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FMF_Doc
06-15-09, 22:10
While we all train to save lives sometimes you are going to lose a patient, so how do you deal with it?

Over the years I have witnessed many traumatic deaths and at first I doubted my skills and myself. Eventually I was able to get to a point where I realized I had done everything I could do and just accepted the fact that if you respond to enough emergencies someone will die.

Once I did that I think I became a better medic, I was able to focus on controlling the situation and providing treatment without the fear of them dying. I took on extra training and became an instructor teaching EMT-B/I, EVOC, BLS, ACLS, ATLS/BTLS, PHTLS, Combat Lifesaver all in the effort to make sure I had truly done everything I could possibly do.

I know medics that have committed suicide over the loss of a patient, I want to know how you deal with it or what your plan is when it happens?

lexmedic157
06-16-09, 00:23
Having seen plenty of people pass, it is an odd way the human body copes with such an event. People that have seen it many times tend to trivialize (almost sacrilegiously) the death, while those that have never seen such a thing are horrified.

I tend to observe the surrounding people in attendance. I cope with the situation very matter of fact, and get it done. At times, off to the side, I ask myself what's the point? Religiously, there really is nothing that we mere mortals can do to "bring someone back." Scientifically, sometimes the cards are stacked from co-morbidities, past medical history, trauma, etc.

I had a cardiac arrest save yesterday. It was very reassuring after months of "working it, then calling it." (see the movie, Bringing Out The Dead) I think after all the training, time you put into your credentials it is perfectly normal to beat yourself up a little when all seems futile. I mean we're supposed to bring people back from the brink.

Experience is the best way to understand the death of a patient. Like you said being around enough will make you see your fair share of death. Keeping on top of your training will let you know whether you did ALL you could, no matter the outcome. Anything short of that is a learning experience for the next time (cause there will be a next time).

For those providers that get scared and turned off at their ability I try and get them to take as little time as possible before getting them back into the saddle. I feel that I am a pretty harsh critic when it comes to patient care. I don't take ineptitude lightly, but for those new providers I tell them I hope they screw up their first code/traumatic death. I feel that it is a valuable experience and they will probably won't make the same mistakes again.

Review of what just transpired is important too. I feel that all involved need to be able to ask questions or make comments so they feel ALL was done for that patient. Not saying there needs to be an official debriefing, but don't leave anyone in the dark.

Thus said, once you've been able to manage your ability to deal with a patient's death, make sure the rest of the team is able to deal with it. Especially important when the death of the patient is a teammate or coworker. NO ONE is ever ready for that to happen, but all are going to look at you, the MEDIC, as to what to do.

mattj
06-16-09, 01:41
For what it's worth -- my dad has been a paramedic for 30+ years (he's eligible to retire, but hasn't yet). He's seen all sorts of grizzly shit in his days, I'm sure half of which we never heard about.

He copes by going fly fishing, alone. Apparently the river has what he needs.

FMF_Doc
06-16-09, 02:39
It's an area that even those of us that are or were professional rescuers aren't trained in, they gloss over coping with death and dying.

So for the ones that are taking first responder type classes should consider...........

Sometimes people die despite your best efforts and you have to learn to live with it, and for those that are preparing for SHTF or TEOTWAWKI situations it may well be a family member or a close friend.

I used to cope with copious amounts of alcohol, but obviously that was a poor choice, so I had to learn to just accept it and drive on.

Gutshot John
06-16-09, 08:20
While I've been fortunate to not have to deal with combat fatalities when I was with the FMF, there was a big difference in how I reacted when I treated the military and when I treated civilians. Most of my experience with patients dying were civilians and I would be far less upset then when I've seen my brother Marines, guys who I knew, would get badly hurt or be diagnosed with something horrible. It's a lot harder to be clinical when its guys you know. Kids are the only exception to this, I have a very hard time and so do many others when your patients are kids.

In general it's not a big deal for me. If you have to do your thing than by-and-large the person is having the worst day of their life and there was probably nothing I could have done to change the outcome. I don't think I ever doubted my skills, decisions or my training...no one else has either. I've done CPR dozens and dozens of times...I've never once seen it work. I do the best I can...and then I move on. I went inactive when I found myself hoping for certain patients (junkies, gangbangers) to die. There's a big difference treating civilians and military.

I have far more reaction when I pull out a save...sometimes the sweetest sound you've ever heard is a child screaming and crying. :cool:

lexmedic157
06-16-09, 12:20
I would have to agree there is a different mindset when you have to treat a loved one, teammate, or someone pretty close to you. Sometimes it is better to be able to suck it up and pass that person off to one of your colleagues who is able to treat with more impartiality (if you had another medic closeby). It is difficult to do, but I have seen providers either become too aggressive and cause more damage, or beat themselves up for years because of the outcome. It is next to impossible to be objective when it comes to someone you know well.

One thing I can say now is that the AHA is beginning to get their stuff straight. Having performed CPR countless times , I can actually see a positive result in their new algorithm. For years we had been very counter protective to the patient because we would either stare at a monitor more than keeping oxygen circulating, or pumping way too fast to be effective. Since 2005 I have had no fewer than 3 code saves out of hundreds, but before 2005 I had none.

