patients. I don't feel that deep human connection. If anything, I analyze where what I did went wrong. M&M style. Otherwise, on to the next disease. I mean, patient.

 

[jace's mom]

It has helped me to address the grief of the situation up front and then move on with what I have to do. Just admitting to myself or even vocalizing (again, sometimes just to myself but actually saying the words aloud) that something is sad seems to make it easier for me to handle. So I'll say a simple, "This is really sad," or something to that effect. Once when I said goodbye to a toddler, I wished him a safe journey (and have continued to say those words to patients since, even if it's only in my heart). For me personally, it helps to acknowledge that a profound event has occurred and that people will be affected as a result.

The first patient I watched die was a young wife and mother who had been in a car accident. I worked just fine all of that day and into the next morning and truly thought I was okay until I got home and discovered that my husband had taken off work early to meet me because he thought I would need his support. I took one look at him and burst into tears. I only cried for a few minutes, and then I was good to go. So I think you can still function at work and grieve when you have time. For myself, I think I have to grieve a bit or it will build. I hope the day never comes where I don't grieve at all.

Honestly, the worst case I've ever seen involved a young child who didn't die. This sweet little one had a terrible stroke and continued to live in a locked-in state. I can't even begin to describe how much that case haunted me. I'll remember that child's name and face when I'm 100. So sometimes I remember that there are worse things than dying.

 

[ArcGurren]

one of the main reasons i hated medicine.....i didnt like the attitudes many of the residents/attendings had adopted. its a defense mechanism i'm sure. death happens so frequently you just have to shell yourself off at some point so you can keep doing your job. Which is fine, just not the person I want to become.

I actually had the exact opposite experience in medicine, and found that when a patient died in the ICU, esp one we knew well, we all felt a really terrible loss. One of my patients died shortly after his ICU transfer after he became hypocoagulable and bled to death (liver failure). I had literally never felt worse in my life; only one week ago we had admitted him and were reassuring him that he'd get better from his SBP.

The residents did a whole lot to comfort me and make me feel better, and they were really good with talking to the family and kind of trying to help everyone through the transition. On the other hand, we had a patient on Surgery code in the SICU and the first thing someone says the following morning about his death at morning report was "well, now we have an extra bed for this next guy!" and the residents had the f***ing nerve to laugh. I understand that it's a defense mechanism, but that's just wrong.