To wonder how the hell drs, nurses and surgeons cope with dealing with death and emotional distressing situations as a regular occurance

[LardLizard]

Like the ones that work in areas of high stress like surgery or a and e etc

Also I think you are much more likely to be friends with your colleagues in these kind of environments. You bond pretty quickly. It is also pretty normal to cry at work and to (hopefully) be supported to process thoughts and feelings.

Bryan

Me neither that’s why I left

Just out of interest, is this why nurses (and doctors) come across as quite hard and uncaring? Nurses in particular seem to be very much 'oh you're fine, just get on with it' unless a limb is hanging off, I've even heard them admit that.

Partially I think that's the case, but in part (in my area of nursing at least) I know that getting on with things is generally the best course of action, and that some people need to be pushed a bit to do things they might not otherwise do.

For example, someone with serious depression may only want to lie in bed (possibly not eating or going to the toilet when needed). I can both feel very much for them, and know that they best treatment I can give is to use my presence to make staying in bed a less comfortable option. Because being active during the day tends to improve mood, but patients can rarely identify this at that time.

I think of this sometimes when I'm at work and feeling stressed. I think of all the amazing people working in healthcare with people lives in their hands, making life or death decisions, seeing traumatic tragic things day in day out. The nurses and doctors who brought dd back from the brink when she was in NICU, the nurses who supported me with my mum until the end. Then I think what a bloody cheek I've got moaning that my job is stressful and get on with my day. It really puts things in perspective. You are all amazing.

Ragged

Yes totally agree with your post.

During nurse training I rendnver working with a lovely socisl worker and we visited a woman who had taken up with a convicted paedophile. She was warned if he moved in her kids would be take into care. She choose him and told us over a fag ‘I will miss them’ as a 20 year old student nurse I was shocked. As a 50 year old mum now I would find it Very hard to not punch her.

I think social workers are quite frankly unsupported and unappreciated massively

@ragged it's interesting, but I can handle all that we've discussed so far, I've seen it all, burns units, NICU, Neurosurgery, ICU, etc., not a problem. The one thing that gets me, the thing that I can't handle, is when people (and I mean 'people' in the very broadest of senses - 'us', the media, the public, the people on the bus, nobody specific) start talking about who is 'deserving' of our care. Who is the 'nice' patient (think nice, polite, middle class lady, circa 60 years old) Vs who is the 'unpleasant' patient (think abrasive, slightly ungrateful, agitated male, early 30s, probably withdrawing from the cigarettes and alcohol he hasn't had for days). I hate it. For me, ill=deserving, full stop.

Totally agree ragged. Social workers have such a hugely difficult job. Frequently there is lots and lots of post registration training they have to go. Their work is often either unrecognised or whatever they do is wrong, while dealing with huge budget cuts.

I also dislike the criticisms that ‘detached’ surgeons get as they are often detached in order to do their job and get so heavily criticised for it.

You do have to step back rather than completely detach. It’s actually a privilege to look after someone at the end of their life- making sure it’s a pain free and anxiety free time makes all a huge difference (often I think more of a difference than many of the other things I do which prolong lives).

I think as Nemo said upthread, you are aware that you have to be strong for the family. Even if I’m very affected I make sure to take a breath and calm down before talking to family. The last thing they need at a terrible time is a staff member who is tearful.

Breaking bad news is hard, it never gets easy. But it’s a really important thing to do well.

Sorry, I typed the wrong name there, I meant I totally agree with Ohmydays about social workers being unappreciated.

@Ohmydayslove but you understand now that this woman had be groomed, yes? That it really wasn't as simple as a choice for her? Because if it was, there is no way that she would choose to lose her children. It was beyond that point of free choice. She needed the Freedom Course and she was a victim, too. Although it was absolutely right to take the children, sadly.

I'm a GP and I think it's easier to care as we know the patients better- usually have referred them into hospital and am waiting to hear how they get on. However I do worry that I become a bit immune to certain things. So many people have anxiety and depression and express suicidal ideation and I hear it so often, that I don't react I the same way I would have done when I was newly qualified or if it was happening to someone I knew. It's not that I don't care, just that I am very familiar with the presentation and will see 4 or 5 patients a day at least like this. I'm also time pressured so partially stressed that I have patients in the waiting room or visits to go on etc. I do care about patients and some patients resonate more than others but I also cope by things being familiar or even routine if that makes sense.

You disengage from you own emotions for the period of time you're dealing with it. Then you go home and digest. Doesn't mean you don't care - just have to do your job at that point.

I've caught myself welling up whilst breaking bad news to family which is when it becomes real and the human dimension comes in. Initially felt embarrassed by this but people know you're only human.

My job brings me into contact with children and young people who have experienced (and in some cases are still experiencing) very high levels of sexual abuse or neglect and who often have significant mental health issues as a result. It's never going to be easy listening to them graphically describing their experiences of sexual abuse and witnessing their distress but you have to remind yourself it's not about you or your discomfort, it's about them. You have to remember that they're so scared, so overwhelmed by the strength of their own emotions, they need you to be calm even if you don't feel calm. They need to have confidence that you can handle whatever it is they have to tell you, or they simply won't tell you. They may never tell anyone.

There are things that children have told me that I will never, ever tell anyone outside of work because it just wouldn't be fair on them. My Husband can generally tell when something like that has happened and he knows to not question me and to just pour me a glass of wine, put some mindless, escapist crap on the TV and give me a cuddle. Sometimes having a good cry in the car on the way home helps too and means I feel like I can leave it behind me when I walk through my front door. Colleagues who you know have your back and who share a dark sense of humour is also essential.

