Coping with Death & Suffering

Medicine is a privilege: people implicitly trust you, share things with you that they haven't told anyone. They come to you on the worst days of their life, and look to you for guidance and support and kindness.

I've come to learn that that privilege comes with a price.

For those of you who, like me, tend to feel things deeply, that privilege can weigh heavily.

We have a front-row seat to human suffering day in, day out. We witness, even participate in, so much suffering. I've told a mother that her son died. I've told a son that his mother died. I've resuscitated the young and the old, often knowing it's hopeless, willing that rhythm to turn from a flatline into something we could at least shock. I've told wives and husbands and daughters and parents and aunts and lifelong friends and lovers that their loved one was irrevocably changed or gone forever. I've listened to wails of despair that echoed across the emergency room.

I've said, "I'm so sorry for your loss" helplessly more times than I can count at this point, always feeling at a loss for other words of comfort.

But if you're reading this blog post, you don't need me to tell you about the human suffering in medicine. You’re here to learn how to cope, and I want to help. I’ve wanted to create a guide for how to deal with the seemingly insurmountable amount of sadness that surrounds us for a long time, because it's a topic I haven't seen frequently discussed.

We’ll take a look at a few techniques: some of them for “in the moment” and some of them for much, much later.

Key takeaways for the busy resident:

• learn how to give bad news so you can make the process better for you and the family
• humanize your patient so they’re not just another chart (stave off burnout)
• take a moment of silence to honor your patient
• walk away & collect yourself after a troubling code
• initiate a group debrief so that you can all learn and be better
• find an outlet (journaling, art, running — find something that works)

Let’s break each one down, one by one:

Be better at giving bad news

I wrote a separate blog post on how to deliver bad news, you can read it here (coming soon!). Telling a family that their loved one died is such an awful experience, but by making it a fraction of a percent better for the family, you can actually sleep easier knowing that you’ve helped.

Once giving bad news is easier, coping is actually easier.

So please be sure to give that a read.

Humanize your patient

For the purposes of today’s blog post, the key to coping with witnessing so much death in medicine is actually to humanize your patient. Allow them to materialize as a human being, with hopes and wants and wishes, so they’re not just another random chart you have to complete by the end of your shift. Perhaps surprisingly, allowing yourself to feel death as a loss of life has actually been shown to help stave off your own burnout.

For instance, one of my patients had collapsed at the airport on her way home. Her husband told me that they had just finished 3 weeks backpacking across Europe (they were 80) and we talked about how he'll always have that memory of their vacation together. The memory of her death (and life) is no longer as morbid as it might have been - I remember, more than anything, how grateful he was that they’d had that time.

Take a moment of silence

As code leader, this is your call. Each hospital has a different culture, and in some places it’s never done — but if you want to do it, you can. And you should.

Honor the person before you, the life they’ve lead, the memories they never get to have. It doesn't have to take long at all.

Don’t let eye rolls and/or someone pointing out how many patients are waiting in the waiting room deter you. Calmly say, “I’d like to take a moment of silence for our patient,” and I guarantee you that not a single person will walk away.

It’s truly the least we can do for the person who lost their life in our department.

Walk away

I call it “taking a lap.” I literally call the code, hold a moment of silence, and walk away. I pretend I need to be doing something important and walk with purpose, but what I really do is walk into a side hallway and take a few moments to collect myself.

Displaying emotion as a physician is absolutely okay and I’m not saying that you have to hide your tears, but sometimes I prefer to. By taking a lap I’m able to take a few deep breaths and return to work so that I can bring all of me into the next patient room.

Hold a team debrief

This is relatively a new thing, at least at my residency program. Some attendings did it, and as a new attending I haven’t had many particularly tough codes, I plan to do these in the future. Even though I’m not working with residents, it’s actually helpful and an important practice for your nursing/tech team as well.

A debrief is essentially an impromptu meeting where you gather everyone for a few minutes and ask the team what went well and what could have gone better.

They don’t have to be done immediately after the code. For instance, at my hospital, we would have an announcement: “Everyone involved in the care of the patient in Resus A, please report to the ambulance bay for a debrief in 15 minutes.”

This small delay gives everyone a chance to check in on their patients, do some time-sensitive tasks, and then head into the discussion with a clear mind (instead of thinking about all the overdue tasks).

Here are some tips on how to approach initiating a debrief in this excellent article by EMRA.

In terms of coping, debriefs are beneficial because part of the reason we struggle in medicine is that constant quiet worry in the back of our minds: “What should I have done differently? Would it have changed the outcome?”

Chances are, others in the debrief will feel the same way, and it’s a good opportunity to reassure each other that you truly did all you could. It’s also helpful for learning from our cases: we can become better doctors/nurses/techs when we learn from our mistakes and ultimately feel more secure in our care.

Find an outlet to your grief

Do not keep this all inside. Share your thoughts, allow yourself to feel. I have two major outlets:

1. I journal. I’ve always loved to write and nothing feels more cathartic than putting into words the depths of my emotions. I actually do this quite publicly, on Tumblr, partly because knowing that someone else feels my sadness makes it easier to bear, and partly because I started this page as a way to show you that medicine isn’t all prestige and glamour and stethoscopes. But you don’t have to do it publicly: take your Notes app on your phone or a Google Doc and just start writing.
2. I cry. I actually take (infrequent) chunks of time when I allow all the sadness from past weeks/months to wash over me, and I bring these especially troubling cases to the forefront of my mind and I just cry. I give into it all: the injustice, the helplessness, the fear, the horror.

Whatever you do: find an outlet. If you like art, paint. If you like running, pour your emotions into that track. If you have a supportive family who listens, talk to them. But find something, anything, that makes it easier for you to feel your emotions.

Show your emotion

This one is the hardest for me. I’ll never forget the first time I told a mom she lost her baby. She was from out of town, here for work, with no one to support her. 22 weeks. As the attending explained that we couldn’t find a heartbeat, I felt my eyes well up with tears - and then I felt guilt.

This wasn’t my grief. This wasn’t my heartbreak. What right did I have to cry?

But that’s not the case.

You’re allowed to feel.

I’m not saying that you should bawl your eyes out when delivering bad news. But letting a patient hear a quiver in your voice, or see the heartbreak in your eyes: it’s not harmful. It makes this interaction much more palatable. It makes you less robotic and gives them the space to feel their own emotions.

So no, you don’t have to be stone-faced. It’s reassuring for humans to know that their doctors care, and it’s easier for us because we don’t have to bottle up our emotions like we used to.

I have a running list in my head of patients who have died. I remember the cases where something went wrong. I strive to never forget the lessons I learned, even as I mourn their passing. I try to honor them by remembering the individual and strive to be a better doctor moving forward.

Because that’s all we can do.

We can’t change the past, but it’s easier to cope knowing that I can change the future.