How to Separate Yourself from the Patient

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

hopeful25678

Full Member
5+ Year Member
Joined
Mar 9, 2017
Messages
38
Reaction score
10
Hi Everyone,

I am a scribe in ED. I always knew that things would get hard and that I would have to deal with death while at work and when(hopefully) I get into medical school. I've seen a few people pass away and although it was sad, I've never been affected quite like this. I just saw a child die for no reason other than the incompetence of their family. I cried for about 2 hours after the child died and could barely finish my EMR. It's been a couple of weeks now, and I can't stop thinking about the kid.
I don't know what to do. I have never been so depressed, and my heart hurts from how much pain that kid felt.
My question is, how do you cope with this and not let it affect you in the future. Do you think with time I will not be as affected by these cases?

Sorry for the long post and thank you for your advice.

Members don't see this ad.
 
Members don't see this ad :)
I don't think you need help, I can't speak for those who have experienced this but just think of all that you've helped and the thousands more you will help as a scribe and future doctor


Sent from my iPhone using SDN mobile
 
  • Like
Reactions: 1 users
Learn to disconnect.
 
  • Like
Reactions: 2 users
Hi hopeful25678,

First off, I want to validate your feelings. We all bring ourselves into the practice of medicine including our cultures, educations, and personal experiences. Sometimes there will be cases that affect you more than others do, and these cases may not be the same for you as others. In medicine you will often be dealing with life and death, self-neglect, abuse, codes and other things that most other people don't deal with in a typical "day on the job." Especially if there was no real "debrief," it can be difficult to process these emotions. Talking to a friend or family member (or counselor) about the feelings this case evoked would probably be helpful for you. It's OK to mourn the loss of this patient, but you can't let it overtake you.

It is healthy to feel (and you should feel something), but you can't let cases take over your day-t0-day life. There does have to be distance between you and your patients (both for your and the patient's benefit). The work has to stay at work if you want to stay emotionally healthy and remain resilient. This doesn't mean you don't empathize and care for your patients, but often you'll need to be able to step back in order to be helpful to them. Try to transform your feelings of anger/helplessness into something productive. What did you learn from this case? How will you use this information when you see a similar case? In short, give yourself a break--it sounds like this was a tough case.

Take care.
 
  • Like
Reactions: 5 users
This may be the worst thing that you see in your career. Probably very hard to put it in perspective. I always ask myself if I made any mistakes when there is a negative outcome.
Maintain good support and a hobby. Your school may have resources for you.




Sent from my iPhone using SDN mobile
 
  • Like
Reactions: 1 user
dude. you super need to see someone. your school should have a counseling center. you need to aware your boss too because this is very no bueno
 
  • Like
Reactions: 2 users
You should avoid walking around with tape, glue, and other adhesives in the ER.

A lot of people cope with time and reflection, chances are you will too. But nothing wrong with talking to someone about it if you want to, it can help. Most schools have some sort of student counseling center, and a certain amount of consultations / visits are usually included in the fees you pay every semester. Just drop by or give them a call, simple as that.
 
  • Like
Reactions: 1 user
Members don't see this ad :)
Talking to someone is definitely good.

I'm extrapolating here, but hard things are made harder when they feel senseless. Obviously this child's death was senseless, but can you make sense of your involvement? It's worse if you're a bystander and you feel no hope of making things better. As a scribe, you're not treating anyone directly, but you are there for a reason: to get into med school, become a doctor, and work to make things better. If you can make sense of just why it is so hard and why it is that you are there, it can make it easier to process.
 
  • Like
Reactions: 1 user
I totally agree with the poster above. Talking to someone really helps. You can even say to the attending physician, 'Wow, that was really tough. How do you handle situations like that?' And more often than not, the attending physician will guide you through their own experiences and how they've coped.

I've worked as a scribe in a pediatrics ED and that truly changed how I viewed medicine. The only thing I can say is that although I never found experiencing death (especially for peds) to get much easier, the grieving part does. You learn to grieve for the patient and their family for 2-5 minutes or so, but then you have to move on. You just can't spend everyday mourning for every patient or you will end up completely useless.
 
