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.