This message from another physician sat in my Epic inbox. Feelings of disappointment and sadness surfaced as I prepared to start my overnight shift in the emergency department. The death of a child simplified to an Epic chat message felt eerily impersonal and distant.
Months prior to receiving this message, I had another traumatic patient experience in the same emergency department. I will never forget the feeling of my hands on the chest of a four-year-old as I performed compressions – up, down, up, down. I remember my breath, being more tired than I expected, my patient’s curly hair so voluminous and full like the life I imagined he lived before entering the hospital. I remember the unfairness of it all.
What I remember most is leaving that code and walking back into the ED and into my next patient’s room.
I apologized for the wait. I had just left a code, just left a traumatic experience, and I apologized for the wait.
There was a patient in front of me that needed me. There was no time to process what I had just seen and experienced. Compartmentalize. Move on. Distance yourself. The hospital isn’t the place to cry. Don’t be weak or unprofessional. Death is part of the job. Next.
“Don’t worry about it. I saw what happened on the news,” the grandmother of my current patient responded.
I remember being taken aback by her kindness, her recognition that something so horrific had happened, and how she allowed me space during her grandson’s visit to pause and reflect on the joys and hardships of being a pediatrician. The juxtaposition of coding a four-year-old and then walking into a room of a child the same age with a viral illness is not lost on me as a pediatric resident.
I often reflect on the conversations around trauma, tragedy, and CPR after the shock of NFL player Damar Hamlin’s resuscitation on the field. As a country, we collectively witnessed something so traumatic on national television that we as health care professionals experience frequently. I often reflect on the expectation that health care workers experiencing situations like Hamlin’s should show up the next day or the next hour for someone else.
I have been a member of PICU teams that have slow-coded patients for over 12 hours. I went to work the next day. I have lost multiple patients only days apart while on a 12-day stretch. The stretch continued–and so did I. Until I couldn’t, and the grief became too much to bear. As a resident physician, you are often the first doctor patients see in the morning, the one that regularly checks in with families and develops the inside jokes and connection that makes medicine worthwhile–until the end. The trauma of death and near-death experiences witnessed by health care workers daily can take a toll.
Medicine has the tendency to focus on the next, for better or worse. On to the next rotation, the next patient, the next loss, the next “win”; moving on to the next without time to process can be dangerous. Taking the time to grieve patient loss is crucial to providing quality patient care. Without addressing grief, health care workers are more likely to make medical errors, experience burnout, and lower job satisfaction.
Patient losses are never easy, nor should they be. I have used a few tips throughout residency to help cope with patient deaths.
1. Take time to be human. No one should be expected to deal with death and move on so easily. Yes, even us as doctors.
2. Attend debriefs. These are good opportunities to process a multitude of feelings – sadness, disappointment, and failure with your medical team. Oftentimes, you are not the only person feeling a certain way.
3. Grieve. You are not “only” the doctor; your patients are yours to grieve. Own your grief, as messy and uncomfortable as it may be.
4. Embrace connection. As physicians, we are active participants in helping families grieve, but we should also be active participants in managing and processing our emotions. Reach out to chief residents, colleagues, friends, and family to discuss difficult situations.
5. Prioritize mental health and coping mechanisms. Incorporate meditation, mindfulness, therapy, getting outdoors, exercise –whatever works for you. Do those things unapologetically.
6. Systemically, steps should be taken to incorporate formal education on grief and coping mechanisms throughout all levels of medical training, starting in medical school. The profound grief we experience as health care providers is not new or unexpected, so it is important to brainstorm and implement ways to improve physician wellness and foster the development of coping skills.
Patients are yours to grieve–fully, wholeheartedly, and without guilt or fear. Your patients will stay with you. I honor my lost patients by giving them space in my mind and heart.
Only then do I move on to the next.