Thursday, January 15, 2009

post traumatic stress

in a previous post one of the topics i touched on is the aftermath of losing a patient or rather the effect it can have on you as the doctor. a good post i read recently also touched on the desensitisation we tend to undergo. it is often forced on us, as was demonstrated by the sister's comment to me after the patient died in my post quagmire. there was no space for feelings. she didn't follow me out to speak to the family and be confronted with feelings. she just jabbed me a bit, maybe to help with the desensitisation process.

but sometimes the reality itself doesn't allow for the luxury of emotions. there are so many stories i could tell to illustrate this point like the time one of my patients crashed while i was resuscitating another one. when patient one died i didn't have time to even register emotion. i had to get to the other one who was in the hands of my medical officer whom i had sent ahead. when i got there to find him dead too i mustered up the troops to get back to the endless streams of impatient patients in casualties. they didn't care about our emotions. they didn't want to wait and they were willing to throw abuse at us if they did.

but the real reason i'm reminiscing about all this is a recent conversation with an anaesthetic friend. he was also talking about the effects these things have on you. it is quite sometiong to have someone die literally under your hands and wonder if there is something you missed that may have changed the outcome. to possibly be partially responsible for the death of another human being seems to leave quite a mark.

he was on call. a disaster was presented and the team got to work. he describes scenes quite similar to the fan fair i spoke about in the case presented in quagmire. anyway the details are not important. the point is there was high drama and it was traumatic and shocking to all involved and the patient died in great thespian style on the operating table despite all efforts by everyone concerned.

my anaesthetic friend was shaken, as can be expected. he wanted to go home, or even just sit and let the adrenaline work out. (home would no doubt have been better). the theater matron came in. he looked at her with a blank stare. maybe he felt empty and his face reflected that. the matron asked;
"so what case are we doing next?"

just like that! the dead patient, the devastation of the family (still to be faced), the blood all over the place, the shock to the team, specifically the anaesthetist and all the matron wanted to know was what case to do next! in a certain sense you can understand it. the list is there. there is not another anaesthetist on call, so if he is not up to helping with the next patient, the next patient would not be helped. also it could easily be that the next patient is just as critical, but it could also be that it is something quite mundane. the point is my friend had no time to recover. reality steam rollered him and he had to deal with his own time...when he would be so tired post call he would probably not be able to deal with it. somehow that is the way it usually turns out.

when we fall off the horse, most of the time before we can even shake the dust out of our hair, we are shoved back on and the horse is given a hard thwack on its rump.


Anonymous said...

Nice post. Sometimes I wonder if I should stop studying medicine... Time you post something positive too!

Thanks and good luck.

rlbates said...

Very nicely said, Bongi. Reality often has a way of "steam-rollering" over us. Nicely said.

Anonymous said...

Hi Bongi,
We have similar problems in pre-hospital care in the uk. I have had multiple cases where we have been exposed to really rather traumatic deaths in the community. We tend to take a couple of minutes following the job before we press ' clear', and if we are lucky we might get sent back to station for a cuppa, but mostly we are asked to clear for a further emergency! I know both mine and your job dictates the need to be able to move on quickly for the benefits of other patients, but it doesn't make it any easier.

Anonymous said...

What a difficult situation. I wonder how long one can distance himself from strong emotion before you begin distancing yourself from people, especially the ones you care about, and then from yourself?

I used to work with victims of political violence. I found I had to use the 10 minutes between sessions to just cry.

mitchsmom said...

It feels amazing that the mundane things can and do go on after such an event.

In L&D, when we lose a baby (thankfully, not very often, but it's more shocking for that very reason, and even rarer a mom where I live)... but, just as you described... there's another mom at the desk saying, innocently enough, "I think I'm having contractions" - or the phone rings, or the buzzer buzzes, or whatever - life always goes on - definitely a clash of emotions in those moments.