Reactions when you saw a patient die?

[Psycho Doctor]

Anyone care to comment how you felt/responded when you saw a patient die and/or one of your patients died? Does it have an impact on you puruing a career in medicine? Has your reacton/response changed any as you've had to deal with it more frequently?

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[MsEvolution]

I've actually never watched somebody die... I hope this doesn't disqualify me in some way. I saw my mother moments after she died... my brother, sister and I had taken care of her for two years (blindness, end stage renal failure, heart disease, cancer) but it was my brother who was with her when she had her heart attack. She was still alive when the EMT's took her, but when we next saw her, she was gone.

I've volunteered at an ER, and there were some pretty serious cases on the days I was there, but I never watched someone die. I guess I have to wonder how I'll take it...

 

[Psycho Doctor]

sorry about your mom...that must have been awful.

i'm surprised being in the ER you never saw anyone die.

how did you react when someone was near death and they shocked them back to life or used some other emergency intervention?

 

[Treg]

I have not watched someone die, although I have been present a few times when people who were getting assessed for liver transplant ended up being told that they have terminal cancer and were going to die. It was really sad--they were nice patients. I had to push back tears during the last one (we saw these people all in the same afternoon).

Treg

 

[ShyRem]

Being a paramedic for 10 years, I've unfortunately seen a few. The usual basic first reaction? "****!"

If the person stays dead, that's a very personal question, and has a very personal answer that differs from circumstance to circumstance. Children are different than adults are different from terminal patients. It's not an easy question, nor an easy answer. Sorry, you'll have to wait for your own reaction to each situation for that one. Unfortunately, you get used to it. Mostly. With a few exceptions.

On the other hand, how did I react bringing someone back from "freshly dead"? Relieved. Usually.

 

[Psycho Doctor]

I actually have seen a few and it's bothered me incredibly, to the point that it made me question whether i was cut out for this....that's why i wanted to know how others reacted and if over years it gets easier to handle. However i'd never want to get hardened to it to the point of not really caring; when that happens, it's time to leave....

 

[VFrank]

I've watched one person die in the emergency room -- he came in full arrest, though, so he may have already been dead. Is wasn't bad watching him die (the bones cracking from CPR and the blood coming up the tracheometry tube weren't pleasant, though), but I was most upset by the way the nurses/staff handled it. When they got the call saying a full-arrest was coming in, all the nurses said was, "well, this won't take long." That kind of got to me. It's just so weird how normal a thing it is to them -- to see death. I guess that's something we'll all have to expect someday. I was also in the room when several people where told they would die of cancer. I remember one woman with lymphoma who I saw pretty much every week for about eight weeks. Both I and the doctor thought she was getting better (battling anemia from chemo), but then one day her family came to the clinic and said she had died overnight -- that was probably the worst. To see someone healthy and talk to them and think things were looking good and then finding out not ...

 

[Psycho Doctor]

I was most upset by the way the nurses/staff handled it. When they got the call saying a full-arrest was coming in, all the nurses said was, "well, this won't take long." That kind of got to me. It's just so weird how normal a thing it is to them -- to see death. I guess that's something we'll all have to expect someday.

When death becomes so routine that they make jokes about it, when they lose the ability to see a person connected to the death and fail to see a family affected by the death; it's time to stop being a healthcare giver.....and time to find a new career.

 

[stillpremed]

being future docs one day who will treat patientts with utmost respect and privacy....

what ever happened to confidentiality?

 

[ShyRem]

Don't assume that the jokes mean apathy. Many in the EMS field, medics, cops, doctors, nurses alike joke about it so they don't cry. Pick one. And remember, they have other patients that just won't wait for you to go blow your nose. Sounds harsh, doesn't it? Believe me, I've been there. You cry about it later, but when you've got patients and calls stacked back to back, you don't have the time. Be careful how you judge other's coping mechanisms until you have to get some yourself. I've been known on at least one occasion where all I had was a day of dead and dying folks to put it into a song. "Start your day with a DOA.. doo dah.. doo dah... " Doesn't mean I didn't care... just that I had other patients and calls to handle, and they deserved someone not mentally burdened by the patient I had five minutes ago.

Crass? yes. Necessary?
yes.
It's a fine line between caring enough and caring too much. Care too much and it will break you.

