How to deal with death. the stress involved when you see a person dying?

[lmay0001]

currently 3rd year medical student. however on the wards im finding it hard to deal with deaths. it clearly is effecting me.

couldnt sleep well after seeing a young mum with METS to the lungs and brain. just feel like crap and depressed

if this is medicine i dunno what guts one needs to deal with this on a daily basis

dunno what to do anymore, really need suggestions on how to deal with it on a mental level and not feel bad every bad shift i have

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[OrthoTraumaMD]

Focus on the good.
Also read “the house of God.”


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[HomeSkool]

This is a very difficult question without an easy answer. Ultimately, you have to determine what works for you. No matter how long you've been working in this field, though, I think it's undesirable to become so inured to tragedy that it no longer moves you. Nonetheless, you have to learn how to compartmentalize sufficiently to maintain professional distance and continue working in the face of death. I have a few suggestions that may help you.

• Don't go through it alone. Confide in your close friends and loved ones when you struggle with sickness and death. Talking about it allows others to share the burden, and you can draw on their strength with the knowledge that you'll someday be in a position to either repay the favor or pass it forward. When a trauma patient died in my OR last month, I had no fewer than a half dozen colleagues who approached me within the next day to see how I was handling the death. Knowing that my colleagues love and care for me helped me work through my feelings and carry on.
• Focus on the good. In your role as a healthcare professional, you will change countless lives for the better. You'll alleviate suffering, extend life, and improve health and wellness. Even during those dark times when a patient worsens, you bring comfort to them and their loved ones. Your role allows you to be a healer to more than just your patients.
• Accept that all lives end. Yours will, mine will, and every patient's will. We never know when our time will come. You need to accept that to find peace with it.
• Find peace through faith. If you're religious, share your concerns and heartaches with God. If you're not religious, consider whether religious activity might benefit you, either through the development of faith in a higher power or simply through the sense of community you can achieve with other churchgoers. My faith that God will right all wrongs helps me move past the apparent injustices and afflictions of this life.
• Seek professional help if necessary. Some of your post reads like a declaration of depression. Depression can be either situational/temporary or chronic, but either way it's a problem and should be addressed. You may benefit from seeing a counselor or mental health professional to help you develop positive coping strategies. Such professionals can help you find the tools to succeed when you struggle.
• Allow yourself to grieve. Even when you maintain professional distance, don't lose your compassion. You may need to maintain your composure while you're working, but you still need to acknowledge your emotions and grief at the appropriate time.
• Don't assume that you're the only one struggling with death. Other people around you struggle with it, too.

 

[togaedere]

It’s good to be resilient to be able to attend to the dead and dying, but I would recommend not putting pressure on yourself to feel like you need to be totally unaffected to be a good doctor. Everyone has different coping mechanisms — I can tell you what I do (which is all a combination of the below in different scenarios).

I work in both medicine and pediatrics. I’ve had deaths on both sides and naturally the pediatric deaths tend to wear at me the most. Talking does in fact help, and finding a classmate and or like-minded person to help you debrief is paramount—if you have access to a good mentor who can help offer some advice that is also great. I always recommend getting a therapist. Far too few people have one and our careers are so full of daily stressors that it’s very important to have a trained person who can help you maintain a healthy perspective and be there to help steer you otherwise if/when you start to develop some maladaptive behaviors (substance issues, resentment, anything.)

I’m not endorsing religion per se, but I do recommend engaging in some aspect of spirituality. Asking the “why” questions and really attending to the deep aspects of human suffering can deepen your toolkit to help yourself and others. Very awful and unfair things happen to people, and a lot of time there isn’t an answer. But there can be strategies to help you put one foot in front of another to be able to take care of the next patient fully. Sometimes medicine doesn’t exactly allow for us to have the time we need when we need it—but there are coping strategies to help without becoming subsumed in the process. Most of the beginning work starts with being honest with yourself and the process. There are some pretty hardened people you’ll see out there and I just really recommend that you don’t feel pressure to become like them.

Crying is at some point inevitable if that’s where you’re at. I keep it under my hat when there’s work to do, but I have cried with families a handful of times as well as cried afterwards and in between. It becomes a problem when the family feels like they need to comfort you. But when it’s occurred the families are usually touched. I have attendings that day the same.

I recommend the book “trauma stewardship” by Laura Van der Noot Lipsky. If I remember correctly she comes from social work.

currently 3rd year medical student. however on the wards im finding it hard to deal with deaths. it clearly is effecting me.

couldnt sleep well after seeing a young mum with METS to the lungs and brain. just feel like crap and depressed

if this is medicine i dunno what guts one needs to deal with this on a daily basis

dunno what to do anymore, really need suggestions on how to deal with it on a mental level and not feel bad every bad shift i have

 

[operaman]

I think this is normal for anyone I’m medicine with a soul. For many of us, this is the closest we’ve been to death in our entire lives.

It never gets easier, but you do get used to it.

There is no easy answer. The house of
God rule that states the patient is the one with the disease is a good thing to keep in mind. This is done with the knowledge and respect that our time is on the horizon as well.

I wish there were more opportunities to discuss these moments openly when they occur. Sometimes there are gifted faculty around who can facilitate this but that’s uncommon and less common still that there is time.

Turn to your support system, your religious faith if that applies to you; refocus your energy and thoughts on other things. Remember that it isn’t your fault, you did not give that person cancer. Whatever your beliefs, you are probably supremely confident that you yourself are not god and did not will things into being as they are. I think of that point frequently as well.

