What's it like to have a patient die?

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It sucks, but the important thing to note here is that the state of medicine today is that we don't ever let patients die without doing every goddamn thing we can to save them, no matter how absurd or unlikely to succeed it is. We just coded a pt for 40 minutes last night - honestly, it would have been better if we hadn't gotten a pulse back.
 
There are many cases in which "doing everything" isn't in the patient's interest.
In the absence of a durable power of attorney for health or a clear advance directive it has nevertheless become "the American Way of Death."
 
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Tawantinsuyu said:
How does it feel when a patient dies, knowing there may have been something else you could have done to save them?
Click to expand...

Most of the time, the patient dies despite knowing you have done everything.

Sometimes, the patient dies while you do everything, while feeling like you shouldn't be doing everything (spend time in the ICU and you will understand)

But you can't be too emotionally invested in all your patients, otherwise with time you will burn out.

Some fields, exposure to death is rare. Other fields, it is more common. When picking a specialty, pick one that is suitable to you.

and this video, from Scrubs, I think best answers your question

 
I've had two patients die so far:

1. A 1 year old baby girl who was shot through the chest and coded. I did chest compressions on her along with an EM resident, but our efforts were futile. Sometimes I wonder whether my chest compressions were adequate enough. But CPR does have a low success rate. Nonetheless, although I didn't cry, it took me some time to gather myself for the rest of the night call. Fortunately, I had understanding residents who were willing to help me through what I had just witnessed.

2. More recently, a man came to the trauma bay with a GSW to the head. The bullet passed through both hemispheres of his brain, and that's almost always lethal. I helped take care of him, but there really wasn't much I could do for him, so I didn't feel as bad as I did with the first patient. But it sucked seeing the mother receive the news about her son and to watch her pray, having hope he would get better (highly unlikely).
 
As an intern you will have a lot of patients die. Many are not unexpected, and neither they nor their family expects them to ever leave the ICU. So you get a bit desensitized. Young healthy people dying still will freak you out though.

The biggest issue with a patient dying on your watch is the mountain of paperwork you have to fill out. And if its not exactly right, it gets sent back to you to try again. So you will get really good at keeping patients alive until at least sign out.
 
Depends on the patient. Usually it's not so bad. Every now and then, you feel horrible. Usually that doesn't have anything to do with what you did though, it's usually because you knew them too well, or their case was just sad to begin with. It gets better with time though, you start to get kind of numb to the whole death thing.
 
gyngyn said:
There are many cases in which "doing everything" isn't in the patient's interest.
In the absence of a durable power of attorney for health or a clear advance directive it has, nevertheless become "the American Way of Death."
Click to expand...

The best part is when a patient has a DPAHC and has adamantly said they don't want heroic measures, then as soon as they become incapacitated the DPAHC says DO EVERYTHING, NOW.

/IhatetheICU
 
lisi326 said:
The best part is when a patient has a DPAHC and has adamantly said they don't want heroic measures, then as soon as they become incapacitated the DPAHC says DO EVERYTHING, NOW.

/IhatetheICU
Click to expand...
So sad. This is why you can't trust loved ones to be DPAHC.
 
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group_theory said:
Most of the time, the patient dies despite knowing you have done everything.

Sometimes, the patient dies while you do everything, while feeling like you shouldn't be doing everything (spend time in the ICU and you will understand)

But you can't be too emotionally invested in all your patients, otherwise with time you will burn out.

Some fields, exposure to death is rare. Other fields, it is more common. When picking a specialty, pick one that is suitable to you.

and this video, from Scrubs, I think best answers your question

Click to expand...


Also like this:

 
Law2Doc said:
As an intern you will have a lot of patients die. Many are not unexpected, and neither they nor their family expects them to ever leave the ICU. So you get a bit desensitized. Young healthy people dying still will freak you out though.

The biggest issue with a patient dying on your watch is the mountain of paperwork you have to fill out. And if its not exactly right, it gets sent back to you to try again. So you will get really good at keeping patients alive until at least sign out.
Click to expand...
:laugh: It's funny because it's ridiculously honest and true. The "not on my watch" mentality is less about the good of man and more about the aversion to paperwork and having to run through a code during change of shift.
 
