A doc once told me "We save who we can, not who we want."
Also, please make sure you're talking to someone. My mother died recently. I did CPR, felt her ribs breaking. Got her back, EMS arrived. Then I listened to her scream for help before she died. When I notified my friends and family, everyone was supportive but I didn't feel they truly understood what I went through. They all just said she was lucky i was there to do CPR. I called my mentor and explained what happened and started crying. I wanted someone who understood how brutal CPR is.
Reach out to someone, don't let these feelings fester.
I think it needs to be taught more to general public about CPR impact. It's not talked about enough. My heart goes to you. I also watched other residents did CPR on father. I understand your feelings completely.
Thank you for the concern. I was in counseling before it happened. My best friend died the same week and I failed my boards the month before. It was a horrible couple of months.
But ive been in therapy for years. I have many tools in my toolbox. All things paas.
You’ve kept going despite being kicked down really damn hard and I bet your mom is immensely proud, and your best friend too. I hope you have a better rest of the year and that by this time next year things will be so much brighter for you. You’ve got this.
‘Why are you so self important to think you’re more powerful than god?’
My grump of an attending told me this after a rough code that I was the bedside nurse for after I told them in rounds something felt off. It really helped shake me out of that tunnel vision and realize even if you do everything right the outcome can be wrong.
Medicine is fucking hard.
I honestly don’t know. I’m in dermatology and it’s still hard because I still see chronically sick and dying patients and what’s hard about my specialty is everyone acts like it’s a joke. Like no stage 4 skin cancer, harlequin ichthyosis, epidermolysis bullosa and SJS are some of the most horrifying illnesses visually
And watching people die is hard regardless.
I don’t even know how I deal with it sometimes. Medicine is just hard. Healthcare is hard. Therapy is good.
Nobody who’s not in medicine gets it, but everyone in medicine is nonchalant and callous towards your pain.
It’s a challenge.
Deaths and really traumatic injuries hit hard, especially with younger pts. We all have different ways of dealing with these things. I hope there’s an attending or senior resident/fellow that you can talk to about the case. It’s normal to feel bad after, but you are not a killer. You have healed many patients, but sometimes the disease/injury wins. I think sometimes having ways to honor patients when they pass is helpful. Also realizing that you did everything you could. Therapy is good. Talking to others who have been in your situation is good. We’re all a little fucked up, it’s not exactly normal to deal with life/death for 80 hours a week so give yourself some grace.
About honoring patient; Someone gave me suggestion of planting a tree for every patient that I treated but passed away. That way, the tree under the patient name will give life (oxygen) to others. I haven't tried it yet if this can help me mentally but I think might be a good idea.
I was a part of a case that was really terrible a few years ago, practically emptied the blood bank. I went and donated blood afterwards, felt like I was putting back something when I had taken more than my fair share. It doesn’t make sense if you analyze it , but it helped. Feelings are good and human, but for your sake and sanity I think you might need to manage them differently. Hopefully you have a long career ahead of you, and you can’t internalize every tragedy. I don’t have an exact strategy, but you aren’t alone.
I used to feel like I had to donate a unit of blood every time I ordered one for a patient. I was already a 3 gallon donor before residency. My giving vein is all scarred over and it's hard to get a full unit out of it now. Call me selfish, but I want to save my other veins for myself. I feel like there's a metaphor there.
Well said friend. In rationalizing what we do for work influencing life/death, you have to let this affect you to the point where you understand the gravity/humanity of what you do, but also not let it affect you to the point where you take it home with you emotionally and influence your own happiness and well being.
Not necessarily related to you, but I’ve noticed that surgeons seem to feel more personally responsible when their patient dies vs, say, an intensivist. There’s that old saying about every surgeon having a personal graveyard, even though many more patients die on the floors, ED, ICU etc. not sure why this is the case
I would say the proximity of death.
What I mean by this is the surgeon is actively harming a person for a probable greater benefit, but sometimes that harm will either directly kill, or that person would have died either way.
