The only certainty in life is that eventually we will all die. We do not know how or when that moment will be.  However, as a Christian, I believe in the afterlife and that gives me a great sense of comfort in the face of death.  In the Bible, God tells us in Job 14:5 “You [God] have decided the length of our lives. You know how many months we will live, and we are not given a minute longer.”

I spent my first clinical block of 2019 in the neurosurgical ICU at Tygerberg Hospital. During that time, I treated a fair amount of patients who suffered brain injuries and who subsequently passed away. In the ICU, I never interacted with the family or friends of those patients. Their deaths didn’t really affect me much. I almost felt like I lacked clinical empathy towards their deaths because I was not dejected.

A few weeks later I started my paediatric block at the Red Cross War Memorial Hospital. During my second week working there, I received a young girl as a patient. She had undergone brain surgery a few days earlier to remove a brain tumour. Her mother and father were sitting with her and they were very excited about their child getting better and mobilising out of bed. Upon checking in on my patients the next Monday morning, the staff informed me that the patient regressed over the weekend and that she was back in the ICU. I went there to find out what was going on and upon arrival the doctors made it clear that her prognosis was not good. She passed away two days later. Her parents were there as well and for the first time in my life I saw the reality and pain of parents who had lost a child.

The death of this young girl in some way really affected me. I thought that I was strong and that I could just somehow brush it off and move on with my life. However, it just was not as easy as that. Everywhere I went, the family was in my thoughts. I would think about the patient and about her parents and how they are suffering. I realised I was actually feeling really sorry for them and the loss that they had suffered. It was real clinical empathy that I was feeling towards them.

During my time at the ICU at Tygerberg Hospital, I suspect I was simply being a “neutrally empathetic” physician who only needed to do what had to be done without feeling grief, regret, or other difficult emotions (Helpern, 2003). Possibly, this was because I knew that these patients were in the ICU and often in palliative care. There was always a good chance of them passing away. However, this changed at the Red Cross Children’s Hospital. As a student physiotherapist at Red Cross Children’s Hospital, students are not emotionally prepared to work with a child who might pass away, and that is perhaps why it had such an emotional impact on me. According to Helpern (2003), clinicians recognise that it is not always possible to overcome all emotions. Clinicians will in general try to view the patient’s emotions objectively – and in this case the parents’ emotions as well.

Research conducted by Clouder, (2014), indicated that students may develop emotional distress during such traumatic experiences that could lead to long-term detrimental effects, both personally and professionally. These students can also develop conditions such as post-traumatic stress disorder (PTSD), burnout, reduced clinical effectiveness and professional compassion fatigue. Such distress may also limit emotional engagement and thereby contribute to a lack of support and compassion for the dying patient and/or their family in the future.

Healthcare workers becomes “desensitised” to patient death after working for an extended period of time within the hospital setting. There are healthcare workers who are able to “turn-of” or establish a professional distance to death (Williams, 2013). However, students do not have that experience yet and have to look at other coping strategies. Therefore, it is important that clinical coordinators recognise a student’s response to a patient’s death and that an environment is created that legitimise emotional reactions and enables discussions. This will help to facilitate the ability for students to cope. Students mostly use discussion with their peers who has had similar experiences to talk to. This gives students reassurance and confidence in what they are doing (Williams, 2013).

Therefore, I believe it is important that students get encouraged to talk to family, friends, other students and university staff after experiencing a traumatic event like death. This is especially important during university years throughout clinical blocks as students are developing into who they are and who they will become in their workplace. Mental health is something society often downplays and therefore I think it is an important issue to confront before it affects us as young physiotherapists.

Halpern, J. (2003). What is Clinical Empathy?. Journal of General Internal Medicine, 18(8),670-674. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1494899/

Powell, S. & Toms, J. (2014). Passing Away: An Exploratory Study into Physiotherapy Students’ Experiences of Patient Death whilst on Clinical Placement. International Journal of Practice-based Learning in Health and Social Care. 2 (1): 108-121. doi:10.11120/pblh.2014.00026. Retrieved from: https://www.researchgate.net/publication/275380456_Passing_Away_An_Exploratory_Study_into_Physiotherapy_Students’_Experiences_of_Patient_Death_whilst_on_Clinical_Placement 

Williams, A. (2013) The strategies used to deal with emotion work in student paramedic practice. Nurse Education in Practice 13 (3), 207 – 212. doi:10.1016/j.nepr.2012.09.010. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/23083896