Mad Jack said:
:laugh: It's funny because it's ridiculously honest and true. The "not on my watch" mentality is less about the good of man and more about the aversion to paperwork and having to run through a code during change of shift.
Click to expand...
Dying "on the table" is the only thing worse than dying on my service...
 
There's different kinds of deaths and different reactions to them.

Most deaths, it's the patient's disease process. All you are doing is buying them more time but you know what the end result will be. At first these are hard, and sad, of course. But over time you get more used to and understanding of these. They remain sad, but not soul crushingly so.

Some deaths are a good thing. An end to suffering. These can sometimes bring with them a sort of relief, because you know that it was the right thing and that the patient is not in pain any more.

Some deaths you still have no power to intervene or save the patient, but the underlying process is so horrible it feels soul crushing. Traumas, abuse cases, crazy one in a million diagnoses fall under this blanket. After a month or so on trauma these weigh you down a lot.

"Straight kills" are about the worst, but they are truly rare. But knowing that something you did with your hands resulted in a bad outcome can weigh on you. This is one of the hardest parts about being in an invasive field.
 
We've had more than a few losses in the ED, of course. Some seem inevitable, and those are easier to deal with. But some hit you a bit hard - we had an infant come in. Mom had either not wanted to come in because she needed her booze, or she was too drunk to realize she was in labor for real. Either way, she delivered at home and then they just snipped the cord even at the skin. Came in a few hours later when someone finally realized that the kiddo was pale and still bleeding. Couldn't be resuscitated in the ED. Just seemed so unnecessary - I mean, the kid was in for a rough life anyway, family like that, but if delivery had happened in the hospital, maybe the social situation would have been recognized. At the least, the baby would have lived.
 
An important, and oft-forgotten, Law :

13. THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.

People on hospice often live longer and have better QoL than their counterparts... http://news.medill.northwestern.edu/chicago/news.aspx?id=220360

mehc012 said:
We've had more than a few losses in the ED, of course. Some seem inevitable, and those are easier to deal with. But some hit you a bit hard - we had an infant come in. Mom had either not wanted to come in because she needed her booze, or she was too drunk to realize she was in labor for real. Either way, she delivered at home and then they just snipped the cord even at the skin. Came in a few hours later when someone finally realized that the kiddo was pale and still bleeding. Couldn't be resuscitated in the ED. Just seemed so unnecessary - I mean, the kid was in for a rough life anyway, family like that, but if delivery had happened in the hospital, maybe the social situation would have been recognized. At the least, the baby would have lived.
Click to expand...

The social situation would have been recognized and the kid probably sent home with the family anyway... I did not mourn those sorts of deaths as much as I probably should have.
 
lisi326 said:
An important, and oft-forgotten, Law :

13. THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.

People on hospice often live longer and have better QoL than their counterparts... http://news.medill.northwestern.edu/chicago/news.aspx?id=220360



The social situation would have been recognized and the kid probably sent home with the family anyway... I did not mourn those sorts of deaths as much as I probably should have.
Click to expand...
For me, it was more sadness at recognizing that it was probably for the better anyway. That's a pretty bizarre thing to have to realize.
Things like that seem more upsetting than actual deaths, though, for the most part.
 
mehc012 said:
For me, it was more sadness at recognizing that it was probably for the better anyway. That's a pretty bizarre thing to have to realize.
Things like that seem more upsetting than actual deaths, though, for the most part.
Click to expand...

Absolutely. I wish for people's deaths on a regular basis. And I feel like a terrible person every time.
 
Death is a part of life. I don't expect to feel much or anything if a stranger dies. Nor do I think being emotionally invested in a particular patient makes one surgeon better than the next. Leave that for the social workers, imo.
 
freemontie said:
Death is a part of life. I don't expect to feel much or anything if a stranger dies. Nor do I think being emotionally invested in a particular patient makes one surgeon better than the next. Leave that for the social workers, imo.
Click to expand...

