المتخصصون في المجالات الطبية

June 23, 2023

In past decades, when a patient with a traumatic injury died, the trauma team culture was essentially, "Suck it up, buttercup."

The idea was to put away your emotions after a death and move on to the next patient.

"Sadly, that's the reality in the trauma bay and ICU settings," says Brenda M. Schiltz, M.D., M.A., a pediatric ICU specialist at Mayo Clinic in Minnesota. "You still have to carry forward. The next patient deserves your full compassion and thoughtfulness just as the patient who is deceased. That's not easy to do, and I had to learn how to do that well."

Yet while the next patient has valid needs, a medical professional also may have legitimate needs following a patient's death.

"We're still combatting the 'ignore your emotional response' mindset and trying to find the right balance of taking a moment to process what just happened, have a breather and then set it aside in order to complete our shifts," says Dr. Schiltz. "Yet there can be times when you just can't go on to the next patient."

Dr. Schiltz explains that while the medical community used to frown on its professionals stepping away after a patient death, now it is crucial this be respected.

"There's been a culture shift in dealing with patient deaths," says Dr. Schiltz. "It used to be about just powering through, and there was stigma that you were weak if you couldn't. Now the culture has moved to thinking that if you can't perform your duties, stepping aside is the best thing for you as a professional and for your patients at that time."

Grief manifestations in medical professionals and addressing the emotions

Cathy A. Dudley, a specialist in Decedent Affairs at Mayo Clinic's campus in Rochester, Minnesota, says she sees physical manifestations of grief in health care professionals, especially after an unsuccessful resuscitation. She perceives that emotional impacts compound for trauma professionals, who see patients after near-fatal injuries and witness patient deaths.

"It's not just the deceased patient's family who grieves — it's the health care team and everyone working in the area when a person dies," says Dudley. "People need to find their coping mechanisms to come to grips with the inability to save the patient, especially in trauma."

Just like these colleagues, Dudley says she understands the need to address her own emotions related to deaths in the hospital.

"I know when my accumulated stress is due to the numerous deaths I've seen, and I need to take care of myself," she says. "Don't think you've got it down and you don't have to take care of yourself. Emotions from a death have a way of rearing their ugly heads later. It's just knowing when to take time and learning how to cope in productive ways."

Dr. Schiltz says after a patient death, dealing with one's emotional responses as a professional is equally as important as a mortality review conference to review the care given to the deceased patient.

Taking tragedy with you as a medical professional

Though medical professionals may attempt to move on after a patient dies, the emotions surrounding such events can go home with them. Dr. Schiltz advocates for equipping professionals to address negative events at work.

"Patients die — that's part of what happens in health care. We witness suffering, critical illness and health deteriorate to the end of life," says Dr. Schiltz. "However, you have to leave it at work. A chaplain friend of mine at Mayo, Zach W. Lovig, once said that when he goes to work, he envisions wearing a backpack. He uses this backpack to carry or help shoulder people's loads, bearing heaviness with them. He said that when he leaves work, he envisions removing the backpack and then goes home."

Dr. Schiltz says medical professionals must "remove the backpack" to fully participate in their home lives, stating "there's a sacred time and space at home and at work."

Due to the persistence of death at a hospital, Dr. Schiltz indicates that helping professionals cope with tragedies such as patient deaths is critical. She mentions that physicians have the highest suicide risk by profession, a statistic unacceptable to a younger generation of medical professionals, who have insisted on change.

Dr. Schiltz says time in the field has impacted her outlook after a patient tragedy.

"Health care professionals want to be compassionate as caregivers," she says. "Without compassion, they'd be robots. Now my perspective is that death is a part of life. This is our privilege to be part of intimate moments between life and death. I have become grateful I'm able to be there."

Tools to help you through the death of a patient

Dr. Schiltz says professionals grieving the loss of a patient need support and help from others.

She says there is no one right way to process grief, but she explains that Mayo Clinic encourages the use of the following tools that may be useful at other trauma centers:

Work colleagues. It's important to develop a relationship with a colleague who can identify anything amiss with you. This might mean noticing you are missing meetings or noting you are now drinking significantly more coffee or eating foods such as cheese puffs and chips. Sharing triggers and even your unhealthy coping mechanisms with a colleague can help that colleague look out for you.

HELP. Mayo Clinic in Rochester and Mayo Clinic Health System sites offer HELP, a program offering peer support for stressful or traumatic work events. The program provides an opportunity to talk to another person without judgement or offering solutions — the peer is simply open and listening. Dr. Schiltz says half-day trainings for this program are available, and she welcomes trauma center inquiries about starting HELP.

Attuned managers. In high-risk hospital units, managers are attuned to death. Whether in these units or lower-risk units, it is key that supervisors check in with staff members, directing them to grief resources after a patient dies. Dr. Schiltz recommends that managers proactively seek out these resources before they are needed.

Office of Decedent Affairs (ODA). At Mayo Clinic, a specialist from the ODA arrives after a patient's death and speaks to the attending nurse. Dudley says this interaction connects the nurse and specialist and demonstrates caring. The ODA specialist also can condole the entire care team, helping to honor the patient and acknowledge the death.

Dudley says the ODA specialist also helps the deceased patient's care team navigate all needed tasks after a death occurs. The specialist presents the family with the opportunity for a postmortem examination and explains how the family can give back through research and education. They help with funeral home logistics, donation opportunities and transport. They even take care of the patient's belongings, ensuring the family members have what they need prior to leaving the hospital. All these tasks that nursing staff previously performed now are taken care of by another team member, offering relief to nursing after a patient dies.

Hospital chaplains. In cases of unusually difficult patient deaths, a Mayo Clinic chaplain will go to the unit where the patient died and arrange a nurturing time for the care team. This typically includes snacks and opportunities for the team to speak with the chaplain.

Employee health. This is a service available at trauma centers of any level. It includes mental health services for staff members.

Refreshing activities. Dudley says when her emotions are full from experiencing patient deaths, it refuels her to get out in nature and take her dog on walks. She also says, "A good piece of chocolate cake doesn't hurt once in a while either."

Dr. Schiltz says she is aware a patient death in a small community may include the added complexity of social ties to the patient and family. Another unique factor for hospitals in smaller communities is patient transfer to higher care levels. With the transfer, the local trauma team may not know if a patient has lived or died. Dr. Schiltz suggests follow-up with the receiving hospital for a patient update post-transfer.

"There is an added challenge with a lack of closure," says Dr. Schiltz. "If you transfer a patient to Mayo Clinic, you are always welcome to reach out and inquire about status."

For more information

Refer a patient to Mayo Clinic.