When a person we know dies, even if it’s just an acquaintance, there are a flood of emotions we may have – surprise or shock, sadness, disappointment, sometimes even anger.
Our reactions may depend on who that person was, what type of relationship we had with them, the circumstances under which they died, and the impact their death may have on others (for example, family members).
When a patient dies, we do have feelings about them regardless of the events leading up to their demise:
A patient presents in an emergency and we were a part of the operative team but the patient “died on the table”.
Or a patient is admitted to the ward ill, and you think that they’re making progress but they “crash and code”.
Or we were providing outpatient care for a patient with an illness and they died, whether suddenly or expectedly.
I mentioned before that death is routine for us, but even so, we mourn in our own way, especially if there was a long term relationship with that patient or he/she was a favourite.
Mr. B.
I remember such a favourite patient. He was elderly and we first met when he was being treated for a complication of his diabetes. Mr. B. was upbeat and engaging and I looked forward to his follow-up appointments.
On one such visit it was discovered that he had kidney disease, which would imminently require dialysis. He was fine with the medication, dietary and lifestyle adjustments, but was not entertaining dialysis.
At all.
We continued to monitor his status, and each visit I got the same response. Then there came the day that I told him that if he didn’t start dialysis, he wouldn’t make it to the 120 year-old goal we had set when we first met 🙂
His wife was with him and she was visibly upset, but held her composure and remained silent. I begged relentlessly and he eventually agreed to be evaluated by a Nephrologist.
He returned with his wife and was adamant that he *still* did not want dialysis, despite extensive counseling from the Nephrologist and pleas from his family.
I had to respect his decision, and so we managed any related illnesses as they arose.
Then one Friday his wife informed me that he was admitted to the ward for renal (kidney) complications. I went to the ward that evening after work for a status report.
I looked at him lying in the bed, frail and drowsy.
I said, “Hi Mr. B., do you know who I am?”
He looked right at me and with a weak voice replied, “No, but could you cover me up a little bit more please? I’m cold”.
Later I went to speak with his wife who was in the waiting area. I couldn’t look her in the eye, because I knew he was near death, and by all accounts was too unstable to dialyze even if his family had approved it on his behalf.
Without saying a word, I hugged her.
Her eyes welled up as she understood what that meant.
She called the next day to tell me that he had died, and after we hung up, I cried.
I was mad at him for refusing dialysis in the first place.
I was sad for his wife of over 50 years.
I was upset because I liked him as a patient.
And I mourned alone.
By the time I returned to the office on Monday, my MASK was on, so upon telling the staff that he had died, no one was the wiser as to how hurt I was.
I shed a tear or two at his funeral and smiled at the collection of photos in the program booklet.
Shortly after the one year anniversary of his death, Mrs. B. came for a visit (she had subsequently become my patient).
She said, “Doc, do you realize it’s been a year since Mr. B. passed?”
We then started a conversation about him, wherein she mentioned all the love and support she continued to receive from family, friends and her church. At one point I quipped, “Yeah Mrs. B., he was a hottie, I see why you married him.”
We both burst out laughing.
It’s a good moment… that point in time when you’re still healing but you’re able to reflect more on the great memories.
We Are Not Alone
I thought about the concepts of memories and support after one of my colleagues recently had to manage a patient with violent trauma. He was unable to be resuscitated despite her best efforts.
The man’s death created some media buzz, and while we rallied around to support our colleague, it occurred to me that no one from an administrative or professional standpoint likely asked her how she felt about the whole situation.
Do we die a little inside or become more indifferent to patient death, even if the manner of death is violent?
Does anyone ever ask us this??
Where is our emotional support???
We see, or hear of, or are present for the deaths of patients
EVERY. SINGLE. DAY.
We need to be able to process and to grieve without being judged.
For me, being able to “put pen to paper” today has been nothing short of cathartic!
I was also relieved to know my colleague enjoyed herself with family and friends this weekend.
We Need HELP!
As physicians, we all have our own ways of dealing with patient death.
Some of those methods are healthy, others, not so much.
As a result, we are at risk for physician PTSD.
Do I feel that more could and should be done to provide support and screening for physicians (and other health care workers) in coping with patient death?
Most definitely!!!
Sometimes we ask for that help early, sometimes we’re on the brink of collapse and someone recognizes it in time, sometimes we’re just not ready to talk about it.
Wherever we are in that spectrum, I believe that having the space and freedom to express our feelings helps to keep us mentally healthy, and empathetic, and by extension, human.
It is also important that when we are ready to address the feelings we have when a patient dies, the resources and upliftment needed on our journey to recovery, will be readily available.
One day, we will get there, uninhibited by the expectations and judgement dictated by the prefix “Dr.”.
***Text reformatted and image replaced on 18/3/21.
Recent Comments