How to cope with losing a patient ?

[Some dude 99]

Hi guys,

Today I lost a patient. He was not the first patient nor the first person that died in front of me. However, this case was pretty difficult for me. It was a kid, suicide attempt and we almost saved him. He spent almost 3 weeks in our ICU and I became somewhat of a friend to the family. I couldn't even give them the news without crying, which is silly, I know. We spent some time talking about him after they're able to calm down a bit (and me aswell). However, I have to be back on that same ICU tomorrow. Any advice on how to cope and move on ?

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[tiedyeddog]

Hi guys,

Today I lost a patient. He was not the first patient nor the first person that died in front of me. However, this case was pretty difficult for me. It was a kid, suicide attempt and we almost saved him. He spent almost 3 weeks in our ICU and I became somewhat of a friend to the family. I couldn't even give them the news without crying, which is silly, I know. We spent some time talking about him after they're able to calm down a bit (and me aswell). However, I have to be back on that same ICU tomorrow. Any advice on how to cope and move on ?

Sadly you'll get numb to it after awhile.

My advice would be to drink a beer/wine tonight. Go running or watch something good on TV. And then go to the hospital and do your job.

 

[ACSurgeon]

Hi guys,

Today I lost a patient. He was not the first patient nor the first person that died in front of me. However, this case was pretty difficult for me. It was a kid, suicide attempt and we almost saved him. He spent almost 3 weeks in our ICU and I became somewhat of a friend to the family. I couldn't even give them the news without crying, which is silly, I know. We spent some time talking about him after they're able to calm down a bit (and me aswell). However, I have to be back on that same ICU tomorrow. Any advice on how to cope and move on ?

- detach yourself. Patients and their families are patients and their families. They are not your friends or your family.

- realize that death isn't the worst possible outcome. Many critically ill patients survive and have a horrific quality of life.

- if you're relogious, maybe knowing it was his time.

- it gets easier with time. You do have to adjust your mindset though...

 

[giantswing]

Its ok to be sad. Be sad, but move on.

Also, and i hate to say it, but i agree with the above. I would never want to live in an icu for very long. Death may not be the worst thing

 

[alpinism]

Agree with the above.

Sounds like a tough case.

The whole thing is horrible, but his life ended 3 weeks ago.

 

[Rendar5]

You talk about it with someone without giving identifying information. Loved one, therapist, colleague. You probably won't forget the case ever again, so it's good to get any emotions out in the open so you can deal with them.

 

[TooMuchResearch]

Sadly you'll get numb to it after awhile.

My advice would be to drink a beer/wine tonight. Go running or watch something good on TV. And then go to the hospital and do your job.

If you get numb to the deaths, it's time to seriously consider moving on to a new career.

OP, patient death is hard. Especially in younger patients who you think have a shot at living. Recognize you weren't their friend, you were there (student) doctor. To do that job, you can't be a friend and you can't be completely detached. You have to ride ride the line in between that allows you to care but also do the (sometimes dangerous) things that need to be done for your patient.

Listen to Rendar's advice. Find someone and talk about it.

 

[Stagg737]

Agree with this ^^^

Being able to keep your emotions in check or separate from overwhelming emotions while working with the patient/family is different from detaching or numbing yourself from the situation. Be professional at work and in with your patients, but do what you need to at home or in private. If you need to cry, then cry. If you need to go hit a punching bag or workout, then do it. There's a reason the picture of the ER doc crying has become viral, and it's not because his behavior was wrong or unacceptable.

If you're totally detached or numb then there's a problem and you should either take some time to do some serious introspection or talk to a professional about it.

 

[Lord_Vader]

- detach yourself. Patients and their families are patients and their families. They are not your friends or your family.

- realize that death isn't the worst possible outcome. Many critically ill patients survive and have a horrific quality of life.

- if you're relogious, maybe knowing it was his time.

- it gets easier with time. You do have to adjust your mindset though...

I seriously hope that you're in a specialty where you seldom have to deal with losing your patients and talking to their families.

 

[CherryRedDracul]

I seriously hope that you're in a specialty where you seldom have to deal with losing your patients and talking to their families.

Why?

 

[2010houston]

I seriously hope that you're in a specialty where you seldom have to deal with losing your patients and talking to their families.

LazyMed is right on point #2 though-- spend much time in an ICU and you will want "DNR" tatooed on you and all of your family members' chests.

 

[tiedyeddog]

If you get numb to the deaths, it's time to seriously consider moving on to a new career.