Two signs you need to get out of medicine: 1. you stop caring. 2. you stop learning.

 

[deleted50541]

The first person I ever saw die was a young woman who was involved in an mva. I was working in the ed trauma unit when they brought her in around midnight. She had been cared for by a paramedic I knew and he looked visibly distraught. Right off, it was apparent from the head trauma that she probably was not going to make it. Nonetheless, her body refused to give up. All the while, I kept one eye on the flurry of activity and the other eye on the monitor.

After several defibrillations, all efforts were finally stopped. At first I did not know what to feel. I returned to work with a rather numb feeling in my chest. After the area was cleaned up, I walked over to the bed and looked at the woman for a few minutes. Still, I did not know what I was feeling, if anything at all. There was no new found appreciation for life. I accepted what I had been witness to, the death of a human being, and I moved on.

 

[Ypo.]

I actually have seen a few and it's bothered me incredibly, to the point that it made me question whether i was cut out for this....that's why i wanted to know how others reacted and if over years it gets easier to handle. However i'd never want to get hardened to it to the point of not really caring; when that happens, it's time to leave....

Psycho, you could always go into dermatology. Even family practice you don't see as many deaths as an ER doc.

I would think that being as religious as you are that you would have an easier time accepting death, as you have your personal understanding of what happens when life ends.

Not trying to be rude, I just know that those with religion often have a better time coping with death.

 

[UseUrHeadFred]

Dealing with the family of the deceased is the hard part.

 

[Ypo.]

being future docs one day who will treat patientts with utmost respect and privacy....

what ever happened to confidentiality?

Uh...no one mentioned any names-and no one knows anyone's real name anyways.

 

[VPDcurt]

During a mission trip to Ecuador, an old woman came into the hospital with tetany. She couldn't open her mouth and she couldn't breathe. Unfortunately, the hospital didn't have any oxygen - only an empty tank in the corner that looked as if it had been sitting there for a hundred years or so. It was really strange because of the language barrier. I guess the interpreter we were with told the woman that there was nothing we could do. She just began to tear up - she couldn't speak. She actually grabbed my father's hand, curled her lips a little bit, and then shook his hand. It was actually really emotional and knowing that had she been in the US, she could have been saved. She just laid there for about an hour or so and finally passed away. Don't they say that the body releases endorphins when you are about to die so that it isn't too painful or harsh for the person? This definitely seemed like the case for her. It was really sad and I will never forget her face for as long as I live.

 

[DSM]

Don't assume that because the staff is cracking jokes or seems apathetic to a cardiac arrest that they are burnt out or should seek other fields. You MUST detach yourself to some degree from these emotionally traumatic events. If you break down and criy or became emotionaly upset every time you see someone die then you should find another job. As long as you do everything in your power that is best for the patient then you have done your job. You must not sacrifice your own mental health to do it though. Do not take home this job! Be detached and level headed.....maintaining the ability to recall all the knowledge you need for the patient.

I have been a paramedic for 13 years and in EMS for a total of 15......I know what I am talking about.


I did not cause the death...I am doing everything I know to prevent the death....then I am doing the right thing.

 

[Psycho Doctor]

If you have a difficult time dealing with death, you don't have to give up on medicine. There are other fields such as psychiatry, dermatology, radiology, and some other fields.

I actually was strongly considering psychiatry until some of you people here talked me out of it by saying i couldn't become "involved" (like really care for my patients). I have no interest in dermatology and radiology seems boring and does not directly deal with patients as much as I would want to or in the way i would want.

 

[MadameLULU]

I actually was strongly considering psychiatry until some of you people here talked me out of it by saying i couldn't become "involved" (like really care for my patients). I have no interest in dermatology and radiology seems boring and does not directly deal with patients as much as I would want to or in the way i would want.

psycho, can you clear out your pms?

 

[Psycho Doctor]

Psycho, you could always go into dermatology. Even family practice you don't see as many deaths as an ER doc.

I would think that being as religious as you are that you would have an easier time accepting death, as you have your personal understanding of what happens when life ends.