A) Yes, you will feel something. Will you feel a lot for the guy who rolls into the ED DOA and get pronounced immediately? Maybe not. But I can absolutely assure you that you WILL connect with one patient or another and you WILL feel bad when that patient dies. If you don't, you have no business doing ANYTHING involved with direct patient care. We all get desensitized throughout the process, but if you can't feel even a small touch of sadness for the families of the loved ones or the loss of a life, you're going to be a terrible doctor.

B) Being "emotionally invested" in patients does make you a better doctor, regardless of your field. Of course there are lines you have to draw and you have to be able to set your emotions aside when you go home at the end of the day, but when you are in with your patients you should feel at least a small amount of connection with them. Patients are absolutely aware of whether their doctors give a crap about them and patient/doctor relationships work much better when patients feel like their doctor actually cares about them, at least a little. Saying that we need to "leave that for the social workers" is incredibly dismissive and cold, and that sort of attitude certainly isn't helpful and can definitely be harmful.
 
Even after reading all the excellent responses in this thread, I find this answer to be disturbing.

freemontie said:
Death is a part of life. I don't expect to feel much or anything if a stranger dies. Nor do I think being emotionally invested in a particular patient makes one surgeon better than the next. Leave that for the social workers, imo.
Click to expand...
 
southernIM said:
Also like this:

Click to expand...



In this video, Dr. Cox Demonstrates the classic dilemma faced by any physician who is simultaneously a hospitalist, intenstivist, nephrologist, cardiologist, gastroenterologist, and the (non-surgeon) leader of am entirely in house transplant team.
 
lisi326 said:
A) Yes, you will feel something. Will you feel a lot for the guy who rolls into the ED DOA and get pronounced immediately? Maybe not. But I can absolutely assure you that you WILL connect with one patient or another and you WILL feel bad when that patient dies. If you don't, you have no business doing ANYTHING involved with direct patient care. We all get desensitized throughout the process, but if you can't feel even a small touch of sadness for the families of the loved ones or the loss of a life, you're going to be a terrible doctor.

B) Being "emotionally invested" in patients does make you a better doctor, regardless of your field. Of course there are lines you have to draw and you have to be able to set your emotions aside when you go home at the end of the day, but when you are in with your patients you should feel at least a small amount of connection with them. Patients are absolutely aware of whether their doctors give a crap about them and patient/doctor relationships work much better when patients feel like their doctor actually cares about them, at least a little. Saying that we need to "leave that for the social workers" is incredibly dismissive and cold, and that sort of attitude certainly isn't helpful and can definitely be harmful.
Click to expand...

A. I'm sure I will. I'm only human. That wasn't the point of my statement. (I probably wouldn't label them strangers in that case-- though again that won't get them better medical care from me)

B. Being emotionally invested in someone has nothing to do with being a good surgeon; one could argue it's often counter-productive. Nor does caring about a treatment outcome necessitate being emotionally invested.
 
Perrotfish said:
In this video, Dr. Cox Demonstrates the classic dilemma faced by any physician who is simultaneously a hospitalist, intenstivist, nephrologist, cardiologist, gastroenterologist, and the (non-surgeon) leader of am entirely in house transplant team.
Click to expand...

Scrubs is by far the most realistic medical tv show I've ever seen.

While yes they use narrative convenience like this (Dr. Cox and Kelso appear to be the only attendings JD ever has), they capture the spirit and pathos of residency like no other show.
 
southernIM said:
Scrubs is by far the most realistic medical tv show I've ever seen.

While yes they use narrative convenience like this (Dr. Cox and Kelso appear to be the only attendings JD ever has), they capture the spirit and pathos of residency like no other show.
Click to expand...

I love the show, but some episodes are more realistic than others. I thought a lot of them were good representations of residency, and they actually had a great one on the subject of death (season 1 episode 4, "my old lady"). This one, on the other hand, is pretty nonsensical.
 
freemontie said:
A. I'm sure I will. I'm only human. That wasn't the point of my statement. (I probably wouldn't label them strangers in that case-- though again that won't get them better medical care from me)

B. Being emotionally invested in someone has nothing to do with being a good surgeon; one could argue it's often counter-productive. Nor does caring about a treatment outcome necessitate being emotionally invested.
Click to expand...

