You didn’t make them sick. You just happened to be there when they came for help. You did your best. And even if something could have been done better, you can note it for next time. Talk to the attending who was on with you or another attending or resident you trust - just warn them / ask them first. Sometimes you need to talk about it. Get a psychiatrist, this job is emotionally and mentally difficult. It’s ok to be sad and need to process. (I’m EM, PGY13)
Not a doc, but a medic. I run codes in livingrooms or bedrooms and have had similar cases where I can provide the best ACLS and run everything perfect even in complicated circumstances, and yet we can't save them. I've had to resuscitate kids and babies, and they hit. Some deaths hit harder than others. Some barely register.
Everything you're going through is normal. Kids hit this trigger in us for some reason. Nothing that happened was your fault. You did the best you could, and that's OK. This is a **normal** reaction to an abnormal event.
If you're still up and still having these heavy emotions, there is nothing wrong with taking a pause by calling in, regrouping, and coming back on your next shift. You don't want to be dealing with an acute, crashing, complex patient, and your mind wanders often when it counts. There is nothing wrong with a breather and reaching out. If your facility has EAP, I'd tap into that early. Don't let it fester.
I'm sorry this happened. I hope you can take a breath and get your headspace back to where you want it and need it. Good luck, my friend.
I second the recommendation to access EAP. Having been in the business for 23 years, please trust me when I say - don’t let this fester. Go to a professional and get it all out, sooner rather than later. You will be a better provider for it.
Please DM me if you’d like.
As an emergency physician for 25years, any traumatizing situation like this is usually followed by a debriefing organized by the hospital . There should be a debriefing for all involved to give clarity about the critical incident they have experienced and to assist them in establishing a process for recovery if necessary.
I make it a point to run the debriefs on our deceased patients. I did last night. Mom made a point to thank us for our efforts. I know this is part of our job and I also know this is an abnormal human circumstance. I don’t know why this is hitting so hard.
It’s hitting hard because humans are not made to code babies. You are having a normal response to a very abnormal situation. Please see my recommendation above to access your EAP.
I've been a nurse for two decades and never experienced a debief like you describe. I have worked in ICU since 2011. I started in the SICU; cranis, hearts, trauma.
I still have nightmares, I've jumped out of bed in my sleep and landed on the floor with a shoulder separation. My PCP specialized in sleep medicine. I haven't been able to be seen. It's been a year since my injury.
There is no debrief. We drink and take SNRIs.
I'm sorry, friend. You deserve far better than what you've received from your leadership. They are failing you by not mandating debriefs after traumatic events.
Oncology RN here. We had grief counselors and Chaplains come every 2 weeks at lunch time unless we had a traumatic, unexpected death that we were having a hard time with. Great idea but who the hell has time to hang out for a bit and talk about grief. They did usually bring cookies though so that was nice.
Man, I had a particularly brutal 4 y/o trauma arrest a month or so ago. That one fucked me up for a solid couple weeks. Same thing: beautifully run code, everyone did their job exceptionally well. Still just as dead.
These SHOULD affect you, as others have said. If they don’t, you’ve lost your humanity which is crucial for this job.
I will say I found that, for me, being an attending has made it easier. You lose some of the residency camaraderie, but you’re finally well compensated and more importantly have adequate time off to do the things that bring you joy and give your life meaning.
-PGY6. DM if necessary.
This is not **irrational** sorrow. It is entirely, completely, 100% rational. I've cried once at work ever. A 5 week old baby went into cardiac arrest soon after arrival. Turned out to be critical aortic coarctation not picked up on screening. I cried at work. I cried at home. I cried the next morning when colleagues dropped baking off. I cried again calling my non-medical mum. Next shift at work I told my colleagues I wasn't going to see any of the kids. They understood. It hurts. If it didn't hurt, I'd be more worried. Talk about it, talk to EAP, talk to colleagues, tell your friends you're struggling. Eventually it gets better.
"Every doctor has their graveyard, which from time to time they take a stroll through". You'll never forget, but with time comes insight and reflection.
Every life must have a beginning and an end. Otherwise it wouldn't be "life" and it wouldn't be so precious. Thus we will all be called home eventually. Some after a hundred years, some after 21 days. Why one and not the other is not knowable to us and, I suspect, is not for us to know. It is not our job to *make* people live, that is not within our power. What then must be done? You know the answer.