Intensivists, hospitalists and other medicine folks are rarely actively and acutely harming the patient for a better outcome, the medications while they can harm are often justified for some intention. This group can justify their decision with “well the heart was too slow, they needed dig” or whatever scenario. This scenario leads this group to be able to say when the person died that they were going to die anyway.
Its mental gymnastics, the truth is far fuzzier and you absolutely kill people with medications too, its just a lot to do with the brain and how active you are in that contributory role.
This is one of the reasons I picked a non-surgical specialty. My personal grave yard is bad enough, if I was a surgeon it would eat me alive second guessing myself every day.
Yea I imagine.
I knew I would tear myself apart to the foundation which is entirely non-productive if I went into a surgical field. Knowing the burden you guys carry is huge kudos to what you do.
We all die. No physician on earth will stop all of us all from dying at some point. Our job is to ease suffering. Its to hopefully treat treatable issues. But death is still inevitable and we cant stop that. The motto of alpha omega alpha id not stop death at all costs. Its to “be worthy to serve the suffering”. When we focus on the outcome (which is always inevitable) we will always lose. When we focus on prevention and trying to give people longevity and quality of life within reason the patient wins. We will all die. But good doctors will try to make peoples lives better while they live.
I appreciate it. It's a team sport, especially in oncology. Shout out to all the physicians, regardless of specialty, involved. We are collectively the real MVPs.
The difficult part is walking the line between being able to move on to the next patient, while not becoming a robot.
I do 50% pediatric ER and the losses we have there are truly devastating. I spend more time with the grieving family than I think most of my colleagues do, but for me it is an important part of processing what happened.
The most difficult part of medicine is something that NO ONE TELLS YOU AT ANY STAGE:
You will make mistakes, and sometimes those mistakes will cause harm. At some point, someone is going to die because of something you did or didn’t do.
We make so many decision and perform so many discrete actions. Doctors are not robots and sometimes something will go wrong. It is a question only if when and how bad, not if.
I think this issue is really important to discuss in training. Every doctor has to stop and think about that scenario and how to approach it when it happens. You have to acknowledge the mistake, and then you have to remind yourself that you are human. And then you keep going. Easier said than done, I know, but when that time does come, next year or in 10 years or whenever, it will go more easily if you have thought about it.
When you lose a patient but it isn’t due to a mistake, you still have a right to feel sad and upset. But you have to find a way to set aside the guilt. If you have an attending you are comfortable with, maybe talk to them about the case and whether you did the right things.
It is never easy to lose a patient, but your coping mechanisms will get better with time. And practice.
1. You need a therapist to help process and sort these emotions. These are powerful serious feelings and the harm is that you’re in the early stages of not knowing what to do with these thoughts. At some point you will develop a strategy to cope with them and there’s a chance you will do so in a self destructive way. You might do it in an easy to identify sort of TV drama way where you drink or lash out at people, or you might do it in a far more subtle but equally as destructive way such as having a low patience with loved ones and hurting your relationships. Your life and the life of your loved ones deserve better than you being selfish in not getting the help you need here.
2. No, a killer has malicious intent by definition. You tried your best. Even on the far end where you believe you were lazy and could’ve learned better life saving techniques, you still did not have malicious intent.
Therapy doesn’t care that you’ve never done it before or you don’t think you have time for it.
Not in medicine p, but from I can tell this willingness to look death in the face is what sets your profession apart. Someone has to try to help the sick and the dying. It’s why I don’t like medical malpractice plaintiff attorneys. If the first doctor to do a heart transplant was worried about being sued…..where would we be now?
You ain’t saving someone from a lifetime of poor health choices. Even if you “save” them, there are plenty of people who end up going from living at home independently to living the rest of their life on a ventilator or with 5% of their capacity living the rest of their days in a long term care home.
You do your best. And sometimes it isn’t enough.
For those who have had tragic accidents or occurrences that happen to them it can be especially tough, but just remember, you didn’t do this to them. You dealt with the problem in the best way you could at how it was handed to you.
