physician grief

[selvanr4]

Do you grieve if you lose your patient unexpectantly? How do you manage to come out ? do you turn to religious texts, solitude, or others?

please mention any reading materials also

selvan

[Stefan Johansson]

Thanks for raising this important topic.

Personally, I can be influenced a lot about death and misery in the NICU.

And, I believe we could help each other in the NICU to manage these events in a more professional way. We are so keen to formalize and structure a lot of things/procedures, but this field is a white map for everyone to "do their best".

I do not have any good solutions how we could cope in a better way, my point is that we may not just go away for a coffee break and then start working "business-as-usual".

How I have solved this... my daily bike trip to/from work is my most important time for reflection (this may seem a bit strange, but it's true!). I process a lot of the days burden this way.

Music and ordinary family life are also essential.

I must rush now, will follow this discussion closely!

[selvanr4]

I have found it difficult to come to terms with death at times.

Hindu religion says that you have to leave for the other world which is blissful , to be with the Creator.I sometime think that the time has come for the baby to reach it's home and be with the GOD. ( i worry lot about the mother and father and their aspirations)

I take some time off ,to reflect back. to talk to seniors about what could have been done and read the latest on the condition including untested anectodes.

i Talk to family ,friends for support and wait for the healing time.

Remember to note any important things which might be help in future treatment.

i do not know any set protocol to come out of grief;

as you said ,it's worth pursuing

selvan

[Stefan Johansson]

Although I think religion can be supportive at these occasions, I believe that suffering and grief is a universal human feeling. I mean, for example, if African parents with 8 previous children loose a newborn baby, I am sure they share feelings with a couple in Sweden, losing a child that was a result of in-vitro fertilization.

I belong to the state-church of Sweden (i.e. I am a protestant) but I must admit I hardly ever go to church as a practising christian. Maybe I cannot find religious support for myself due to myself being closer as an atheist or agnostic, but I find it hard to "understand" or reason about the death of a newborn infant. Nature is mysteriously cruel sometimes.

Just in case someone would misunderstand my first post, what I have sometimes lacked in the NICU is not really a clinical protocol "Handling grief - chapter 1-9". But more that the working group should be more aware of grief and to "see" it, in ourselves and in others in the team. That we have an opportunity to put some words to it before leaving our shift.

[panwaranjika]

i believe when we r out to save some we r surely going to lose a few . the point is put in ur best effort , the best way possible . make sure that death of one pt does not adversly affect mx of other ones . i prefer to go for a long run longer than my usual distance when something unexpected happens in my nicu .

[JACK]

We are all human and to expect stone like emotions from any medical staff is hypocritical. But at the same time, we are called upon to make many decisive decisions multiple times through out the day.

So it is part of our duty, to remain focused on our job, to be objective while taking decisions. Too much of emotion may cloud judgement and may force us to take erroneous decisions. We have families of our own and with them we are completely human and have visible emotions. But I think that the parents of our babies in NICU, expect objectivity from us, they expect us to be a little bit less human,....little more mechanical...more strong willed. They expect that no matter how distressing the situation and no matter how severe the pain they feel, their doctor will remain focused and will do what is right 'all the time'.

I also do feel grief, but i strongly believe that if I internalize the grief it may affect my decisions while dealing with other babies. Though not always possible, we have to try to be as detached (emotionally) from our babies as possible. Though it is impossible to be 'stone hearted' when you look in the eyes of a helpless preterm, but I feel doing this is best for the baby.

[selvanr4]

i searched the pubmed and found out an article on one model which will help the physician. It shows that only little is known about it and the research is limited. Why don't we try to put in our thoughts an d write a paper and send it to ADC of ACTA?. It will kindle discussions and might bring out a model

( not manual as pointed out by stefan )which will help every one.

any support?

selvan r

Erode. India

[Stefan Johansson]

Why don't we try to put in our thoughts an d write a paper and send it to ADC of ACTA?

Good idea. As an editor I know one needs to consider the format before submitting. It seems that ADC has no suitable format for this kind of paper, but the "different view"-series in Acta may be suitable.

I am terribly busy right now, but would like to participate in the group as a co-driver. Selvan - would you like to be the coordinator?

[selvanr4]

yes, i will be pleased to do.

[Stefan Johansson]

yes, i will be pleased to do.

I know the editor-in-chief of Acta (prof Hugo Lagercrantz), I email him and ask about the idea.