Obviously there's really nothing to save in a patient that has been apneic for more than 7 minutes, and if someone codes in the field from massive blood loss there's really nothing to be done either (even though we try our damnedest). Our window for a possible save is very narrow, and unfortunately we miss more often then not.

And as I said before we train countless hours for that small window, only to miss, I can see how we could second guess our training, place blames, or give up the fight ourselves. And as said before the chapter on Patient Death is glossed over or even non-existant, it is up to us, the providers that have been there for a while, to be able to help the junior providers with this very subject.

In the end each person will deal with it in their own way, but I think it helps to let newer providers know that we all go through it, and we are there for their support.

FMF_Doc
06-16-09, 14:46
It is the worst feeling on earth to tell a friend that you can't save them and then watch them die. I've done it a couple of times in the last few years and it never gets easier.

lexmedic157
06-16-09, 14:55
It is the worst feeling on earth to tell a friend that you can't save them and then watch them die. I've done it a couple of times in the last few years and it never gets easier.

+1

(mine was telling a friend her daughter was going to die and we can't do anything about it)

ST911
06-16-09, 16:53
I've watched a number of folks bleed out, circle the drain in a declining medical emergency, and just unexpectedly pass for no externally apparent reason.

People die every day. It sucks. Humans are imperfect things, and can sometimes only be healed by the transcendence of the soul to the afterlife.

I cope by acceptance of that reality, the love of friends and colleagues, and the belief in a power greater than myself who has a greater plan, and is much smarter than I.

In the interim, I learn, train, and do, so that where I can effect change I'm able.

NinjaMedic
06-16-09, 23:18
I have only broken down once at work, typically I deal with it the way most of us do through humor and laughter, defusing at the station with friends, hunting fishing etc. Typically I deal with things just fine like most of us, although granted I do have a great support system. The only time I have truly broken down was on a structure fire where I pulled out a beautiful German Shepherd and couldn't revive it. To this day I don't know why but it hit me really hard. Is that weird? Does it make you a bad person if you brush it of when a person dies but you cant cope with the loss of an animal?

lexmedic157
06-16-09, 23:20
I have only broken down once at work, typically I deal with it the way most of us do through humor and laughter, defusing at the station with friends, hunting fishing etc. Typically I deal with things just fine like most of us, although granted I do have a great support system. The only time I have truly broken down was on a structure fire where I pulled out a beautiful German Shepherd and couldn't revive it. To this day I don't know why but it hit me really hard. Is that weird? Does it make you a bad person if you brush it of when a person dies but you cant cope with the loss of an animal?

Poor GSD, I think I would have done the same thing.

FMF_Doc
06-16-09, 23:35
TacMedic- no it doesn't make you bad, weird things just hit you sometimes.

I broke down on my last code that I worked, it just seemed so futile and I couldn't take it. I have done CPR hundreds of times over the last 20 years and was resigned to fact we were just practicing our skills. I've had 3 saves in 20 years.

lexmedic157
06-16-09, 23:39
Like I said before our window to save someone is soo small that we rarely actually get to see the fruits of our training. Many of the contributing factors to the small window is totally beyond our ability to correct (time it takes to activate 911, response time, etc).

citizensoldier16
06-17-09, 14:07
I wrote this some years back in college for an English essay. I think it pretty much sums it up. My number is higher now, unfortunately, but the idea is the same.


"21 and Counting"

The new EMT cadet asks me "How many people do you think you have saved?"
"I don't know, really. I can't rememer" I reply. And the conversation ends right then and there. But even though no spoken words remain, the thoughts in my head persist.

EMTs and Paramedics are probably the most numb people in the world. We deal with pain, agony, and sometimes Death itself on a daily basis. For the sake of professionalism we suppress all human emotion during critical calls for the sake of doing our damn best in the interest of patient care. Take for example the cardiac arrest call.

EMTs, Paramedics and firefighters rush into a strange house filled with strange people and begin treating the fallen patient without any though of how their actions might look to the bystanders. We are goal-oriented and proceed accordingly. We break ribs. We shove tubes down throats, poke needles into the skin, and run more tubes into the stomach. Drugs go in one after another...Epinepherine, Atropine, Sodium Bicarbonate. All of these empty little glass vials litter the floor around the operators. Family members are crying uncontrollably in the next room as a police officer tries his or her best to console them and keep them out of the Medics' way.

Certainly to the untrained bystander this must be a horrible scene. Not only has their loved one fallen dead in front of them, but it almost seems to them that the patient isn't human anymore. It must appear to the family that their father, mother, brother, sister, son, or daughter has become something other than a person...they have, in the blink of an eye and in a blip on the monitor, become something foreign. The EMTs and Paramedics press on, fighting a loosing battle with every passing second. We do our best to pull our patients back from the cold grasp of Death, but sometimes even our best efforts aren't enough.

Friends of mine in EMS have told me that, while working an arrest, they become machines...acting on instinct and training, all the while forgetting that this carbon-based life form in front of them is really a Human, just like the rest of us. I believe this holds true for most EMS personnel. But it is only afterward that we have time to recollect on the events that have taken place; only afterward do we have the mental capacity to ask the hard questions. Did I do everything right? Did I forget something? Was there something else I could have done? Were the drugs in date? Was I sure there wasn't a pulse? What if the monitor was wrong?

