chef

Senior Member
10+ Year Member
15+ Year Member
Nov 6, 2001
1,004
1
Status (Visible)
are there specialties where more pts end up dead vs walking out alive?
 
About the Ads

carrigallen

16th centry dutch painter
10+ Year Member
15+ Year Member
Feb 27, 2003
1,542
7
Status (Visible)
well..I think all specialities have their fair share of deaths. =/

Neonatology, surgery, picu's, medicine, geriatrics...all specialities have a significant amount of M & M.
 

yaah

Boring
Moderator Emeritus
15+ Year Member
Aug 15, 2003
28,059
430
Fixing in 10% neutral buffered formalin
Status (Visible)
  1. Attending Physician
Originally posted by emedpa
PATHOLOGY( COULDN'T RESIST)...
maybe oncology....

Haha so very funny. Please resist next time!

Most pathology "patients" are those in which biopsies are done. They are very much alive. Their tissue, when received in the lab, may be inanimate.

Autopsy is about 5% of pathology. Even less for many practicing pathologists. Unless you're in forensics of course. And they're dead when you meet them anyway.

This is kind of a silly question. ER folks I guess see the most because the wheel in a lot of almost DOAs. The situation you describe of more dead than alive isn't realistic. Most oncology patients don't die in the hospital.

The real question is, why are you asking? I don't really see much point unless you are petrified of death, in which case you should not be in medicine, or you love death, in which case you should not be in medicine either and should be a mortician or a Puritan.
 

yaah

Boring
Moderator Emeritus
15+ Year Member
Aug 15, 2003
28,059
430
Fixing in 10% neutral buffered formalin
Status (Visible)
  1. Attending Physician
Yeah laugh it up, fuzzball. When I do your autopsy, it's going to be painful. I'm going to start with the neck. Pathologists have enough to worry about without being made the butt of jokes of all you cool people.

From now on my life's goal is to make pathology cool.
 

beyond all hope

Senior Member
7+ Year Member
15+ Year Member
Dec 18, 2003
623
7
47
Status (Visible)
Death comes in many forms (he waxes poetic). It's one thing when you're called by the nurse to sign the death certificate because your octagenarian patient died peacefully last night.
It's another to code a 3 month old who already had rigor mortis, or to watch a young man bleed out at your feet from multiple GSWs. So if you're afraid of seeing death, EM is not your bag, but the only specialties you're likely to get away from it in are Psych and Rads.

For me it's children that are the most emotional. When an 80 year old man comes in DOA, found blue and not breathing in his bed, I don't feel any sorry or pity. He had his fair share of life. I just wish we didn't have to code him. Kids dying always tear me up.

I think death by SOB (shortness of breath) is the worst. They look at you with panicked eyes and they know they are going to die but it takes a long time. You paralyze and tube them, but if you've gotten there too late the acidosis and MSOF kicks in, and they end up in some terminal rhythm later in the ICU.

You will probably become pretty blase about death after a while as a physician. I used to get panicked and emotional during codes. Now I don't.

I lost a little bit of myself the first time I started cracking jokes in a code. We had an old lady with renal failure, found down with assytole, and everyone knew she had been dead for an hour but we ran the code anyway. I don't remember how it started but someone cracked a joke and soon we were flinging them across the body guffawing while putting in lines, pushing drugs and doing CPR. I'm just glad the family wasn't around.

How you feel about death will change as you progress in medicine.
 

juddson

3K Member
7+ Year Member
15+ Year Member
Aug 21, 2002
4,049
3
Status (Visible)
It's my impression (correct me if I am wrong) that some people are cut out for pediatric oncology and some simply are not. I am not. That doesn't mean I should not be in medicine.

Judd
 

Docxter

Senior Member
7+ Year Member
15+ Year Member
Jan 27, 2004
462
3
Status (Visible)
Originally posted by beyond all hope
Death comes in many forms (he waxes poetic). It's one thing when you're called by the nurse to sign the death certificate because your octagenarian patient died peacefully last night.
It's another to code a 3 month old who already had rigor mortis, or to watch a young man bleed out at your feet from multiple GSWs. So if you're afraid of seeing death, EM is not your bag, but the only specialties you're likely to get away from it in are Psych and Rads.

Oh, radiology is unfortunately not immune to patients dying. People die in the IR suites not too infrequently. Last week an MVA trauma patient with a crushed liver came to us after the surgeons couldn't repair the liver in the OR. He was bleeding like hell with an open abdomen spilling blood and already had about 50 units of blood transfused. He died on our table about an hour into the procedure. The same week another lady coded and died after dialysis graft declotting (probably displaced thrombi?). Another one died while treating a basilar artery thrombosis when the atherosclerotic basilar artery ruptured when infusing tPA. I have once seen a patient code and die due to contrast anaphylaxis for a simple neck CT, though it's rare nowadays with the newer contrast.
 