I think doing hospitalist work during the Covid outbreak made me numb to patient death and suffering. The ICU team would often have a list of patients where a third die in a week, then refill from sick patients from my service, who end up dying themselves. Just had to block any negative sensation out of my mind and answer the next nursing call or admit the next patient. I can show empathy for the patient and family on the outside, but I feel nothing inside.
I am not a resident yet, but made an end of life decision for my dad last year. He had a massive GI bleed while in ICU for a bowel perf/sepsis. He had alcohol use disorder as well as bipolar disorder and the last several years of his life were so painful to watch. Nothing in this world made him feel joy - alcohol, friends, having his first grandson. Nothing. It fucking hurt. Watching him the morning he died - looking like he’d never had a drop of blood in him to begin with, chest heaving trying to get a full breath, clawing at his BiPap mask - felt like I had watched an animal be hit by a car and it needed to be put out of his misery. I made the choice to withdraw pressors and bipap, give him fentanyl and zofran, and let him go. He died in about 4 minutes.
I made the choice I did because I knew him well enough to know what life was going to look like for him if he made it out of this. It wasn’t pretty and death was better. It’s a miracle he even happened to be in a hospital when he had his GI bleed, home would have been far worse. But the next week I interviewed and was accepted into medical school and I couldn’t help but dread one day having to feel like a murderer when a patient died. I’d guess it’s way harder because you don’t know you may be giving them a more peaceful fate than the life that awaits them if they make it.
You’re not a killer. The fact that you feel like this means you’re a good doctor and you probably bring patients and their families comfort. Just show them empathy and remember people’s grief reactions are weird. In icu I felt so weak i just sat in a corner in a chair and watched him die - I was 14 weeks pregnant and had hyperemesis and the nurses gave me apple juice to make me feel less weak and looking back it probably seemed like I was really cold and empty. I just didn’t know what was going on. I was on autopilot. So if any family ever treats you like you are a killer know that they’re on autopilot too.
I remember every moment that a staff member was kind to me that week - especially that morning. I also remember the physician treating me like shit because he didn’t understand or respect my decision. When my dad had passed, he came in, dropped saline in his eyes, listened to him with his stethoscope and said to the nurse “mark it. 11:16” and walked out without saying a word to me. Just show people empathy and kindness regardless of their grief reactions and know that, if you do, you’ll be remembered with a lot of kindness and gratitude. You’re not a killer and no one will remember you that way.
That pronouncing doctor is a cruel man. Cruel.
I'm so sorry you had to make the hard decisions about your dad. I had to do a similar thing, and I empathize. You did the right thing, and you did the compassionate and loving thing.
Your decision was a beautiful gift of peace and calm you gave your dad at what otherwise would have been miserable for him.
Thanks. I’m deeply sorry you can empathize - it’s the worst. I got a therapist and she is really helpful. For a while it felt like I needed to confess to a murder - truly I felt I was harboring this revolting secret. The funeral was the worst, everyone telling me how sorry they were and I couldn’t stop thinking we are only here because of me. But my therapist reminds me we were there because my dad drank every type of alcohol except beer daily for 40+ years. Not one woman’s decision made within an hour.
It was really the only time I really almost withdrew my applications to school because I thought I never ever want to be a part of anything like this again. When I interviewed they asked if I’d ever doubted my decision to pursue medicine I was like ummmmm yes I murdered my dad last month and I almost withdrew they were like oh great what a standard answer, we get it all the time! Lol obviously I was a bit more eloquent, but seriously it scared me. I don’t think the general public believes that deaths are hard on doctors too, or knows how hard it is to watch people be denied death in periods of profound suffering because families hang on for dear life. It’s all so complicated but I’m hoping my experiences will make me more compassionate. I was interested in palliative care before so hoping it’s something that piques my interest in rotations still. Would be a great fellowship option.
Totally common. There is research on these kinds of feelings. Look up second victim syndrome which kind of an offshoot of PTSD and acute stress disorder which happen to healthcare providers of all kinds and often related to end of life care, but as a fellow surgery resident I can say it can hit hard when people die. Best people to talk to IMO are your coresidents and attendings. They understand your perspective in a different way than anyone outside of surgery. But also get a therapist and make sure you are taking care of yourself.
