Making sense of death in paediatrics

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Per unitatem vis – ‘Through unity, strength”…

A patient died in our unit last week. A child. His parents were two of the loveliest, bravest souls I’ve ever encountered. I looked after him on a series of night shifts. He deteriorated, slowly but surely, over those nights.

I found it hard to look after him. When he became agitated, he’d settle if his hair was stroked. His parents did it if they were around, but on nights they took the opportunity to sleep, and so the task fell to us, his doctors and nurses. As I stood there by his bed, stroking his hair, I couldn’t help but think about how hard this was for me. Then I’d admonish myself, thinking how much worse it was for his family, let alone for the little boy himself.

He died during the day, so when I came on again for my last night, he was gone. The staff were shaken. The handover process was subdued, and prolonged by some much needed general chatting and debriefing. We hugged, and we talked about all the patients we’d lost this term (intensive care has an unfortunately high rate of loss compared with my previous general paediatric jobs). We tried then to remind ourselves of the successes, and talked about patients who made us smile, and patients who’d made it through against the odds.

It’s often like this with difficult events. The juniors rally around each other as best we can, and sometimes there’s a debriefing session with seniors – not always though, which is sad. It’s a vulnerable time for all of us, particularly as doctors in training. I myself tend to feel overwhelmed with a sense of inadequacy for the job. Will I ever be smart enough? Skilled enough? Strong enough? For an occupation in which these are the stakes? I inevitably contemplate alternative careers at this point, for on the alter of my own self-judgement, I always come up wanting.

No wonder doctors quit, burn out, became depressed, even suicide. Every day in medicine we walk a tightrope, holding aloft the heavy burden of our patients’ needs, praying at every moment that we don’t all come crashing down together. If we make it to the other side, to the end of the day or the end of the shift, and all is still intact, we’re grateful, but we rarely acknowledge the strength it took to make that journey.

Doctors – medicine is brutal. It’s also wonderful, mysterious, joyful, and an absolute privilege to practise. A success can bring us to dizzying heights of elation, but every failure rocks us to our core. At times we’ll all feel like frauds, like failures, and like a change of career. The important thing is that it’s normal to feel that way. I believe many of the doctors who take their own life have an extremely misinformed concept that they are the only ones who feel lost.

When we lie to each other and say all is well all the time, this myth holds. There is great power instead in being honest with one another. In admitting that we don’t have it all together, and reaching out for help and support when times are tough. We must focus on a change in the medical culture in which no doctor is ever left to feel alone in their pain. If we don’t, we stand to lose much more than pride.

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About 

Dr Annabel Smith is a paediatric advanced trainee based in New South Wales, with interests in public health and doctor's wellbeing. She lives with her border collie, two chooks, and her husband on the Central Coast.

5 Responses to "Making sense of death in paediatrics"

  1. Paul Colditz
    Paul Colditz 10 months ago .Reply

    A very nice piece. Congratulations.
    I agree with the tag “Through unity, strength”…”, but also consider “Through diversity, strength…”. Just like our patients, we are all different and may feel things in different ways. Tapping into that will also help bring the healing you so appropriately call for.

  2. c
    c 10 months ago .Reply

    There is bravery in honesty and we owe it to our colleagues junior and senior to acknowledge the burden grief puts on us… We are in this together, it still sucks to lose a patient but being human makes us better doctors.
    Together we can change the world

  3. Annabel Smith
    Annabel Smith 10 months ago .Reply

    Thanks for your comments. I agree, we all come from very different backgrounds, and our different approaches (good and bad) for dealing with grief are invaluable when shared. It’s also worth knowing how our patients (or in paediatrics, more so their families) feel about seeing emotion in their doctors, and by and large I believe it’s taken in a very positive light. We certainly don’t have to stop being human beings to be professionals, and I think the community understands that.

    Change happens when a new generation chooses to act differently to the one above, no longer accepting that the status quo has any inherent value. The more we prioritise our own wellbeing, and that of our colleagues, the better things will be for our patients, too.

  4. Jane Peters
    Jane Peters 10 months ago .Reply

    for on the alter of my own self-judgement, I always come up wanting.

    This sent shivers up my arms as when we look at the outer face that is shown, it does not always reflect the inner reflections. Continue the courageous journey of the profession you do so well Annie. When we are priviledged to support and care for those who are most vulnerable, we need not get carried away with the sense of power that we inevitably wield. We must do as you are doing and reflect on how it changes us and use it to keep in touch with our humanity as the job is both beautiful and brutal. Much love to you and your colleagues and thankyou for bringing self awareness and awareness to others.

  5. Dr Annabel Smith
    Dr Annabel Smith 10 months ago .Reply

    Thank you, Jane. Yes, one of the things we learn quickly as doctors is how to hide our feelings. We project confidence, calm, and stoicism even when we feel quite the opposite. It’s not necessarily always a bad things, as a calm, confident doctor makes for a good leader and gains the trust of their fellow colleagues and their patients, but we need to learn to be a little more vulnerable with each other between times, when the work is done and the patients are stable. If we think we have to keep the confident mask on all the time, we’ll never ask for help for ourselves or with our patients, which is a very bad idea!

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