Then I try to move forward and be thankful today isn’t my day.

 

[Stagg737]

This is part of the medical education, and the fact that you're feeling this way shows you're empathetic and human. That's a good thing. At the same time, this is medicine. You should have known coming in that the point of clinical medicine is to help sick people. Some people people we can fix, many we can't. It's something we all just have to learn to deal with at some point; the method that works depends on the person though.

Others can give advice on how to deal with it, but I will add that there are plenty of fields where you will not have to deal with this on a regular basis. That doesn't mean it won't happen or that you shouldn't develop appropriate coping mechanisms, but it doesn't have to be something you deal with daily for the rest of your career.

 

[lmay0001]

Thanks guys for the support. really helps. i feel im not that alone hehe

 

[Xorthos]

Whiskey helps.

 

[deleted480308]

With some variability due to specifics (kids always hurt more) you deal with it in the same way allergy densitization kind of works......your 20th death hurts less than your first

There is also the fact that you are too busy to wallow in pain, the patients in the other 20 rooms on that floor are still sick and they’re injuries/illnesses don’t care that someone else died

 

[Psai]

Tbh its way worse to see someone who is basically dead, suffering on a vent for months with family who don't even care to visit

 

[SurfingDoctor]

For better or worse... you get used to it so you can instead focus on the people who you can help.

 

[VA Hopeful Dr]

Become a family doctor.

Snark aside, there are fields that have less of this than others. Oncology = bad. Allergy = good.

Peds has much less death but when it happens its way way worse.

 

[SLC]

I never really struggled that much with it; nothing special about me but I can compartmentalize pretty well and I have a religious perspective that probably colors some of my experiences with death. I also had to take a number of death and dying courses in undergrad that very much normalized the dying process for me.

My suggestion would be that you do a rotation in Hospice and Palliative Care. Being in an environment where death is normal, often beautiful, and the expected outcome might be very helpful for you. Often times in the wards, patients who die do so from complications or progressions of chronic illnesses, and would have benefitted from palliative/hospice care Long before their deaths.

I know that my oncology rotations in med-school had huge hospice/palliative care components, the palliative care docs were part of the oncology team and every patient got regular meetings with them. It was an amazing model IMO.

During those experiences I feel like I learned when to accept and even embrace death as the best, or least horrible, or perhaps simply the inevitable outcome for certain patients. Once I was able to do that, dealing with death has been much easier; and I feel I’ve been better able to help families through it too.

Hope that helps.

 

[mistafab]

First aid says Humor, Sublimation, Suppression, and Altruism.

 

[letsdoit]

It just shows that you are human. You should be happy and proud that you are saddened by your patient's passing. Try and hold on to that during your career.
Now to your question about how to cope. Talking to your friends and loved ones helps. Also, praying helps me as I am somewhat religious. Finally, I take solace in the fact that I am given an opportunity to touch people's lives through my job.
I also like the idea of doing a rotation in Palliative Care by another poster but that might be my personal bias as I practice Palliative Care.
I had a patient in med school who was young and in terminal stages of ALS. It was sad to see especially because he was married. But I keep his memory alive by thinking about him and his family periodically even after all these years.

 

[Mad Jack]

When I'd seen enough death I kind of just died inside. I've seen... Oh, rough guess, maybe 700 people die over the years, if not more. Might even be into the four figures tbph, we had a lot of codes back in my old life due to the size of the institution. The first few were rough, and there's occasionally a case that tugs at my heartstrings, but for the most part I've just learned to appreciate the circle of life. It's an honor and a privilege to be there in a person's last moments, for you are only born and die once. Do all that you can to save them, but when you fail, recognize that it is just how things go. Life begins and ends, and we can only do so much to stop that last step. Be proud of the work you do, and the fact that you gave a patient their best damn chance at survival even if it ended in vain.

 

[Menander's Bust]

You should do a rotation with hospice. It sounds counterintuitive because that would put you around terminal patients nonstop for several weeks, but the perspective of the people who work in hospice will give you a new perspective on death.

First, you will come to feel that death is a part of life, something that happens to everyone eventually. Our culture is obsessed with avoiding anything related to death. Everyone is obsessed with looking young, we have 60 year old actors who get so much work done they look 35. In other cultures death is not so taboo of a topic. Even in recent times in the US it was a constant reality - WW2, Vietnam. Many Americans more routinely knew people who had died tragically than it seems like happens now.

Another thing they will tell you is that we make a huge deal about birth, but people deserve as much dignity when they die as when they’re born.

Ultimately I know that I was uncomfortable with death because I did not want to be confronted with my own mortality. Seeing other people dieing reminded me that I was going to die and made me think about what it would be like when or if I got to a point where I had cancer or some terminal condition, or just old age, where I knew the end was near. What would I think? How would I feel? Being around terminal patients and the fantastic hospice workers helped me accept death and view it in a more healthy way, as a natural part of life and as one where as physicians we can still help our patients. Death is not a failure, a terminal diagnosis doesn’t mean nothing is worth anything and the situation is a total lost cause. Everyone will die some day. It is a great blessing to be able to die in peace, in comfort, the way you wanted to go. These sorts of things are part of what we as doctors can give our terminal patients.

So that is my recommendation. I don’t think you’ll regret the experience. Best of luck!