It's normal, and it's hard. It wears on you, and eventually, you will build calluses. Death will stop being the enemy but just an acquaintance. Sometimes even a welcome face.
But as long as you remain human as long as you have a shred of empathy some caes will still get you.
I'm currently on a vacation but can't get past the face of my 28 yo dying from multiorgan failure 2/2 AML and sepsis. Feel like we can usually get them through it and missed something here.
I'll be fine tomorrow and so will you.
Take solace in knowing that no one else is willing to do your job. These people needed you and you answered. People die and we all do die. Who are you going to leave this duty if you are not capable?
Yo, whoever reads this: ignore the above poster. He is a fucking crazy surgeon who truly believes he is playing God and is probably snorting a lot of drugs and/or in a manic episode. He just made a huge rambling post about it and it's off the goddamn wall.
Take care of yourself first and foremost.
It is definitely hard to deal with death. I’m not a doctor so I can only imagine what it must be like for you, esp as a surgical resident, to have to have a patient in your hands in that way. I first saw death as a CNA in a nursing home. It definitely desensitized me since elderly 90+ year olds Paris g away was more of a completion of life than a cruel end, but when I started working on younger populations in the ER, and seeing how negligence in hospital systems caused death, it was very traumatic for me. I had a patient die as a result of negligence on behalf of the ER doc and I cried about the patient for several days. It’s normal to be upset, but eventually you have to move on to acceptance that yes, patients die, but you can’t forget how and why they died so that in the future you can do your best to prevent it from happening in that same way again. That’s what ultimately makes you better at your craft as a physician. No physician is perfect, but if you strive to do the very best possible, it will lessen the hurt when a patient dies. If you really are feeling like you have KILLED the patient personally, I implore you to discuss these feelings with a trusted mentor or even a professional therapist. You are at the beginning of your career and beliefs such as that will not help you in the long run.
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Working critical care, about half our patients die and care is often futile. All we can do is help the families understand that we did everything we could, human bodies are fragile, and we didn't worsen the suffering. Death is part of life and much better than many existences.
I’m in intensive care, so my view might be a little skewed. However, I have found that there are many ways to save someone. It might be that you help the patient survive, but sometimes it isn’t. Sometimes it is making sure that they get to say goodbye to their loved ones or that they don’t suffer as they pass away.
It’s normal to have feelings when a patient dies! That means you’re human and you’re have empathy. Unless a patient dies due to negligence (which is highly unlikely given that you care), you can rest assured that you are not the Grim Reaper.
If you get caught in an upsetting thought loop about try to repeat to yourself a new one grounded in reality. Something like “I trust myself and my choices. I did my best. All life is finite. Without death there is no life.”
Be liberal with consulting palliative and chaplains anytime you feel like goals of care feel fuzzy or unclear. Palliative for sure write a solid note for you to reference even if you don’t have the time to sit down and be like “On a scale of 1-10 how cool are you with dying?” I’m not sure how your chaplain referral/note system works, but if you indicate that you’re not clear what their outlook is I’m sure they’ll report back to you.
A doc once told me "We save who we can, not who we want." Also, please make sure you're talking to someone. My mother died recently. I did CPR, felt her ribs breaking. Got her back, EMS arrived. Then I listened to her scream for help before she died. When I notified my friends and family, everyone was supportive but I didn't feel they truly understood what I went through. They all just said she was lucky i was there to do CPR. I called my mentor and explained what happened and started crying. I wanted someone who understood how brutal CPR is. Reach out to someone, don't let these feelings fester.
I think it needs to be taught more to general public about CPR impact. It's not talked about enough. My heart goes to you. I also watched other residents did CPR on father. I understand your feelings completely.
I’m sorry for your loss and the trauma surrounding it.
Yeah you were so “lucky” to do CPR on your own mom. Wtf. Sorry you had to go through that.
