Coping With a Patient’s Death
January 2020 Issue
I didn't think it would be an appointment that would affect me so profoundly. It seemed routine: an orthotic casting appointment for a ten-month-old girl. She was slightly on the small side for her age, and I remember holding her feet gently as I took measurements and checked her range of motion. Her mother was young, earnestly trying her best to manage her child's medical complications and understand the various treatments she needed. We talked at length during the appointment and I looked forward to seeing the family again.
I received an email a few days later from the physical therapist that our little patient was admitted to the hospital. I put some good thoughts out into the universe hoping she would get better and moved on with my day. The physical therapist told me later that week our patient had a heart attack and had passed away. She offered to send me the information regarding the funeral service, and I did my best to hold myself together in front of her. I promptly went to my car to cry.
I spent the next few days and weeks trying to make peace with my patient's death. As a company, we typically send a sympathy card to the patient's family. I decided I would write a small separate letter to send with the card. A few weeks later I received a letter from the girl's mother expressing how grateful she was we had sent a card, and that she thought her daughter would have more time in this world. I did my best to sort through my own sadness. Even having worked with the patient for just an hour, the loss affected me deeply. I spoke with other practitioners at work, which helped greatly. I took comfort in their words but still felt empty. I did my best to focus on the fact that I had treated her and her mother well. Ultimately, I pushed the feelings aside and devoted more energy to caring for my patients. I wish I had taken more time to work through the situation properly.
In our profession, we can form meaningful long-term relationships and bonds with our patients over many years. We have the opportunity to be truly connected and engaged with the people we care for. This connection can happen over the course of one visit or over many years. Haris Kafedzic, CPO, Eschen Prosthetics and Orthotics Lab, New York, says that "dealing with the death of a patient is something many healthcare professionals will experience in their career. The prosthetist-patient relationship is very unique in that it can be a lifelong bond. Losing a patient can be as tough as losing a friend. I still remember all the patients that passed away. It's important to be able to grieve your patient's death, but not let it affect your work in a negative way."
With the opportunity for long-term relationships comes joy as we see our patients succeed, but also sadness and grief if they are ill or pass away. It is important for us to take care of our own emotional health so we can continue to support our other patients and to remain happy, resilient individuals.
Rae Figueroa, CPO, Capstone Orthopedic, Castro Valley, California, says, "Losing a patient is tough—especially longtime patients and patients hat frequent the office (e.g. prosthetic patients). It's probably one of the toughest parts of the job. I usually get through these times by speaking with the other office staff, reflecting on the patient's rehabilitative successes, which we helped them accomplish through our services. Knowing that I helped increase their quality of life helps ease the pain." Other strategies include seeking the guidance of a senior practitioner, reaching out to a colleague who has also lost a patient, seeking the support of your family and friends, talking to other members of the care team, and being available to the patient's family. The common thread in all of the suggestions is not to retreat into your shell, but to engage with others and find peace through interaction.2 Per an article with interviews with several surgeons about patient loss, some surgeons kept in touch with the family of the patient following his or her death, and one found confidence and reassurance from this type of interaction to continue practicing. Many said that talking to someone they trusted helped to objectively frame the situation.3
A study conducted in three Canadian hospitals in 2010 and 2011 involved interviewing 20 oncologists of varying age, ethnicity, sex, and experience regarding patient loss. "We found that oncologists struggled to manage their feelings of grief with the detachment they felt was necessary to do their job. More than half of our participants reported feelings of failure, self-doubt, sadness, and powerlessness as part of their grief experience, and a third talked about feelings of guilt, loss of sleep, and crying. Our study indicated that grief in the medical context is considered shameful and unprofessional. Even though participants wrestled with feelings of grief, they hid them from others because showing emotion was considered a sign of weakness. In fact, many remarked that our interview was the first time they had been asked these questions or spoken about these emotions at all."1 All practitioners can benefit by speaking openly about loss, helping to show others it is okay to care for our patients, and to grieve their passing. Making this topic an acceptable one to approach our colleagues about and to ease pain is important in maintaining emotional health. It is also a strong reminder of the importance our work has in these patients' lives and that we make an impact no matter what stage of life they are in.
Sheryl Nathanson Sachs, CPO, at Dankmeyer, headquartered in Linthicum Heights, Maryland, says, "What has helped me is to keep in mind that most of the patients we work with have multiple comorbidities and have other health issues they are battling in addition to their amputation. I view my job as a way to help them get part of their lives back. Ultimately when it is their time, it is sad. But I hope that I was at least a small bright light in the time they did have left. Some deaths obviously hit harder than others. But I told myself that if I ever got to a point in my career that it didn't affect me at all, it would be time to find another job."
Grieving for our patients reminds us of how much we cared for them. We are fortunate that we have the chance to form deep bonds with our patients and spend quality time with them during the course of care. Genuinely caring for our patients is what makes this job worth the effort and time that we put in. While we can't always be ready for a loss, hopefully we can learn to be more resilient when handling these emotions in the future.
Nina Bondre, CPO, is the clinical educator for Cascade Orthopedic Supply, headquartered in Chico, California. She can be contacted at firstname.lastname@example.org and welcomes your thoughts on this topic.
1. Granek, L. "When Doctors Grieve." The New York Times. May 25, 2012. https://www.nytimes.com/2012/05/27/opinion/sunday/when-doctors-grieve.html.
2. Vitas Healthcare. "How to Cope when Your Patient Dies." February 1, 2017. https://www.vitas.com/for-healthcare-professionals/making-the-rounds/how-to-cope-when-your-patient-dies/.
3. Rose, D. "Patient loss: Surgeons describe how they cope." February 1, 2015. Bulletin of the American College of Surgeons. http://bulletin.facs.org/2015/02/patient-loss-surgeons-describe-how-they-cope/.