Finally M3

Senior Member
10+ Year Member
15+ Year Member
Jun 28, 2002
974
2
Status (Visible)
  1. Attending Physician
I think the EM/Trauma Sugery deaths are the worst. The patients who die in the ICU generally have 'managed' deaths (excluding, of course, those who die during codes) where the vent is shut off or 'comfort care' with no active interventions.

The EM trauma cases are bad...I think the MVCs are worse than the GSWs because you start thinking 'There but for the grace of God...'. Actually, my first week we had a MVC victim DOA who turned out to be a PGY1...that was absolutely horrible.:( Everyone started looking at faces when MVCs where brought in after that...
 
Nov 24, 2002
22,281
7,938
SCREW IT!
Originally posted by beyond all hope
For me it's children that are the most emotional. When an 80 year old man comes in DOA, found blue and not breathing in his bed, I don't feel any sorry or pity. He had his fair share of life. I just wish we didn't have to code him. Kids dying always tear me up.

A good friend in EMS told me years back that, with kids, "It's all or nothing, and it's usually nothing, but, when it's something, it's everything". I concur that it's tough with kids. I tell colleagues that it's one thing for a 20 year old gangbanger or drug dealer that's been shot in a deal/brawl, or a 50 ETOH abuser/smoker/noncompliant hypertensive/obese - I do everything I can for them, but it's hard to feel sympathy, whereas kids haven't done anything to deserve it.
 
About the Ads

edinOH

Can I get a work excuse?
7+ Year Member
15+ Year Member
Nov 13, 2002
768
4
Status (Visible)
  1. Attending Physician
"I see dead people" "...they don't even know they're dead"

You see quite a few deaths in the ED. Most were either DOA or would have been DOA if traffic had been alittle heavier.
 

lattimer13

good boy!
10+ Year Member
15+ Year Member
Nov 12, 2002
1,187
7
42
Pacific NW
Status (Visible)
  1. Resident [Any Field]
Originally posted by yaah
Yeah laugh it up, fuzzball. When I do your autopsy, it's going to be painful. I'm going to start with the neck. Pathologists have enough to worry about without being made the butt of jokes of all you cool people.

From now on my life's goal is to make pathology cool.

how's it going to be painful for me?

want some cheese?

good luck with making pathology "cool."
 

yaah

Boring
Moderator Emeritus
15+ Year Member
Aug 15, 2003
28,059
430
Fixing in 10% neutral buffered formalin
Status (Visible)
  1. Attending Physician
Originally posted by lattimer13
how's it going to be painful for me?

want some cheese?

How do you know you won't feel it? Confident about death being the end of all feeling?

Actually, I will just make my autopsy report so long, boring, and filled with unnecessary details that you will suffer. Wait, on second though, you'd be dead.

Whatever, the point is, you would be dead. I have the last laugh.

And yes, I'd like some cheese, but nothing french. And no ricotta.

Pathology will be cool because I will be in it.
 

lattimer13

good boy!
10+ Year Member
15+ Year Member
Nov 12, 2002
1,187
7
42
Pacific NW
Status (Visible)
  1. Resident [Any Field]
Originally posted by yaah
How do you know you won't feel it? Confident about death being the end of all feeling?

Actually, I will just make my autopsy report so long, boring, and filled with unnecessary details that you will suffer. Wait, on second though, you'd be dead.

Whatever, the point is, you would be dead. I have the last laugh.

And yes, I'd like some cheese, but nothing french. And no ricotta.

Pathology will be cool because I will be in it.

now i see why you're going into pathology.
 

Scrubbs

Chisellers beware!
7+ Year Member
15+ Year Member
Feb 28, 2003
1,065
12
NeverNeverLand
Status (Visible)
  1. Attending Physician
Originally posted by Finally M3
The EM trauma cases are bad...I think the MVCs are worse than the GSWs because you start thinking 'There but for the grace of God...'. Actually, my first week we had a MVC victim DOA who turned out to be a PGY1...that was absolutely horrible.:( Everyone started looking at faces when MVCs where brought in after that...

I don't even know how to respond to that... that's horrendous! :wow: :wow: :wow:
 

yaah

Boring
Moderator Emeritus
15+ Year Member
Aug 15, 2003
28,059
430
Fixing in 10% neutral buffered formalin
Status (Visible)
  1. Attending Physician
Originally posted by lattimer13
now i see why you're going into pathology.
Are you making fun of me? Just wait another few years, pathology will be cool.

