Coping with the death of a patient

On average 435 Australians die each day. Most will know they are at the end of their lives. Hopefully they had time to contemplate and achieve the “good death” we all seek. It’s possible to get a good death in Australia thanks to our excellent healthcare system – in 2015, our death-care was ranked second in the world.¹

During medical school you learn anatomy and physiology and how these interact and manifest as one or more of a myriad of diseases that humans experience. A recent article by two University of Melbourne medical lecturers provides insight into how medical students and junior doctors are currently taught to deal with death.² An important part of this is meeting and carefully working with your cadavers.  Research has shown that meeting cadavers can itself be very uncomfortable, but when you experience the first death of one of your patients, one with whom you have had a conversation and connected with, it can be a very emotionally challenging time.³
 
Everyone has his or her own unique perspective and experiences when dealing with the first death of a patient.  Your perspective on life and death, personal and clinical experiences and the circumstances surrounding the death all play a role in your understanding of death and how you may deal with the loss.   
 
Dealing with death, in particular your first, is never easy. The following suggestions on how to look after yourself may be helpful to you in working through this trying time.

• Acknowledge that death is not a failure. As Atul Gawande, a surgeon and author from the United States says in his book Being Mortal: Medicine and What Matters in the End, death is normal and the natural order of things. Death is the one shared truth among cultures, religions and creeds.⁴
• Acknowledge the death. As a medical student or junior doctor, it is not uncommon that you spend more time with patients and their family than their treating doctors and during this time close bonds can develop.  If you feel like a hug may be appropriate, or the family members want to share a story about their loved one: then listen, and don’t feel ashamed to shed tears with them. You may find it not only beneficial for their healing, but also for your own. Honesty and kindness are traits valued highly by patients.  
• Look after yourself.  Don’t let your own feelings get lost. Spend some time with family, friends and colleagues. A kind word and advice can be helpful.⁵ You may find that writing in a reflective journal, or doing something creative can help you identify and cope with your feelings about the death and your role as a health professional.  For others something physical may be a better option.
• De-brief with some of the team members involved. Though not everyone may be available and willing. Sharing with other members of the team can help you to understand the death and develop a more thoughtful understanding of what an important role you can play in influencing this significant time in the lives of your patients.  Some patients die. As a doctor I have to live with this inevitable fact  is an article that provides insight into how others in the health care team reconcile their role in the death of a patient.
• If you need to, seek specialist mental health support. Free counselling is often offered through universities and health service facilities which you may wish to consider utilising. Everyone responds and grieves differently and you should not compare yourself to others, but care for yourself in the way that suits you best.

The article Doctors grieve too: A lesson I did not learn in medical school⁶ summarises the importance of acknowledging and working through the feelings you may feel after experiencing your first death of a patient. 
 
By addressing my grief instead of trying to hide it, I will be able to continue to open my heart to patients and their families without burning out. This is not only beneficial personally, but my responsibility professionally, in order to take the best care of my patients.
 
This lesson, that as a physician, not only am I allowed to mourn but that I am obligated to grieve, is not something I ever found in a textbook or heard in a medical school lecture. It may, however, be the most important thing I have learned about medicine thus far.⁶
 
MIGA is invested in the health of our medical students and doctors and has produced a Doctors’ Health e-book which you may find useful not just in this situation, but in caring for your wellbeing in general.  Download the e-book here.
 

1. Winch, S. (2017, September 27).  When life is coming to a close: three common myths about dying [Blog post]. Retrieved from https://theconversation.com/when-life-is-coming-to-a-close-three-common-myths-about-dying-83142  on October 5, 2017.
2. Flynn, E. & Philp, J. (2017, October 23). How doctors are taught to deal with death, The Conversation. Retrieved from https://theconversation.com/how-doctors-are-taught-to-deal-with-death-84429 on October 23, 2017.
3. Bergeron, L. (2005, September 14) Rite of passage for first year medical school students: meeting their cadavers, Stanford Report. Retrieved from http://news.stanford.edu/news/2005/september14/med-anatomy-091405.html on October 9, 2017.
4. Gawande, A (2014, October 31). What doctors don’t learn about death and dying, IDEAS.TED.COM. Retrieved from https://ideas.ted.com/death-and-the-missing-piece-of-medical-school/  on October 5, 2017.
5. First times - coping with the death of a patient, 2016, BMA. Viewed 5 October, 2017 from https://www.bma.org.uk/advice/work-life-support/your-wellbeing/first-times/death-of-a-patient  on October 5, 2017.
6. Gambill, L. (2016, January 14). Doctors grieve too: A lesson I did not learn in medical school [Blog post]. Retrieved from www.kevinmd.com/blog/2016/01/doctors-grieve-lesson-not-learn-medical-school.html  on October 5, 2017.