Last edited:
  • Like
Reactions: 1 users
@DJKitty @bbbcccppp @OchemOficionado @topsoil municipio @ScottTenorman54 @nlax30 @strider144 @happyducky
Thank you all so much for the advice. I really appreciate all of these posts of wisdom. I need to reflect on what I learned from this case and how it can help me become a better person. I would love to talk to someone about this, but this is such a high profile case I am afraid to break any HIPPA laws. After the case was over, the Doctor basically told me to never talk about this again as it could get our hospital into trouble. I never discuss patients outside of work anyways, but this is all over the media in my town. Is it a violation of HIPPA to talk to a mental health provider at school?
 
I would think you could talk to a counselor about YOUR feelings and reaction to this without bringing up identifiable information about the patient/family. If the counselor figures out what case your talking about, they are bound by confidentiality as well.
 
  • Like
Reactions: 1 user
You will have doctor patient confidentiality when speaking with a mental health professional.
Thus they must protect your privacy.


Sent from my iPhone using SDN mobile
 
  • Like
Reactions: 1 user
There is an app which connects you to a psychologist or to doctors. Not free but it might be worth one or 2 sessions to you. I am not sure that this site allows me to mention their name


Sent from my iPhone using SDN mobile
 
  • Like
Reactions: 1 user
@DJKitty @bbbcccppp @OchemOficionado @topsoil municipio @ScottTenorman54 @nlax30 @strider144 @happyducky
Thank you all so much for the advice. I really appreciate all of these posts of wisdom. I need to reflect on what I learned from this case and how it can help me become a better person. I would love to talk to someone about this, but this is such a high profile case I am afraid to break any HIPPA laws. After the case was over, the Doctor basically told me to never talk about this again as it could get our hospital into trouble. I never discuss patients outside of work anyways, but this is all over the media in my town. Is it a violation of HIPPA to talk to a mental health provider at school?

well that's not shady as hell or anything

leave the details at what you posted here, essentially, and you should be ok under HIPAA (IANALATINLA).
 
  • Like
Reactions: 1 user
Sounds like they do since they have a PCP. A copay can be expensive. Especially when you have to go several times.
A copay through a student health insurance plan shouldn't be too expensive if in network? This would be plausible if OP's PCP was outside of their network. Even if OP were on a different insurance plan wouldn't their copay come out of some form of an HSA?
 
  • Like
Reactions: 1 user
A copay through a student health insurance plan shouldn't be too expensive if in network? This would be plausible if OP's PCP was outside of their network. Even if OP were on a different insurance plan wouldn't their copay come out of some form of an HSA?
hsa iz expenzive gotta have muniez 4 it. if ur plan even haz hsa.
what if no cover outside netwurk?
20$ copay equalz no dinner
 
  • Like
Reactions: 1 user
Your hospital should also have a employee helpline for talking about stuff like this.
 
  • Like
Reactions: 1 users
A copay through a student health insurance plan shouldn't be too expensive if in network? This would be plausible if OP's PCP was outside of their network. Even if OP were on a different insurance plan wouldn't their copay come out of some form of an HSA?

Not everyone has health insurance through their university.

A lot of people pay cash for their co-pays. Also, a lot of people have less money than you can imagine.

Someone above mentioned free mental healthcare through their school. I've never heard of that, but I think that's worth looking into!
 
  • Like
Reactions: 1 users
A copay through a student health insurance plan shouldn't be too expensive if in network? This would be plausible if OP's PCP was outside of their network. Even if OP were on a different insurance plan wouldn't their copay come out of some form of an HSA?
You got to have money to put into a hsa before you can take it out.
 
  • Like
Reactions: 1 user
Not everyone has health insurance through their university.

A lot of people pay cash for their co-pays. Also, a lot of people have less money than you can imagine.

Someone above mentioned free mental healthcare through their school. I've never heard of that, but I think that's worth looking into!
I'm not arguing against any of that, but I do think we are all making assumptions with incomplete information here. As mentioned before definitely seek out help from your university's mental health services. More often than not they do provide free services to students.
 
  • Like
Reactions: 1 user
@Monkitty @bbbcccppp @topsoil municipio @laxbrah20 @OchemOficionado @sleepyhead22 @libertyyne
I called my school and they said I can get 2 sessions for free! I go to a school that's the equivalent of a 4-year community college, so they don't have the best resources, but I'll take what I can get. But, are mental health counselors bound to HIPPA? I believe the lady I am seeing is a social worker.

