How do you handle patient tragedies?

[Pemulis]

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Hi, this is my first post on this board, although I've been reading for a while. I'm 27 and thinking of going back to school for medicine, and I have a question which I haven't seen addressed much in this forum. Basically, I find medicine COMPLETELY fascinating, and I think I could be a good Doctor, but I am a bit concerned about how I would handle situations like telling somebody they were going to die soon, or having to deal with the parents of a terminally ill child. I was hoping some of you could give me your perspectives on this kind of situation: do you just get used to it after a while? Do you find that your patients take this sort of thing courageously more often than not? Does it wear you down? I'm not sure which forum to post this in, but if any of you have some experiences to share I would really appreciate it. Thanks.

 

[BassDominator]

You never get used to it.... but you do get better at giving bad news.

Every individual or family reacts to bad news differently. Some grieve with you.... some don't.

How I react to it is entirely up to the situation. A school age child getting run over will really bother me. An 85 year old who dies in his/her sleep usually doesn't bother me much at all.

 

[southerndoc]

See my post in the other thread you created in the Allopathic forum (or was that the Clinical Rotations forum?). Man, I need sleep!

 

[Neuron]

do you just get used to it after a while?

Yes

Does it wear you down?

Hasn't yet.

 

[beyond all hope]

There are some situations which grip you more emotionally than others, and often you are surprised by what gets you.

I found a unexpected lung mass in a 65 year old Hispanic drag queen. I sat down with him and had a half-hour conversation, and he told me how to live life and to stay in touch with family (he had lost touch with his due to his lifestyle). It sort of broke me up.

Then again, I code people every day and rarely feel much emotion. Even children sometimes don?t cause a reaction.

It?s part of the beauty of medicine, and I wouldn?t have it any other way. No other profession gets to be with other people for the ultimate highs and lows.

 

[Winged Scapula]

I don't know if you get "used to it" and I haven't found that it wears me down, but there are some cases - either because of your connection with the patient, the disease process, or maybe just because you're tired - which hit you harder than others. Mine was a infant diagnosed with a rare agressive cancer; an infant whose parents had spent years waiting for the right partner to come along, finally met each other in their late 30s, then spent years in fertility treatments only to nearly give up when they found out they were pregnant with their beautiful baby daughter. Talking with them, and then seeing them dissolve into tears in each other's arms was really difficult for me.

Then again, as others have said, I've seen lots of other dire diagnoses and deaths and haven't thought twice about it. I also feel pretty comfortable with my skills in this area.

Patients handle such bad news in a variety of ways: denial is a big one (I'm doing ENT/Head and Neck right now and I'm still stunned over the size of some of these oral cancers and how long patients have let them go), fear, fear masked by bravado, etc. Some will get angry with you, others will fall into your arms, needing some comfort.

Don't let this fear dissuade you from pursuing medicine - remember you most likely will get better at it, handle it better and there are always fields (ie, Rads, Path), in which you don't have to deliver bad news directly to patients.

 

[Febrifuge]

Oddly enough, this is one of the areas where I feel somewhat confident that I'll be able to do well. It's not that I'm so emotionally tough or I'm so filled with empathy. I just have a lot of respect for the chance to be with people at difficult moments, and I know I do well 'on the spot' because of other training I've had. Maybe it would help allay your anxiety if you think in terms of those times when you've had to endure bad news and bad events... and you've appreciated the way things were handled.

 

[Pemulis]

Thanks to all of you for the insightful replies. I don't think this will stop me from going for med if I decide that it is the right decision for me. It's just that I have a lot of respect for the gravity that goes with the medical profession and also for the massive sacrifice in time, stress, money, and disruption to my family that this will cause if I decide to pursue it...so I'm just trying to do as much research as I can and make sure that my final decision will be the right one. Thanks again for the info, and if anybody else has anything to add, by all means keep it coming.

 

[fourthyear]

You can always keep in mind, you didn't give this disease or injury to this patient (usually). So, although you bring the bad news, patients and families know you did/will do all you can to help the patient get through this. And they usually just appreciate your honest explanation of what's going on and what the treatment options might be. It's actually kind of rewarding to feel you are able to be a comfort to someone during a time they are finding out some bad news. And, if you really dont' feel comfortable with those situations, there are many fields in medicine where you can avoid dealing with critically ill patients.

 

[banner]

You don't "get used to it" anymore than you get "used to" your friends and relatives dying. But, still, it's part of life and one has to accept it.

Conveying the news isn't as difficult as trying to accomadate the ranges of reactions you get from denial to anger at you to acceptance.

Giving bad news in our society is particulary difficult because many walk around and never expect anything bad to happen (a distortion propagated by the media). When it does, they freak out.

 

[Docxter]

Don't let this fear dissuade you from pursuing medicine - remember you most likely will get better at it, handle it better and there are always fields (ie, Rads, Path), in which you don't have to deliver bad news directly to patients.

Actually we do have to deliver bad news every now and then. In mammography, radiologists are usually the ones who call the patients and tell them if they have cancer or not. Sometimes we have to call patients for biopsy results of other organs as well. Also, we sometimes have to deliver bad news to patients in IR and neuroIR. Just last week my attending and I had to talk to the parents of a 17 year old who suffered an acute basilar artery thrombosis and we couldn't save him and he died on our table.

 

[Winged Scapula]

Actually we do have to deliver bad news every now and then. In mammography, radiologists are usually the ones who call the patients and tell them if they have cancer or not. Also, we sometimes have to deliver bad news to patients in IR and neuroIR. Just last week my attending and I had to talk to the parents of a 17 year old who sufferred an acute basilar artery thrombosis and we couldn't save him and he died on our table.

Of course you're right. Thank you for clarifying what was a hasty comment on my part.

 

[roja]

In the ED, I have run the gamut. I have had to tell a young person they had HIV. I have told family members their loved one is brain dead. The truth of the matter is, that you don't know how each individual situation will affect you. I think the one mistake people make is that if a situation DOES affect you, that you don't necessarily need to hide behind a stone wall. I have been tearful before, and the family member felt so much more relieved. They would only talk to me. I guess for whatever reason, to them, that let them know I cared. Its inappropriate to sob etc, but you can let families know that you empathize with them.

And I had a healthy 10 day old aspirate and die. I went home and sobbed.

Different deaths will affect you differently. They key is to always hold onto your humanity.

You find that you can actually bring alot of comfort to families in these times by simply letting them know you are compassionate and caring.