OP, patient death is hard. Especially in younger patients who you think have a shot at living. Recognize you weren't their friend, you were there (student) doctor. To do that job, you can't be a friend and you can't be completely detached. You have to ride ride the line in between that allows you to care but also do the (sometimes dangerous) things that need to be done for your patient.

Listen to Rendar's advice. Find someone and talk about it.

Obviously, I don't agree. In some fields too many people die too often to be "sad" in the traditional sense for every single patient. That doesn't mean you can't be empathetic towards family members.

 

[CherryRedDracul]

Obviously, I don't agree. In some fields too many people die too often to be "sad" in the traditional sense for every single patient. That doesn't mean you can't be empathetic towards family members.

100% this. Emotional detachment is a valid and perfectly normal defense mechanism against stressors (in this case, death) that would otherwise overwhelm you emotionally. To some degree, most of us do this, but do it as a conscious decision. Otherwise, we'd be bawling our eyes out at every sad story we hear. This is different from dissociative disorders or PTSD where individuals who are affected do not make the conscious decision to be emotionally detached.

Emotional detachment does not preclude a loss of empathy.

 

[ACSurgeon]

100% this. Emotional detachment is a valid and perfectly normal defense mechanism against stressors (in this case, death) that would otherwise overwhelm you emotionally. To some degree, most of us do this, but do it as a conscious decision. Otherwise, we'd be bawling our eyes out at every sad story we hear. This is different from dissociative disorders or PTSD where individuals who are affected do not make the conscious decision to be emotionally detached.

Emotional detachment does not preclude a loss of empathy.

Exactly. Caring and being emotionally attached are different things. When you deal with death and disability (trauma and surgical critical care for me) on a daily basis, you are able to care and empathize, but cannot be attached and survive for long. End of life and palliative care services are things that I'm passionate about, and hate to see these aspects poorly managed.

Finally, as someone who has taken care of patients that have family members in healthcare, I can tell you that your role as a provider and a friend/family member are very different.

 

[ACSurgeon]

If you get numb to the deaths, it's time to seriously consider moving on to a new career.

OP, patient death is hard. Especially in younger patients who you think have a shot at living. Recognize you weren't their friend, you were there (student) doctor. To do that job, you can't be a friend and you can't be completely detached. You have to ride ride the line in between that allows you to care but also do the (sometimes dangerous) things that need to be done for your patient.

Listen to Rendar's advice. Find someone and talk about it.

There are semantics in this discussion. "Complete detachment" and being "numb to death" mean different things to different people. You become numb to death in the sense that it doesn't affect you in the same way that it affects a non medical person. If losing every patient is received with the same grief as losing a friend or family member, we'd burn out very early on.

Losing a patient sucks. It sucks much more when it's a younger patient or one who seemed to come in walking/talking who you expect to make a full recovery then they turn a bad corner. You feel a sense of defeat and helplessness. You also empathize with families and are sorry for their loss. When this occurs more frequent than usual for your specialty you feel drained at the end of that day/week/month. Being detached or numb or whatever word you chose is how most of us deal with this difficult aspect.

 

[referee3]

Scotch. Scotchy scotchy scotch.

 

[tiedyeddog]

There are semantics in this discussion. "Complete detachment" and being "numb to death" mean different things to different people. You become numb to death in the sense that it doesn't affect you in the same way that it affects a non medical person. If losing every patient is received with the same grief as losing a friend or family member, we'd burn out very early on.

Losing a patient sucks. It sucks much more when it's a younger patient or one who seemed to come in walking/talking who you expect to make a full recovery then they turn a bad corner. You feel a sense of defeat and helplessness. You also empathize with families and are sorry for their loss. When this occurs more frequent than usual for your specialty you feel drained at the end of that day/week/month. Being detached or numb or whatever word you chose is how most of us deal with this difficult aspect.

This is exactly what I meant but much more eloquently phrased.

 

[cbrons]

However, I have to be back on that same ICU tomorrow. Any advice on how to cope and move on ?

Sorry to hear that... are you a M3? Just wondering how people get ICU experience in med school - via IM rotation?

 

[WeAreNotRobots]

Just wondering how people get ICU experience in med school - via IM rotation?

4th year rotation in ICU/Critical Care. may actually be a requirement for graduation at many schools.

 

[tiedyeddog]

Sorry to hear that... are you a M3? Just wondering how people get ICU experience in med school - via IM rotation?

I did a neuro Icu rotation. It is mostly run by neurosurgeons and neurosurgery residents at my institution so I spent a ton of time in the unit as an MS3+4.

Other people at my school mostly did it during 4th year if they did it at all. It's not really a requirement but id say most people do at least 1 month of either sicu, neuro Icu, micu, or PICU before graduation.

