“life is for the living, death is for the dead. Let life be like music and death a note unsaid”- Langston Hughes
In my I have experience death, I mean there are not many people who hasn’t experience death. My first patient that had passed away was only in my final year.
A 26 year male from the Congo. He had been admitted to the ICU for a community acquired pneumonia. He had already been there for more than a month, having many setbacks. From being septic, having acineobactor, a lung collapse. It was touch and go for awhile, many times we thought would be his last. Eventually he was improving enough to be moved over to the high care. It was after lunch, my last patient of the day. While treating him, he needed suctioning and there was an issue with the suctioning. I called a nurse over to assist me, and at this time the patient stats started to drop. The nurse says “ why did you call me this late, your patient is basically dying” I had no words, not because of the patient, because I knew that after suctioning he would be better and his stats would improve. I was shocked at what the nurse had said. The next day, my clinician told me that the patient had died. The first that popped into my head was, what the nurse had said. I got a lump in my throat and I could feel my eyes wanted to start watering. I composed myself, I had to be professional and not let this effect my day and treatment with other patients. It was at the back of my mine all day. Of course the thought crossed my mind. “ was it my fault” I was emotional all day but covering it up.
I think that I didn’t know how to deal with this patient dying, I spoke to my clinician and told her that I was feeling really traumatized after hearing about the death and having the incident with the nurse. She just brushed it off and just said it was not my fault.The literature suggests it is important that clinical educators recognise a student’s response to patient death and that an environment is created that legitimises emotional reactions and enables discussion thereby facilitating an ability to cope.(Powell and Toms,2014)
Speaking to a classmate we discussed that we were never knew how to handle some stressful situation. If we had some class on a way to manage a death of a patient. The best place to learn would of course be in the clinical placement, but just to have a background on knowing how to handle it or even if clinicians could give some extra support when knowing a student patient had died.. Without this the values and skills that are necessary for providing quality end-of-life care may struggle to develop, as well as the culture of openness and transparency that is essential so that students no longer feel they have to hide their emotional distress.( Powell and Toms, 2014)
After dealing with this patient death, I would handle the situation better. Speak to someone about how I’m feeling and how it effected me. Not bottle I’m my emotions as I did with this patient. Definitely a learning opportunity that you never expect but really need to have.
Powell ,S And Toms, J.(2014) Passing away: An exploratory study into physiotherapy students experience of patient death whilst on clinician placement.D.Clouder, J. Thistlewaite and V. Cross, The Higher Education Academy.
3 thoughts on “Meaningful life and death”
Hi Courtney
I like your opening statement. It immediately grasps the reader’s interest and prepares us for what your piece is about which is very effective. Well done on this.
I also enjoyed reading your piece throughout as I felt like I could relate to a lot of what you were saying. I too had a patient who was very ill, she was 66 years old with multiple strokes, was partially blind, hypertensive, diabetic, etc. Her baseline of function was really low so a lot of the staff members did not think she would make it but I did all I could for her and eventually she exceeded over her baseline. The multidisciplinary team all agreed that she was ready to be discharged after the family received family training. The family came for the training but ended up fighting in front of her which upset her greatly and unfortunately she passed away the Monday morning. I was not even informed of this and walked into the room ready to talk to her when I realised I was talking to a lifeless body. These type of experiences happen every day but it can really be traumatic especially when your patient is doing great then the next minute they gone.
Just a few tips to help you out with your piece:
Make sure to proof read your written piece once or twice before submitting it as I picked up a few sentences that may need to be reconstructed. Eg. In your second paragraph you said, “In my I have experience death…” I was not too sure what you meant here, also you may like to add a bit more information to those two lines as compared to your overall piece it does not seem very relevant. Maybe add that this death of your patient as caused such an impact on your, hence you decided to write about it, etc.
Lastly, at the end of your piece you state very nicely that you have learnt not to bottle up your emotions which we all know is not a good thing. Maybe include how you think this could have effected your treatment of other patients and what got you to the point of informing your clinician. It might be nice to also add some literature on some techniques students could use to deal with this type of traumatic experience as I believe majority of students in health faculty would agree with you that this can be quite traumatic.
