The Time to Grieve: A Difficult Question in Medical Training

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The sixth time her heart stopped, perhaps our surprise was matched only by our exhaustion as we reinitiated CPR. The usual activity surrounding an arrest seemed lacking as we again attempted to resuscitate this elderly woman in multiorgan failure. Despite our multiple attempts to address goals of care, her daughter was focused on a miracle. After the fifth arrest, the nursing staff asked, “Why are you doing this? This is wrong. We can’t participate in this.” Whether or not we agreed with the futile efforts ahead, our role was to lead the code, so we did. For better or worse, the patient did not survive her sixth arrest (all within one hour), and, after briefly comforting her daughter, we returned to rounds.
This was one of the most jarring moments in a fulfilling but emotionally difficult three years of internal medicine residency. It was not only the extreme number of resuscitation efforts on a single patient but the intern’s tears (quickly wiped away after 10 minutes to scarf down lunch) and the staff’s words that would remain the most memorable.
More difficult than becoming accustomed to patient death during residency is grappling with the lack of time to grieve. Because strength and efficiency are valued above most other traits and because we must provide for multiple patients and families at once, it is rare that residents manage to process the deaths that occur during their training. Not only is there minimal time, particularly immediately after such events, but there is minimal training regarding how one handles the death of someone who is neither family nor friend, but patient. Each patient death is a unique event, and every provider will likely have his or her own reaction, making education in this realm particularly challenging.
Recently there has been increasing focus on resident well-being and reflection, with wellness groups being developed and many residencies holding peer-to-peer sessions to reflect on difficult patient experiences. Although these are a welcome development, they rarely coincide with the immediate post-event processing that residents may need. A first step to improve physician comfort in discussing these issues with one another so that our senior residents and faculty can lead by example is to create a learning environment where discussions and manifestations of grief are accepted. In this way, we might work to alleviate the grief-related mental distress and potential burnout that trainees face.
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