When a patient dies

341972-8fce3496-cf08-11e4-b2b7-70a9cb122812I wasn't going to write this. Ever. I'm not sure why. I think out of respect of the families of patients whom I have looked after. I think as my own coping mechanism, not to talk about things that make me sad. However, the last couple of days have seen this picture - a doctor, grieving for the loss of a young patient in the emergency department. It really tugged at my heart strings. I've been that doctor. We all have, publicly or privately. The nature of medicine is that patients do leave us. It's something medical school seemed to want to prepare us for. We learnt how to break bad news. We talked about services to offer families in their time of need. We talked about paperwork. I don't recall talking about how to handle our own grief though. And I'm not sure that is because it was a glaring omission from our training. I think it's because nobody really gets better at it over the course of their career. It hurts the first time and it will hurt every time after that.

The times I've had to tell someone's family that the person they love in this world is no longer here, it's an overwhelming experience. Sometimes, I want to cry with them. I don't think that's the right thing to do, so I choke down my own tears and emotions. I always feel like I need to be the strong one there for this family. But that being said, I have no idea what words, explanations, services or tea to offer them to make anything I say hurt any less. Their pain is so raw and I feel so badly for their loss. I wish I could take it away for them, or at the very least, find the right words to ease it. I'm really not sure that's possible.

This doctor, grieving for his patient, is something we've all done. We'll wish we were smarter, even a miracle worker. We wonder what else we could do, even in the face of heroics, it always feels like we fall short. It's like you spend years and years training to save people and then you can't and it feels like you have failed. We take a moment as a team sometimes and then pick up the pieces. Because what's hard is that there is someone else who needs our help. I wish we had time, to walk outside and cry or pray or whatever gets you through the day. I cry. Every time. Just a moment usually, in private. Sometimes, I've sat in the chapel for five minutes, just thinking. Other times, I've had a glass of wine that night to just turn everything down a little.

I think sometimes of the patients I've looked after who have died. Some patients I've known for only minutes. Some, like our transplant patients, I've known for years. Likewise their families. I wonder how they're coping, how they're doing. Some patients have stuck with me so much, I can close my eyes and see them. I remember their names and occupations and life stories. Although we do often pick up and keep going, they're there with us for a long time. Maybe they'll be there forever.

I think we should prepare medical students for these horrible times. Maybe its changed since I was in medical school. When my juniors, my medical students see somebody pass away, I try to remember to thank them for the efforts they went to and tell them they tried their best. Sometimes, it's hugs all round. One of my anaesthetists gave me a hug one day when I was particularly upset by a young person dying and it just made me cry but I'm so glad she did. It made me remember we're not alone, we worked as a team to the best of our ability (and sometimes beyond). I guess to the medical students I just want to say, it's hard and it never gets any easier.

A doctor's grief for a patient will never match the grief their loved ones feel but it hurts like hell.