Not trying to be rude, I just know that those with religion often have a better time coping with death.

dermatology , perhaps family practice....

being religious does help to deal with death in some respects. I have worked in an AIDS hospice before and since they were already terminal and everyone knew it, i could more easily deal with their death. it's the young people, those with a full life ahead and those who are shocked by their diagnosis and impending death or those whose life was snatched in minutes due to an accident or heart attack that i have a hard time dealing with.

disregarding my personal losses, the first time someone's death really hit me hard was the summer after my freshman year in college when i was working in a radiation oncology department at a hospital. I had befriended a 7 yr old boy and used to visit him on my days off and after hours; i used to play games with him and i got to know his family very well. I had promised to take him to a Braves game when he got out of the hospital...except that he never did. His death really shocked and impacted me, and as much as i hate to admit it sent me to talk to a counselor. yea, ok, i was now forced to deal with other unresolved grief issues so maybe that had something to do with it.

I've seen death since then and i've gotten a little better about it, but i'm torn between trying to dissassociate my feelings from what is happening. The thing is I don't want to be hardened to it but as others have said, i'm also worried about it destroying me. And I agree with whoever said it somewhere in this thread; dealing with the family afterwards is the hardest part.

Ok, this was hard to admit my insecurities but i guess it's been bothering me more than i care to admit. So, is there any hope for me?

 

[Psycho Doctor]

psycho, can you clear out your pms?

ah i tend to do it one at a time when i realize i'm up to 100. i nus thought i might need the stuff at some time.

if i move them to folders, does it count towards the 100 PMs?

 

[MsEvolution]

When death becomes so routine that they make jokes about it, when they lose the ability to see a person connected to the death and fail to see a family affected by the death; it's time to stop being a healthcare giver.....and time to find a new career.

I'll second that.

 

[v-tach]

The only experience like this that I have had was when I was doing my clinicals for EMT training. I was at the end of a 4-hour shift in the ED when one of the techs tossed me a plastic gown and said "here, put this on, there's a code coming". So I got ready, and the EMT's/medics brought the patient in while doing CPR the whole time; he was intubated as well. They got him onto the bed in one of the bigger treatment rooms and then asked me to switch in doing compressions, so I did. Then somebody else switched with me, and after a few minutes they called it. The guy was gone before he even got to the hospital, he was in asystole when the EMT's got to him with the AED. I was a bit bummed that he didn't make it, but I knew that those are really the more likely scenarios when somebody comes in like that. So I took it OK. I guess we just have to remember that there will be times when we aren't going to be able to get somebody back, if it's their time. After all, God is the one ultimately in control, we are not.

 

[Psycho Doctor]

I guess we just have to remember that there will be times when we aren't going to be able to get somebody back, if it's their time. After all, God is the one ultimately in control, we are not.

for me, that is key...but then I still keep asking "God...why? He was so young and didn't even have a chance to live...why?"

 

[DocMizzle]

Death is a part of life. You just have to try your best to help a patient get better, but if it's their time to go, they will go. I've seen people die working in the ER, and it does affect me, but as much in a good way as in a bad way. Seeing someone die makes me try even harder and brings me back to reality when my life gets hectic, which are both good things.

I think it will be MUCH harder though when I am a doctor and I happen to misdiagnose a patient that leads to his death (which I hope never happens).

 

[jules0328]

I have had many patients 'expire' who were under my care. Well, technically speaking, they were patients who were either part of my exercise programs or on a unit I was currently working in. When a patient dies, it is just another part of your job to take that occurence and put it past you. As callous as it may sound, I feel that one has to do this in order to move on with your job as a healthcare professional. Have I ever had someone literally die on me while I was working with them? No, however, I have had to call a code several times on people going into an MI. It's not an easy thing to experience but you have to just count it as part of your job as either an allied health professional, or a physician. It's hard to come face to face with death, but you have to come to grips with it in a way.

As much as people want to criticize about not having compassion and sympathy when it comes to death, physicians need somekind of defense mechanism, as I like to call it. A physician must keep their composure at all times and if growing a bit callous about death helps them save a life, then that is what it takes. This is my view and my own first hand experience when it comes to patients dying, some of you may of had different experiences. Then again, some of you may not have had any at all, and in an ignorant way, that is a good thing. Sometimes, ignorance can be bliss when it comes to death. It all depends on your perception of death and what the physicians role should be during that particular moment.