I started typing up a response, and then I realized that debating this with you is useless. This view is widespread in medicine (esp surgery) and I know at least some of my classmates feel the same way and I'm not going to convince them otherwise. All I can say is, I've had many, many interactions where I have been personally thanked or had patients tell my attendings how wonderful I was to work with because I simply forged an emotional connection with them and treated them appropriately, while also doing the "doctor" work of collecting information and making plans. That's the part that makes medicine special to me and makes the nonsense we have to go through worth it. /shrug. good luck to you, anyway. I hope you become a very proficient surgeon.
 
lisi326 said:
I started typing up a response, and then I realized that debating this with you is useless. This view is widespread in medicine (esp surgery) and I know at least some of my classmates feel the same way and I'm not going to convince them otherwise. All I can say is, I've had many, many interactions where I have been personally thanked or had patients tell my attendings how wonderful I was to work with because I simply forged an emotional connection with them and treated them appropriately, while also doing the "doctor" work of collecting information and making plans. That's the part that makes medicine special to me and makes the nonsense we have to go through worth it. /shrug. good luck to you, anyway. I hope you become a very proficient surgeon.
Click to expand...

Now you're equating being emotionally invested in the outcome of a patient to --> displaying good beside manners. If this was an actual debate, in a college tournament, you would literally be snickered off the stage. I'm being unnecessarily harsh but it's too glaring to resist. Sorry.
 
Perrotfish said:
I love the show, but some episodes are more realistic than others. I thought a lot of them were good representations of residency, and they actually had a great one on the subject of death (season 1 episode 4, "my old lady"). This one, on the other hand, is pretty nonsensical.
Click to expand...

The setting of one physician overseeing all aspects of these three patients' care is nonsensical, sure.

The actual story - of multiple transplant recipients being infected with rabies from an unrecognized donor infection - is actually true and was "ripped from the headlines" for this episode of Scrubs.

The important part of the story - the message that the hospital overwhelms you sometimes, and bad events seem to have a way of steamrolling one after another. That just when you think you can't take any more, something else goes wrong, and the emotional impact of that on a physician - is absolutely accurate. It was one of the show's best moments. If you can't empathize with and appreciate John McGinley's portrayal right there, well...I don't know what to tell you. Wait til more of your patients die.
 
CherryRedDracul said:
I've had two patients die so far:

1. A 1 year old baby girl who was shot through the chest and coded. I did chest compressions on her along with an EM resident, but our efforts were futile. Sometimes I wonder whether my chest compressions were adequate enough. But CPR does have a low success rate. Nonetheless, although I didn't cry, it took me some time to gather myself for the rest of the night call. Fortunately, I had understanding residents who were willing to help me through what I had just witnessed.

2. More recently, a man came to the trauma bay with a GSW to the head. The bullet passed through both hemispheres of his brain, and that's almost always lethal. I helped take care of him, but there really wasn't much I could do for him, so I didn't feel as bad as I did with the first patient. But it sucked seeing the mother receive the news about her son and to watch her pray, having hope he would get better (highly unlikely).
Click to expand...

Surprised no one else has asked, but how does a 1 year old get shot? Inner city?
 
lisi326 said:
The best part is when a patient has a DPAHC and has adamantly said they don't want heroic measures, then as soon as they become incapacitated the DPAHC says DO EVERYTHING, NOW.

/IhatetheICU
Click to expand...

gyngyn said:
So sad. This is why you can't trust loved ones to be DPAHC.
Click to expand...

I listened to this recently and thought it was interesting:
http://www.npr.org/blogs/money/2014...lls-are-the-talk-of-the-town-in-la-crosse-wis
If only every city had a program like this, I'm sure we would save a lot of money and heartbreak.
 
mehc012 said:
For me, it was more sadness at recognizing that it was probably for the better anyway. That's a pretty bizarre thing to have to realize.
Things like that seem more upsetting than actual deaths, though, for the most part.
Click to expand...

