Wednesday, September 26, 2007

Journal asks: After a patient dies, how do doctors deal with their emotions?

It was more than 30 years ago, but Dr. Katharine Treadway (left) vividly remembers answering her first "code" call to revive a hospital patient.

The resuscitation attempt failed, and in this week’s New England Journal of Medicine she recalls what it felt like, as a freshly minted intern, to simply walk away from a life that had just ended.

“Someone had just died. But we all behaved as though that was not at all what had happened,” she writes. “We learned to bury our fear of death in an avalanche of knowledge. … And for good reason. We could not do what we do – take responsibility for the lives of our patients – if we were aware, minute to minute, of the true significance of what we were actually doing.”

The journal is publishing Treadway's essay to spark an online discussion, which the Boston-based publication calls Perspective Forum. Its physician readers are invited to write about how they cope with the emotions they put away while meeting clinical challenges.

Treadway, a Harvard Medical School faculty member and primary care doctor at Massachusetts General Hospital, writes that many doctors have private rituals they observe whenever a patient dies -- she says aloud, "May choirs of angels greet thee at they coming" -- but they rarely share them.

White Coat Notes asked Treadway what she would like to hear from readers, why she chose this topic, and what she teaches medical students about it.

What do you hope to hear in the forum?
What I hope is people will in fact share some of their experiences and write what it was like to be at a code the first time, or other experiences. I hope doing that is just the beginning of 'well, gee, if I write into the New England Journal, maybe I can talk to the doctor I share an office with.' I really believe that we’re all hungry for this.

What do you teach medical students about emotions?
I try to get them to recognize early how powerful they will become in the lives of their patients. I don't mean this in a hierarchical way. I mean when someone is ill, the emotional need that is there is so profound, if they don't recognize how powerful they are, they won't know how to use this in a positive fashion.

What about situations like the code call?
When you focus so intently on the problem you are trying to solve, (it’s) easy to forget about the person. I want them to remember to experience the experience and be aware of what’s taking place, not just the task.

There’s this tremendously fine line that we have to walk in terms of dealing with acute life-threatening situations in which you absolutely have to stifle your emotions. You can’t fling your hands into the air and say, 'Oh my god.' That wouldn’t help anyone.

At the same, time, if you completely shut that off, then you lose something.

How do you find that middle ground?
Part of the message I teach is being honest with yourself about what you have done well or not so well, and being aware of your emotions in a way that allows you to continue and come back another time.

How about your own work?
I love being a doctor. To me it's the combination of the intellectual demands and the fascination of how our bodies work, mixed with dealing with people and all of the interactions that take place in this human drama. I still feel like I have to pinch myself to believe I’m doing this, more than 30 years into it.

Being a primary care doctor, I take care of my patients’ children, or their children’s children, or in one case, the great-granddaughter of my original patient. In addition to teaching medical students who are so eager and idealistic, it’s just so renewing. I feel very lucky.

Posted by Elizabeth Cooney at 05:20 PM

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