How do physicians cope with the emotional aspects of death?

I have the paradoxical privilege of being an emergency medical contact for dozens of people. Have you completed a healthcare medical directive with durable power of attorney? While reviewing a DPA with others, I strive to understand their choices in delicate life-or-death situations. This has me confronting death more often than many people.

They still talk to me

Triggered by seemingly insignificant events, fond memories of friends and relatives enter my mind on some days more than others. Brewing a warm beverage revives a conversation with an exuberant friend explaining a detoxifying cleanse to me for the first time. Despite his healthy routine, he succumbed to cancer.

Memories of my younger brother visit me whenever I hear the words, “bunk beds” or view constrained spaces, as those on a handrail or fence. My grandmother came to greet this newborn. But older siblings were hindered from retrieving him since he was motionlessly suspended with his head pinned between the wall and upper mattress. How could I, at just 3 years of age, break the news to my mother and grandmother? Solemnly I announced, “Something’s wrong with David.” Shielded from the effects of death, EMTs rolled no gurney through the living room; Baby David was apparently lowered out the bedroom window. There was no funeral. He just ceased to exist.

I reminisce about my grandmother in the kitchen years later. She tried to tempt me with a steak after discovering I was a vegetarian. Within a few months, she died of “c,” as she called it, unable to vocalize the final five characters.

Certain vehicular movements remind me of an empathetic passenger who spontaneously struck up a conversation with a stranger walking down the sidewalk during my Y-turn. Some time later, I was summoned to the hospital at 3am. Immediately, I began prepping personnel for a potential media storm since she was an actress. Then I was interrupted with the news that she was DOA. A 3am “ring” awakened me to a dial tone for months thereafter.

I prayed with a brave single mother of two minor children before her unsuccessful brain surgery. She assured me that her children would be well cared for should she not fare well in the operation. The syncopated puffs of air from mechanical life support systems do not compare with the gracefulness of natural breathing. This police officer was kept alive long enough for family to say their last goodbyes.

Several visits were made to comfort the grieving sons. Imagine my excitement to see one emerge from despair a year later. Within a week, nearly on the anniversary of his mother’s death, I was crossing crime-scene yellow tape after conspirators allegedly had the two boys assassinated for their inheritance.

Ironically, a shy radiologist complained of backache for a year. When doctors eventually discovered cancer, she was accurately given eight months to live. With wide-open moist eyes, she touched my shoulder asking what seemed at the time to be the most important question of her life, “Will you remember me?” Yes, I remember you Nancy.

Predicting death

After dozens of experiences, I have developed an ability to sense death. It’s an eerie feeling where I sense myself in the not-to-distant future in the absence of that person — just like after my infant brother was taken away.

I candidly told another brother when my mother had less than 30 days to live. There’s nothing uncanny about it. There are telltale signs. When someone says they have no appetite for food, I am reminded of four individuals who expired shortly after uttering the same. By the time I am tugging a water-dipped swab from their parched lips, the clues are all-too obvious. Renal failure shortly follows.

It’s a solemn task to care for someone’s end-of-life health care needs. It’s even more precarious as an emergency contact when the next of kin is in the waiting room beside me. With all I have learned about health and human anatomy, my voice is buffered through the lips of the next of kin.

Continuing with life after death

I faced my own mortality during a mugging. Surrounded by multiple shotgun-toting assailants, it appeared as if my life was over. Despite extensive training, I could see no safe way of defensively extricating myself. I thought at the time that the Creator’s future prospects for me would be based on the good done up to that point. Obviously the outcome was more favorable.

Whether from violence, tragic accident or natural causes, death is never pleasant. It has unpredictable effects on different people. In fact, it seems something has died within me. I feel an emotionally awkward inability to shed tears at someone’s passing. Shock or angst may be present but I must struggle to get beyond platitudes. It is not uncommon to distance myself from the bereaved even when my absence appears socially inappropriate. Alongside so many others, the news of a death transmigrates to more stoic vignettes of past conversations.

Death is a fact of life. But is it just a normal biological process? Death has the power to immobilize or inspire. We must continue living despite the passing of loved ones. The grieving process can last a few days or linger for many years. People may find comfort in a well-worded poem, a hope based firmly on the Holy Bible, a human tradition, or the thought that through organ donation, or at least through our memories, they live on.

Coping with patient death

I ponder how physicians cope with emotional aspects of death. We don’t generally envision them undergoing a protracted grieving process. After expressing terse condolences to family, they are expected to continue with their medical rounds — attending to the next patient with a positive bedside manner.

Are sympathetic reactions to death excised from physicians during med school cadaver autopsies? Is death a natural consequence that follows unsuccessful heroic measures? Has a patient already died by the time life support is required? Perhaps doctors anticipate patient mortality earlier in the diagnostic process, when statistical probabilities are unfavorable or when there’s a disagreement over treatment recommendations.

It is wise for patients to discuss end-of-life matters with their physicians and loved ones while still living. The conversation after death is characteristically one-sided.

Kevin R.R. Williams blogs at ClinicalPosters.com and can be reached on Twitter @ClinicalPosters.

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  • James deMaine

    Thanks for the interesting post and your perceptions about being close to death and wondering how physicians handle it. After 32 years in the developing area of Critical Care Medicine, I saw the whole spectrum of ability to cope with death in myself and fellow physicians. How we deal with it depends on so many factors: education, upbringing, religion, mentors, family experiences and attitudes about death, and our level of maturity. As I aged, I found I was more comfortable with death as a natural process than many younger colleagues. To survive dealing with death on an almost daily basis, I slowly developed a skill set of being able to talk to patients and families with caring, yet not adding their trials as my own burdens. It may sound uncaring, yet I found I had to be able to not carry these concerns to the next patient or to my own family. Science training can sometimes delay the broader perspective that comes with liberal arts training. The complete doctor needs both, but of course we’re not superhuman. Again, thanks for your thoughts. You might be interested in a post I did wondering if we can talk about death: http://www.endoflifeblog.com/2011/09/can-we-talk-about-death.html

    • http://ClinicalPosters.com/ ClinicalPosters

      Thanks for such kind words. Your blog post is quite appropriate and well written. By mentioning the buffering “skill set” you provide for other patients and family, you elucidate an interesting dimension. When children ask, “How was your day,” I can imagine responding in relative terms (not as many deaths as another day), ‘Not too bad.’

      I appreciate that you mention how maturation and environmental upbringing affect one’s ability to cope. The “d” word is an uncomfortable subject for many. It went through several iterations when describing this post. In an early draft, this was entitled, “Conversations With Dead People,” as I was revisiting conversations with individuals who have since expired. It was then changed to “Conversations Live After Death.” Editors attempted to make it more palatable, even though each includes the word “dead” or “death.”

  • Joshua

    I have a SIL who is a medical doctor, when my father died in the emergency room she was there with us and it seems like she is no longer affected by the death scenario in the ER despite the fact that the one who died is a family member. Do doctors get numbed because death is something that they usually witness as part of their profession? http://remediesforhealth.wordpress.com/2012/12/19/greasy-meals-to-evoke-stroke/

    • dr shafiq chughtai

      don t know joshua.its a routine.they see every day and they are normal.but they feel too.when we are young in profession we feel more as we age we feel less………ha kind of protective mechanism..if they keep on feeling normally, it will become too hard on them!

      • http://ClinicalPosters.com/ ClinicalPosters

        So are you equating maturity or prevalence with the development of your “protective mechanism?”

      • Joshua

        I guess you are right. If doctors would start feeling normally and get affected with what they see inside the emergency room or with their patients, it will be difficult for them to become objective. :)

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