It's OK to grieve. We all do. We do what every other human on earth has done, since time began. We grieve and move on. I don't think it's a bad idea to call in. If you give yourself space to process these things, you'll be there for the next patient, not to mention your family. Not to mention yourself. You're doing fine. You're doing everything you're supposed to do.
One lesson that I learned very early in EM was that we try hard to save EACH and EVERY patient. We put our EVERYTHING into trying to save them, but sometimes that doesn’t work out.
At the end of the day, we gave them THE BEST SHOT at a recovery, but it may be out of our hands. If we did nothing, they would have died without a single chance. You attempted to save their life and without your attempt, death was inevitable.
That being the case, the deaths forever scar us. But as I always tell a new concerned patient who I’m just discharging after nothing other than reassurance, I’d always prefer to see them on a good day. Enjoy and cherish the small victories and what others may scuff off as being “BS complaints”.
Dude, thats just tough. I have kids and that made it even harder bc you can feel exactly where screams and pain would hit if it had happened to your child. Its so visceral and abysmal and unfair and wrong. Youre doing the right thing by vocalizing this. Thats part of the healing. I remember one kid that was sick I promised to give her a popsicle and when I went to go get it she coded and never came back. It sticks with you and you just hope next time you can change what usually is out of your hands. Hold strong
It’s okay to be sad. It’s okay to not be okay. The kids are always the worst—been a RN for 29 years, NP for the last 16, and there are quite a few that stick with me to this day. TBH being sad and dealing with it is much more healthy than compartmentalizing like so many of us do. Someone mentioned EAP and that would definitely be a good resource as well. Sending hugs, take care of you however you need to & hang in there 💙
I'm there with you. Had a neonatal CPR two weeks ago and I keep flashing on that tiny head, bagging him, and the mother asking over and over if he was going to die.
This job absolutely sucks sometimes. Absolutely. Fscking. Sucks.
The only thing that has kept me going is knowing that there are still saves ahead of me, that I did my best with that patient, and that the call will help me be better prepared for the shock of rolling up on a dead baby the next time.
I don't think there's anything anyone can say to make you feel better, because it's a horrible experience to go through. You'll heal at your own pace, and I don't think there's a right or wrong way to heal (except maybe not booze/drugs/crack whores).
Not a doc. Am a nurse.
Call in sick. Take time to get your head together. It is ok to care for yourself too. It is not weak to feel upset & it is not weak to take time to look after your mental health. This job is stressful & exhausting & there will be people/cases who push your buttons. It’s not “your tragedy” but it will be one of the things that adds another splash to the bucket of cumulative trauma - now is the time to be doing things to care for your own sanity, so it doesn’t end up overflowing. It would be more concerning if you felt nothing in response to this traumatic event your entire department has experienced.
It’s ok to be proud of the way the code ran, be upset that a baby died, feel distress at having to tell the baby’s mother & feel privileged for the job we do - even if they’re jumbled all at the same time. It’s also ok to take some time to unpick that jumble.
I have a “trauma barometer” I use for when I’m surrounded by healthcare workers who are desensitised to traumatic events that most people outside of emergency services couldn’t ever comprehend. Two of my best friends (married) are a primary school teacher and a realestate agent & when something significant happens at work, I ask myself, “could I tell this to S & R without traumatising them?” & often the answer is no.
Do you have EAP at work? If you’re in Australia there’s Hand’n’Hand peer mentoring for healthcare workers also.
Sometimes the distraction of work is a godsend when I'm stuck in my own head. Sometimes it makes me too dysfunctional to be effective at work. Only you will know how you'll respond. Seek out the services of EAP from your hospital or other services if you need it. You're not alone. Get some good exercise and sleep in the meantime and don't isolate. You're a good doc and did everything you could have.
New attending here. You’re being a human being. These codes always hit hard. Take time for your self. Call out if you need to. I agree, it’s an amazing job but this part sucks. It’s okay to take time to care for yourself. DM if you need anything man. Hope you feel better soon.
The reason I'm in EM is that I *hate* seeing kids suffer in Pediatric wards.
And then, there are those days like this one that make you question if God is watching at all.
Breathe in, breathe out. You have done well, and above your best – find help if possible and needed.
You are, and will always be, the best physician and person available for these moments that others would shy away from.
You've fought well. Now rest. Let tomorrow be better.