 

[deleted500612]

If you get numb to the deaths, it's time to seriously consider moving on to a new career.

As a medical student who hasn't yet had to deal with a lengthy career filled with death and misery, I don't really get how you can tell people who have been doing this since before you were born what sort of emotional reaction they "should" be experiencing after seeing a patient die, and that they should be finding a new career if they don't experience that emotion.

Everyone has their own way of coping with things, but some physicians (depending on specialty obviously) will see literally thousands of patients die during their career. If you think they should get all emotionally distraught every time someone died they would become a complete train wreck mentally and would no longer be able to do their job or function properly in their own personal life. Some physicians will become more blunted than others, but all will become desensitized to an extent. However they choose to deal with it, I don't think it makes them any less human for not getting emotional over every death. On the contrary, I would argue it makes them more human for realizing that that kind of sh|t will get to you and eventually tear you apart if you don't find a way to keep your emotions in check. Just because someone does not experience an emotional reaction when every patient dies, it does not mean that they didn't care about the quality of care or outcome for the patient.

 

[alpinism]

Sorry to hear that... are you a M3? Just wondering how people get ICU experience in med school - via IM rotation?

We had the option to do neuro ICU and PICU during M3 as part of neuro and peds.

MICU, SICU, and Burn ICU are 4th year electives.

 

[TooMuchResearch]

As a medical student who hasn't yet had to deal with a lengthy career filled with death and misery, I don't really get how you can tell people who have been doing this since before you were born what sort of emotional reaction they "should" be experiencing after seeing a patient die, and that they should be finding a new career if they don't experience that emotion.

Everyone has their own way of coping with things, but some physicians (depending on specialty obviously) will see literally thousands of patients die during their career. If you think they should get all emotionally distraught every time someone died they would become a complete train wreck mentally and would no longer be able to do their job or function properly in their own personal life. Some physicians will become more blunted than others, but all will become desensitized to an extent. However they choose to deal with it, I don't think it makes them any less human for not getting emotional over every death. On the contrary, I would argue it makes them more human for realizing that that kind of sh|t will get to you and eventually tear you apart if you don't find a way to keep your emotions in check. Just because someone does not experience an emotional reaction when every patient dies, it does not mean that they didn't care about the quality of care or outcome for the patient.

Because I can.

Hey mods, can we Android app functionality to change training status?

 

[VisionaryTics]

Sorry to hear that... are you a M3? Just wondering how people get ICU experience in med school - via IM rotation?

MS3, saw some SICU on surgery. Internal medicine was 8 weeks of general medicine floor + 4 weeks outpatient (no ICU).

MS4, did rotations in trauma, burn, and SICU. All were essentially ICU months.

 

[Some dude 99]

Sorry to hear that... are you a M3? Just wondering how people get ICU experience in med school - via IM rotation?

I'm not from the US. Right now I'm in the 5th of 12 semesters of medical school. However, we already see some ICU/ER cases, due to our surgery classes.

 

[ACSurgeon]

As a medical student who hasn't yet had to deal with a lengthy career filled with death and misery, I don't really get how you can tell people who have been doing this since before you were born what sort of emotional reaction they "should" be experiencing after seeing a patient die, and that they should be finding a new career if they don't experience that emotion.

Everyone has their own way of coping with things, but some physicians (depending on specialty obviously) will see literally thousands of patients die during their career. If you think they should get all emotionally distraught every time someone died they would become a complete train wreck mentally and would no longer be able to do their job or function properly in their own personal life. Some physicians will become more blunted than others, but all will become desensitized to an extent. However they choose to deal with it, I don't think it makes them any less human for not getting emotional over every death. On the contrary, I would argue it makes them more human for realizing that that kind of sh|t will get to you and eventually tear you apart if you don't find a way to keep your emotions in check. Just because someone does not experience an emotional reaction when every patient dies, it does not mean that they didn't care about the quality of care or outcome for the patient.

I've worked closely with our palliative care doctors, and I'm confident you'll never find any physician who cares about patients and their families as much as palliative doctors. Nonetheless, they find joy in their job, inject a lot of humor in dark situations, they use one another to decompress, but ultimately, when they leave one patient to go to the next, they have already moved on and ready for the next encounter.

 

[Promethean]

The worst case that I have been a part of (so far) was a 14 year old suicide by handgun to the head. I am still haunted by the view of the inside of his right cranium as it lay disregarded on the back table... and by the things that I thought as I packaged up that bit of bone to be processed and stored against the unlikely possibility that he would recover enough to ever have it reimplanted. I wept while doing that, and it wasn't silly, nor am I embarrassed to have done so, even though I didn't have the opportunity to get to know the patient or his family.

