Coping with Patient Deaths

A few days ago, I experienced my first OR table death. I am still in SHOCK.

A patient bled to death during surgery while we tried to remove a ruptured bleeding tumor.  HYPOVOLEMIC SHOCK.  It was a traumatic experience to struggle with suturing to complete the surgery, during external compression of CPR.

When I scrubbed in, the estimated blood loss was already 2 liters - hemoperitoneum from a ruptured tumor.  Our usually cool anesthesiologists asked me at least four separate times in different ways: "doc, have you controlled the source of bleeding?", or "doc, have you ligated the bleeders already?", or "doc, have you successfully clamped the bleeding tumor?" and if "doc, is there any active bleeding?".  Just as calmly, the team of anesthesiologists informed me that the patient was bradycardic (heart rate slowing down)... then that the patient was almost coding... and finally that someone should initiate CPR because she flat-lined. 

All these events seem like a flurry of events happening before my eyes.  We struggled to remove the uterus and suture close the stump and ligate all bleeders with all the movement of somebody else doing CPR to revive the patient.  We heard someone say that there was blood coming out of her nose and through the oral tube.  Blood was being pushed through the IV for faster transfusion.  People were running to the blood bank to get more blood.  People were calling for help.  Residents and interns were taking turns at external compression.  We stapled the skin (OBGYNs almost never use stapler for skin closure) just to finish the surgery as soon as we could.  We continued with CPR for more than one hour, administered two shocks and gave 8 doses of epinephrine.  With somber faces, the whole team wordlessly accepted that the patient was gone, despite all our heroic efforts.  MENTAL SHOCK.

I had to face the patient's life partner to show the tumor that we had removed, and to explain that the patient's heart stopped because she had lost so much blood.  Even before I had finished speaking, the husband started sobbing.  It was heart-breaking, and all I could do was to offer him my condolences.  I could not give support, because I was in shock too, EMOTIONAL SHOCK.  As soon as we showed him the ECG reading showing a flat line, I returned to the operating room and had my own cry. It felt a part of me died with the patient.

My friends told me that it is alright to grieve and to mourn the patient "because you are human.  That was a woman who died.  Someone's wife and daughter.  So yes, you should grieve"

I had difficulty sleeping that night so I wrote a post on facebook to express my grief:



In our hospital, maternal mortality is high.  There are several mothers who die of pregnancy-related causes every month.  How does a health professional keep emotionally divorced from death and dying, especially if you wonder if the deaths could have been prevented?  Writing this blogpost may be cathartic (therapeutic) for me as a doctor, but I honestly wish to discuss with others out there who may have experienced these challenges and difficulties, so that we can help each other cope with patient deaths - so that we can serve our patients, but not at the cost of our own emotional and mental health.

1. How do you cope when you lose a patient?
2. What advice can you give to a fellow HCP who grieves over a patient's death?
3. What is the role of social media in helping HCPs cope with grief over a patient's death?