Dear Courtney,
I thoroughly enjoyed reading your piece, I think partly as I could relate to it. I experienced my first patient death in my very first block of third year, and then the major ones after that occurred in my first block (again) this year. Of course last year I had no clinical experience and it was difficult to handle the death of the patient as I had been treating her for almost 3 weeks and she was mostly stable during most of her hospital stay. I had also developed a relationship with her family and when she passed, although the block was done, they managed to contact me to let me know of her death. However, it wasn’t as direct as the next death I dealt with this year. This experience was colder. I was angered by the situation in actual fact. I went to treat a patient after lunch, whom I’d been seeing for 2 weeks. He was a paralegic who had developed septic bedsores on both gluteal regions and they could have been the size of my head! On this day I walked to his single room, passing the nurses station on the way where a doctor and student doctors were standing. The door of his room was pulled closed (which it often was) so I first read his folder outside to check his vitals for the day. I walked in and he was in his bed. Nothing seemed unusual about the picture. I greeted as I walked in and then did not get a response so I went up to his and greeted again, but no response once more. Then I shook him lightly on the shoulder – and still no reaction. I then began to panic. I checked for a radial pulse and got nothing but I was highly panicked at this point and I was unsure if I was feeling incorrectly due to the frenzy I was in. Then I checked for a pulse in his neck and there was none. I then literally sprinted to the nurses station to alert the doctor, to have her say “Oh the patient died just before you came”. One of the students smerked at me and said “awkward”, followed by a giggle. I was deeply unimpressed by this level of disrespect from the student as this was a patient’s life, and to laugh, take the situation lightly or joke about it was not at all appropriate! Also, clearly I was panicked about the situation and to lack empathy that much… Absolutely crippling! Needless to say I said my say. Could have been more professional about it, in retrospect, but I was just so upset by how they informed to let me know my patient had passed away when I walked past them and they clearly knew who I was and that I treated him. Duarte, Almeida & Popim, 2015 states undergraduate programs must offer opportunities so that technical and emotional competences can be enhanced, based on scientific, ethical and legal knowledge.
I reported to my clinician via the whatsapp group chat and she asked me if I was okay. She then asked to meet up with me on my way to my next patient. I tried my best to not but I cried a bit on my way out of the ward. She did her best to debrief me regarding the situation and she displayed empathy towards me. She could clearly see how much the whole situation upset me and that I was dissatisfied with the demeanor of the student doctors and their senior’s inability to let her know that that response was out of line.
I thought about the situation for the rest of the day. This is when I read up more about dealing with patient death and started to read alot about similar experiences faced by others (also students) in the health profession. There is some useful published literature worth reading such as ….
Your experience was also a difficult one and I think the nurse could handled that better. She did not have to make you feel as though you were responsible for it because his death was not your fault. There was definitely a level of insensitivity from her part and also, knowing that you were a student, she should have known that saying this was just going to cause you anxiety and guilt.
I know that medical students have a course on how to handle patient death and how to deliver bad news to patients and their families. Our education is less informal with regards to death. If I recall correctly we’ve discussed it briefly in clinical practice prep theory classes as well as in one ICU theory class. I do agree with you when you say that we should be given a formal lecture or education on how to deal with the death of a patient, irrespective of the fact that we may not deal with it frequently, as it can be emotionally taxing for most of us and we don’t know how to process it. Edo-Gual et al., 2014 states that there should be adequate training to help minimise the impact of death and preventing emotional fatigue. It is an article on the experiences and feelings of nursing students but the principle remains – we need to be suitably trained on how to deal with death.
There is also a website where you can find a few informative facts on what makes handling death a bit easier and I think you should give this a quick read – it’s an article by Katie Imbrock (check the reference list).
Death is an inevitable part of life and we know this. But dealing with the death of patients is something new to us, and although it may become somewhat easier with time, we still need to take responsibility to deal with and protect our own emotional and professional well-beings.
References:
Duarte, A., Almeida, D., & Popim, R. (2018). Death within the medical undergraduate routine: students’ views. Retrieved from http://www.scielo.br/scielo.php?pid=S1414-32832015000401207&script=sci_arttext&tlng=en
Edo-Gual, M., Tomás-Sábado, J., Bardallo-Porras, D., & Monforte-Royo, C. (2014). The impact of death and dying on nursing students: an explanatory model. Journal Of Clinical Nursing, 23(23-24), 3501-3512. doi: 10.1111/jocn.12602
Imbrock, K. (2018). A Few Practical Thoughts for Dealing with Death in Medicine. Retrieved from https://www-studentdoctor-net.cdn.ampproject.org/v/s/www.studentdoctor.net/2018/02/20/dealing-with-death-in-medicine
* a proper link for the tips:
https://www-studentdoctor-net.cdn.ampproject.org/v/s/www.studentdoctor.net/2018/02/20/dealing-with-death-in-medicine/amp/?amp_js_v=a2&_gsa=1&usqp=mq331AQCCAE%3D#referrer=https%3A%2F%2Fwww.google.com&_tf=From%20%251%24s&share=https%3A%2F%2Fwww.studentdoctor.net%2F2018%2F02%2F20%2Fdealing-with-death-in-medicine%2F