- Did I do everything I knew how to do to care for this person?
- Was there something I missed, something I should have changed?
- What will happen now? Will the family blame me for the consequences of their loved one's frailty? Will I lose everything I worked for even though I did the best I could?
- If the hospital or the family wants me punished, how much punishment will be enough, since no punishment could possibly bring their loved one back?
- If someone else had been taking care of her, would things have been different?
- Even if I am a good physician, will this forever color people's ability to recognize that and their willingness to hear my opinions and advice?
- Whom can I talk to who would actually understand?
- Even if losing this patient wasn't my fault, will this churning of thoughts ever heal, this ache ever go away?
Saturday, August 30, 2008
One of my friends lost a patient some time ago. It happened during the induction of anesthesia. Just as aviation disasters often happen during take-off or landing, operating room codes or emergencies often take place as anesthesia is being administered or terminated. His patient was terribly, terribly ill, chronically with diabetes, heart disease, kidney disease, and vascular disease, and acutely with other things. She had been through many operations already. He prepared the anesthetic with meticulous care, spoke to the patient's family about the risks, but despite all his efforts, his patient was too weak to tolerate this one last anesthetic. He labored for over an hour to resuscitate her, to no avail. It was the kind of case every anesthesiologist hopes never to have to face.
Unfortunately, it's also the kind of situation that comes to every anesthesiologist's table sooner or later, regardless of his or her skill and experience. My anesthesiologist friend asked me a very thought-provoking question after he told me about his experience. He asked, "Are you willing to continue in a career knowing that this will happen to you someday, if it hasn't already, and you're going to have to deal with it and live with it and not give in to grief and self-doubt afterward? Do you love this work and believe in yourself enough to keep going? Because if you don't, you need to get out now while you can."
These were sobering reflections. If I left my work as an anesthesiologist now, what would I do? Where would I go?
I can only imagine what he went through. The indelible image of his patient's face seared into his mind. The questions he asked himself.
Doctors grieve. Doctors shed tears, seen and unseen, over patients, for many different reasons - at least, the ones who care do. I know this to be true. Seen it. Done it. But doctors also can't be debilitated by grief or doubt or regret for too long. Other lives hang in the balance. The question is, how do doctors heal?
Just read another brilliant post by Bongi of other things amanzi on the subject of post-traumatic stress in doctors who face the loss of a patient and had to reproduce its well-wrought final sentence here: "When we fall off the horse, most of the time before we can even shake the dust out of our hair, we are shoved back on and the horse is given a hard thwack on the rump." So true.