All I could think about was a certain precocious 14 year old friend of mine who had just learned that he has an invariably fatal genetic disorder. I don't know if I was more afraid that my friend would do as the patient had done, or outraged that a young man with healthy genes had squandered the shot at life that my friend was going to be denied.

It was horrible. Tragic. Senseless. And the passage of time hasn't changed that.

But I took from it what lessons I could, to try to make as much good come out of it as possible. And I spent some time doing life affirming things... enjoying the company of friends and family, savoring small pleasures, taking care of myself. You may try to be detached, but you can still be wounded by these tragedies that you witness, and that isn't a flaw. Acknowledging the hurt and treating it with a little self-care is important. Trying to push through a minor physical injury can lead to greater harm, and the same is true here. Do you have any vacation time coming up? Can you take a long weekend to spend with someone you love? You need at least a little break from responsibility.

 

[tiedyeddog]

The worst case that I have been a part of (so far) was a 14 year old suicide by handgun to the head. I am still haunted by the view of the inside of his right cranium as it lay disregarded on the back table... and by the things that I thought as I packaged up that bit of bone to be processed and stored against the unlikely possibility that he would recover enough to ever have it reimplanted. I wept while that, and it wasn't silly, nor am I embarrassed to have done so, even though I didn't have the opportunity to get to know the patient or his family.

All I could think about was a certain precocious 14 year old friend of mine who had just learned that he has an invariably fatal genetic disorder. I don't know if I was more afraid that my friend would do as the patient had done, or outraged that a young man with healthy genes had squandered the shot at life that my friend was going to be denied.

It was horrible. Tragic. Senseless. And the passage of time hasn't changed that.

But I took from it what lessons I could, to try to make as much good come out of it as possible. And I spent some time doing life affirming things... enjoying the company of friends and family, savoring small pleasures, taking care of myself. You may try to be detached, but you can still be wounded by these tragedies that you witness, and that isn't a flaw. Acknowledging the hurt and treating it with a little self-care is important. Trying to push through a minor physical injury can lead to greater harm, and the same is true here. Do you have any vacation time coming up? Can you take a long weekend to spend with someone you love? You need at least a little break from responsibility.

That was very touching, thank you for sharing that.

 

[devilpup]

Hi guys,

Today I lost a patient. He was not the first patient nor the first person that died in front of me. However, this case was pretty difficult for me. It was a kid, suicide attempt and we almost saved him. He spent almost 3 weeks in our ICU and I became somewhat of a friend to the family. I couldn't even give them the news without crying, which is silly, I know. We spent some time talking about him after they're able to calm down a bit (and me aswell). However, I have to be back on that same ICU tomorrow. Any advice on how to cope and move on ?

Best thing you can do is to learn from the case... Coping strategies that have worked for me is running, hitting a punching bag, and having a drink. As you go forward in your training you will find that morbid humor is sometimes inevitable.
Someone once said, "the second you start blaming yourself for people's deaths, there's no coming back."

 

[Chipster.]

Best thing you can do is to learn from the case... Coping strategies that have worked for me is running, hitting a punching bag, and having a drink. As you go forward in your training you will find that morbid humor is sometimes inevitable.
Someone once said, "the second you start blaming yourself for people's deaths, there's no coming back."

Did The Fray happen to be playing in the background when this was said?

 

[devilpup]

Did The Fray happen to be playing in the background when this was said?

lol, yes!

 

[NickNaylor]

A critical skill to learn in medicine is the detachment people have mentioned. Detachment doesn't mean that you're a robot with no feelings or that you're unable to express empathy in a genuine way. Instead, what it means is that you're able to move on with your life and not let bad outcomes which are bound to happen destroy your ability to function. If you become overly attached to the people you're treating, you will never be able to your work effectively without some impact on your personal or professional life. Some deaths are harder than others, which sounds like what happened here. That's ok and normal, I would say. I'd recommend seeing your school's mental health services for a quick counseling session or two just to talk it out. Another option is to talk to members on your team about the experience if you think they might be receptive (not everyone is). When a patient I was taking care of died for the first time, my senior resident offered to talk if I needed to. It was a very nice gesture that I think in a lot of ways is more constructive and helpful coming from other healthcare providers rather than laymen.

 

[cinnamonlady]

Scotch. Scotchy scotchy scotch.

Scotch *with friends* Pour some out and sing along to a song with bagpipes in it such as The Pogues "The Body of the American"

 

[cinnamonlady]

But I think it is refreshing and definitely a good thing that you are thinking about it