All of a sudden we find ourselves doubting. The human emotions take over as the adrenaline rush subsides and we realize that we've failed. We've fought the good fight and lost. We realize that a precious life has slipped away right in front of our eyes; right through our very fingers. We drive away in an empty ambulance in silence contemplating, each in his or her on way, what happened.

Something happens to you after you've seen Death. You're not the same afterward. Some people play the hardass...saying they don't mind, or choosing not to acknowledge it in front of their peers. But even those who play strong are affected inside. Believe me when I say "Death remains with the living."

During my career in EMS, which has spanned nearly 6 years, I have lost 21 patients. Thats the only number I keep track of, and I can see each of their faces; I remember each one. 21 human beings have lost their lives in front of me. For me, those 21 patients, those 21 faces that I covered with a white sheet as if waving a white flag to God are all that matters. "21" is the only number worth remembering...and sadly, that number will only grow with time.

But until then, EMTs and Paramedics like me will press on and run the bullshit calls at the nursing homes, the homeless shelters, and the residences of frequent-fliers and EMS abusers. We will continue to train, continue to practice our skills, and continue to maintain a state of readiness in hopes that the next truly critical patient that we fight for when they cannot fight for themselves will have a better chance to live out their life because we made a difference...because we were there.

Truckie
06-17-09, 23:14
This is my first real "hello" post... so, "howdy." Been a board lurker for a couple of years but, only recently joined. I didn't intend to post much. I'm shied by the experience this board possesses and opined that I'd not much to offer.

Lexmedic invited me to this thread. Possibly here I'm among peers. So, we'll see if, in fact, I've truly nothing to contribute.

A disclaimer to the military Lifesavers and Medics. I cannot fathom what you endure emotionally. I fully understand the brotherhood as the FD / PD have likewise on the civilian side of things. Being made to work on your Brothers adds another plateau to what we do… one I only have a small taste of. I can’t imagine having my Bros severely injured or dying in my hands. Such would be horror on top of tragedy. My hat is off and I stand humbly in your presence… which says a lot from me as I’m not one to stand humbly before many.

Getting my start in the FD during my mid teenage rearing, I’ve now been at this job for 32+ years. I’ve not seen and done “it all.” But I think, and others would likely agree, I’ve toiled more than my fair share. As I sit and reflect tonight, the experiences have been vast and varied. The cost to my psyche, soul and health are becoming evermore evident as I age away.

At one level or another, I can identify with everything said in this thread. I get it when Gutshot John differentiates between civilian and your own. Working on “your own” brings emotions into the equation and damages objectivity. Emotions are an avoided aspect of my approach. I have a distaste when they cannot be suppressed. The smearing of objectivity is detrimental to our work. The involvement of emotion and the loss of objectivity are the only two things I fear at this point. Both interfere in more ways than one… our jobs and our lives.

I’ve never been the one to go back to the House and mope. Even children never rocked me to the edge; I couldn’t let it happen. Such is “unprofessional, not macho” and the like… yeah, I’m old school. In reflection though, maybe that worries me more, that I’ve been detached, that I’ve been suppressed. As I age in the darkness, with only my wares and ‘me’ to contemplate, I, and only those like us, can reflect on the price we’ve paid.

Citizensoldier mentions working like a machine. That has always been my approach; I am a machine doing a job. With very few exceptions, I’ve always thought I may as well be stamping out fenders at GM… khachunk – khachunk, hour after hour, day in and day out. An attitude that I thought served me well. In retrospect and maturity, our job can’t be shucked at the time-clock. Without matter of how hard we try or how successful at it we think that we are… the images are burned forever, the smells remain in our skin and the haunts forever live within our sub consciousness.

Thank God for what we do, for firehouse humor, and for good partners… three gifts that have kept me on this side of sanity.
Keep safe Bros

Edit to answer the OP’s question (oops). We are thrust into a time, circumstance and place charged with doing our best under the worst conditions. When another dies, I didn’t put them there, I only tried to help. Death is God’s Will and not within my ability to alter. I don’t question it nor do I dare. The dead are just that; we cannot change it. Use every event as a learning tool and move on. This is how I cope.

I’ve one more fear not mentioned, that of making a decision, which results in the injury or death of my Brothers. I cannot let this hinder me as I recognize that indecision and inaction are much more dangerous and unproductive. I do fret my aggressiveness at times however, and worry if “what I will do” is something that I should not expect of my partners, thus needlessly endangering them. Yep, my prayer is that I'm never made to figure out how to cope with such... I may not prevail.

lexmedic157
06-17-09, 23:29
Go to see you on here Truck. I respect what you've seen and done wanted a little of your input.

I think that anyone that can endure a career (long or short term) of this business needs to be applauded. No one should ever see then things we do, and for much of nothing in compensation.

I hear everyday, "I couldn't do what you do." My usual response is to brush it off because I honestly don't know what to say. Most of the time I say, "Someone's got to do it." It is nice to see that there are others out there that go through the same wave of emotions, or not at all, that I do, and that I'm not weird.

