Monday, August 13, 2007

When My Patients Die

On July 27th, I posted about my participation in the National Youth Leadership Forum, where I discussed my career with teenagers who have expressed an interest in the field of medicine. One question that I was asked more than once was:

“How do you handle it when a patient of yours dies?”

Whenever I’m asked that question (and given my profession, I get asked that a lot!), I’m reminded of a scene from my favorite old TV show, Homicide: Life on the Streets. In one episode, a new character, a female Chief Medical Examiner named Julianna Cox, is introduced. Dr. Cox is young and beautiful, and one of the detectives, Bayliss, is clearly attracted to her. He tries to make small talk, and he asks her how she deals with her job, doing autopsies and dealing every day with death. Her answer? “Sometimes I drink too much, sometimes I drive too fast, sometimes I fall in love with the wrong people.”

So how do I handle it?

I remind myself that just because the patient died doesn’t mean I didn’t do some good, it doesn’t mean I didn’t help the patient, and it doesn’t mean “we lost.”Helping a child with cancer can mean providing treatment that results in a better quality of life, relieving pain and suffering, and allowing the patient to have as normal a childhood as possible. These things have immense value to the patient and the patient’s family.

I also find it important to remind myself of the patients whose outcomes have been better. I’ve taken care of many patients that everyone thought would not do well – patients like K, who was the subject of my second post here, and others. Although I know I can’t cure everyone, after one of my patients dies it’s reassuring to remind myself that there are others who lived.

Finally, I try to attend the viewings, wakes, or funerals of my patients who have died. I have found over the years that this allows me a certain amount of closure. Perhaps more importantly, it gives me a glimpse into the life my patient had outside of the hospital. It reminds me that they were children and young adults with full, rich lives, not just patients with a disease. Unfortunately, doctors rarely get this view of their patients, and almost never see their patients outside of an office, a clinic, or the hospital.

Does any of this make the death of a patient any easier? No. Nothing makes that easy. Even when the patient was suffering and we all knew that death brought relief that I was unable to provide with medicine.

However, in order to go on treating children with life threatening illnesses, doctors and nurses have to develop strategies to allow them to cope. Everyone is different, and what helps one may not help another. The fictional Dr. Cox drinks too much, drives too fast, and falls in love with the wrong people. The non-fictional Dr. Loeb tries to recognize that he might have helped a patient even if he did not cure their cancer and he gains strength from recalling the patients who did survive and have gone on to really wonderful lives.

7 comments:

Phoenyx said...

Greetings!

Thank you for sharing this. Death in general is not a subject we seem to be very comfortable dealing with in this society, so when it happens, as it inevitably does, those left behind are left with so many general unanswered questions about death and dying and how to cope with both, as well as whatever specific ones there may have been.

Thank you for answering some of those general questions a little bit....
-Katrina

i2y said...

David - thank you for your comment on our Stupid Cancer Blog. We would like to invite you, and your AYA oncology team to become an i[2]y affiliate and distribute our free support literature to your AYA population. Please visit our website, http://ImTooYoungForThis.org and click on the "request literature" button - or call directly at 877-735-4673. Best, Alan Swann, Executive Assistant to Matthew Zachary

Wendy S. Harpham, MD said...

Dr. David,

As a physician, I identify with your focus on the good that can be done in a terrible situation. As a cancer survivor, I see triumph over cancer as how one lives (and not how long).

For some, the battle metaphor creates serious problems when treatment options run out and patients die. I wrote about it in a column for Oncology Times, called "Misguided Metaphor." If interested, it can be found at http://tinyurl.com/y594v6n

With hope, Wendy

Doctor David said...

Thank you for your comment, Wendy. I couldn't agree with you more -- triumph absolutely has more to do with HOW you live than how LONG you live.

~Dawn~ said...

As a parent who has lost a child to neuroblastoma, I found it made me smile to read you attend funerals when you can. Our oncologists do not, and while I understand that too, I find it comforting to know some can. We felt very close to our physicians, they became like family to us on our journey. Keep doing what you're doing, I believe most parents will be encouraged by it. It's nice for us to see and feel that our children were special to other people as well, not just us. Nothing comforted us more than laughing, sharing and crying WITH the wonderful doctors, PAs and nurses who treated our son.
It's very comforting to us to see they mattered to their all of their care team as well.

Anonymous said...

Thank you very much for sharing your experiences! I am a paediatric trainee from London in General Paediatrics, and I am seeing for the first time a teenager dying from his leukamia, its vry sad and I seem to keep wanting to phone the hospice and find out how he is doing. I am not sure if this is a good thing or not? Some fo the nurses tell me I shoudnt get too involved but I find that really difficult, do you have any advice please?? Many thanks!

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