My husband the Anesthesiologist came home one evening solemn, affected, not himself. His patient died in the recovery room. It was sudden, unexpected for my husband, and despite the team’s swift efforts and perfectly executed code, the patient died anyway. It’s relevant to note that his patient was an almost 90 year old man with significant Congestive Heart Failure, probably Chronic Kidney Disease, and complete occlusion of one of his carotids who sustained hip fracture and thus required the surgery to pin his hip for both healing but also comfort. This is the ultimate Catch 22 in medicine (or at least in Geriatrics). Someone who really should not be having Anesthesia or surgery due to their life-threatening chronic medical conditions has an accident and now requires a surgery to make their remaining life bearable. My husband and the surgeon delivered the bad news together, and as the patient’s wife understandably fell apart, my husband cried in front of patients (family) for the first time, ever. As we processed this together, he asked me, the Geriatrician, “How do you deal with death all the time?”
I won’t pretend to have all the answers. However, I don’t think my husband or any doctor is alone in needing help or any tips at coping with death. So here are some ways this mother, family physician now Geriatrician copes with death, an ever-present part of Geriatric medicine.
1. Rework the hierarchy of goals in medicine to reflect reality – Currently the undertone of “save all life” is primary and trumps all else. Whenever possible, we should be working to save lives. Yes. However, we often forget that all humans are mortal. We need to keep the goals of reducing harm and striving for quality of life on equal footing with saving life. Death is the one shared truth among cultures, religions and creeds. Reminding myself of this helps me keep grounded. If I’m an ER doc and treating a young person with a traumatic limb injury, there is a lot medically I can do to ensure the patient not only survives but also thrives despite the trauma. But when I have an elderly person (85+ years old) who fractures their hip from an accident, I know that even if that person had superb health they will probably not be alive in 1-2 years if all goes well with the hip surgery. Either way, that surgery is necessary for comfort (displaced bones don’t stop hurting no matter how much pain medicine until they are put back in place). This mindset helps me reflect on everything I do to ensure I am giving or recommending the best care for my patients relative to their individual goals and situations.
2. Take Control and responsibility for what you can, but recognize when it’s out of your control – To become a physician, we must be driven. This serves us in our studies, physical endurance, and constant strive to help our patients in what can seem like insurmountable odds. This focused determination has also led to some of modern medicine’s greatest achievements (and extended life expectancy). However, we can have a tendency to develop tunnel vision in thinking we have more control over life and death than we really do. An Anesthesiologist’s job is essentially to control all the life-essentials (breathing, blood flow and circulation, etc) so the surgeon can best control their procedure. A medical doctor uses medications to control blood pressure, high sugars, and a variety of other symptoms. It can be very easy in the day to day to forget how very little control over death we humans have. We realize early in our practicing years what little control we have on what patients individually choose to do with their own lives and our advice. But we still forget that we are not the puppeteers in death.
3. Allow yourself to Grieve with the Families of the Deceased – Grief is raw, scary, unpredictable, and hard. It is also part of healing and acceptance. Physicians are humans too, humans who love other strangers enough to sacrifice much to help them. It’s ok and necessary to feel. I regularly cry with my deceased patients families, attend any services I am able, and process the loss of a loved one with their families. Because I love my patients, and it hurts when I loose them, even when I know it’s inevitable.
4. Know Yourself – Cheesy? Perhaps. Yet essential. I started in Family Medicine with a young child. Like many physicians, I don’t like loosing control of things. However, when I became a mother as a medical student, any pretenses I had at control over my newborn, his sleep and feeding preferences, etc went out the window. Confronting my utter lack of control early as a physician helped, but it also made me assess what I can and can not emotionally handle. Death is part of life, but personally I can’t actually handle death daily in children or adults with young children. It hits too close to home for me and drudges up all my unhelpful worries surrounding my inability to protect my son always and forever from everything bad. Knowing this about myself (and also liking Geriatrics) helped me choose Geriatrics. I am capable of confronting the reality of death regularly in this population. I’m extremely grateful for the physicians who cope with it routinely in younger people.
Lastly, I want to emphasize how important it is to ask for help. There is still a undertone that if the physician asks for help they are somehow weak. This couldn’t be farther from the truth. We are human, knowing when to ask for help is a sign of character, courage and love. No one should think they must bear the weight of these burdens alone, and no one should bear this alone. It’s too much for our mortal bodies and souls to handle. I’m sure there are many more helpful words of wisdom from other medical practitioners out there. Please share.