I hope one thing we all can take away from this thread is exactly what Citizen says, to be able to refocus our attitude through all the BS calls to know what we actually train for. Again we do find ourselves on the front lines, maybe not like our brothers in the service, but the front lines of gang warfare, horrific motor vehicles crashes, and bizarre medical emergencies. We are expected to function and make that critical decision; something that we have done before, and will be called upon again when time is of the essence.

Truckie
06-18-09, 04:41
YO lexmedic,
I too applaud your efforts. You have evolved and achieved. I worry you now realize my warnings concerning the weight you bear up there. For the most part though, you’re running the bases like an All Star. Thank you… it ain’t much but, you know coming from me it’s not hollow. I’ve been where you’re going and the mountain can be crushing.

My previous post is unintentionally quite dark. Those reading my words who live it will understand, especially the old timers. This job robs you in immeasurable ways, and it gives back the same. The casualty to all trinkets of “self” likely cannot be gauged, nor can the rewards.

I wouldn’t trade what I’ve experienced for anything except the eternal life and happiness of my family. This job, its relationships, triumphs and heartaches, the blood, sweat and tears are aspects that only a few in this world will ever understand. Real soldiers, firemen and cops are likely the select group. I classify “real” as we all know there are folks in our jobs that shouldn’t be or whom will never get to a place offering the opportunity… but, even they may “get it” to a certain extent. And although there are millions of us worldwide, we’re still a minority. Anyone outside looking in will never truly know, even when it's their deepest desire to understand.

This job provides a good fight most of the time. I still love a good fight, especially when digging-in delivers a victory. But, satisfaction can be achieved even in a loss. We must remain positive thinkers… and at instances have a laugh or a time at another’s expense… it’s what we do and it’s an avenue that keeps us doing it.

When others say, “I couldn’t do what you do,” the best response is a smile and a “thank you.” Such will present an uncomfortable moment in humility. But, take their words of gratitude with grace. Because the reality is that most don’t possess the fortitude to do this job and you know that they don’t. And I respect that they know it. There are things in this world I cannot do… these are simple equations of being human. Thankfully for society and our fellow beings, we each possess talents. The trick is with the knowledge of what those gifts are and exploiting them… be that digging ditches, singing a song that makes others cry or piloting the space shuttle.

One overt trait I recognize the loss of over the years is my patience and compassion. Where years past I spread both with a boat oar, I now offer the like from a spoon. Those that merit receive it… the many that don’t, won’t. All continue to get my professionalism because that’s our honor and my stance. As for the rest, eh; earn it. I’m kind of sorry about this jaded view.

To place your life in a Brother's hands, to take his in yours... to risk your safety and very life on behalf of unknown others, for the sake of duty and a higher responsibility... well, this is a unique business to say the least. A calling that earns respect and awe. I want each of you here to know that you have both from me.

Truck

Barbara
06-18-09, 06:12
I'm new to the whole thing, and a basic, so not doing the tough stuff, and there is a whole lot I haven't seen, so its not equal, but I got the death out of the way my first time out and have had a couple since then but all elderly or sick people. No trauma yet.

I was actually surprised that it didn't bother me when the first guy went. I had expected it to, and nothing really. One minute he was talking, next he was gone. I was just doing CPR, and other people were working on him, but for me it was pretty mechanical and honestly, there just wasn't anything there.

It bothered me, to be honest, that it didn't bother me. I didn't expect to fall apart but wasn't expecting no reaction at all.

I think for me, the key is that I haven't had to work on someone suffering who then dies. For me, anyway, someone being in pain that I can't stop is more difficult than someone who dies. We'll see how I deal with it when I get there, I guess.

Cardiac Nurse
06-18-09, 08:50
For me, anyway, someone being in pain that I can't stop is more difficult than someone who dies.
That exactly explains my time in ICU... Cancer patients were some of the hardest because they fought so hard for so long undergoing lethal treatments to buy time...time that only God is in control of. So often we would give the max dose of meds and still have issues with pain control. Those times burned me out...the suicide attempts were pretty successful no matter what we did to save them. They were probably the most frustrating type of patient just because we were doing our best to save someone who wanted to die in the first place.

God and I have had a lot of conversations over the years...it has definitely helped me when things have become too dark to spend time with my husband and kiddos that has NOTHING to do with death and dying.

On the CPR side doing hospital codes I have seen a handful of saves that ultimately resulted in surviving to discharge...with good outcomes. Codes in the hospital setting can be just as frustrating because regardless of how hard you train only a certain number of patients will respond even with rapid intervention.
It helped that we were a close unit of nurses and we could vent to each other.

Barbara
06-19-09, 21:00
Not patients, but I find its been the same with my parents. My father died several years ago of sepsis following bypass surgery. His death itself, while hard for the family, was quick..roughly 4 hours from the time he felt bad until he slipped into a coma. The physical act of dying wasn't difficult for him and he was never aware that that was what was happening. He didn't know he was going to die and felt little pain.

