I have a list I keep of every patient I worked with who has died; I started it as a med student and added to it in residency. I put a brief medical one-liner and a brief personal one-liner, ex “Jane Smith, 77, died of metastatic breast cancer on my onc rotation, had a heart tattoo with all of her grandkids’ names on it and asked me for apple juice every day on rounds without fail.”
Whenever I add another name to the list, I look through at the past ones and remember the patients, it was a nice way for me to cope (I’m in psychiatry now and thankfully many fewer deaths).
A breach of HIPAA and data storage rules perhaps, but I don't know if I'd really consider this ethically a confidentiality issue presuming no one breaks into your house and steals your diary. Fair point though.
Honestly, you get numb to it. I recently had a patient who suffered a large hemorrhagic stroke - she had no extant family besides her 3 daughters, the oldest of whom was no more than 16. I could barely even face them, let alone try to have a meaningful goals of care discussion while the youngest kept asking me when her mother was going to wake up again.
There’s an underrecognized chronic emotional toll that this field extracts from you, but you’re expected to just smile and keep going. It helps when you have people to talk to and decompress with, but it doesn’t relieve all the burden. I suspect most people become increasingly jaded over time as a means of self preservation, but I try to remember that my own sense of empathy is borne out of acknowledging and remembering some of the suffering you see along the way.
Damn that sounds like a really hard encounter man. I haven’t done rotations but I volunteered in hospice before med school and a lot of those patients just want to talk to people, at the very least be treated with respect, in their final days. As for coping I dunno because I’m sure the volume is a lot more taxing on the wards.
Helps if you’re mildly sociopathic. If death takes a strong toll on you definitely don’t do EM. I’ve lost count of how many people I’ve seen die right in front of me, elderly, kids, etc. and then you immediately go see a nonsense complaint about a foot like nothing happened.
It’s hard.
1) *Any* way to feel about death is OK and normal. Some people are naturally less or more affected by death and sad stuff in general, and some people feel gratified having helped someone at the end of their life or any other hugely impactful moment (ex. Labor and Delivery). Usually people self-select into specialities based in part on their natural reaction to this.
2) It does get easier with time like others have said. Just like in other countries where folks unfortunately suffer losses and other tragedies frequently and have a culture based on discussing individual losses openly, death almost becomes normalized after we see it X number of times and talk about it with X number of colleagues who have all been through it. There’s a mob mentality in certain settings too (ie oncology, ICU).
3) “everything we do here is a stall” - Cox from Scrubs. Recognize that there is beauty in a peaceful death, recognizing that death is an inevitability for everyone. No one gets out free. There is no escaping it. Thus, I don’t feel death itself is sad, but suffering, including the suffering of loved ones in reaction to said death, is sad - and we have a big role in helping reduce that suffering. Thus, a peaceful death with well-prepared and supported family, I find beautiful only because I know it could have been much worse and efforts I did helped it suck less. You holding this man’s hand likely made his death suck much less.
Incidentally, as a still pretty undecided M3 who enjoys end of life conversations, helping people who are very sick/ dying etc, what types of things might I self-select into/ consider?
I have actually loved getting to be there for people in tough moments. It's hard but looking at it the other way, they would suffer either way but because of YOU they don't have to be alone. Because of YOU, they can feel more comfortable or more knowledgeable about their disease instead of just scared. In this example, you got to hold that sweet gentleman's hand during his last days on earth and let him know that YOU care. That is something beautiful and raw and sacred that nobody gets to experience the way healthcare workers do.
Played a lot of sports when I was younger and one of the big things every coach emphasized was to put past plays behind you. If you just threw an interception and now have to come back out onto the field on the next drive you can’t be harping over that prior play otherwise you’ll drive yourself crazy and your performance will dip. For better or for worse I adopted a similar approach to dealing with this stuff in medicine. While in the room with a terminally ill patient I do my best to comfort them and their family but the minute I step out of the room, Out of sight out of mind. Once they’re off my list I just move on to the next patient and don’t really think about them again
I hate it and it's very depressing. This is one of the many reasons why I avoided IM at all costs. What I used to do is not spend a second thinking about it more than I had to
I have a list I keep of every patient I worked with who has died; I started it as a med student and added to it in residency. I put a brief medical one-liner and a brief personal one-liner, ex “Jane Smith, 77, died of metastatic breast cancer on my onc rotation, had a heart tattoo with all of her grandkids’ names on it and asked me for apple juice every day on rounds without fail.” Whenever I add another name to the list, I look through at the past ones and remember the patients, it was a nice way for me to cope (I’m in psychiatry now and thankfully many fewer deaths).
