Tips for a difficult death

[u/Amazing-Ad8160]

New attending. Had a gruesome death of a little boy happen in front of me the other day. I will spare the specific details but it was a penetrating trauma. Peds trauma cracked his chest, chest tubes, whole blood, blood on the floor, fingers in the wounds to stop the bleeding, the whole deal. Screaming parents and grandparents afterword. Have two sons similarly aged and I can’t get this out of my head to function normally at home. Just so happened to happen right before a week off so haven’t been back to work yet. Seen what seems like tons of deaths at this point and was never affected to this degree . Never seen a traumatic death of a healthy child though (seen pediatric codes but chronically Ill kids on borrowed time) Any tips for getting over it? How do you deal with bad deaths and making sure you don’t develop ptsd/burn out? I love what I do but if this was any weekly occurrence I would quit.

[u/Baileysahma]

You should absolutely seek out debriefing which should have been offered to you by the hospital before the end of your shift. If they fail to provide this you should find a professional provider on your own. Some situations will haunt you all your life unless you process them and no one will protect you from this but you. I am so sorry.

[u/sluggyfreelancer → u/Baileysahma]

Debriefing that should have been offered by the hospital? Before the end of the shift? Have you ever seen that? In my over a decade of practice I have not seen any post traumatic event debriefing that wasn’t run by the attending. Who else from the hospital would be offering this?

[u/revanon → u/sluggyfreelancer]

**waves**

(For clarity: I don't ever try to take the place of an attending-led debrief, and I'm often instead with the patient's family immediately after. But when a particularly awful death or experience takes place, I do try to pull aside the folks most involved in the event, since I can offer a different skillset in helping them process what they've experienced and, if need be, offer them additional resources.)

OP, about a year and a half ago I had a death of a little child who was my own kid's age. I still think of that kid and their family, and there are particular memories of the code I don't think I'll ever forget. I say that not to be a downer or tell you those patients stick with you forever, but to say that there is way to process such deaths in a way that lets you remember how deeply you've been impacted and the humanity of the child you cared for while still moving forward with your life and career. Therapy, as others here have said, is a big part of that, but so are individual practices of reflection, meditation, self-care, and the like, whatever may work best for you. The goal isn't to get to a place where you're just numb or apathetic to the very worst experiences we have in the ED, but to get to a place where you are able to respond to such an experience by tapping into a preexisting support structure that exists both internally within yourself and externally with other people who care about you. Happy to offer help or care however I can via chat or DM.

[u/sluggyfreelancer → u/revanon]

Thank you for the thoughtful message. I agree with everything you said. I am not dismissing the role of reflection or other practices people find meaningful. I have used therapy, prayer/church/bible study, and creative writing as coping mechanisms myself. I also try to debrief my team after traumatic events and provide whatever lay guidance I can.

What I was responding to is that I have never seen a hospital who has a resource dedicated for this in the ER. I work at a well resourced hospital right now, and there is not such resource for on shift debriefing. It's really up to the attending physician. There is no ER dedicated chaplain. Sure, we could call a chaplain (like any other hospital service can call one) but they are not available on a time scale that is relevant in the ER. And that would still be on the attending physician to arrange that. So I found the comment about "debriefing which should have been offered to you by the hospital" to be laughably naive.