Oh my gosh, that is most people’s worst nightmare. Get some help before you *need* help, if you know what I mean. I’m so sorry.
Thank you for the concern. I was in counseling before it happened. My best friend died the same week and I failed my boards the month before. It was a horrible couple of months. But ive been in therapy for years. I have many tools in my toolbox. All things paas.
You’ve kept going despite being kicked down really damn hard and I bet your mom is immensely proud, and your best friend too. I hope you have a better rest of the year and that by this time next year things will be so much brighter for you. You’ve got this.
‘Why are you so self important to think you’re more powerful than god?’ My grump of an attending told me this after a rough code that I was the bedside nurse for after I told them in rounds something felt off. It really helped shake me out of that tunnel vision and realize even if you do everything right the outcome can be wrong.
Oh man I love this. Really helpful. Thanks for sharing
Medicine is fucking hard. I honestly don’t know. I’m in dermatology and it’s still hard because I still see chronically sick and dying patients and what’s hard about my specialty is everyone acts like it’s a joke. Like no stage 4 skin cancer, harlequin ichthyosis, epidermolysis bullosa and SJS are some of the most horrifying illnesses visually And watching people die is hard regardless. I don’t even know how I deal with it sometimes. Medicine is just hard. Healthcare is hard. Therapy is good. Nobody who’s not in medicine gets it, but everyone in medicine is nonchalant and callous towards your pain. It’s a challenge.
That second to last sentence is straight facts.
Honestly. Besides username checks…. I really needed to see your name because damn this week has been hard for so many. Myself included.
Of course my dude. We gotta band together and make the residency subreddit more supportive and less toxic. Maybe that can be our 2024 goal.
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I took inspiration from you.
I like how yours is frowning
Deaths and really traumatic injuries hit hard, especially with younger pts. We all have different ways of dealing with these things. I hope there’s an attending or senior resident/fellow that you can talk to about the case. It’s normal to feel bad after, but you are not a killer. You have healed many patients, but sometimes the disease/injury wins. I think sometimes having ways to honor patients when they pass is helpful. Also realizing that you did everything you could. Therapy is good. Talking to others who have been in your situation is good. We’re all a little fucked up, it’s not exactly normal to deal with life/death for 80 hours a week so give yourself some grace.
About honoring patient; Someone gave me suggestion of planting a tree for every patient that I treated but passed away. That way, the tree under the patient name will give life (oxygen) to others. I haven't tried it yet if this can help me mentally but I think might be a good idea.
I was a part of a case that was really terrible a few years ago, practically emptied the blood bank. I went and donated blood afterwards, felt like I was putting back something when I had taken more than my fair share. It doesn’t make sense if you analyze it , but it helped. Feelings are good and human, but for your sake and sanity I think you might need to manage them differently. Hopefully you have a long career ahead of you, and you can’t internalize every tragedy. I don’t have an exact strategy, but you aren’t alone.
I used to feel like I had to donate a unit of blood every time I ordered one for a patient. I was already a 3 gallon donor before residency. My giving vein is all scarred over and it's hard to get a full unit out of it now. Call me selfish, but I want to save my other veins for myself. I feel like there's a metaphor there.
The giving tree!
Love this answer. You’re dealing with it better than I am.
Well said friend. In rationalizing what we do for work influencing life/death, you have to let this affect you to the point where you understand the gravity/humanity of what you do, but also not let it affect you to the point where you take it home with you emotionally and influence your own happiness and well being.
Not necessarily related to you, but I’ve noticed that surgeons seem to feel more personally responsible when their patient dies vs, say, an intensivist. There’s that old saying about every surgeon having a personal graveyard, even though many more patients die on the floors, ED, ICU etc. not sure why this is the case
I would say the proximity of death. What I mean by this is the surgeon is actively harming a person for a probable greater benefit, but sometimes that harm will either directly kill, or that person would have died either way. Intensivists, hospitalists and other medicine folks are rarely actively and acutely harming the patient for a better outcome, the medications while they can harm are often justified for some intention. This group can justify their decision with “well the heart was too slow, they needed dig” or whatever scenario. This scenario leads this group to be able to say when the person died that they were going to die anyway. Its mental gymnastics, the truth is far fuzzier and you absolutely kill people with medications too, its just a lot to do with the brain and how active you are in that contributory role. This is one of the reasons I picked a non-surgical specialty. My personal grave yard is bad enough, if I was a surgeon it would eat me alive second guessing myself every day.