Anyway, about the ER, it can be tough. First time I ever saw someone die was in the ER when I had a registration job there in high school. She fell off a chair right in the waiting room, they never got her back. Other specialties, you can somewhat prepare yourself for it. But in the ER, it can be pretty sudden, you definitely have to have the right kind of personality. I thought about it, but after spending time there I felt like I didn't get much chance to sit and think about cases, explore them more, see some follow up. I just don't feel like I can be intelligent down in the ER. Lots of people couldn't disagree with that more, by the way.

Most people going into medicine are worried somewhat about how they will respond to death and all the related issues that come around it, but many find that they are quite well equipped to deal with it. Others take every death as a failure and worry constantly about it. Honestly though, this shouldn't factor much in how you choose a specialty.
 

IMGforNeuro

Senior Member
7+ Year Member
15+ Year Member
Dec 11, 2003
153
1
Status (Visible)
I think we should modify this to ' which clinical specialities see the most deaths?' because only these physicians treat patients .
Physicians in other specialities see investigative films , specimens etc but not a dying patient.
Regarding most deaths, I think physicians in Neurosurgery see most deaths. Physicians in cerebrovasc and critical care neurology also see a lot of deaths.
Oncology and cancer related fields also see a lot of deaths.
 
About the Ads

yaah

Boring
Moderator Emeritus
15+ Year Member
Aug 15, 2003
28,059
430
Fixing in 10% neutral buffered formalin
Status (Visible)
  1. Attending Physician
I think you're probably misunderstanding me, because what I wrote wasn't that clear.

I feel, personally, unintelligent when I am in the ER. I don't get enough time to think about things in detail and work through problems. I don't feel like I have the opportunity to use my thinking and reasoning skills as much, it feels more like I am reacting.

What I mean by my comment is that there are lots of people who feel the opposite of me. They feel that the ER is the perfect place for them because they feel their intelligence and quick thinking is utilized more than any other place.

My brain just likes to work in different ways. I prefer not to be in the ER environment where things move so fast, change constantly, things beg for your attention, etc.

Please don't think I am trying to disparage ER. My Dad has been an ER doc for >30 years, and obviously I have a lot of respect for my Dad and his career. It's just not for me!
 

monkeyarms

jello wrestler
7+ Year Member
15+ Year Member
Mar 19, 2003
167
3
all up in your area
Status (Visible)
pathology will be cool.
"cool pathologists." :laugh: :laugh: :laugh:
go ahead, say it out loud:
"dude, last night i was hanging out with these bad a$$ PATHOLOGISTS and we slugged some brewskis then got into a fight and then this hot chick with huge knockers just started going at it with this COOL pathologist!!" :laugh: :laugh: :laugh:

btw i did see a stand up one time who said he alwaysthought it would be funny to go to a funeral of someone you don't know and then lean over the casket and say "check-MATE!"
kind of twisted. but funny
 

augmel

Senior Member
10+ Year Member
15+ Year Member
Oct 7, 2002
275
1
Status (Visible)
Dude, if "slugging brewskis," getting into fights, and making out with huge knockered chicks is what defines cool, then the guys that work out at the aluminum smelter are WAY cooler than any physicians I know.

By the way, Psych folks have to deal with death in a very painful way. When their patients commit suicide, they go through hell. It feels much more like a personal failure than when your patient dies of cancer or heart disease. Or so my psych friends tell me.
 

yaah

Boring
Moderator Emeritus
15+ Year Member
Aug 15, 2003
28,059
430
Fixing in 10% neutral buffered formalin
Status (Visible)
  1. Attending Physician
Pathologists thrive on the subtle, the illusion, the possibility. The translation of that too small to be seen by the naked eye into that which may define a disease causing suffering. The understanding of disease at its fundamental, cellular or molecular level. The responsibility for the ultimate diagnosis, even if that be from the single cell.

Other physicians turn to the pathologist for the answers that have thus far eluded them. To define an illness, or perhaps to guide a treatment that will fight it. The arbiters between surgeon and internist. The noble task of education. The streamlining of laboratory studies.

That, I dare say, is cool. Not putting in a chest tube. For me, anyway. Others will disagree. But I won't be up to my elbows in someone's rectum.
 
Nov 24, 2002
22,281
7,938
SCREW IT!
Originally posted by yaah
What I mean by my comment is that there are lots of people who feel the opposite of me. They feel that the ER is the perfect place for them because they feel their intelligence and quick thinking is utilized more than any other place.