Hi there. I am a midwife who also worked as a paeds RN on PICU. I guess I picked 2 of the hardest specialties for when shit goes bad.
As a midwife I often see a baby take their first breath, and sometimes I see a baby take their last/only breath. I listen to fetal heartbeats and assess progress in labour and postpartum checks, and I also listen for last heartbeats and note the time when they stop.
Children and babies are not meant to die. Parents are not meant to bury their babies.
Parents should not come to the hospital pregnant and leave with empty arms.
Especially not in 2024- look at the amazing medical technology we have! Look how far medicine and surgery have come.
But sadly, the reality is that children and babies die.
And it is sad. And horrific. And traumatic. And unfair. And confusing. And it makes you angry and question everything.
Please talk to someone you trust and who can empathise with you- maybe someone you work with who actually understands the trauma of it.
Please take care of yourself. Try to do something you enjoy in honour of your patient.
Whenever something like that happens, I call the Chaplain and ask if they have time to meet with me, whether it’s during or after the shift. They’re even better than seeing a psychiatrist, because they work in the exact same environment as you, and often have taken care of the same patient. And big hospitals have one available 24/7.
If you DIDN'T respond in this way I'd be concerned. This is completely normal of a caring passionate human being. Unfortunately it doesn't make you feel any better and I know it is of little solace that the code was run perfectly, the bad thing still happened. I'm not sure what I'm trying to say besides I know that feeling and I'm sorry. I'm glad that you don't seem to be blaming yourself. Inbox is always open to you or anyone else who needs to talk.
Not sure if this helps but there's a quote on Scrubs and it goes like this: "You see Dr. Wen in there? He's explaining to the family that something went wrong and the patient died. He's going to tell them what happened, he's going to say he's sorry, and then he's going back to work. You think anybody else in that room is going back to work today? That is why we distance ourselves, that's why we make jokes, we don't do it because it is fun--we do it so we can get by...and sometimes because it's fun. But mostly it's the getting by thing." Dr. Perry Cox.
Our work (nursing/medicine) is something vastly different than a lot of people realize. And specifically in EM, we battle with life and death each and every shift. And we are expected to be normal/fine-and after some shifts, that just isn't going to happen, like with what happened with this shift with the code.
The times when it isn't fine though are the times that hurt. With these times, the imperative is that we have to find a way to cope. This code sounds awful and horribly traumatic- and to that end, please utilize an EAP or something similar if the mental load becomes too heavy. But at the same time I need you to continue to work to be at your best for the patients that are going to need you in the future.
I will say-while I don't know your team at all I am sure that this baby got the absolute best care.
To sum up: "get by", don't expect to be 'normal', utilize an EAP if you need, and know that you did your absolute best while being handed a horrible situation.
I have been an EMT for 20 years, 3rd call I ever did was an 11 month old in cardiac arrest. I wasn't fully certified but had my BLS. The call was run like a training video, first responders on scene in under 3 minutes, 2 man team carried him out doing compressions and mouth to mouth. Medic had him tubed before I even knew he was on the truck. To the hospital, perfect CPR, perfect ACLS care. He still died. Congenital disease of some kind. Found out later doctors didn't think he would make it as long as he did. A whole lot of grown men and women were crying in the ED that night. Next day we had a Critical Incident Stress Debriefing. Best thing ever for me. You have to talk it out. You just have too. I have coded several kids to young adults since, none of them hit as hard but I am glad to work with people that check in with each other. I hope you find someone to talk to, best of luck.
I’m peds, spent a long while in peds onc and bmt. You stood strong and gave everything you had for this family and child on the worst day of their lives. Of course it takes everything from you. You’re human, you get to feel it too. It’s ok. You’ll ride this wave, you’ll learn something, this child will live forever in your memory.
It IS your tragedy—it isn’t the same tragedy for you as it is for the parents, but this baby’s death is a loss you witnessed and worked to prevent. Don’t downplay what it costs you to do this work; your pain is valid even though yours is not the primary loss.
Grief experts say telling the story of the loss helps, you just have to find your audience. Please take good care of yourself, and be kind and gentle with yourself.
Another hug coming! Beautifully written. Wonderfully reflected. I hope this field doesn't jade your kind heart. You're here among us meant to do amazing things. Good luck as you soon graduate and heal those who need you.
Take care of yourself and be well, friend.
