When is a right time to move on after your patient dies?
How often do we get a chance to debrief and mourn for our past patients? Should we be given that time?
As an intern, I spend time in the ICU in 2-week increments for a total of about 5 months. During my non-ICU rotations, I often find myself thinking of my patients in the ICU, those who are still there and those who have passed during my time or shortly thereafter. These thoughts don’t arise until I sign-out to the next team, or “pass the baton,” because while I’m in it, I simply don’t have the time. When I am sitting in the ICU unit reviewing patients’ charts, vitals, orders, I am interrupted every few minutes by nurses, respiratory therapists, co-residents, case management, palliative care team, consultants, beeping noises from pages, new test results, I could go on. These hundreds of “distractions” keep me occupied and there is simply not enough time for me to process what is going on around me. And because of this chaos, my actual time with patients, who are mostly unable to see or talk to me because they are hooked up to all sorts of machines, is minimal.
Many of the patients who I take care of, I’ve never talked to them before. I’ve never seen them when they were healthy and smiling. The only time I get a glimpse of their livelihood is when I talk to their family members. They tell me what their grandma used to cook for them. They tell me how they looked up to their grandpa as a father figure because their father wasn’t around. They ask me how I would feel if I cannot see or touch my mom when she is sick alone in an isolated room in a hospital where no one knows who she really is. They tell me their dad is a fighter and that he would want us to do everything to keep him alive.
That’s when I see myself in the shoes of the family members. That’s when it becomes personal. It reminds me why I’m here and why I need to do everything I can to help my patients and their family.
But despite my best effort, some of my patients pass away.
Was it inevitable? Was it fate? Did I do something wrong? What happened?
More often than not, this initial gut response is the only “mourning” I have time for before I have to move on. I have to move onto the next patient. There is another admit waiting for me to see. I need to write my notes and make sure everyone else is doing okay. How’s my covid patient’s blood pressure? Is he peeing? Does he need dialysis? When is he scheduled to be proned? How about my encephalopathic patient? Is her mental status any better? How long has she been off of sedation? Can we extubate her? Oh, there is a code blue. Is he gonna make it? Who’s contacting the family members?
Maybe I’m feeling this way because I’m just an intern. Maybe it’ll get better as I become more and more familiar with the management and the pace of the work. Maybe…
But what if, along with experience, I get more and more numb to the morbidity and mortality of patients? Do these experienced intensivists take the time to debrief on a regular basis? Do they still feel a rush of sadness when they lose a patient?
hayoungyoun 