Death is a part of life, and it is a part of being a healthcare provider. Unfortunately, during training, nobody teaches you about the emotions that come with facing death and dying. Even if they did, there is no “one size fits all” approach to dealing with a dying patient or the emotional toll it can have on you as a healthcare provider and a human, but there are several strategies that can help.
Three patients particularly stand out to me when I think about death and dying in my career:
The first time I saw a patient code
A 32-week stillborn I delivered
A 13-year-old girl with cystic fibrosis who passed away after we admitted her to hospice care
Each one of those broke my heart differently, and my experience delivering a stillborn has stayed with me to this day.
I remember it was the middle of the night, and I was the senior resident on the floor for OB-GYN, ICU, and our inpatient patients. The OB nurse ran into my call room and told me we had a G1P0 at 32 weeks gestation coming in for “no fetal movement.”
I introduced myself to the mama, asked her a few questions, placed some gel on her belly, and used the ultrasound probe to find the baby’s heartbeat. I could make out the entirety of her little baby boy; his head, hands, spine, abdomen, and heart. The heart chambers were not moving; there was not even a flutter. My stomach dropped, and I felt like I was going to vomit. I knew right then and there that this baby was no longer alive, and at 32 weeks along, I had to induce labor and deliver him.
I had to tell the mom. I excused myself from the room for one second to grab the nurse, to confirm what I saw on the ultrasound, and to call my attending. I sat down and explained to this young mom, in the most humane way I could, that her baby was no longer alive, and I had to induce labor so we could deliver the baby promptly. She was by herself, and I asked if I could call anyone to be with her during this time. I asked her if she wanted to hold her baby after she delivered. The delivery was one of the most challenging death experiences I have been through.
I will never forget the color, the smell, and the rigid body. I will never forget coming in to check on the mom throughout the night and the following day, as we still had to monitor her for postpartum changes. This experience changed me, broke me, and molded me, lingering in the background even as I kept going, and to this day, my heart breaks when I think of the details.
These experiences are real and often outside of our control. They occur throughout our careers—reading this article probably brought one to mind for you. We are expected to keep moving forward, yet we're left silently coping with the emotional toll. The topic is rarely discussed openly and honestly.
Death is often said to be "part of the job," but that does not mean that we shouldn’t acknowledge the immense impact it can have on our mood, behavior, mindset, how we care for our future patients, and our relationships in our personal lives. The first step is talking about it, then finding what best helps you cope.
The following are some healthy coping strategies that can be helpful when dealing with the death of a patient. Remember, there is no "one-fits-all" approach. Focus on the options that resonate most with you.
Seek help—no stigma attached
Losing a patient, no matter the circumstance, changes us, and when we experience death and dying regularly, we may change without even realizing it.
Talk about it
Tell your experience to a colleague, tell your friends and family how you feel, write down your thoughts and feelings in a journal, ask your mentor for advice, and review the case with your medical team.
This is an important step to normalize talking about these experiences.
Take a moment of silence
We don’t always have all the answers, nor do we have to have all the words. Taking a moment of silence alone, or with the patient's family, is appropriate at the time of death.
Give empathy to family
At the moment of death and immediately after, the family is your first priority. It is essential to be available for them.
Some practices—like showing empathy, praying with them, answering any questions they have—can help you cope, too.
However, keep in mind that words, hugs, tears, even touching a shoulder can sometimes be too much for many family members, and it is important to be respectful of their emotional space while giving yourself space to cope with your feelings, too.
Allow yourself to feel your emotions
Avoidance, numbness, and emotional distance can exacerbate stress. When you do not allow yourself to process grief in a healthy manner, you may feel reluctant to become close to other patients, you may struggle with your personal relationships outside of medicine, and you are at risk of putting your physical and mental health in jeopardy.
Lean on your support system
Cry to your partner, ask your mom to go to dinner, spend time away with friends. Your friends and family outside of medicine don’t understand what you go through daily, but the more you share your thoughts and emotions with them, the more they can support you, especially after a patient dies.
Find a healthy outlet
Running, painting, journaling, baking, gardening, or any healthy activity that brings you focus and joy is necessary to take your mind off the stress associated with death. Healthy outlets, in general, are important for everyone who has undertaken a career in medicine, as they provide a way to unwind and enjoy happy moments.
Experience moments of joy
It is important to give yourself permission to experience joy and humor in the dying process. There is often an amazing amount of grace, inspiration, and admiration at the end of a patient’s life. Sometimes you may have to look harder than other times to see it, and it's not always obvious, but beauty and peace can be found in death.