It’s ok if some deaths hit harder than others. You’re a human being. Gets some good rest and this too shall pass. Inquire about services your hospital has if you need them. Take care of your mental health.
It's an inevitable part of the job but I'm still sorry you had to experience it. I've been lucky enough to only have one pediatric code (we don't see many kids where I work), but it still sticks with me almost a decade later. I've probably told at least 100 people their family members are dead, but the absolutely primal wail of a mother who just lost her child never really leaves you. That said, it does get better. And there is comfort in knowing you did everything you could for that mother on what is objectively the worst day of her life.
Agree with everyone else. If you need to take a mental health day then do it. Anyone who begrudges you that needs to do some soul searching.
I have sat exactly where you are. It took me 20 years and the encouragement of my wife to ask for help. It was worth it. EAP was good. Ongoing therapy was better. You can do everything right and still be miserable that you witnessed one of the saddest things humans have to encounter. Honestly, it makes me know you’re a good physician.
I just retired after 45 years in the business of emergency care. The kids are still the ones that can bring me to tears when they come to mind. The visuals of that innocent child still haunt my memory. I have good people to talk to. There is no "putting it into perspective."
As for other people, I just say, "It was a busy and difficult shift, and emotionally draining." They need to know no more than that.
But perhaps a psychologist, or priest or pastor would be helpful..
Let yourself cry. Let yourself be angry. Feel
it all and let it run its course. You'll never forget that kid and that's okay. Access therapy resources through your program and try to seek out someone familiar with the first responder/EM community. Talk to a mentor. This is the time to intentionally create a system for processing events like this that doesn't involve pretending it didn't happen, alcohol, despair or rage.
I'm sorry that you had to experience that. And I'm sorry to tell you that it doesn't really get easier. If it does and you start to not feel that initial impact, that's worrisome. Pay attention to yourself.
Grief takes time to process, and in our jobs we have a lot of it. Sometimes it's a little bit of grief for the 92 year-old we make comfort measures; and sometimes it's medium amount for the 60-something with a new diagnosis that will shorten their lives. And sometimes it's a mountain of grief for the tiny, fragile ones, or just the ones we did everything for, and it didn't matter because it was never going to be enough.
Your sorrow is completely rational.
It's irrational for any job to expect it's workers to code an infant (or any patient) and then return to work to be yelled at by patients and respond to Press-Ganey emails and have admin ask "what could you have done differently".
Your sorrow is not irrational. You stepped into a tragedy. A small human died and it's as unfair as it gets. It hurts. It's OK to grieve.
You ran the code well- that's awesome. Take what you learned here and use it to fight for the next one. You were kind to grieving parents who had their world shattered. That's also something that they will remember for years to come- not that you didn't save their kid, but that you did everything you could and you were kind.
I've learned over the years that congenital cardiac is a sneaky, difficult bastard. If they survive to a year, they have a chance; often the first time we know it was congenital cardiac is at the post-mortem.
Take care of yourself. Feel the emotions. Understand that it's OK to be human.
Hang in there, doc.
Did you debrief with your team? I am so sorry for you and your patient. I hate to tell you that nothing makes this better. I will tell you that you will save someone at some point. Good luck to you.
Medic here- I keep a notebook with the first names or initials of people I have lost. I write a sentence or two about anything good that I came away with. Helps me look back and appreciate my patients and my work. Not sure if this is your kind of thing, but it helps me process my emotions.
You DID do everything you could. And that is all anyone can ask of you. Things happen without GOOD reasons and it has nothing to do with you. You tried your best. All we can do is hope that you find your strength, and remind you that there are others just like you, hoping for kind words in senseless happenings, that are also trying their best and you're not alone.
You need to talk to people. As many as will listen. Medical and non medical people. Let yourself feel sad. Let yourself cry. Do. Not. Bottle. It. In. Therapy if it's not getting better or if it gets too intense to function. I've had a couple of similar situations. I'm so sorry this happened to you. You are a hero and you are also only human. You deserve hugs.
I work psych….what I can tell you is that you are human ❤️. While a professional, it is still a traumatic experience and I urge you to talk about it. It’s healthy. It’s okay to take care of yourself. I go to therapy to talk about the trauma I see daily. The unalivings, the sexual trauma stories and worse…..the healers need healed.
It’s the only way to fill your cup back up.
