MS3/MS4: How do you deal with deaths during rotations?

[docONcall]

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Deaths are not uncommon during rotations. Tell me how do you deal with them?

I'm currently in Pediatrics and it depresses me so much when I see kids that are in pain or... dying. I just get so emotional because I love kids. I can't concentrate whenever I remember all those kids dying... it is horrible and I have to deal with it for two months.

I'd take Surgical over Pediatrics any day! I thought Pediatrics would be easy. I was so wrong!

 

[Rendar5]

It honestly depends what rotation or service you're on. Best thing I can say to do when something really hits you hard is to suck it up, act professional while you're around the patients, and as soon as you have a chance to do so, go someplace private and call someone, cry, do a crossword, or whatever you can do that helps you deal with the grief. Honestly, it sucks a lot, but at least you're able to cope better and more often as time goes on.

 

[USCguy]

I've been present for a few deaths so far. I usually try to hold back as much as I can around the family, which usually results in enough emotion (wet eyes, etc) coming out that I don't seem like a heartless statue. I usually leave and go to the bathroom to compose myself, take a few breaths, and concentrate on giving my best to the next person.

I remember my first death and think about it when I go down that wing at the VA hospital; cancer patient who was made DNR about an hour before he passed. I sat at his bedside and held his hand until his family got there a few minutes before his death. Pretty emotional experience

I haven't done Peds yet; and I'm not looking forward to that part of it. Definitely a big difference between adults and kids dying, so no advice to give on that one

 

[docONcall]

It honestly depends what rotation or service you're on. Best thing I can say to do when something really hits you hard is to suck it up, act professional while you're around the patients, and as soon as you have a chance to do so, go someplace private and call someone, cry, do a crossword, or whatever you can do that helps you deal with the grief. Honestly, it sucks a lot, but at least you're able to cope better and more often as time goes on.

Thanks for the advice. Maybe I was just not prepared to see kids dying - I just didn't know that this would be harder to deal with compared to adults dying. I've dealt with a couple of deaths before this but this one just got me so emotional. Thank God, I'm not leaning toward Pediatrics.

 

[docONcall]

I've been present for a few deaths so far. I usually try to hold back as much as I can around the family, which usually results in enough emotion (wet eyes, etc) coming out that I don't seem like a heartless statue. I usually leave and go to the bathroom to compose myself, take a few breaths, and concentrate on giving my best to the next person.

I remember my first death and think about it when I go down that wing at the VA hospital; cancer patient who was made DNR about an hour before he passed. I sat at his bedside and held his hand until his family got there a few minutes before his death. Pretty emotional experience

I haven't done Peds yet; and I'm not looking forward to that part of it. Definitely a big difference between adults and kids dying, so no advice to give on that one

Maybe this one got me emotional because the kids were... very young and innocent. Every time I look at them I feel like they don't deserve to get hurt or... to die. I feel like there's a life ahead of them.

I wish you good luck on Peds. I hope you don't deal with what I'm dealing with right now.

 

[montessori2md]

I don't know if this will help you feel any better or not, but I talked to someone the other day who was very ill and hospitalized a lot as a child, and she told me that, when she was sick, she wanted to die, because she was in so much pain and didn't want to be sick anymore. It wasn't until she was an adult and became a parent that she really valued her own life, because she needed to be there for her kids.

For me this was a great reminder that what I'm feeling may not be what someone else is feeling. Sort of "put me in my place". But regardless of how the dying patient feels, there are also all of their family members and their feelings to contend with too.

Dr. Thomas Smith has written a bunch of articles about end of life, if you search JAMA or medline, I've found them to be helpful, and I would bet there are great articles specific to peds also. You could also talk to someone in palliative care or your hospital clergy about how you feel.

 

[ZagDoc]

When I was in the PICU, we'd debrief whenever there was a death, in a similar fashion that emergency services personnel do when they're on a call involving a death. I thought it was an excellent way to go about it.

 

[Scaredshizzles]

Maybe this one got me emotional because the kids were... very young and innocent. Every time I look at them I feel like they don't deserve to get hurt or... to die. I feel like there's a life ahead of them.