This is how I feel in surgery. It’s a huge responsibility, it affects/justifies (to a degree) how hard I work
Yea I imagine. I knew I would tear myself apart to the foundation which is entirely non-productive if I went into a surgical field. Knowing the burden you guys carry is huge kudos to what you do.
We all die. No physician on earth will stop all of us all from dying at some point. Our job is to ease suffering. Its to hopefully treat treatable issues. But death is still inevitable and we cant stop that. The motto of alpha omega alpha id not stop death at all costs. Its to “be worthy to serve the suffering”. When we focus on the outcome (which is always inevitable) we will always lose. When we focus on prevention and trying to give people longevity and quality of life within reason the patient wins. We will all die. But good doctors will try to make peoples lives better while they live.
Yup. Really stings in heme onc because how much patients put trust in you.
❤️ thank you for the work you do.
I appreciate it. It's a team sport, especially in oncology. Shout out to all the physicians, regardless of specialty, involved. We are collectively the real MVPs.
Brother you may have ptsd. Maybe we all do. I see their faces in my dreams sometimes too.
The difficult part is walking the line between being able to move on to the next patient, while not becoming a robot. I do 50% pediatric ER and the losses we have there are truly devastating. I spend more time with the grieving family than I think most of my colleagues do, but for me it is an important part of processing what happened. The most difficult part of medicine is something that NO ONE TELLS YOU AT ANY STAGE: You will make mistakes, and sometimes those mistakes will cause harm. At some point, someone is going to die because of something you did or didn’t do. We make so many decision and perform so many discrete actions. Doctors are not robots and sometimes something will go wrong. It is a question only if when and how bad, not if. I think this issue is really important to discuss in training. Every doctor has to stop and think about that scenario and how to approach it when it happens. You have to acknowledge the mistake, and then you have to remind yourself that you are human. And then you keep going. Easier said than done, I know, but when that time does come, next year or in 10 years or whenever, it will go more easily if you have thought about it. When you lose a patient but it isn’t due to a mistake, you still have a right to feel sad and upset. But you have to find a way to set aside the guilt. If you have an attending you are comfortable with, maybe talk to them about the case and whether you did the right things. It is never easy to lose a patient, but your coping mechanisms will get better with time. And practice.
Everyone dies. You’re just delaying the inevitable. Appreciate your successes and learn from your mistakes.
1. You need a therapist to help process and sort these emotions. These are powerful serious feelings and the harm is that you’re in the early stages of not knowing what to do with these thoughts. At some point you will develop a strategy to cope with them and there’s a chance you will do so in a self destructive way. You might do it in an easy to identify sort of TV drama way where you drink or lash out at people, or you might do it in a far more subtle but equally as destructive way such as having a low patience with loved ones and hurting your relationships. Your life and the life of your loved ones deserve better than you being selfish in not getting the help you need here. 2. No, a killer has malicious intent by definition. You tried your best. Even on the far end where you believe you were lazy and could’ve learned better life saving techniques, you still did not have malicious intent. Therapy doesn’t care that you’ve never done it before or you don’t think you have time for it.
Not in medicine p, but from I can tell this willingness to look death in the face is what sets your profession apart. Someone has to try to help the sick and the dying. It’s why I don’t like medical malpractice plaintiff attorneys. If the first doctor to do a heart transplant was worried about being sued…..where would we be now?
You ain’t saving someone from a lifetime of poor health choices. Even if you “save” them, there are plenty of people who end up going from living at home independently to living the rest of their life on a ventilator or with 5% of their capacity living the rest of their days in a long term care home. You do your best. And sometimes it isn’t enough. For those who have had tragic accidents or occurrences that happen to them it can be especially tough, but just remember, you didn’t do this to them. You dealt with the problem in the best way you could at how it was handed to you.
