Photo credit: By Vikiçizer at the wikipedia project [Public domain], via Wikimedia Commons
“It is a curious thing, the death of a loved one. We all know that our time in this world is limited, and that eventually all of us will end up underneath some sheet, never to wake up. And yet it is always a surprise when it happens to someone we know. It is like walking up the stairs to your bedroom in the dark, and thinking there is one more stair than there is. Your foot falls down, through the air, and there is a sickly moment of dark surprise as you try and readjust the way you thought of things.”
― Lemony Snicket, Horseradish: Bitter Truths You Can’t Avoid
OK, so I know that the last few posts I have written have been a heavy combination of either nostalgia or the difficult issues we face as residents. After this week I promise to lighten the mood. However, there are just times in residency that are emotionally and mentally taxing and there are a lot of lessons that come out of them. Death is a part of what we face in medicine every day. We have so many roles in death: preventing it, making it painless, guiding patients to come to grips with it, helping family members grieve it, supporting our colleagues as the medical team struggles with it. It always provokes emotion, however, never such strong emotion as when it is unexpected. As Lemony says, it forces you to readjust the way you thought of things…
There have been a few such instances I have been a part of recently and, as I have readjusted, I made some observations:
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Don’t leave the family when they need you most. Rarely in medicine is there such a fantastic show in terms of sheer number of personnel and amount of resources than a code. In its full scale at the university hospital, people line the halls. Everyone has their small job and there is 1-2 backup staff for each task. However, once efforts have ceased, the exodus is equally swift. All of a sudden, the room is quiet and clean. The natural reaction is to provide distance between you and the family (in part because you feel like you failed, in part because you feel they may want to grieve in private). However, it is the precise moment that the family needs you most. It can be uncomfortable, but just sitting there in silence is all that is needed (even out of the way in the corner). Those quiet moments show how much you cared for their family member and how much you care for them. They are your patients too.
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Debrief. People who participate in the care of the patient who unexpectedly passes come from varied backgrounds and levels of experience (attendings, fellows, residents, nurses, medical students, etc.). A group debrief should occur the same day of the event. This serves many purposes. From a scientific standpoint, it allows for an orderly review of the events leading up to the code as well as a review of the code itself. It should always include specifics of what was done well and what, if anything, could be done to prevent future events or to improve resuscitative efforts. From a team morale standpoint, it allows for group grieving and sharing of emotions. It also allows for identification of members who were particularly affected. As a team leader, it is important to make note of these people so that you can follow-up with them as they begin to fully process the event.
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Reflect. This comes after you have spent time with the family (both sitting in silence and answering questions) and following your team debrief. It is a delicate balance which must allow for you to both feel the emotions and not let them consume you to the point you can’t take care of your other patients, your loved ones, and yourself. Nevertheless, some amount of time in quiet reflection is invaluable. It allows you to take inventory on your life and remember what really is and what really isn’t important. It is also important to share these feelings with others. This could be your significant other, family members, friends, or colleagues. You may even choose to write about it.
With that, I will say, thank you for letting me share. In a way, you have participated in a stranger’s healing.
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