I agree. I witnessed sooo many absent/bad parents during peds. The crappy social situations those kids are in are usually sadder than the kids being sick. I've always heard people say that the worst part of peds is the parents, but I always thought they meant demanding/neurotic parents. I'd rather deal with those parents than parents who don't seem to give a crap, or who drink/smoke while pregnant or around their kids, or who leave their loaded guns in places that young kids can reach...ugh.
 
I feel like physicians can be too hard on themselves when their patients pass away (or in general). Physicians are human and need time to grieve as well.

Is emotional detachment really beneficial for both the physician and patient?
 
Shinobiz11 said:
Surprised no one else has asked, but how does a 1 year old get shot?
Click to expand...

Crossfire, drive-bys, ricochets, stray bullets. People who shoot at each other in this country are rarely expert marksmen, and instead resort to repeat action weapons that spray bullet over a wider area. Additionally people shooting from moving cars (drive bys) rarely account for the motion of the car.
 
First Death = Can't eat for the rest of the day
Second Death = Feel sad
Third Death = Don't feel much but feel weird that I don't feel much
Fourth Death = Don't feel much
Fifth Death = Don't even notice that I don't feel much
Sixth Death = Walk out of room and take another bite of my protein bar

Uncomfortable to say but true

Of course there always will be instances which touch you especially, but those are exceptions.
 
freemontie said:
Death is a part of life. I don't expect to feel much or anything if a stranger dies. Nor do I think being emotionally invested in a particular patient makes one surgeon better than the next. Leave that for the social workers, imo.
Click to expand...

I'm curious. Is this what you mean? (skip to 43s)

Non-attachment is an interesting element of many Eastern religions - albeit a complicated one.
 
When I started my residency, my program director told me, "More than 50% of the patients you take care of this month will be dead before you leave this program." The nature of being in a Vascular Surgery program with a heavy emphasis on dialysis access. I am focusing on our dialysis population right now. The average life expectancy of my patients is about 3 years. For our elderly group, less than 18 months. They are sick. Their prognosis is worse than most stage IV cancers and there are a ****load more of them than the cancer center has.

To be honest, those deaths don't really bother me a whole lot. Circle of life, inevitable, etc. It sucks and I feel bad for a few minutes when I hear, but it just isn't unexpected and doesn't weigh you down as much.

Trauma on the other hand... Besides the dozens of 'dead on arrival' patients, having someone transfer in in bad shape and then die with your hands all over them, sometimes with your hands literally squeezing their heart is a lot more brutal. Sometimes things are too busy to really notice, but when you sit down and think for a second, it hits you. Then the family shows up and it hits you even harder. You talk to them, comfort them, and then go back to work. That is the job. And that part of it sucks.
 
mimelim said:
When I started my residency, my program director told me, "More than 50% of the patients you take care of this month will be dead before you leave this program." ..
Click to expand...

And this is why I'm in Pediatrics. 50% of the patients I take care of in a month will try to pee on me during the physical exam, but that's about it.
 
lisi326 said:
It sucks, but the important thing to note here is that the state of medicine today is that we don't ever let patients die without doing every goddamn thing we can to save them, no matter how absurd or unlikely to succeed it is. We just coded a pt for 40 minutes last night - honestly, it would have been better if we hadn't gotten a pulse back.
Click to expand...

We've had patients with good cpr from the start of their downtime walk out of the hospital intact after 2+ hours. Depends on the patient.
 
CherryRedDracul said:
I've had two patients die so far:

1. A 1 year old baby girl who was shot through the chest and coded. I did chest compressions on her along with an EM resident, but our efforts were futile. Sometimes I wonder whether my chest compressions were adequate enough. But CPR does have a low success rate. Nonetheless, although I didn't cry, it took me some time to gather myself for the rest of the night call. Fortunately, I had understanding residents who were willing to help me through what I had just witnessed.