FYI I am on state insurance plan which is closer to a $80 copay to see your PCP.
Thanks again for all your advice!
 
  • Like
Reactions: 3 users
@Monkitty @bbbcccppp @topsoil municipio @laxbrah20 @OchemOficionado @sleepyhead22 @libertyyne
I called my school and they said I can get 2 sessions for free! I go to a school that's the equivalent of a 4-year community college, so they don't have the best resources, but I'll take what I can get. But, are mental health counselors bound to HIPPA? I believe the lady I am seeing is a social worker.

FYI I am on state insurance plan which is closer to a $80 copay to see your PCP.
Thanks again for all your advice!

ImageUploadedBySDN1495660575.903028.jpg



Sent from my iPhone using SDN mobile
 
  • Like
Reactions: 1 user
The question would be what is the nature of patient privilege with the social worker. I really doubt there would be a problem. But you could ask the social worker up front. Shouldn't be a problem


Sent from my iPhone using SDN mobile
 
  • Like
Reactions: 1 user
@bbbcccppp Thanks for the info! I have an appointment in a few days!
mad propz 4 seeking advice, considering and accepting it, and taking action 2 improve ur situation. if u apply urself like this to other aspects of ur life u r in good shape
 
  • Like
Reactions: 3 users
Feel free to message me if I can help. Hopefully your counselor will be compassionate. It's funny how that varies.


Sent from my iPhone using SDN mobile
 
  • Like
Reactions: 1 user
As a scribe you see an employee right? Every hospital I have been at has singing along the lines of employee assistance specifically for debriefing from these sorts of situations. I'm glad you have an appointment, but if you run into financial issues or it just doesn't work out, you might look into what the hospital has for employee debriefing.

Sent from my XT1254 using Tapatalk
 
  • Like
Reactions: 1 users
HIPPA Works all ways. Even if you are a counselor they can't talk unless there is a major legal issue that may hurt someone. If you think something is wrong you need to talk about it. Honestly, I think you need to make sure you are mentally healthy.

My counselor told me about a concept that helps me. I don't know if it will for you... but yeah.

With your emotions you can remember things. Like a book they can bring back pain, joy, fear, love... they bring us back to these exact times you are going through. It sucks. You may not want to feel it. I know I wouldn't... but you feel stuck feeling the way you do... (you sound in so much deep pain, I won't try to place a label on it.) perhaps you need to take a break. As hard as it may be, close the book of emotions that are associated with this case... for now. You may not have the tools( mechanisms, keys) to deal with it now. However I swear you will later. You are not forgetting the child, or denying your emotions. Rather you are getting off the mental/ emotional wringer you put yourself through. You need to clear you head. Take a deep breath, cry with a SAFE person, talk with them, and place some mental blocks for yourself. I know for me, I would rehash the same emotions and not stop... I eventually had to come to terms with the fact that answers to the problems I have will eventually come around, and for now I don't have them.

What I hear from you is a cry for justice... to right a wrong. A child died that shouldn't have. If you could you would want to bring him/her back. You can't. You have to think about what you leave as a legacy for that child. Perhaps it is still working at the place, helping others receive care they need... or maybe it's going up though admin. Telling them what happened... I don't know and I think you need some time.

I don't want you to ever forget this child, but I don't think you need to continue this way. I hope you find some counseling and a SAFE person to talk with.

Perhaps see if you can take some time off and just take some time to process this. I would recommend, if you do this, spend time with people that you can trust. Spend as much time in public as you can, and remember to stay in contact with people that are close by. I'm not saying you might try anything, but I know that these types of emotions can get so strong that you may not be able to handle it by yourself. Just be safe.

If you need an ear... I'm here. Just PM me.

M
 
Last edited:
  • Like
Reactions: 1 user
OP - this is really hard and I know very experienced nurses, doctors, police officers and firefighters who have a very difficult time with pediatric deaths. Your reaction is normal, especially after being told not to talk about it.