 

[Psycho Doctor]

I disagree I think it just might be there way to get through it... I am an EMT and have had to perform CPR on many dead patients. We know that we will not save them and are only doing CPR because it is protocol, because we are not allow by law to pronounce death so when you get to the ER the nurse take over until the DR say they are dead. We joke around to get through it because seeing a dead person in very emotion. It is only the freshly dead, less the 5 minute before CPR is start that are sometimes revived. Then we take our job very seriously....

ok, i guess i can partially understand that...the needing a way to cope with death. However when it sounds so callous and people make off handed comments, they never know who may hear...is the patient's family near by? is there someone in the next cubicle who was just told her little boy didn't make it? was someone lying on a stetcher within ear-shot range just told they have a terminal disaease? Fellow caregivers who know each other may understand this coping mechanism but will the patients and their families understand as well when they have just lost their loved one? Whereas i realize no one intended any disrespect, you can not imagine what the perception of those who are alreay angry and grieving may interpret it. As healthcare givers we must be cognizant of how anyone may take it. Also don't forget your fellow healthcare giver who may have lost their dad last month and this conjures up the images of taking him to the ER and being told he didn't make it. Death may be hard for us, but never as hard as one who has just lost a loved one. One day we will be the ones who has to break that horrific news to the family.

 

[Addicted To SDN]

I've watched one person die in the emergency room -- he came in full arrest, though, so he may have already been dead. Is wasn't bad watching him die (the bones cracking from CPR and the blood coming up the tracheometry tube weren't pleasant, though), but I was most upset by the way the nurses/staff handled it. When they got the call saying a full-arrest was coming in, all the nurses said was, "well, this won't take long." That kind of got to me. It's just so weird how normal a thing it is to them -- to see death. I guess that's something we'll all have to expect someday. I was also in the room when several people where told they would die of cancer. I remember one woman with lymphoma who I saw pretty much every week for about eight weeks. Both I and the doctor thought she was getting better (battling anemia from chemo), but then one day her family came to the clinic and said she had died overnight -- that was probably the worst. To see someone healthy and talk to them and think things were looking good and then finding out not ...

VFrank, that is so true! I get annoyed when nurses have an apathetic attitude towards trying to save someone's life...maybe they need to find a new peofession. But my god, they need to get off their high horse while they are working in the ER. I have worked in the ER as a tech for over a year. I give it all I have got when doing chest compressions and these nurses have the balls (well not usually) to take their sweet old time. That is not even the disturbing part...before the person comes in they put the body bag on the stretcher...I have seen this about a dozen times!

 

[Psycho Doctor]

VFrank, that is so true! I get annoyed when nurses have an apathetic attitude towards trying to save someone's life...maybe they need to find a new peofession. But my god, they need to get off their high horse while they are working in the ER. I have worked in the ER as a tech for over a year. I give it all I have got when doing chest compressions and these nurses have the balls (well not usually) to take their sweet old time. That is not even the disturbing part...before the person comes in they put the body bag on the stretcher...I have seen this about a dozen times!

hmmm...i already said the exact same thing and got "attacked" my some people; glad to see i'm not the only one who feels this way.

 

[Addicted To SDN]

hmmm...i already said the exact same thing and got "attacked" my some people; glad to see i'm not the only one who feels this way.

Hey Psycho Doctor...I enjoy following your post...for that poster who was so "close-minded", he needs to understand that, although many healthcare workers are like him--trying to hide their emotions through humor--there are many healthcare works that just don't give a f#$k. These are the healthcare workers we are talking about.

 

[Psycho Doctor]

Hey Psycho Doctor...I enjoy following your post...for that poster who was so "close-minnded", he needs to understand that, although many healthcare workers are like him--trying to hide their emotions through humor--there are many healthcare works that just don't give a f#$k. These are the healthcare workers we are talking about.

exactly!!

 

[RaistlinMajere]

When death becomes so routine that they make jokes about it, when they lose the ability to see a person connected to the death and fail to see a family affected by the death; it's time to stop being a healthcare giver.....and time to find a new career.

I understand you comment, but I respectfully disagree. People deal with death in different ways. I don't think it is routine for the joker crackers, but rather just how they cope with a tragic situation. It allows these people to detach from the awfulness of it all.

I agree with your sentiment that it is not cool to joke about death, and I wouldn't do it, but I've seen a lot of excellent nurses kidding around and it would be a shame if they stopped.

