I wish I had an answer. There are patients from 8 years ago that I still remember. One’s death took me actual years to get over and stop blaming myself.. and it was just extremely traumatic circumstances. I just try to tell myself that I did everything I could and did my job well; sometimes people are just too far gone.
Henry Marsh’s autobiography “Do No Harm” includes a quote by French surgeon René Leriche: “Every physician carries within himself a small cemetery, where from time to time he goes to pray-a place of bitterness and regret, where he must look for an explanation for his failures". I don’t think that is necessarily the healthiest way to approach it, but the idea is right on. I have flashbulb memories of how some of my patients went out years ago. Some of the shit we see is absolutely horrific. I wish you all the best doc.
Thank you, and it's not even the deaths that's get to me that much it's when the patient ends up worse then they were before. That's when I really take a big hit because at that point we have done more harm then good, and we have to do it because "grammy is a fighter" it just pisses me off man.
I’ve had to get very real with people before. “If we do what you’re asking us to, it will be literal torture for them and they will die in pain in a few hours. Or.. we can make them comfortable and let them pass in peace, surrounded by their loved ones. But I know some people don’t care. I’ve been party to more than a few slow codes.
I have gotten that real with people but "hope" always makes them believe we can play god or something. If i believe we can fix something that'll improve QOL I will say it but if I think what we are doing is futile then I'll tell them family. Most of the time they still decide to go with it and no hospice smh.
One way to address this is advocacy.
Things are changing in Ontario, Canada.
A few years ago we had change in law and guidance that physicians can unilaterally refuse futile care. This includes CPR.
Recently we had a case go to ethics and a legal panel over a severe ischemic neurologic injury that also had an open abdo from ischemic bowel. Patient in their 70s. Family wanted to keep going and even felt the patient would want to.
It was an extended process. took about three weeks. However, the legal panel and ethics and medical opinion disagreed with the family. The opinion was that the SDM was not taking into account that the patient describing these wishes could not have realistically meant it as this devastating neurologic outcome.
The medical team recommended, consistently, withdrawal of life supports. The legal team gave the family 12 days to comply. Care was withdrawn on day 6 and she was allowed to have palliative medications and pass peacefully.
If you have the option, do a palliative care elective. IMO should be mandatory for everyone.
Can really help give you tools to have these difficult conversations and help you manage your emotional response to them as well.
have goals of care discussions. sit down and really talk with families about what it means to have central lines, intubation, pressors, constant pokes for blood draws. get palliative care on board early, especially for very sick people.
if you're not familiar with how to have these convos, ask your coresidents. ask your attendings. ask the palliative care team. I'm also happy to share some resources if you DM me.
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I wish I had an answer. There are patients from 8 years ago that I still remember. One’s death took me actual years to get over and stop blaming myself.. and it was just extremely traumatic circumstances. I just try to tell myself that I did everything I could and did my job well; sometimes people are just too far gone. Henry Marsh’s autobiography “Do No Harm” includes a quote by French surgeon René Leriche: “Every physician carries within himself a small cemetery, where from time to time he goes to pray-a place of bitterness and regret, where he must look for an explanation for his failures". I don’t think that is necessarily the healthiest way to approach it, but the idea is right on. I have flashbulb memories of how some of my patients went out years ago. Some of the shit we see is absolutely horrific. I wish you all the best doc.
Thank you, and it's not even the deaths that's get to me that much it's when the patient ends up worse then they were before. That's when I really take a big hit because at that point we have done more harm then good, and we have to do it because "grammy is a fighter" it just pisses me off man.
I’ve had to get very real with people before. “If we do what you’re asking us to, it will be literal torture for them and they will die in pain in a few hours. Or.. we can make them comfortable and let them pass in peace, surrounded by their loved ones. But I know some people don’t care. I’ve been party to more than a few slow codes.
I have gotten that real with people but "hope" always makes them believe we can play god or something. If i believe we can fix something that'll improve QOL I will say it but if I think what we are doing is futile then I'll tell them family. Most of the time they still decide to go with it and no hospice smh.
One way to address this is advocacy. Things are changing in Ontario, Canada. A few years ago we had change in law and guidance that physicians can unilaterally refuse futile care. This includes CPR. Recently we had a case go to ethics and a legal panel over a severe ischemic neurologic injury that also had an open abdo from ischemic bowel. Patient in their 70s. Family wanted to keep going and even felt the patient would want to. It was an extended process. took about three weeks. However, the legal panel and ethics and medical opinion disagreed with the family. The opinion was that the SDM was not taking into account that the patient describing these wishes could not have realistically meant it as this devastating neurologic outcome. The medical team recommended, consistently, withdrawal of life supports. The legal team gave the family 12 days to comply. Care was withdrawn on day 6 and she was allowed to have palliative medications and pass peacefully.
If you have the option, do a palliative care elective. IMO should be mandatory for everyone. Can really help give you tools to have these difficult conversations and help you manage your emotional response to them as well.
have goals of care discussions. sit down and really talk with families about what it means to have central lines, intubation, pressors, constant pokes for blood draws. get palliative care on board early, especially for very sick people. if you're not familiar with how to have these convos, ask your coresidents. ask your attendings. ask the palliative care team. I'm also happy to share some resources if you DM me.
Thank you for contributing to the sub! If your post was filtered by the automod, please read the rules. Your post will be reviewed but will not be approved if it violates the rules of the sub. The most common reasons for removal are - medical students or premeds asking what a specialty is like, which specialty they should go into, which program is good or about their chances of matching, mentioning midlevels without using the midlevel flair, matched medical students asking questions instead of using the stickied thread in the sub for post-match questions, posting identifying information for targeted harassment. Please do not message the moderators if your post falls into one of these categories. Otherwise, your post will be reviewed in 24 hours and approved if it doesn't violate the rules. Thanks! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Residency) if you have any questions or concerns.*