That is more clear, and I do take your point. But that's the good thing about medicine - so many roles to play, and we're all on the same team!
 

HooahDOc

Full Member
15+ Year Member
Jun 23, 2003
5,784
895
Status (Visible)
  1. Attending Physician
Just to play devil's advocate, why is the death of a child worse than the death of an adult? A child doesn't have a huge network of friends and loved ones to leave behind. A child doesn't have a lover or a wife.

I think the death of an adult has more negative impact and affects more people overall than the death of a child.

Again, playing devil's advocate.
 

Gleevec

Peter, those are Cheerios
7+ Year Member
15+ Year Member
Nov 24, 2002
4,129
9
Status (Visible)
Originally posted by JKDMed
Just to play devil's advocate, why is the death of a child worse than the death of an adult? A child doesn't have a huge network of friends and loved ones to leave behind. A child doesn't have a lover or a wife.

I think the death of an adult has more negative impact and affects more people overall than the death of a child.

Again, playing devil's advocate.

1. Instinct
2. Potential for long life lost

It's more a gut feeling than anything else for most people. I think you could logically make the case you did, but then again, since when are emotions logical Mr. Spock?
 

Homunculus

SDN Caveman Administrator
Moderator Emeritus
15+ Year Member
Jul 24, 2000
3,530
318
Status (Visible)
  1. Attending Physician
Originally posted by JKDMed
Just to play devil's advocate, why is the death of a child worse than the death of an adult? A child doesn't have a huge network of friends and loved ones to leave behind. A child doesn't have a lover or a wife.

I think the death of an adult has more negative impact and affects more people overall than the death of a child.

Again, playing devil's advocate.

for me, it's usually due to the fact that most kids aren't players in their disease-- they aren't overweight uncontrolled hypertensive diabetic smokers. this is one of the main reasons i went into peds-- i can get the same subspecialties in a patient population that i care about.

there's also the "life years lost" issue. these kids haven't had the chance to really do anything with their lives yet-- go to college, have sex, get married, drive a car, see other places of the world, see their favorite team *finally* have a decent season, make their own money through employment, etc.

also, most kids' deaths are unexpected, insomuch that they're simply young. *most* adult deaths occur at an age where death is not unexpected. an 80 year old with an MI that slowly spirals to death in the ICU isn't nearly as disturbing to me as the 14 year old MVA with head trauma that does the same spiral. and, contrary to "ER", most of the deaths you will see in the hospital will probably be on a general medical or ICU floor. ED docs and surgeons are pretty damn good at what they do, and will *usually* get a patient stabilized and repaired befor they hand them off to the internist to slowly die from XXX (kidney failure, infection, strokes, DIC, etc) that pops up to knock them off.
 

misfit

Blinded Me With Science
10+ Year Member
15+ Year Member
Apr 20, 2000
235
0
Minnesota
Status (Visible)
  1. Attending Physician
Unfortunately, the problem is that kids are useless. Thus, their deaths mean nothing. Well, actually the funeral costs and hospital bills mean something... at least to the survivors, which can add up pretty quickly and cause a lot of heart-ache from money being so mis-spent.

Adults sure do mean more



















(If you did not figure out this was an incredibly facetious statement, you need a personality check.)

misfit
 

dobonedoc

Senior Member
7+ Year Member
15+ Year Member
Nov 12, 2002
149
3
Status (Visible)
Perhaps the most personally attacking site I've seen, over really a simple question.

JKDMed: When (and if) you ever have a child of your own, you will look back on your thought process and want to die.

Yaah: I suppose you are one of those outliers on the curve of all that is good and decent. Oh yeah, and good luck on making path cool. It is not that path is uncool, it is just that you never will be with such a screwed up mission in life. Enjoy your cubby in the corner of the lab.

As for most death, interesting question. My guess would be the Intensivist. Post ops, s/p cardiac arrests, and ER survivors who are technically alive on the vent, sepsis, massive CVA, etc . . . Outside of the county hosptial downtown in Big City, USA, the majority of people in the ER are just too lazy to make an appointment with their docs. Most ERs will see far more URIs, UTIs, and "pain" than anything that is about to die. When they do get death at the door, you just put a tube in them, and ship them to surgery, or the ICU.
 
About the Ads
This thread is more than 17 years old.

Your message may be considered spam for the following reasons:

  1. Your new thread title is very short, and likely is unhelpful.
  2. Your reply is very short and likely does not add anything to the thread.
  3. Your reply is very long and likely does not add anything to the thread.
  4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
  5. Your message is mostly quotes or spoilers.
  6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
  7. This thread is locked.