 

[stinkycheese]

I actually was strongly considering psychiatry until some of you people here talked me out of it by saying i couldn't become "involved" (like really care for my patients).

Oh, that is such a load. We never said that. You still don't understand respecting boundaries and how it differs from "not caring" about a patient? Please. Stop twisting people's words around.

Here is the thread for those who are interested.

http://forums.studentdoctor.net/showthread.php?t=134130

 

[v-tach]

for me, that is key...but then I still keep asking "God...why? He was so young and didn't even have a chance to live...why?"

Yeah, I agree that it doesn't always seem to make sense, and that's tough. The thing is to trust that God has his reasons for things and it's all part of his plan--I know it's not easy!

 

[Cerbernator]

I saw a few people die in the trauma ward. It felt a little sad but I realize that death is as much a part of life as is living, so it didn't really bother me.

 

[Mumpu]

You deal. Work through the case, make sure there was nothing you missed. If you did miss something, you learn from it and don't do it again. A patient my team was taking care of unexpectedly died a few days ago. I actually took the time to go to the autopsy and the path conference. The key is to obtain complete follow-up.

 

[Psycho Doctor]

You deal. Work through the case, make sure there was nothing you missed. If you did miss something, you learn from it and don't do it again. A patient my team was taking care of unexpectedly died a few days ago. I actually took the time to go to the autopsy and the path conference. The key is to obtain complete follow-up.

and that's it? you live with it and move on? No remorse? No guilt? No nightmares? I don't think it's that easy....

 

[stinkycheese]

and that's it? you live with it and move on? No remorse? No guilt? No nightmares? I don't think it's that easy....

He just told you that he followed up professionally to the fullest extent by going to the path conference and the autopsy. Why should a physician feel guilt? You didn't make them sick, you just tried to help. We're not Gd, we're physicians (to be). After you have been practicing for some time, I assume that you will begin to understand that for many patients, death is a blessing -- they won't continue to suffer. For those times when it is sudden and unexpected, then at least they didn't have to live for many months knowing they were going to die, and it was not a dragged-out process. You will have to find things about death that are good, otherwise how will you deal?

Do you really think you will have nightmares and flip out every time a patient dies? If that is true, you should think about how the hell you're going to get through intern year!

 

[Psycho Doctor]

He just told you that he followed up professionally to the fullest extent by going to the path conference and the autopsy. Why should a physician feel guilt? You didn't make them sick, you just tried to help. We're not Gd, we're physicians (to be). After you have been practicing for some time, I assume that you will begin to understand that for many patients, death is a blessing -- they won't continue to suffer. For those times when it is sudden and unexpected, then at least they didn't have to live for many months knowing they were going to die, and it was not a dragged-out process. You will have to find things about death that are good, otherwise how will you deal?

Do you really think you will have nightmares and flip out every time a patient dies? If that is true, you should think about how the hell you're going to get through intern year!

I know he followed up academically. my question was once you do that and learn from it, it's easy to move on? i don't know...i'm not a doctor; i don't have my own patients...i've had patients in a sense but not as their physician.

guilt for not being able to save them despite all efforts and despite that we are not God, and we know that

i am well aware that some people are better off not making it than to exist in a world of endless pain; i've dealt with those patients before and i'm ok with that; it's those who should have had a whole life ahead of them...the little kids who were abused or born with a fatal disease, the teens who were careless as new drivers, the dads who were so busy supporting their families they ignored the early symptoms of a heart attack; the moms who were killed by a drunk driver; the ones you should have been able to save but they got to the hospital minutes too late; the ones whose families are sitting outside waiting for any piece of hope that their lives are not totally shattered as well....the list goes on.

People here (and others i know) have stated that they have gotten nightmares whentheir first patient/a special patient/ a young patient, or a particular patient died; they've mentioned how years later they still see that patients face whenever they perform a certain task, or go some place reminscent of that patient. I know many people in the health field, myself included, who have taken the job home with them, who have wondered what happened to a particular patient, have checked up on him/her even after they ceased to be their patient any more. I know people who have talked about certain patients and the impact they have made on their career/lives, whatever, even years later. Don't make it seem like i'm the only one who feels this way; i've heard it many times from people in different capacities of the health field and at different levels in their training.

