The porters needed to remove a body to the morgue, so we were late opening the doors for visiting time. When I walked past and saw the small crowd in the waiting area, I accidentally made eye contact with a relative whom I had spoken to before. She gave me that look that said: ‘Can we not come in yet?’
Accidental eye contact generally leaves me with an extra job to do, so I duly enquired, ‘Can’t they just remove the body by the other door?’ The health care attendant whose job it was to clear the route shrugged and said she didn’t know why they weren’t. A quick word with the porters and it was agreed the other door was as convenient a choice, so we let the relatives in.
Passing the discussion, a physio said: ‘Oh no, don’t bring her around that way, the student physio is there and has been upset this morning, that was her first patient.’
‘She’ll get used to it,’ I replied - the student physio wasn’t in earshot. ‘We can’t let the porters out through a waiting room of anxious relatives to avoid her seeing.’
And I moved on.
Later that day I bumped into a student nurse who had been at a prolonged cardiac arrest with me in resus earlier that week. The man had thrombolysis for a massive pulmonary embolus and more than an hour of on-and-off compressions.
Against the odds, he came around, opened his eyes and seemed entirely appropriate. A bedside echo however revealed an almost stationary right heart and in the end this and his pre-existing illnesses meant we could not keep him alive.
When we sedated him for transfer to critical care, the student nurse helped me by holding his hand and echoed me when I told him everything was ok, when I told him we would keep him safe.
I was pleased I’d bumped in to her, because I wanted to tell her how wonderful her manner was with that patient that day. I wanted her to know that she had been a help to me, by being there for him and she was going to make a great nurse. She seemed surprised at this feedback, but said thank you and added that patient had ‘got to her’, she said she’d ‘had a cry about it’.
I reassured her this was normal, but to myself I still thought ‘she’ll get used to it’ and I moved on.
That evening I was half watching television and half on my phone, scrolling absent-mindedly through a feed of news and clickbait on Facebook, when I was struck by a photo of dog being hurt.
It was a petition; ‘…sign this and make sure these people go to prison’, and it made me mad. Suddenly, angry that I had to see it and disproportionately despairing at the animal’s plight. I deleted the app from my phone.
When I lay in bed, I still couldn’t shake it off. I felt like I’d been ambushed and in that moment, some sort of floodgate of despair had opened.
Really, it wasn’t like me to cry over a photo of a dog… and I guess maybe I wasn’t simply upset about that dog.
Maybe the truth was we just don’t ‘get used to it’ at all.
By the Secret Doctor
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Beautifully written. Inspiring author for an aspiring doctor :)
Over the years I've become more emotionally vulnerable outside of work, whilst maintaining a mask of being disaffected by death. I realise it might be a cumulative effect of grief built-up over time. I've only ever cried at work following a patient death once: a little 2 mth-old baby. But now I cry at movies and stuff when previously I didn't. It's strange dealing with mixed up emotions from being exposed to awful situations...
We never get used to death but too much personal distress leads to coping strategies and this is where some physios, docotrs and nurses appear hard - it is just a protective shell!
I was taught in my nursing training that the day we get used to a death and don't get even slightly upset is the day we need to quit. It never gets easier, but you learn coping mechanisms so it doesn't effect your day to day life. But I often come home and think about that person's life and their family/friends. We cannot save everyone, but knowing we did the best we could for them helps you pick yourself up ready for the next person who needs us.
Never get used to it painful though it may be ! Better tears than a shoulder shrug. Rtd paediatrician
Interesting that this is in the same Email as a "Saving Surgeons " survey. Death is part of life and, as accute health workers, we see more than most. I always use the analogy of a graveyard, around which I sometimes wander. Each marker labled with who, no names, I am no good at knowing names, just details, girl killed in car crash the previous night, her friend who arrested as we put her into an ambulance to go to the neurosurgery unit; each one marked if only I had known more at the time, if only I had done this rather than that, or been able to get someone to do the other but, fortunately, most were just that I was there, sometimes able to comfort berieved sometimes just a passerby.
I wonder if burnout is just when the graveyard has no more room.
For me , as a GP, it is often the journey towards death that causes sadness - from diagnosis to life's end that can be difficult. Supporting a patient and their family often takes a culmulative toll
This can often go unnoticed in the frantic working day
No wonder we have high rates of depression,anxiety and burnout.
Do you not think that we expect too much of ourselves in the health profession? We can't save everyone. We can certainly try, but disease and age defeat us many times and we should allow for this? not blame ourselves for failing? give ourselves credit for trying? and give ourselves credit for caring? We keep going by trying to do the best we can for each patient, and need to keep trying, keep caring, and accept that at times we will lose patients, but if we have cared for them and about their health outcome we have been a positive part of their journey from birth to death. If 'get used to it' means caring less, it's not a good option. It's okay that patient pain hurts us too, so long as we learn from that pain, from their experience and our own and do at least as well or better in our care of our next patient.
I delivered a footling breach in a bath, there was no backup. He came out flat with no respiratory effort. My backup arrived and I bagged him all the way in. I handed his little body over in Resus and burst into tears. I've never ever cried during a job before. I thought I was used to it but I guess I'm not and that makes me glad. A little aside he did live and was out of special care 2 days later. We deal with things that others don't and somewhere inside they mount up.