I wish you good luck on Peds. I hope you don't deal with what I'm dealing with right now.

Well the good thing about peds is you don't usually see as many deaths...Now if you're at a tertiary-quaternary care center, you might see your fair share. But if you were interested in peds, I hope this experience won't turn you away from it, because as a practicing pediatrician, you probably won't see too much death.

 

[docONcall]

Well the good thing about peds is you don't usually see as many deaths...Now if you're at a tertiary-quaternary care center, you might see your fair share. But if you were interested in peds, I hope this experience won't turn you away from it, because as a practicing pediatrician, you probably won't see too much death.

I don't see much deaths in peds, but when I see them it's crazily scary. I handled adults dying very well and I just CAN'T do the same with kids. The last time I found myself shaking after a 3-year old kid died from a heart condition and I had to go to somewhere I could be alone to call my mom (a nurse)... I know that isn't very professional but I just couldn't hold back (and I swear, I was trying my best not to cry!).

To be very honest, I'm not a very emotional person. That's why my mom was shocked when I called her cause she couldn't remember when was the last time I cried to her. She thought I was crying because me and my boyfriend broke up.

Thank goodness, I'm not interested in peds (despite my love for kids). I'm leaning on neuro, cardiothoracic, and orthopedic surgery.

I hope the next rotation is better than this one. This is the worst so far for me.

 

[docONcall]

I don't know if this will help you feel any better or not, but I talked to someone the other day who was very ill and hospitalized a lot as a child, and she told me that, when she was sick, she wanted to die, because she was in so much pain and didn't want to be sick anymore. It wasn't until she was an adult and became a parent that she really valued her own life, because she needed to be there for her kids.

For me this was a great reminder that what I'm feeling may not be what someone else is feeling. Sort of "put me in my place". But regardless of how the dying patient feels, there are also all of their family members and their feelings to contend with too.

Dr. Thomas Smith has written a bunch of articles about end of life, if you search JAMA or medline, I've found them to be helpful, and I would bet there are great articles specific to peds also. You could also talk to someone in palliative care or your hospital clergy about how you feel.

But the kids I talked to said they wanted to fight because they didn't want to leave their parents. I just encourage them as much as possible. When you see kids after their chemo, they couldn't smile but they would try to... and it's really, really heart breaking.

I remember asking one kid what he wanted for X-mas, and he answered, "I want the cancer to go away... or live a little longer for my mom and dad."

I will sure check out Dr. Thomas Smith. Thank you for your wonderful advice.

 

[docONcall]

When I was in the PICU, we'd debrief whenever there was a death, in a similar fashion that emergency services personnel do when they're on a call involving a death. I thought it was an excellent way to go about it.

That is the last place I want to be in. And unfortunately, that is included in this rotation.

 

[ZagDoc]

That is the last place I want to be in. And unfortunately, that is included in this rotation.

It's been my favorite rotation of MS3 so far. It's challenging sure, but enjoy the challenge. The deaths are tough, but kids are tough as nails, and for every tragedy, there's 3 or 4 cases where you get to bring a kiddo back from the brink of death, and within 2 or 3 weeks they're being discharged. It's a remarkable area of medicine.

 

[csmmedic]

Deaths are not uncommon during rotations. Tell me how do you deal with them?

I'm currently in Pediatrics and it depresses me so much when I see kids that are in pain or... dying. I just get so emotional because I love kids. I can't concentrate whenever I remember all those kids dying... it is horrible and I have to deal with it for two months.

I'd take Surgical over Pediatrics any day! I thought Pediatrics would be easy. I was so wrong!

I am not a medical student, but as a paramedic, when a death really gets to me I go into my car and listen to a favorite U2 song or something, and than get something to eat. For some reason, it really helps.

Everybody has their own way of making themselves feel better. You have to remember that you go into medicine so that you could give at least one person a chance to live through an illness or injury so that they can have a chance at pursing a dream of theirs. Along the way, you are going to see cases where you cannot make this happen, but you keep your mind on the successes in the past, and you keep going for future patients.