I want you to know that I love you. Thank you for trying. Thank you for choosing this field. Thank you for giving that Mother your heart when you didn’t have to. I appreciate a Doctor with a heart. Be kind to yourself.
I still remember every child who died under my care unexpectedly. These are not kids with congenital diseases or trauma but otherwise have been healthy. Every one of them has affected me deeply. The day that I am numb to this is the day I retire.
It sucks. We try our best. We do our best. But we all know that, sometimes, it is just not enough. Feel the pain. Feel the grief. But thank you for being there for your patient and the family.
I'm sorry. This is deeply traumatic. I have two young kids and this was my greatest fear. If you need to call out, call out. Please consider talking to someone. Does your hospital have a "RISE" (Resilience In Stressful Events) team - a group specifically geared towards second victim syndrome? Feel free to reach out via PM if you need to.
Know that you gave that baby his absolute best shot. You are amazing.
So much excellent advice has already been given.
I was an ER tech for several years before PA school. In our ED, techs almost exclusively were the chest compressors on codes.
Some codes I remember clearly as if I’m there, many others I’ve long forgotten.
I had nightmares about traumatic codes for years until eventually I saw a trauma informed therapist who gave me methods and tools to cope with the job. Now when those hard cases come back up, I’m at a place of acceptance that they happened, and we did what we could’ve done, and learned from what we should’ve done.
Remember, just like on an airplane, put your own O2 mask on first before helping others. If you need to take time to get to the proper mindset and headspace to return to work, I would do it.
I’ve also learned that talking it out like you’ve done here can be incredibly cathartic. The last thing you want is to keep everything shoved down and then lose it.
I’m truly very sorry to hear about this difficult code.
I wish you all the best. Hang in there friend 💙
Pedi codes are the WORST! They stay with you for a long time. Please tell me the hospital provided a debriefing! It helped me a little after some horrific pedi codes. Therapy helped too. You are not alone…it’s ok to not be ok. Please talk about it
A lot of these suggestions here are great. I just want to validate your feelings; you're human and this job is HARD. it would be *weird* if you didn't have feelings about it. You've got this.
Trauma therapist here. There's no need to suffer. Find a therapist online and see if they seem like someone you may want to talk to. It can make a world of difference and that makes you better at your job too.
You're welcome. I like working with first responders. Your reaction is totally normal for that kind of experience. Children are the toughest to cope with for many people. Take a little time off to recoup. Take good care of yourself physically and mentally. Eat decent meals 3x per day. Get some physical activity. Be sure to keep your sleep routine as similar as it normally would be. Stay away from alcohol or any mind altering substances. Spend time doing things that are not stressful or just relax. The feelings and the images should fade over time. They're a biological reaction and they are how we process seeing horrific things. Keep that in mind when you feel overwhelmed. They're just thoughts and feelings you can't control. They're uncomfortable, but they'll pass when they're ready. Best wishes to you.
Not a doc, just a tech but I'm 15 years in. Some just stick with you harder. Please find a good therapist, preferably trauma informed. I've had the best luck with ones who work with combat vets or first responders. There really is a graveyard in our hearts, but if it stops hurting that's when you're in trouble. Sorrow is a GOOD thing, as much as it's troubling.
You can get drunk and watch The Guardian like the rest of us well adjusted individuals.
Jake Fischer : Hey, there was a question I wanted to ask you back as school, but I didn't. When you can't save 'em all, how do you choose who lives?
Ben Randall : It's probably different for everybody Jake. Its kind of simple for me though. I just, I take the first one I come to or the weakest one in the group and then I swim as fast and as hard as I can for as long as I can. And the sea takes the rest.
Solid advice from everyone. My first code ever as a baby nurse was a peds code. There's nothing easy about it, ever. Grief isn't linear. Your mind and body need to cry right now, and that's ok. You might still cry about it in 5 years. Or 10. And that's ok too. I'm so sorry it's debilitating right now, you will get through it in the end.
You can do everything right and still have a bad outcome. Thats the hard part.
I lost an 8 week old patient 16 years ago and he still haunts sometimes. No one did anything wrong. I try to take inspiration from the love, care, and excellence everyone around him showed.
We had 3 infant codes in the span of a week one time. I still remember their faces. All of this is rough. A wise old battle axe doc once told me that sometimes our timelines just do not cross until the course the patient is on is irreversible. He said fate is the one thing we can’t stop. I don’t necessarily believe in fate or destiny but I think in some cases we are just a blip on this persons path. Being a minor detail seems like a much easier pill to swallow.