2. More recently, a man came to the trauma bay with a GSW to the head. The bullet passed through both hemispheres of his brain, and that's almost always lethal. I helped take care of him, but there really wasn't much I could do for him, so I didn't feel as bad as I did with the first patient. But it sucked seeing the mother receive the news about her son and to watch her pray, having hope he would get better (highly unlikely).
Click to expand...

Closed chest cpr for traumatic arrest is essentially never adequate. What blood volume are you circulating? I don't know the data on thoracotomy for traumatic arrest secondary to penetrating trauma in infants, but it is actually relatively successful in adults. This wasn't your call to make, though, and the outcome wasn't your fault.
 
lisi326 said:
A) Yes, you will feel something. Will you feel a lot for the guy who rolls into the ED DOA and get pronounced immediately? Maybe not. But I can absolutely assure you that you WILL connect with one patient or another and you WILL feel bad when that patient dies. If you don't, you have no business doing ANYTHING involved with direct patient care. We all get desensitized throughout the process, but if you can't feel even a small touch of sadness for the families of the loved ones or the loss of a life, you're going to be a terrible doctor.

B) Being "emotionally invested" in patients does make you a better doctor, regardless of your field. Of course there are lines you have to draw and you have to be able to set your emotions aside when you go home at the end of the day, but when you are in with your patients you should feel at least a small amount of connection with them. Patients are absolutely aware of whether their doctors give a crap about them and patient/doctor relationships work much better when patients feel like their doctor actually cares about them, at least a little. Saying that we need to "leave that for the social workers" is incredibly dismissive and cold, and that sort of attitude certainly isn't helpful and can definitely be harmful.
Click to expand...

It's not usually the DOA that gets me. It's the DOA's loving family mourning in the room during the code.
 
Awaiter said:
First Death = Can't eat for the rest of the day
Second Death = Feel sad
Third Death = Don't feel much but feel weird that I don't feel much
Fourth Death = Don't feel much
Fifth Death = Don't even notice that I don't feel much
Sixth Death = Walk out of room and take another bite of my protein bar

Uncomfortable to say but true

Of course there always will be instances which touch you especially, but those are exceptions.
Click to expand...


This.
 
Tawantinsuyu said:
How does it feel when a patient dies, knowing there may have been something else you could have done to save them?
Click to expand...

Awaiter said:
First Death = Can't eat for the rest of the day
Second Death = Feel sad
Third Death = Don't feel much but feel weird that I don't feel much
Fourth Death = Don't feel much
Fifth Death = Don't even notice that I don't feel much
Sixth Death = Walk out of room and take another bite of my protein bar

Uncomfortable to say but true

Of course there always will be instances which touch you especially, but those are exceptions.
Click to expand...

I'm not a doc, but I have seen some hairy situations during my time as a paramedic. The above quotation has been true for me throughout my career. I barely remember most of the cardiac arrests or obviously dead patients I have cared for. However, it's going to take me a while to completely forget the dead one-month old I recently had, and every once in a while, I still think about three teenagers who died a couple of years ago while hill-hopping.

It is human to feel emotion. I would argue it is important for healthcare providers to "feel something" when dealing with death, but it is equally important to keep these emotions from clouding your ability to make sound clinical decisions.
 
The biggest mistake I have made is to let myself imagine a patient as my wife. I had a lady over the summer when I was on trauma...34 y/o female out running WITH her husband and 2 young children when some gomer who had no business still driving nails her with his car. Ends up tubed in the unit with the most ridiculous looking CT I have ever seen, not even recognizable as a brain. Brain dead. Kept her optimized for gift of life....the next AM i go into the room and her kids had drawn her all these pictures with crayons "mommy we cant wait until you wake up we want to play with you." FML And I let myself pretend that was my wife for a second. I ****ing cried for a minute in the bathroom after that, grown man here.
So if some premed is going to claim they will never form any sort of emotional connection to a patient they are full of $hit.
 
I think it really depends

The first patient that died under my care did so under the best circumstances and was a relief for everyone involved. He went peacefully in good company and I was glad to have been a part of it
 
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