My mother has stage 4 cancer. She's beat the odds by a couple of years now, but I know the inevitable outcome. I'm grateful for the time we have but dread the time when pain gets worse for her. I'd give up time with her if it meant she wouldn't hurt but its not a decision we get to make. I dread her dying, not just because she'll be gone but because of the struggle she will have, and wish she didn't know what was ahead.

In the meantime, I like hanging out with her. She's a tough old lady. :)

jnr4817
06-20-09, 00:41
Death is the one thing that will inevitably happen.

I have been an ED nurse since 2004. I have had patients die and observed many more.

The one thing I rely on to keep me going, is knowing that I did my very best and gave %100.

Every time you lose a pt, you take a little bit of that person with you. I try to learn from what just happened, so I can go on and help another pt in need.

Jason

gruntmedik
06-21-09, 22:01
I've been working on people for a bit over 19 years now, with the last 8 being a Flight Paramedic, and have managed to actually learn a thing or two along the way.

Everyone is different. We cope with death and dying in different ways, not all of them good. I learned, a long time ago, how to disassociate. The trick is learning how much to disassociate. Not enough, and you will have a very short career. Too much, and you have become a callous burnout just going through the motions. I still vividly remember the 1st time I did CPR, my 1st full arrest as a new medic, and my 1st pediatric full arrest. I still question myself when I have a pt die, but like many here, I realize that despite everything we do, people die. I use the experience to make me better--as a medic, and as a human.

docfubar
07-25-09, 20:48
When I was in the Navy as a Hospital Corpsman, the first PT I had die was an 18 y/o Marine who commited suicide over a girlfriend. He was coded on the ambulance twice in the ER and the last time in the ICU for 3 hours. That was hard but the people I worked with helped alot. The 2nd hard one was a DR went into the drink on a helo. The crew and the medevac was fine but the Doc got confused underwater and snapped c1-c2 after inflating his vest. He was my age and a shipmate. The hardest was my sonat 19 days old.

You do doubt yourself but as long as you know deep in your heart you did EVERYTHING you could and have a support group, other medics, DRs Nurses, Corpsman or Friends to help, you will be fine. Talking is sometimes the best medicine.

Robb Jensen
07-25-09, 21:10
While on the Fire Dept I served as a Firefighter and a EMT-B I did CPR on 6 different patients. Of those only 1 patient survived. It was hard to except at first as I thought I had failed, it took me quite some time to except that some things are out of my hands. CPR rarely works and it's nasty, you break ribs and the patients vomit.
Sadly the only damn patient that survived that I performed CPR on was OD'd on crack. Her heart stopped on me 4 times. Chest compressions and a few rescue breaths and she was back.
While serving I saw everything you can think of except for child birth, weird but true.

joker581
07-26-09, 15:11
I try very hard to stay detatched. I give the patient everything I have and walk away when care is transferred. I rarely follow up on a patient's condition unless it is to determine the effectiveness of something I did.

This approach doesn't always work, but it helps.

Barbara
07-26-09, 19:22
CPR rarely works and it's nasty, you break ribs and the patients vomit.


My very first day out during ER clinicals, I had to do CPR on a patient and the sternum wires from prior cardiac surgery worked their way out of his chest, through my glove, and into my hand. I felt something poking so figured I'd busted his rib, and kept going...I was so busy watching the monitor, and the doctor putting in the line that I didn't really think about it and figured it was normal until I saw the torn glove and me bleeding and him bleeding. Oh, Shit moment for sure.

Pt. didn't make it, unfortunately, but wasn't infected with anything icky.

thedog
07-26-09, 21:42
You move on. And pray, but you move on. And keep praying.

Thanks, Medics!

dog

Limey-
07-28-09, 02:19
Over the 24 years or so in the field I have seen lots of Death and dismemberment.
I have seen the best and the worst of mankind....death is often a grisly business.

Any reasonable man might believe that, if there is a God, he's a vicious psychopath.

As others have said you get your 'saves' and you do the best you can for the rest.
Detatchment to a greater or lessor extent will help to some extent until you see yet another young child with a bullet in the head. It not a job for the weak or the depressive.

BTW: (on a positive note) I have saved and helped save lots of folks over the years with CPR, Drugs and Electricity. It can be done well

thedog
07-28-09, 23:48
Well... between military duties of harming people and then civilian life of helping/saving I figure my score at -3, +5. So I am 2 up, for sure. And I didn't work any EMS, other than first responder. So I believe God let me catch up and pass the negative, to help me get on with life. I still have bad dreams, but not the horrible dreams of before.
The guy I lost a few weeks ago in my front yard? Well, I guess that's another lesson I am still learning. But remember, medics, you are always the good guys when you are doing it right. And most of you do, everyday you are alive. Thanks, all of you!

dOg

benthughes
08-04-09, 18:18
I think I can speak for most people in saying that I do everything I can to be the best medical provider I can be. I train and study regularly and teach alot to keep my skill up. If I have a patient who dies I realize that I gave them their best chance at survival. I always try to learn from a bad situation and try to be better for it.

Humor is the big way to diffuse bad situations. We respect the dead and will talk about a bad situation in a productive matter but can always find humor in a situation.

