How do you react when your patient dies?

[FMF_Doc]

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]

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]

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]

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]

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.

[lexmedic157]

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]

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]

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]

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]

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?