Professional firefighters have something called a "Critical Incident Stress Debriefing" (CISD) where the firefighters, dispatchers, police officers and trained leaders (counselors, chaplins, fire chiefs, etc) sit together and get it all out. They find that doing this keeps wounds from festering and getting worse. Some ERs have this too - either formal or informal. Maybe ask an experienced co-worker.

I hope you'll reach out and get some help/support from somewhere. You have choices - a counselor, a boss, or a co-worker. Do you have an onsite boss like a medical director? I would suggest talking to a "boss" (but not a college grad chief scribe - no offense to chief scribes but they won't have the life experience to help), nursing director, or ER social worker in your ER department. Or you can go back to one of the doctors who was in the ER at that time and say "This is not working for me. Can you and I talk about the impact of this death on someone who is not accustomed to death?" Or perhaps you'll need an outside counselor.

Some big employers have Employee Assistance Programs (EAP) that offer like 3-5 free counseling sessions to employees to deal with divorce, stress, childrearing etc. You should check to see if your employer offers an EAP. This would mean that you wouldn't even need a co-pay.

I hope that you can get some peace OP and that you come back and tell us. The fact that it affects you is good - don't let it derail your career.

Edit - just saw that you got an appointment through your college - excellent news.
 
  • Like
Reactions: 1 users
@topsoil municipio
Thanks!
@bbbcccppp
I really appreciate your willingness to help.
@PTPoeny
I am a per diem employee, so I don't know if I get any benefits. The Doctors I work for are not super compassionate people, so I am avoiding talking to them as I don't think they will really care.
@miniman
I really appreciate the advice. I can't take time off right now as I am providing for myself, but I think you're right: I need to clear my head. I think I might go on a hike or something and just take a day off next weekend. Also, thanks for you PM offer.
@precisiongraphic
Like I mentioned, the doctors I work with are pretty cold people and would not be surprised if they brushed me off. I pretty sure some of them still don't know my name after almost a year...I appreciate you validating my feeling, I know a couple of nurses though who I think would be willing to talk to me.

Again thank you all so much for the support and advice, it really means a lot to know that I'm not the only one. You all don't even know me, yet so many of you have been taking the time to post suggestions. Bless you all.
 
  • Like
Reactions: 1 user
@topsoil municipio
Thanks!
@bbbcccppp
I really appreciate your willingness to help.
@PTPoeny
I am a per diem employee, so I don't know if I get any benefits. The Doctors I work for are not super compassionate people, so I am avoiding talking to them as I don't think they will really care.
@miniman
I really appreciate the advice. I can't take time off right now as I am providing for myself, but I think you're right: I need to clear my head. I think I might go on a hike or something and just take a day off next weekend. Also, thanks for you PM offer.
@precisiongraphic
Like I mentioned, the doctors I work with are pretty cold people and would not be surprised if they brushed me off. I pretty sure some of them still don't know my name after almost a year...I appreciate you validating my feeling, I know a couple of nurses though who I think would be willing to talk to me.

Again thank you all so much for the support and advice, it really means a lot to know that I'm not the only one. You all don't even know me, yet so many of you have been taking the time to post suggestions. Bless you all.
One other thing, there can be free counseling with your religious leader. I don't know if you are religious or not, but most have at least some sort of counseling background or have at least some type of wisdom that can help. Its free, and it may help.
 
  • Like
Reactions: 1 users
@Monkitty @bbbcccppp @topsoil municipio @laxbrah20 @OchemOficionado @sleepyhead22 @libertyyne
I called my school and they said I can get 2 sessions for free! I go to a school that's the equivalent of a 4-year community college, so they don't have the best resources, but I'll take what I can get. But, are mental health counselors bound to HIPPA? I believe the lady I am seeing is a social worker.

FYI I am on state insurance plan which is closer to a $80 copay to see your PCP.
Thanks again for all your advice!
Yes they are. Everything said between you both is confidential and cannot be held against you. I wish you the best of luck and I hope that this helps out!
 
  • Like
Reactions: 1 user
Its good that you've seen death this early, especially on a young child that died unexpectedly. If you want to be a doctor then this isn't the last time you'll see death or someone die unexpectedly. Take this as an experience. I hope you feel better hun.


Sent from my iPhone using SDN mobile
 
  • Like
Reactions: 1 user
Its good that you've seen death this early, especially on a young child that died unexpectedly. If you want to be a doctor then this isn't the last time you'll see death or someone die unexpectedly. Take this as an experience. I hope you feel better hun.