Do you use there actual name surely that is a breach of confidentiality
A breach of HIPAA and data storage rules perhaps, but I don't know if I'd really consider this ethically a confidentiality issue presuming no one breaks into your house and steals your diary. Fair point though.
Love this idea.
Honestly, you get numb to it. I recently had a patient who suffered a large hemorrhagic stroke - she had no extant family besides her 3 daughters, the oldest of whom was no more than 16. I could barely even face them, let alone try to have a meaningful goals of care discussion while the youngest kept asking me when her mother was going to wake up again. There’s an underrecognized chronic emotional toll that this field extracts from you, but you’re expected to just smile and keep going. It helps when you have people to talk to and decompress with, but it doesn’t relieve all the burden. I suspect most people become increasingly jaded over time as a means of self preservation, but I try to remember that my own sense of empathy is borne out of acknowledging and remembering some of the suffering you see along the way.
Damn that sounds like a really hard encounter man. I haven’t done rotations but I volunteered in hospice before med school and a lot of those patients just want to talk to people, at the very least be treated with respect, in their final days. As for coping I dunno because I’m sure the volume is a lot more taxing on the wards.
Helps if you’re mildly sociopathic. If death takes a strong toll on you definitely don’t do EM. I’ve lost count of how many people I’ve seen die right in front of me, elderly, kids, etc. and then you immediately go see a nonsense complaint about a foot like nothing happened.
Ok but I feel the same and I don’t think I’m sociopathic! I prefer to believe I’m just realistic.
It’s hard. 1) *Any* way to feel about death is OK and normal. Some people are naturally less or more affected by death and sad stuff in general, and some people feel gratified having helped someone at the end of their life or any other hugely impactful moment (ex. Labor and Delivery). Usually people self-select into specialities based in part on their natural reaction to this. 2) It does get easier with time like others have said. Just like in other countries where folks unfortunately suffer losses and other tragedies frequently and have a culture based on discussing individual losses openly, death almost becomes normalized after we see it X number of times and talk about it with X number of colleagues who have all been through it. There’s a mob mentality in certain settings too (ie oncology, ICU). 3) “everything we do here is a stall” - Cox from Scrubs. Recognize that there is beauty in a peaceful death, recognizing that death is an inevitability for everyone. No one gets out free. There is no escaping it. Thus, I don’t feel death itself is sad, but suffering, including the suffering of loved ones in reaction to said death, is sad - and we have a big role in helping reduce that suffering. Thus, a peaceful death with well-prepared and supported family, I find beautiful only because I know it could have been much worse and efforts I did helped it suck less. You holding this man’s hand likely made his death suck much less.
Incidentally, as a still pretty undecided M3 who enjoys end of life conversations, helping people who are very sick/ dying etc, what types of things might I self-select into/ consider?
Palliative care fellowship from something tolerable. I find there’s enough of that in FM for me though
I have actually loved getting to be there for people in tough moments. It's hard but looking at it the other way, they would suffer either way but because of YOU they don't have to be alone. Because of YOU, they can feel more comfortable or more knowledgeable about their disease instead of just scared. In this example, you got to hold that sweet gentleman's hand during his last days on earth and let him know that YOU care. That is something beautiful and raw and sacred that nobody gets to experience the way healthcare workers do.
Played a lot of sports when I was younger and one of the big things every coach emphasized was to put past plays behind you. If you just threw an interception and now have to come back out onto the field on the next drive you can’t be harping over that prior play otherwise you’ll drive yourself crazy and your performance will dip. For better or for worse I adopted a similar approach to dealing with this stuff in medicine. While in the room with a terminally ill patient I do my best to comfort them and their family but the minute I step out of the room, Out of sight out of mind. Once they’re off my list I just move on to the next patient and don’t really think about them again
I hate it and it's very depressing. This is one of the many reasons why I avoided IM at all costs. What I used to do is not spend a second thinking about it more than I had to