What does it feel like to lose your patient

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An em doc where I shadowed told me, "we all die, patients die and doctors die....death is going to happen to all of us......your job is to delay as many as you can and not speed any up, but you are a doctor, not a deity...don't ever begin to think that you can fix them all"
 
Depends on your relationship with the patient and the circumstances surrounding their death I think. I had a patient I was following die overnight when I was in medicine. It was somewhat of a surprise, but to be entirely candid I wasn't all that beat down by it. I saw a younger patient progress from "difficult to intubate" to death over the course of about an hour after ~45 minutes of CPR. That was more of a beat down because of the circumstances surrounding her death and her age despite the fact that I had never spoken with her.

All and all, though, it's just another day at the office. Crude though it may be, it's not something I think about all that much once I get out of the hospital. It sucks in the moment and it certainly sours my mood a bit, but I don't go home and cry into my pillow for hours.
 
At my old job as a med/surg aide, I used to be responsible for taking care of my patients who died (e.g., removing lines, cleaning bodies, wrapping in them in shrouds, etc.), transporting them to the morgue, and completing death paperwork. I realize I was just an aide but every patient I had that died I had gotten to know him/her and/or his/her family fairly well. For the most part I just accepted it as a normal life process, though three whom died while I was working truly affected me. Despite that, I still realized it was a normal process and at least those patients were no longer suffering or awaiting the inevitable and the anxiety with which it comes.
 
Served said:
How do you feel when your patient dies despite your care?
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Context is everything. Most patients who die in the hospital are terminally ill and dying in spite of whatever we can do, and my job is to help their families accept that and make both patient and family as comfortable as possible during the dying process.

The worst deaths are the ones where no one expected the patient to die, especially if they are young, and especially if you feel like you could or should have done something differently. I had one "perfect storm" patient like that during residency where I honestly feel like my attending and I didn't do something that could have been life-saving as early as we should have. We'll never know if events would have turned out any differently had we done something else, but that was a really tough patient death for me.
 
Reading this is depressing, a patient dies on you overnight 🙁

How do you just go back to living life?

I guess we all die, this world is only a soujourn.
 
I know some doctors that just don't care (like they are not just putting up a front. they literally just don't care.) Would that be considered sociopathic behavior?
 
Xenoblade said:
I know some doctors that just don't care (like they are not just putting up a front. they literally just don't care.) Would that be considered sociopathic behavior?
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Maybe they've become desensitized to watching people die.
 
Xenoblade said:
I know some doctors that just don't care (like they are not just putting up a front. they literally just don't care.) Would that be considered sociopathic behavior?
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There's a lot to socio/psychopathic behavior. If they legitimately don't care that someone dies, why are they doctors to begin with? If that's the case, and not just a coping mechanism, then it's a personality trait, and a concerning one at that. Whether they are psychopathic depends on more than that factor, though.
 
QofQuimica said:
Context is everything. Most patients who die in the hospital are terminally ill and dying in spite of whatever we can do, and my job is to help their families accept that and make both patient and family as comfortable as possible during the dying process.

The worst deaths are the ones where no one expected the patient to die, especially if they are young, and especially if you feel like you could or should have done something differently. I had one "perfect storm" patient like that during residency where I honestly feel like my attending and I didn't do something that could have been life-saving as early as we should have. We'll never know if events would have turned out any differently had we done something else, but that was a really tough patient death for me.
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We had a soldier die during a training rotation in our field clinic. It was a sudden illness that progressed over about 6 hours from coming in the clinic feeling ill to stopping breathing. There was a definite delay in evacuating him by ambulance due to logistical issues and not having hindsight that this young, previously healthy soldier was seriously ill. When the soldier stopped breathing and then there were still delays in evacuating him by helicopter for stupid, ridiculous reasons that I won't elaborate on. But it was definitely a hard loss to take and for many of the young medics it was their first.

I have no idea whether a more expedited evacuation would have saved his life but, it certainly wouldn't have hurt him. I still remember that kid's name, and I definitely keep it as a reminder that physicians need to take the lead when it comes to their patients, not the admin folks.
 
We had a young woman die of the flu within hours of admission. Her tough looking husband crying and apologizing and begging her to not leave him alone as we struggled to keep her alive and then finally just becoming silent and broken the end finally came- that got to me. Watching hope just die in front of me as a guy realized he was going to have to raise his kids alone and never see the woman he loved again was rough.

Then there's the ones that you know. The frequent flyers with inoperable cancer or end-stage COPD/CHF/whatever that you're on a first name basis with, the kids with congenial problems that come in all the time to the point you get to see them growing up, the ones who get stuck in the hospital for months and years because they never get well enough to leave... Some of them will make you pretty damn sad, when you hear they pass and you see their obituary and an almost unrecognizable picture of the healthy person they once were that you never met.