You have to remember that the more disturbing the information they're sharing with you, the more courage it must have taken for them to share it. To have them place their trust in you to that extent, to be the safe adult they feel they can unburden themselves to, is an absolute privilege. Witnessing their pain is traumatic but hopefully in time you also get to watch them heal and know that you've helped them on that journey to recovery.

I'm an anaesthetist, but also spend a lot of time in ICU and attend emergencies in ED. I think the most important part of my being able to cope with tragic events is knowing that everyone will die one day. It sounds trite, but for so many people outside the profession with no experience of death, the thought of it is terrifying and the idea that it might happen to their loved one is incomprehensible. I also have a fairly good knowledge of what we can do and what we can't do, to help people who are critically ill - again, this helps me be realistic, whereas to many people "there must be SOMETHING you can do." If there is something we can do, then I will get it done, and my focus is on achieving that; if there isn't, then I will try to ensure the patient has the best death possible in the circumstances.

For many emergencies there are well-publicised, straightforward algorithms, for precisely the reasons described here - it is a stressful situation and you need something obvious and memorable to stick to when there's chaos all around. I often think of Kipling's lines "If you can keep your head when all around you are losing theirs and blaming it on you..." It's important to remember that this isn't my gran/husband/child, this is my patient, and that is how I should be caring for them. I'm not hardened or desensitised, but I am more accustomed to it than the patients and relatives facing this awful situation for the first time.

There are still some cases which are more awful than others, and we do debrief amongst the team afterwards. I am more upset by paediatrics cases now that I am a mother, but even before then they were harder than almost anything else.

Nemo I loved your post. It made me cry. When I had my baby he was in nice and I was in intensive care. The doctors and nurses there were so compassionate and in my darkest hours of ptsd it’s the kindness and compassion that they showed for my husband )who was coping with this all alone) and my darling little boy that o remember how good people are. When my little boy couldn’t get a cuddle from his mummy as I was tied to machines in hdu his nurse held him when he cried. Absolute saints every single person who works in nicu. Thank you!

Another ex-a&e nurse here. I find most of us develop a dark sense of humour to deal with it. And you often need a quiet cry in the sluice. I used my commute home to sob sometimes too. I think the good days help, the days a patient says thank you or you really feel like you’ve achieved, you cling to those days and they make the bad ones not so bad.

I work in the NHS, I used to sit next to a lovely HCA and as we chatted about this and that she said she used to work in maternity, I asked a few questions about it and she mentioned that she'd taken a good few stillborn babies down to the mortuary. I said something along the lines of how awful that must be and she looked a bit surprised and I can still picture in my head to this day her response 'NOOOO, not awful at all! I am so privileged to give those babies their first and only wash, I dress them and hand them over to their mummies and families for their first and only cuddles. Then their mummies give them to me- they trust me with their precious babies to take them down. I say a prayer for them all as we go' (she is a deeply religious lady). I'm not one for emotions but it choked me up a bit. She went on to say what a privilege it was to take their hand and footprints and to cut a lock of their hair for the memory box that hospital gives out to bereaved parents. She cared so much but really didn't see a 'bad thing', just her role. I'm choked up now thinking about that conversation.
I also work with lots and lots of junior doctors (on rotation) and I was on the edges of a big lunchtime conversation in the staff room where we were asking them about how they felt about their A&E or NICU roles and most of them responded along the lines of they dealt with death because they had to, they managed to get on with it because where they'd been involved with the care of a patient who'd died they knew they did what they could. They'd been there and done the very best they could do to keep that patient alive. That the only way they couldn't live with the outcome was if they'd stood and watched and done nothing. As someone who isn't a HCP I thought that was very powerful, how grateful we should be to those who take our lives in their hands. They got very very heated about children and uncut grapes. I won't go there but I don't think I'll ever not cut my children's grapes after what I heard there.

lougle

That’s a very very good point and I honestly have to say I hadn’t seen it that way. She was older then me but I was only a 20 year old kid. Yes she could have been groomed all her life. I judged her from my own nice upbringing.

Goodness me your post has really made me think.

Bear... Hope you and your little one are all good now. The baby cuddles are one of the best parts of my job! No one ever minds that! Working on a NICU is actually wonderful, its such a supportive environment. And to counteract the hard and horrible stuff you have ten times more amazing stuff. Like when you get a tiny premature baby out for its first cuddle (they might already be a month old) or when you get a twenty four weeker all the way to discharge (three or four months on NICU). Those bits make you emotionally stronger for the tough bits!

Can I say what a lovely if sad thread

Yes, if I look back to the incident that has upset me most, it is the time when I didn't stick my neck out and argue to allow my patient’s husband to visit her before she died (he was in isolation elsewhere in the hospital).

I was only a very junior doctor, but I knew my patient was dying (it was quite clear to me, her and the nurses, but the rest of the medical team wouldn’t admit it). I feel I let her down. I should have argued harder.

It must be very hard to deal with it day after day. But I can't help but feel that it's a bad thing that humans have become so distanced from death. That it's become so taboo. It's a normal, natural part of life.

I think my job is why I find the idea often stated on MN that you shouldn’t be good friends with work colleagues. I really couldn’t face the death and destruction I see without the friendship of my colleagues. Their black humour and hugs get me through.

I'm old enough to remember the days when police were called to visit people with bad news about their relatives. My parents had a friend who was a policeman. He called one day to beg a cuppa from my mum because he'd just called on a lady to tell her that her husband had died suddenly at work. I was only a little girl then but I can remember how upset he looked.

I think what you realise is, as SockQueen says, that death and emotionally distressing situations are a part of life. We can’t change that and are as prepared as we can be for it, in contrast often to people who have never experienced these.

Tbh, the things I have seen some of my friends go through in real life, are as bad if not worse than things I have seen at work.