Arclight
09-23-09, 20:03
As with so many things, "it depends." When I can genuinely say to myself that we gave him/her the best possible chance to survive and it wasn't enough, it doesn't phase me. Fortunately, I have yet to lose a patient where I felt like we failed.

My first patient loss felt less like losing a patient than it did a reminder of mortality.

It was during my Emergency Department rotation in EMT training. 32 year old cop, in great physical shape. On duty one afternoon, felt "kind of lousy" and sat down in the parking lot. His partner drove him to the ED.

I spent about an hour with him while we did assessments. When he came in, he looked tired and a little agitated, but not bad. Over the course of the hour, he turned a sickly gray, then coded. We worked him for... oh, I don't even know how long. Over an hour. No luck.

He had a young wife and kid who had last seen daddy happy and healthy and leaving for work like any other morning.

That one stuck with me. Never did find out what went wrong.

Dirk Williams
09-28-09, 12:28
We don't get to pick when we arrive, and we don't get to pick when we leave. All you/we can do is our best based on our skills sets. It's all good.

Peace!.
Dirk

Barbara
10-03-09, 09:51
Dead patients, meh. Caring for my mom full time with hospice? Hard.

I never understood that you don't die all at once when you have cancer. She died slowly over the course of 4 days, with parts of her going each day.

At the very end, her brow furrowed, and she had two tears. That almost killed me.

Sparky5019
10-07-09, 19:20
I always found myself talking with my coworkers in the ICU about the good times that we had with those patients. I think you do, as someone already mentioned, take a little piece from each patient that you have die! I still remember all those who have died while I was taking care of them; some as withdrawal and some in codes.

I have to admit I have gotten the habit (from competitive shooting of course) of running the event back in my mind and figuring out what can be better next time to improve the outcome or at least the efficiency. I can't tell you how many codes that I have prevented that way.

I don't want to say that I got used to having patients die, but it is part of the job and I just found a way to deal with it even though there were a few that were very hard to get around.

I have to admit, I have seen less of that since I started Nurse Anesthesia school!

Sparky

snuffy19608
11-01-09, 19:57
I think it depends on the circumstances.....

In 10 years a a paramedic I've had many different thoughts and feelings, my first peds call was a double trauma code which I still remember every Christmas,the guy in the car crash years ago who was literally wrapped in car up to his neck and I had to watch slip away, the young construction worker hit on the head with 900 lbs of steel who was dead when we got there but I worked because he had a 2 week old baby at home,the many many codes at all hours,the shootings and stabbings and beatings, all of that makes you hard inside.

Sometimes I think it makes me a better provider, never getting upset when everything goes to hell. Other times I hate it, wondering how many people need just a little empathy to make it through and I've missed it.

I thought I got away from most of that when I became a nurse and started doing home care with kids. Started feeling some of the shell peeling away- getting paid well to play on the floor with kids who wouldn't?

Then that alarm goes off and the 14 month old little girl you're watching just - stops. No matter how many problems she had,no matter how many people tell you there was nothing you could have done, watching the light go out in those eyes will stay with me forever.

They all affect you,they all change you, you just never know how in what way or how much.

FMF_Doc
11-08-09, 21:16
I finally decided not to get back into emergency/tactical medicine, I was thinking of taking the EMT course again and starting over but have decided that I did my time and to maintain my skills for around the house and in the woods.

It takes a special breed to be combat medics and EMS providers, and I am glad to have been among them.

mercop
11-27-09, 09:28
As a police we I saw lots of car accidents, unattended deaths, suicides, and overdoses. I just learned to treat everything like a scenario and do me best, disassociating myself from the humanness of the patient. The only one that ever got to me was giving CPR to a dead baby. I could have sworn to God I had a pulse in her little arm. Figure it was just mine. Harder because my son is a heart patient and one of my worst fears was working on him.- George

usaffarmer
11-29-09, 21:42
I start EMT-1 training in January. I would like to think I have what it takes, I think I do. Reading some of the posts on here give me a very sobering feeling. I was in the Air Force, I have grown up in a military, Law Enforcement family all my life. And at this point in my life if need a change. I want to help people. I want to again serve something larger than me. I thank you for your posts!

FMF_Doc
12-29-09, 22:54
trust your training and yourself, always seek out more knowledge and do your best that's all you can do.

nking
01-06-10, 19:47
...I have done CPR hundreds of times over the last 20 years and was resigned to fact we were just practicing our skills. I've had 3 saves in 20 years.

Yes, but what a glorious and infinitely valuable thing saving three unique individuals is. Never underestimate the impact you have had. Have you ever watched "It's A Wonderful Life?"

engine296
01-06-10, 22:12
I try very hard to stay detatched. I give the patient everything I have and walk away when care is transferred. I rarely follow up on a patient's condition unless it is to determine the effectiveness of something I did.

This approach doesn't always work, but it helps.

Me too. I don't really want to know. At first I would ask, but the awnser was almost always bad. Now if I get 'em to the ER alive that's enough. I try to remember it's not the MVA or the cardiac arrest that killed 'em, it's the hard living and dumbass mistakes before that did it.

tracker722
01-09-10, 17:35
***********************

Safetyhit
02-07-10, 16:50
While I have seen my little share, I pray God never makes me hold a child as they gasp for breath while dying, especially just because I stop to help at an accident. Very much like you, I would undoubtedly be in for some extremely bad times.