 

[Rendar5]

I don't see much deaths in peds, but when I see them it's crazily scary. I handled adults dying very well and I just CAN'T do the same with kids. The last time I found myself shaking after a 3-year old kid died from a heart condition and I had to go to somewhere I could be alone to call my mom (a nurse)... I know that isn't very professional but I just couldn't hold back (and I swear, I was trying my best not to cry!).
.

On the contrary, I'd say that's a very normal and professional response.

 

[docONcall]

On the contrary, I'd say that's a very normal and professional response.

I'd say** it wasn't very professional because I could not hold back what I felt real well, unlike my classmates who were very good masking their emotions.

 

[Cruzinman]

Very interesting how times have changed. My brother went to med school in the 1970's and he was kicked out of the patient's room just before the patient "expired" (doctors in those days never used the word "death"). He theorized that it was because the attendings didn't want the students around in case they had trouble dealing with their own emotions. I think he was on to something.

 

[Rendar5]

I'd it wasn't very professional because I could not hold back what I felt real well, unlike my classmates who were very good masking their emotions.

you got emotional, and when it was too much, you properly found a place to get away and deal with your emotions, I"m sure the patient's family appreciated that you cared and i'm sure they could see it. What's unprofessional is to go to either extreme. i.e., to be extremely cold and unempathetic, or to start bawling in front of the patient's family.

 

[dragonfly99]

I can say that this will get a little easier to deal with as a MS4, intern and then resident. It's kind of bad to say, but you'll get a little more hardened and it won't shock you as much, so that you'll likely be able to emotionally deal with it. Just a thought...if you do general surgery or cardiology then you will deal with death. there's a lot of death in internal medicine and some in general surgery, lots in trauma surgery, etc. Orthopedic surgery, not so much. But I agree that dealing with kids dying is harder vs. with adults dying, and I think it factored into me not wanting to do pediatrics.

I actually think that med schools and internships do a crappy job of preparing students and interns in how to deal with dying people. People act like you should just be able to suck it up and deal and not have it affect you, but that's not human nature, at least not if you have a heart. I always felt like if I got into teaching at a med school I would want to see this addressed in the curriculum...not that it would necessarily make it much easier to deal with, but that it could be discussed beforehand so that students wouldn't be surprised about the emotions and situations they end up needing to deal with. And certainly on the wards I feel like the attendings should take the lead in discussing things like patient deaths...and not just the medical aspects.

 

[G'ville Nole]

I can say that this will get a little easier to deal with as a MS4, intern and then resident. It's kind of bad to say, but you'll get a little more hardened and it won't shock you as much, so that you'll likely be able to emotionally deal with it.

Not bad to say at all. Just like anything else in life, dealing with death gets easier with increasing reps. Becoming comfortable with the issue doesn't make you heartless, and doesn't mean you lack compassion, it just means you've had a chance to confront it, reflect on it, and arrive at an outlook that ultimately will serve as a great comfort to dying patients and their families. As an oncologist, I'm in this position nearly constantly (really bad run of cancer progression/deaths here right around Christmas, too!). If you're going into a field where death and dying will be a significant issue, I'd encourage you to seek out opportunities to participate in end-of-life discussions, as uncomfortable as that may be. As a med student/intern, I was blessed with mentors who a) provided excellent examples of interaction during these discussions, and b) allowed me to lead the discussions in some cases.

The other key is the ability to compartmentalize that part of your medical experience so that it doesn't interfere with the rest of your life outside the hospital. Again, practice makes perfect. BTW, I totally agree that it's an order of magnitude harder with children. After I had done my requisite numbers in pediatric rad onc, I had absolutely no desire to see another kid.

 

[docONcall]

If patient deaths are a huge problem for you, you may want to choose a specialty where it's less common (pathology?). Aggressive relatives that blame you for a terminal patient's unfortunate death is another thing med students don't experience that much but it's a reality of the job.

I handle adults dying MUCH better than kids dying. It's the kids that make me emotional.