A lovely 56‐year‐old woman was admitted with ongoing issues pertaining to a recently diagnosed lower‐extremity deep vein thrombosis (DVT). She was originally diagnosed with heparin‐induced thrombocytopenia, but re‐presented with a new DVT despite adequate outpatient anticoagulation. On admission, the patient was initially managed with intravenous bivalirudin; however, during the hospitalization she experienced issues of both peripheral bleeding and progressive DVT. She was switched from bivalirudin to fondaparinux with improvement. On the expected day of hospital discharge, the patient developed “the worst headache of [her] life” and became unresponsive. Emergent brain computed tomography imaging revealed a large left intraparenchymal and subarachnoid hemorrhage. Despite maximal efforts, the patient died the following day in the neurosurgical intensive care unit. The patient's inpatient stay lasted 25 days, during which time the team came to know her as an engaging, kind, and optimistic woman.
Death is not infrequent in the management of patients on an internal medicine service and is intermittently unexpected. A dedicated session to identify and decompress our feelings about the loss occurred less than a week after our patient's death. The entire team was present: attending, senior resident, 2 interns, and 2 medical students. All acknowledged feelings of trauma and grief. The attending identified informing the patient's husband of her passing as traumatic as the patient's death itself. He also freely admitted to crying after the patient died. “I'm OK with that. The day I stop is the day I probably shouldn't be practicing anymore.” The senior resident struggled with the conflict of feeling badly about the patient's death versus feelings of guilt regarding management decisions, as her intracranial hemorrhage was a possible consequence of a treatment he sanctioned. He described a commonly utilized means of dealing with such feelings: “You have to become calloused to what we see in order to do the job.” The intern's feelings about the death focused on regret that he was not in the hospital at the time of the event, as a consequence of duty‐hour requirements. Intense emotional reactions of medical providers to death occur frequently, regardless of gender, rank, or specialty. Literature suggests medical trainees often “cope in isolation,” and that their emotional reactions can affect their subsequent patient care and personal lives. Teams are likely to benefit from the opportunity to “share emotional responses and reflect on the patient's death,” as ours certainly did. All present for our debriefing session strongly agreed that such a discussion was essential in processing this unexpected death.
We propose that attending physicians dedicate time for discussion of such emotions when a death occurs on their service and for educational efforts to improve attending physicians' comfort and skill in leading such discussions.
To cite this abstract:Sankey C, Fogerty R. Death and Grief on an Inpatient Medical Team. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 439. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/death-and-grief-on-an-inpatient-medical-team/. Accessed April 25, 2019.