Deputy25
02-14-10, 17:01
I've been an LEO for 20 years and an RN (surgical/transplant ICU) for four. I've seen plenty of death, violent and otherwise. I'm sorry to say, it doesn't upset me as much as it once did. I'm still a part-time LEO, but witness a lot more suffering as a nurse. My wife is also a nurse at the same facility (trauma surgery), so we talk about it often. Seeing so much suffering, I guess if we let it bother us to the extent that it should, we would be incapable of functioning.

Tmed
03-11-10, 19:32
Go to see you on here Truck. I respect what you've seen and done wanted a little of your input.

I think that anyone that can endure a career (long or short term) of this business needs to be applauded. No one should ever see then things we do, and for much of nothing in compensation.

I hear everyday, "I couldn't do what you do." My usual response is to brush it off because I honestly don't know what to say. Most of the time I say, "Someone's got to do it." It is nice to see that there are others out there that go through the same wave of emotions, or not at all, that I do, and that I'm not weird.

I hope one thing we all can take away from this thread is exactly what Citizen says, to be able to refocus our attitude through all the BS calls to know what we actually train for. Again we do find ourselves on the front lines, maybe not like our brothers in the service, but the front lines of gang warfare, horrific motor vehicles crashes, and bizarre medical emergencies. We are expected to function and make that critical decision; something that we have done before, and will be called upon again when time is of the essence.

I have to admit when I saw the title of the post I thought Hmm a bunch of youngsters who have to get a little seasoning. I skipped over it many times because I did not want to hear some Rookie giving advise about how they handled their one DIF. However after reading it, the thoughtful comments from old heads like me got me to thinking. When you first set off on this path (To be a Sheepdog and not a Sheep)you think you are invincible and nothing can touch you. Later of course you find no matter how hard you try, everything has it's effect on you. It is really how you take it that makes the difference. I think in the final analysis for me at least, as long as I know I did my best for the person or situation then that has to be enough. As truckie says maybe in the next post, we did not put them there (hopefully). No matter how much you train or even how much experience you have you can never really be ready for some calls. The best you can do is keep your head about you and try to keep the scene and everyone on it moving in the same direction; hopefully forward. This job does take so much from you. Truckies statement about patience and compassion are dead on the Mark. There is really not enough to give to everybody anymore, so it is saved for the deserving. Like Truckie this is all I have ever really done since my late teens. Maybe other professions lose compassion as well but it seems like this one (Sheepdog) is the worst. You have to be self aware to make sure it does not affect your relationships with other people. Even then... Thank god for the Station where you can go back and decompress before you go home. And for friends who will be brutally honest with each other. How do I deal with losing Patients? I train for the worst, do my best and then go home and leave it at work as much as possible. How do you deal with working on dying friends, team mates? Do your best, never ever give up( so you can sleep at night, and look their widow in the eye) and you find someone to talk too who will listen. No it's not a sign of weakness to talk to someone. Just make sure that who you are talking too knows where you are coming from. Most people in that profession don't have a clue what the warrior mentality really means and they may not help much. Anyway hope this helps even though it is quite late.:cool:

Truckie
03-11-10, 21:03
Tmed,
Hello. Your words are surely born of experience and wisdom. From one old goat, my respect is yours. Thank you for your post, and thank you for your service. Get to Virginia, the suds and Rib Eye are on me.

In case there are youngins' here, some words of advice... words written long before me. But, words that ring clearer with every passing day:

Train and physically/mentally prepare for the worst.

When you respond, expect the worst... when you arrive, anything less than that is a relief, and you'll never be caught off guard. Scaling back is easy. Ramping up behind the curve, not so much.

Play hard, love hard and find a way/mechanism to put the job in a place where it cannot spoil your life.

Lean on your partners, and never betray the "Brotherhood."

Tmed
03-11-10, 21:43
Wow Truckie I wish i were as eloquent as you. You said it all in nutshell. If you are ever in Alabama PM me and the Beer and Steaks are on ME!:D

DrScooter
03-14-10, 12:04
I'm a 16 year RN, all but my first 2 years (Tele, ICU) have been ER. It's all I want to do, as ADD as I am chaos is what I do best. Each of us sees things different and how we handle trauma. No one, I think ever forgets the first human death we witness but for the most part I am able to leave it at the job. Because it is my job I try to not think of a save as anything special, it's my job. If I was a truck driver (and I was) and did the same save I'd be a hero but I'm a medical pro now, it's waht I do. When someone is dead despite what was done and I must note it's rare a code happens perfect but as long as we do our best for ourselves and the pt I move forward. Seemingly, it does not haunt me or my dreams, your milage my vary.

Yes, I hate pediatric codes, we almost never win and it's a child with a life ahead. I hate working house fires. In some of my trauma training, I rode a rig for a few days, worked a few MVA's and got in on more "Cabulance" calls than I could stand. Many people are not cut out for this, those of us who choose it and stay have our reasons. I could give up Nursing and the ER, one must examin one's career choice when we thank people for giving us urine. Two of my fellow ER nurses are EMS guys, one is still a Fireman and an ER Nurse part time, his wife didn't want him with too many woman so Fireman first. Actually, he is divorced now, the other did EMS and was into "chopper" transport but with 5 kids, well you know went for the cash.