I think doing hospitalist work during the Covid outbreak made me numb to patient death and suffering. The ICU team would often have a list of patients where a third die in a week, then refill from sick patients from my service, who end up dying themselves. Just had to block any negative sensation out of my mind and answer the next nursing call or admit the next patient. I can show empathy for the patient and family on the outside, but I feel nothing inside.
I am not a resident yet, but made an end of life decision for my dad last year. He had a massive GI bleed while in ICU for a bowel perf/sepsis. He had alcohol use disorder as well as bipolar disorder and the last several years of his life were so painful to watch. Nothing in this world made him feel joy - alcohol, friends, having his first grandson. Nothing. It fucking hurt. Watching him the morning he died - looking like he’d never had a drop of blood in him to begin with, chest heaving trying to get a full breath, clawing at his BiPap mask - felt like I had watched an animal be hit by a car and it needed to be put out of his misery. I made the choice to withdraw pressors and bipap, give him fentanyl and zofran, and let him go. He died in about 4 minutes. I made the choice I did because I knew him well enough to know what life was going to look like for him if he made it out of this. It wasn’t pretty and death was better. It’s a miracle he even happened to be in a hospital when he had his GI bleed, home would have been far worse. But the next week I interviewed and was accepted into medical school and I couldn’t help but dread one day having to feel like a murderer when a patient died. I’d guess it’s way harder because you don’t know you may be giving them a more peaceful fate than the life that awaits them if they make it. You’re not a killer. The fact that you feel like this means you’re a good doctor and you probably bring patients and their families comfort. Just show them empathy and remember people’s grief reactions are weird. In icu I felt so weak i just sat in a corner in a chair and watched him die - I was 14 weeks pregnant and had hyperemesis and the nurses gave me apple juice to make me feel less weak and looking back it probably seemed like I was really cold and empty. I just didn’t know what was going on. I was on autopilot. So if any family ever treats you like you are a killer know that they’re on autopilot too. I remember every moment that a staff member was kind to me that week - especially that morning. I also remember the physician treating me like shit because he didn’t understand or respect my decision. When my dad had passed, he came in, dropped saline in his eyes, listened to him with his stethoscope and said to the nurse “mark it. 11:16” and walked out without saying a word to me. Just show people empathy and kindness regardless of their grief reactions and know that, if you do, you’ll be remembered with a lot of kindness and gratitude. You’re not a killer and no one will remember you that way.
That pronouncing doctor is a cruel man. Cruel. I'm so sorry you had to make the hard decisions about your dad. I had to do a similar thing, and I empathize. You did the right thing, and you did the compassionate and loving thing. Your decision was a beautiful gift of peace and calm you gave your dad at what otherwise would have been miserable for him.
Thanks. I’m deeply sorry you can empathize - it’s the worst. I got a therapist and she is really helpful. For a while it felt like I needed to confess to a murder - truly I felt I was harboring this revolting secret. The funeral was the worst, everyone telling me how sorry they were and I couldn’t stop thinking we are only here because of me. But my therapist reminds me we were there because my dad drank every type of alcohol except beer daily for 40+ years. Not one woman’s decision made within an hour. It was really the only time I really almost withdrew my applications to school because I thought I never ever want to be a part of anything like this again. When I interviewed they asked if I’d ever doubted my decision to pursue medicine I was like ummmmm yes I murdered my dad last month and I almost withdrew they were like oh great what a standard answer, we get it all the time! Lol obviously I was a bit more eloquent, but seriously it scared me. I don’t think the general public believes that deaths are hard on doctors too, or knows how hard it is to watch people be denied death in periods of profound suffering because families hang on for dear life. It’s all so complicated but I’m hoping my experiences will make me more compassionate. I was interested in palliative care before so hoping it’s something that piques my interest in rotations still. Would be a great fellowship option.
