Wednesday, 1 August 2007

Is there something wrong with me?

Posted by: Dr. Thunder

It is in some ways ironic that the birth of this blog features a post that dwells on death.

I’ve spent a lot of time today asking myself if there is something wrong with me. I mean apart from the obvious! I’m talking about my abilities as a doctor. I tick most of the boxes.I think my clinical skills are reasonable. My theory is OK. I get on with the staff that I work with. But what I mean is do I react appropriately to emotive situations? Am I kind and sensitive enough to be a paediatrician? Am I the type of human being that people want near them in their most difficult hour?

Let me explain:

I was on the night-shift last night. I’m a junior paediatrician in a very large children’s emergency department in the UK. In the early hours of the morning the paramedic link-radio crackled into life at the nurses station. Ambulance control told us there was a crew enroute to the hospital with a 4 year old girl. “She has no pulse and she’s not breathing”.
A+E sprung into action in the way that it does. Drugs were prepared. Life support machines were cranked up. The intensive care team turned up. Even the surgeons popped in to see if they could help.
Nobody could help.
The long and short of it was that this beautiful little girl died long before she was brought into our department. It looks like she passed away in her sleep. We don’t know why yet. We tried our best to save her, but there was no hope. We gave her about 20minutes, without even a flicker of life.
As we gave up, the room was full of tears. It’s common after a paediatric death to see experienced staff crying. Everyone pulled it together as we called her parents and her older sister into the room.
Agonising, anguished howls filled the department as this poor family was torn to pieces by nature’s cruel hand. Looking helplessly down at your still, cold child is a situation I can’t even imagine being in.
When the commotion died down, and the family were sitting in the relatives room with the hospital priest, the A+E staff had their time to grieve. I walked into a darkened room, as doctors, nurses and auxiliaries all sat together. Nobody said anything. More than half of them were still crying. This isn’t a typical scene in an adult death, but it’s pretty common after an unexpected death of a child.

I don’t really work like that, though. I felt terribly sad for the family. My stomach churned when we called time on our resuscitation efforts. But I wasn’t upset in the way my colleagues were. I didn’t know the child, and I didn’t know her family. I spent about 15 minutes doing chest compressions on her, though. I was there in her final moments. But I wasn’t overly upset. I’m the one who went to see the next patient 5 minutes later, a toddler with an ear infection.

I’m not trying to be tough by saying any of the above. I’ll freely admit I cried when I lost my first adult patient as an intern, and I cried the first time I lost a baby at her delivery when I started paediatrics. I just wonder why I wasn’t upset, while grown men in our department shed tears. Why am I not affected like everyone else?

Some people say that when you stop being upset at a child’s death, then it’s time to leave paediatrics. Maybe this is true. Maybe I don’t have the emotional capabilities to do this job. Maybe we need people who can just get up and move on after tragedy. I don’t know. I’d be interested in the thoughts of others though.


  1. I long ago stopped getting upset by individuals dying. It does kill me to feel I've failed someone (even when I know deep down it was out of my hands) but the idea of loss being upsetting went a long time ago.

    Its not something wrong with you though, thats not something you should ever consider.

  2. Not a doctor, just a transfusion scientist, so I don't know how much worth my opinion is; however, I wouldn't be too quick to say there's anything "wrong" with you at all. Now, I don't know you, so when you say you were unaffected I don't know exactly in what way you mean, but I think it's perfectly possible to be affected, to be saddened, and just have enough control that you don't indulge in the pain and sorrow (it can be a subconscious control - it doesn't have to be that you are consciously making the effort not to be overcome). And like you said, you were the one who was able to go off and deal with a boring, mundane ailment 5 minutes later. Boring, mundane and non-life-threatening it might have been, but the poor kid still didn't need to wait half an hour while people got hold of themselves :)

    I agree with the idea that if you stop *caring* about the death of a child, then get out of paediatrics, just like if you stop *caring* about the death of any patient, get out of clinical medicine, but caring about something doesn't have to mean crying about it.

    Besides, people like me will cry enough for any number of non-crying people :)

  3. I think you need professional distance, or your ability to do your job is compromised. Maybe it's just another price you have to pay to do the job you do.

    sincerely, thanks.

  4. i think people deal in different ways.

    i've had many patients die, and it can be tough, but for the vast majority of those cases you just have to move on. Professional distance is the key thing. No matter whether your doctor or nurse or any other health worker.

    I don't think that it means you shouldn't be doing the job, I think it just means your getting better able to cope

  5. I agree with with the previous posters, give it a few more weeks before you pack it in and become a plumber. Welcome to the blogosphere and I look forward to the next one!

  6. It's not wrong that you don't cry, you have admitted that you were sadden by the death of the child. You mourned her, but moved on quickly because as a doctor you are forced to. Even if you feel this is wrong, it is never your fault. The career calls for professionalism and the ability to step back. You seem to show that and still care.

    Like above, when you stop *caring* then you should get out not when you don't cry.

  7. Welcome to the blogosphere!

    Professional distance is a must, as professionals we need to protect ourselves, being sad is a normal reaction to the death of a child.
    If you did not care anymore you would not of written about this experience.

  8. It's quite a contrast to the scenes on a DME (care of the elderly) ward in the hospital where I used to work. There was normally an unseemly squabble to get the "ash cash"


  9. If I brought my nephew or niece into A+E with a serious condition I want a doctor who is focused on the job, dispassionate and clear of mind. I dont want a teary mess because his last patient was a no-hope case who bit the big one.

    Sorry if that sounds callous, but you're job is to save peoples lives and you can only do that with living people. At the end of the shift, reflect if you feel like it but time is a factor and what if the next kid had had something far more serious then an ear infection. There are plenty of people to empathise with the parents, there arent many people who can save the next kid.

    Stay clear of mind, focused on the job and detached from situation. If I were a parent, I dont care if you are the most heartless c*nt God ever put in shoe leather so long as you do your very best to save my kid and that requires you to be on the ball not an emotional wreck.


  10. You dont go on a 3 day bender when you save a childs life. .

  11. I usually cry when we lose a kid.

    After my shift is over. There isn't really time before then. The last time I cried before the shift was over, I'd known the child for nearly six months. If it didn't touch you at all, I'd worry that you should get out. But you were saddened. You just kept control.