But most deaths aren't that way. They're people who are quite old, very sick, have minimal quality of life, and often are suffering from dementia. It isn't a tragedy so much as their time to move on from life. The really tragic thing is when families choose to drag out their 95 year old great grandfather's dying process, traching and pegging the guy so he can slowly waste away in pain and misery for months in the hospital until a VAP or an infected bed sore or some other awful thing finally does him in. It's the ones that are begging the team to let them die that are the most depressing, the ones who have given their family medical power of attorney and are being kept alive against their will. I've frequently wanted to ask family members "what the hell did he/she do to you to deserve this kind of torture?" Anyway, when those ones finally pass, you actually kind of feel good knowing that they are finally at peace and without pain.

You can avoid dealing with this sort of stuff if you stay out of acute care, so don't let it scare you away from medicine. And it's really not nearly as bad as it sounds, you kind of get used to it after a while.
 
I remember one patient in particular that came into the ER that I used to work at. The patient was coding when he arrived, but had a shock-able rhythm - it's definitely something that can get your hopes up (the patient was younger, too). Sadly, the patient went from vfib to PEA to asystole. Definitely a crappy feeling. It also where I found out that CPR is exhausting.

xffan624 said:
We had a soldier die during a training rotation in our field clinic. It was a sudden illness that progressed over about 6 hours from coming in the clinic feeling ill to stopping breathing. There was a definite delay in evacuating him by ambulance due to logistical issues and not having hindsight that this young, previously healthy soldier was seriously ill. When the soldier stopped breathing and then there were still delays in evacuating him by helicopter for stupid, ridiculous reasons that I won't elaborate on. But it was definitely a hard loss to take and for many of the young medics it was their first.

I have no idea whether a more expedited evacuation would have saved his life but, it certainly wouldn't have hurt him. I still remember that kid's name, and I definitely keep it as a reminder that physicians need to take the lead when it comes to their patients, not the admin folks.
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This stuff occasionally happens on large training bases. When I was at Fort Sam, there was this guy in another company that fell out during a run, so the cadre had him sit down against a fence and wait for them to finish. Came back to get him, and he was dead.

Also heard stories about meningitis outbreaks that would occur from time to time (usually not found out until someone dies from it). There's a big stigma about going to sick call in the military. Guys just think they're sick, like they have always been since basic training (so they don't go to sick call), then they end up dying.
 
sb247 said:
woooooaaahhhh
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Just look into those eyes

Michaelswango.jpg
 
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Guys make it stop.

Jesus I'm going to have nightmares now.
 
It's often sad, but not always. The first patient death I experienced was actually relieving, as he was suffering immensely. He would actually ask you to OD him whenever you would go see him. It was difficult to watch him suffer so much; all that was left of his life were pain and discomfort, and there was no hope for improvement of his condition. I was relieved for him when I came in one morning and heard he had passed; it was a solemn sort of relief, though.
 
The worst ones in my opinion are the ones that are completely fine/talking to you and the next minute you are doing CPR on them (even worse when they don't make it).
Those stick with me, but talking about it always helps me.
 
totally depends on the context of the death. Losing a young healthy patient unexpectedly is f-cking awful. Losing a patient where death was expected can be a rewarding yet emotionally taxing experience.

Losing a long-time patient to suicide was horrific. I spent a lot of time talking to a psychiatry resident friend after that one.
 
you should read Final Exam by Pauline Chen if you have time. It's about how physician's deal with death and their feelings. great read if you have time.
 
QofQuimica said:
Context is everything. Most patients who die in the hospital are terminally ill and dying in spite of whatever we can do, and my job is to help their families accept that and make both patient and family as comfortable as possible during the dying process.

The worst deaths are the ones where no one expected the patient to die, especially if they are young, and especially if you feel like you could or should have done something differently. I had one "perfect storm" patient like that during residency where I honestly feel like my attending and I didn't do something that could have been life-saving as early as we should have. We'll never know if events would have turned out any differently had we done something else, but that was a really tough patient death for me.
Click to expand...

If you don't mind me asking, what kind of residency program are you in (specialty)?
 
It is about context. I've had kids die who were suffering so much--we had to keep them sedated because they'd code every time they moved, or their bellies were so big that they could barely breathe. I've also had patients who were getting routine transfers and came in coding, where we did an hour of resuscitation before having to call the parents and convince them to make the drive tonight instead of in the morning because their son was now dead.
 
J Senpai said:
The second I saw that picture, the mental alarm went off. Very strange and frightening person. People like him are why I switched my major to psych.
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Has anyone seen The Good Doctor with Orlando Bloom? That movie kinda reminded me of him.
 
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