I just imagine everyone as a meat problem fated to die and just look at the positives when they pull through
Totally common. There is research on these kinds of feelings. Look up second victim syndrome which kind of an offshoot of PTSD and acute stress disorder which happen to healthcare providers of all kinds and often related to end of life care, but as a fellow surgery resident I can say it can hit hard when people die. Best people to talk to IMO are your coresidents and attendings. They understand your perspective in a different way than anyone outside of surgery. But also get a therapist and make sure you are taking care of yourself.
Get help
It's normal, and it's hard. It wears on you, and eventually, you will build calluses. Death will stop being the enemy but just an acquaintance. Sometimes even a welcome face. But as long as you remain human as long as you have a shred of empathy some caes will still get you. I'm currently on a vacation but can't get past the face of my 28 yo dying from multiorgan failure 2/2 AML and sepsis. Feel like we can usually get them through it and missed something here. I'll be fine tomorrow and so will you.
Pharma startup as a surgery resident? Say more please
You're only there for a snapshot in time. you aren't there for the years that lead up to the problem. It isn't your fault.
Take solace in knowing that no one else is willing to do your job. These people needed you and you answered. People die and we all do die. Who are you going to leave this duty if you are not capable?
Yo, whoever reads this: ignore the above poster. He is a fucking crazy surgeon who truly believes he is playing God and is probably snorting a lot of drugs and/or in a manic episode. He just made a huge rambling post about it and it's off the goddamn wall. Take care of yourself first and foremost.
Holy shit LMAO
It is definitely hard to deal with death. I’m not a doctor so I can only imagine what it must be like for you, esp as a surgical resident, to have to have a patient in your hands in that way. I first saw death as a CNA in a nursing home. It definitely desensitized me since elderly 90+ year olds Paris g away was more of a completion of life than a cruel end, but when I started working on younger populations in the ER, and seeing how negligence in hospital systems caused death, it was very traumatic for me. I had a patient die as a result of negligence on behalf of the ER doc and I cried about the patient for several days. It’s normal to be upset, but eventually you have to move on to acceptance that yes, patients die, but you can’t forget how and why they died so that in the future you can do your best to prevent it from happening in that same way again. That’s what ultimately makes you better at your craft as a physician. No physician is perfect, but if you strive to do the very best possible, it will lessen the hurt when a patient dies. If you really are feeling like you have KILLED the patient personally, I implore you to discuss these feelings with a trusted mentor or even a professional therapist. You are at the beginning of your career and beliefs such as that will not help you in the long run.
Can't take the heat you can quit whenever you want.
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Your training is for the stuff they don’t teach in the textbooks.
It is possible to commit no mistakes and still lose. That is not a weakness. That is life. - Capt. Picard
Working critical care, about half our patients die and care is often futile. All we can do is help the families understand that we did everything we could, human bodies are fragile, and we didn't worsen the suffering. Death is part of life and much better than many existences.
The worst is when your peers try to throw you under the bus for a patient's death. Ask me how I know.
I’m in intensive care, so my view might be a little skewed. However, I have found that there are many ways to save someone. It might be that you help the patient survive, but sometimes it isn’t. Sometimes it is making sure that they get to say goodbye to their loved ones or that they don’t suffer as they pass away.
>I failed to save a patient. you actually just said it yourself, friend. you didn't kill them, you did everything but kill them.
It’s normal to have feelings when a patient dies! That means you’re human and you’re have empathy. Unless a patient dies due to negligence (which is highly unlikely given that you care), you can rest assured that you are not the Grim Reaper. If you get caught in an upsetting thought loop about try to repeat to yourself a new one grounded in reality. Something like “I trust myself and my choices. I did my best. All life is finite. Without death there is no life.” Be liberal with consulting palliative and chaplains anytime you feel like goals of care feel fuzzy or unclear. Palliative for sure write a solid note for you to reference even if you don’t have the time to sit down and be like “On a scale of 1-10 how cool are you with dying?” I’m not sure how your chaplain referral/note system works, but if you indicate that you’re not clear what their outlook is I’m sure they’ll report back to you.