 

[Mumpu]

Psycho, I'm sorry I didn't meet your expectations for high drama. I've had patients die before as an EMT but a new experience for me this year was the sense of higher responsibility and the very real fear that my patients would have a bad outcome. The key is that you deal and move on even if you could've done better. If you think it's easy to watch the skin peeled off the face of someone you talked to 10 hours prior, think again. It took resolve to go to the autopsy and I did it as a professional duty to my patient -- follow up on every test and lab, follow up on every intervention you do, follow up on every outcome. If you do not, you will have guilt, nightmares, and the fear will chip away at your confidence and make you a worse physician. If you could have done things better, you learn and never repeat the mistake again. And as with everything else in medicine, things will happen beyond your control. Healthy patients will throw saddle emboli in spite of heparin, shunts and sutures will rupture, aortas will erode into the esophagus, etc. And again, you deal, learn, and move on.

Medicine is not hard because of science or MCATs. It's hard because you will be a better, kinder, and gentler person if you do not COR little kids, tell people they have cancer, and see the autopsies of nice people you met 3 days ago.

 

[ShyRem]

Mumpu, amen to that. For me, children were the worst... but I had an entire summer of being the "child trauma magnet". I came back to the field.. my partner didn't. I know someone who's worst was old people CORs... she didn't last long. Couldn't take it and kinda whacked out. The opportunity for guilt is immense. You have to have conviction that you did the right thing at the right time.

One thing medicine does do: it makes you appreciate what you have. Not the material things, but the love of a spouse, your children, your close tried-and-true friends, your parents and siblings. It makes you realize what is truly important in life are not material things.

 

[Psycho Doctor]

Psycho,

Read your signature.

Also, no one talked you out of psychiatry. You just don't understand that boundaries are there to protect your patients. Boundaries exist so you can better CARE for your patient.

perhaps no one deliberately talked me out of it, but what people said convinced me it may not be the right specialty for me

 

[Psycho Doctor]

One thing medicine does do: it makes you appreciate what you have. Not the material things, but the love of a spouse, your children, your close tried-and-true friends, your parents and siblings. It makes you realize what is truly important in life are not material things.

absolutely!!! and death does it to you too, nothing like putting everything in perspective

 

[Psycho Doctor]

Psycho, I'm sorry I didn't meet your expectations for high drama. I've had patients die before as an EMT but a new experience for me this year was the sense of higher responsibility and the very real fear that my patients would have a bad outcome. The key is that you deal and move on even if you could've done better. If you think it's easy to watch the skin peeled off the face of someone you talked to 10 hours prior, think again. It took resolve to go to the autopsy and I did it as a professional duty to my patient -- follow up on every test and lab, follow up on every intervention you do, follow up on every outcome. If you do not, you will have guilt, nightmares, and the fear will chip away at your confidence and make you a worse physician. If you could have done things better, you learn and never repeat the mistake again. And as with everything else in medicine, things will happen beyond your control. Healthy patients will throw saddle emboli in spite of heparin, shunts and sutures will rupture, aortas will erode into the esophagus, etc. And again, you deal, learn, and move on.

Medicine is not hard because of science or MCATs. It's hard because you will be a better, kinder, and gentler person if you do not COR little kids, tell people they have cancer, and see the autopsies of nice people you met 3 days ago.

i'm not looking for high drama..i'd actually wish NOT to have it most of the times, at least not in some of the ways that medicine persents it.

otherwise that was an excellent post and i respect you for all you did and continue to do....

 

[DaveinDallas]

When death becomes so routine that they make jokes about it, when they lose the ability to see a person connected to the death and fail to see a family affected by the death; it's time to stop being a healthcare giver.....and time to find a new career.

Or could it be a defense mechanism? They see it so much that they use humor to keep themselves insulated from it so that they can attempt to save the ones that are 'saveable'?

 

[DaveinDallas]

Only one instance. Watched my wife's grandfather as they took him off of life support. I didn't expect what happened when the survival reflex kicked in, but I knew him and liked him and was sad to see him go. But I remember the good times when I think of him. No nightmares or anything of the sort.

 

[Psycho Doctor]

Or could it be a defense mechanism? They see it so much that they use humor to keep themselves insulated from it so that they can attempt to save the ones that are 'saveable'?

yea i'm realizing tha tthis is generally the case, but they need to be careful that no one directly affected by it or another similar tragedy can hear the (sometimes insensitive) "joke".