Sent from my iPhone using SDN mobile
Wow that's rough. Chill. I don't know what you think you are doing... but just chill.
 
  • Like
Reactions: 5 users
One other thing, there can be free counseling with your religious leader. I don't know if you are religious or not, but most have at least some sort of counseling background or have at least some type of wisdom that can help. Its free, and it may help.

Good idea, but I'm not religious.
 
  • Like
Reactions: 1 user
@DJKitty @bbbcccppp @OchemOficionado @topsoil municipio @ScottTenorman54 @nlax30 @strider144 @happyducky
Thank you all so much for the advice. I really appreciate all of these posts of wisdom. I need to reflect on what I learned from this case and how it can help me become a better person. I would love to talk to someone about this, but this is such a high profile case I am afraid to break any HIPPA laws. After the case was over, the Doctor basically told me to never talk about this again as it could get our hospital into trouble. I never discuss patients outside of work anyways, but this is all over the media in my town. Is it a violation of HIPPA to talk to a mental health provider at school?

@Monkitty @bbbcccppp @topsoil municipio @laxbrah20 @OchemOficionado @sleepyhead22 @libertyyne
I called my school and they said I can get 2 sessions for free! I go to a school that's the equivalent of a 4-year community college, so they don't have the best resources, but I'll take what I can get. But, are mental health counselors bound to HIPPA? I believe the lady I am seeing is a social worker.

FYI I am on state insurance plan which is closer to a $80 copay to see your PCP.
Thanks again for all your advice!

HIPPA Works all ways. Even if you are a counselor they can't talk unless there is a major legal issue that may hurt someone. If you think something is wrong you need to talk about it. Honestly, I think you need to make sure you are mentally healthy.

My counselor told me about a concept that helps me. I don't know if it will for you... but yeah.

With your emotions you can remember things. Like a book they can bring back pain, joy, fear, love... they bring us back to these exact times you are going through. It sucks. You may not want to feel it. I know I wouldn't... but you feel stuck feeling the way you do... (you sound in so much deep pain, I won't try to place a label on it.) perhaps you need to take a break. As hard as it may be, close the book of emotions that are associated with this case... for now. You may not have the tools( mechanisms, keys) to deal with it now. However I swear you will later. You are not forgetting the child, or denying your emotions. Rather you are getting off the mental/ emotional wringer you put yourself through. You need to clear you head. Take a deep breath, cry with a SAFE person, talk with them, and place some mental blocks for yourself. I know for me, I would rehash the same emotions and not stop... I eventually had to come to terms with the fact that answers to the problems I have will eventually come around, and for now I don't have them.

What I hear from you is a cry for justice... to right a wrong. A child died that shouldn't have. If you could you would want to bring him/her back. You can't. You have to think about what you leave as a legacy for that child. Perhaps it is still working at the place, helping others receive care they need... or maybe it's going up though admin. Telling them what happened... I don't know and I think you need some time.

I don't want you to ever forget this child, but I don't think you need to continue this way. I hope you find some counseling and a SAFE person to talk with.

Perhaps see if you can take some time off and just take some time to process this. I would recommend, if you do this, spend time with people that you can trust. Spend as much time in public as you can, and remember to stay in contact with people that are close by. I'm not saying you might try anything, but I know that these types of emotions can get so strong that you may not be able to handle it by yourself. Just be safe.

If you need an ear... I'm here. Just PM me.

M

All good advice but it's HIPAA

hipaa-for-business-associates-5-638.jpg
 
  • Like
Reactions: 3 users
When I'm looking to separate myself from a patient, I usually just say "Let me get your nurse" and back away slowly.

Now, for times when you're emotionally invested... Well, let's just say you get a little dead inside as time goes on. There's still things I can't do, like heme/onc, but generally the things that really shook me up and made the room seem a little dusty are gone now. It's all just the circle of life, it is what it is.
 
  • Like
Reactions: 1 users
It's advice coming from someone who have experienced this. People handle death differently, that's why I told you to feel better. So please...
Wow that's rough. Chill. I don't know what you think you are doing... but just chill.
 
  • Like
Reactions: 1 user
Top