Like I said I could leave ALL work long behind lie on a beach and never look back if I had the money, which I don't. If I have to work, which I do, for the most part this is fun, exciting and I really enjoy the "type" of people who choose this and I get the pleasure of meeting and working with. Besides, we have much better stories to tell than any bean counter.

browningboy84
06-02-10, 01:14
I have to admit when I saw the title of the post I thought Hmm a bunch of youngsters who have to get a little seasoning. I skipped over it many times because I did not want to hear some Rookie giving advise about how they handled their one DIF. However after reading it, the thoughtful comments from old heads like me got me to thinking. When you first set off on this path (To be a Sheepdog and not a Sheep)you think you are invincible and nothing can touch you. Later of course you find no matter how hard you try, everything has it's effect on you. It is really how you take it that makes the difference. I think in the final analysis for me at least, as long as I know I did my best for the person or situation then that has to be enough. As truckie says maybe in the next post, we did not put them there (hopefully). No matter how much you train or even how much experience you have you can never really be ready for some calls. The best you can do is keep your head about you and try to keep the scene and everyone on it moving in the same direction; hopefully forward. This job does take so much from you. Truckies statement about patience and compassion are dead on the Mark. There is really not enough to give to everybody anymore, so it is saved for the deserving. Like Truckie this is all I have ever really done since my late teens. Maybe other professions lose compassion as well but it seems like this one (Sheepdog) is the worst. You have to be self aware to make sure it does not affect your relationships with other people. Even then... Thank god for the Station where you can go back and decompress before you go home. And for friends who will be brutally honest with each other. How do I deal with losing Patients? I train for the worst, do my best and then go home and leave it at work as much as possible. How do you deal with working on dying friends, team mates? Do your best, never ever give up( so you can sleep at night, and look their widow in the eye) and you find someone to talk too who will listen. No it's not a sign of weakness to talk to someone. Just make sure that who you are talking too knows where you are coming from. Most people in that profession don't have a clue what the warrior mentality really means and they may not help much. Anyway hope this helps even though it is quite late.:cool:

I am not a rookie, but I have been in EMS four years, and was a volunteer fireman for 2 years prior to that. I was in nursing school, got burned out on it, and switched to the pre-hospital side. I went through EMT school, then went straight to Paramedic school. It infuriated my parents, because I gave up on nursing school. My father is a physician, and told me I was wasting my time. I have spent the last 3 years working 160+ 24 hour shifts on an ambulance, and have run a few codes to say the least. I just went back to the agency where I started out as a rookie firefighter, and went back as a shift captain and a training officer.

I still think about some of the codes that I have worked, and some of the calls. I worked a pediatric drowning in EMT school, and the child's father was a preacher, who ironically enough, was off preaching a funeral when his child wandered outside and fell in the pond. We worked that kid for 2 hours, got him back, but he died 24 hours later. In the EMS room at the hospital, there was not a dry eye there. I almost quit EMT school after that day. I gutted it out, and I have never regretted it. That child gave me nightmares for the longest time. What helped me tremendously was delivering and rescussitating a child who delivered with the cord wrapped around its neck. The kid made it, and his mother saw me on duty 3 months later, and showed me the kid. I held that child in my arms and realized he is alive today cause I held it together, and did what I had to do for the 28 minutes it took to get to the closest hospital. I rarely ever have nightmares anymore, and I know of 3 people who I have brought back from the reaper.

I did landscaping in high school and part of college( I took over the business when my brother started medical school), but had a heatstroke at 19 years old. I had to get out of landscaping, but I found my calling in EMS. I am going back to nursing school, but I will not leave EMS until I have to( ie back problems, shoulder problems, knee problems). I have driven my great-uncle in as he way dying from CHF, got him to the ER alive, and watched him code in the ER. That was tough, but not that tough, since I knew he had lived to be 73 years old.

Someone asked me one day what EMS was like, what have I seen, etc. I told them this " I have seen life end in the back of the bus, and I have seen life begin. There is no rougher feeling watching someone die while you are doing all you can to prevent it, and there is no better feeling having part of a new life beginning".

I deal with things the best way I can (ie cutting up at the station with co-workers, hunting, fishing, and training retrievers), but I am lucky that I have a wife who is in this field. I am so lucky that I have a wife who hunts, fishes, and shoots with with me, and understands what I go through. I was so proud last month when she graduated from Paramedic School top in her class, and was even prouder when she passed her National Registry. I have obtained my instructor certs in some Life Support courses, and am supposed to help start teaching soon. All in all, it does take a special breed of person to do this, but I dont think I am anything special. It is in my blood, and my family has traced our lineage back to Cornwallis Wall, a surgeon in the Alabama Millitia in the Civil War. Medicine is in my blood, and I love that fact, since I know I found my calling in this field.

Tmed
06-02-10, 16:55
Good for you. I'm glad you found your calling. Take good care of a mate who is understanding, and shares your hobbies. They are more important than anything.