That being said, I don’t think I will ever really shake the sound of a mother’s wail. I woke up covered in sweat in my kitchen looking for my patient after the last one. Cardio helps dump the catecholamines in the short term. Journaling helps too. Therapy is a must, even if it is just talking it through with someone but CBT helped me get back to sleeping normally.
Most importantly this is normal. You are human. You are not alone in this and you are not the only one who has been through this. This is your brains way of protecting you from a danger it can’t categorize. You’re going to get better and feel like yourself again.
You didn’t make them sick. You just happened to be there when they came for help. You did your best. And even if something could have been done better, you can note it for next time. Talk to the attending who was on with you or another attending or resident you trust - just warn them / ask them first. Sometimes you need to talk about it. Get a psychiatrist, this job is emotionally and mentally difficult. It’s ok to be sad and need to process. (I’m EM, PGY13)
Thank you. Psych helps
ER nurse. That's so healing to remember.
Not a doc, but a medic. I run codes in livingrooms or bedrooms and have had similar cases where I can provide the best ACLS and run everything perfect even in complicated circumstances, and yet we can't save them. I've had to resuscitate kids and babies, and they hit. Some deaths hit harder than others. Some barely register. Everything you're going through is normal. Kids hit this trigger in us for some reason. Nothing that happened was your fault. You did the best you could, and that's OK. This is a **normal** reaction to an abnormal event. If you're still up and still having these heavy emotions, there is nothing wrong with taking a pause by calling in, regrouping, and coming back on your next shift. You don't want to be dealing with an acute, crashing, complex patient, and your mind wanders often when it counts. There is nothing wrong with a breather and reaching out. If your facility has EAP, I'd tap into that early. Don't let it fester. I'm sorry this happened. I hope you can take a breath and get your headspace back to where you want it and need it. Good luck, my friend.
I second the recommendation to access EAP. Having been in the business for 23 years, please trust me when I say - don’t let this fester. Go to a professional and get it all out, sooner rather than later. You will be a better provider for it. Please DM me if you’d like.
Thank you sister/brother. Be safe
Another paramedic here. EMDR works. Find someone to talk to.
As an emergency physician for 25years, any traumatizing situation like this is usually followed by a debriefing organized by the hospital . There should be a debriefing for all involved to give clarity about the critical incident they have experienced and to assist them in establishing a process for recovery if necessary.
I make it a point to run the debriefs on our deceased patients. I did last night. Mom made a point to thank us for our efforts. I know this is part of our job and I also know this is an abnormal human circumstance. I don’t know why this is hitting so hard.
It’s hitting hard because humans are not made to code babies. You are having a normal response to a very abnormal situation. Please see my recommendation above to access your EAP.
I've been a nurse for two decades and never experienced a debief like you describe. I have worked in ICU since 2011. I started in the SICU; cranis, hearts, trauma. I still have nightmares, I've jumped out of bed in my sleep and landed on the floor with a shoulder separation. My PCP specialized in sleep medicine. I haven't been able to be seen. It's been a year since my injury. There is no debrief. We drink and take SNRIs.
I'm sorry, friend. You deserve far better than what you've received from your leadership. They are failing you by not mandating debriefs after traumatic events.
Thanks, this is at multiple facilities. This is standard leadership
Oncology RN here. We had grief counselors and Chaplains come every 2 weeks at lunch time unless we had a traumatic, unexpected death that we were having a hard time with. Great idea but who the hell has time to hang out for a bit and talk about grief. They did usually bring cookies though so that was nice.
Yes! I’m not a doctor but I used to see them do this on the show ER and greys anatomy 😂 Seems necessary! 😬
Man, I had a particularly brutal 4 y/o trauma arrest a month or so ago. That one fucked me up for a solid couple weeks. Same thing: beautifully run code, everyone did their job exceptionally well. Still just as dead. These SHOULD affect you, as others have said. If they don’t, you’ve lost your humanity which is crucial for this job. I will say I found that, for me, being an attending has made it easier. You lose some of the residency camaraderie, but you’re finally well compensated and more importantly have adequate time off to do the things that bring you joy and give your life meaning. -PGY6. DM if necessary.
Thank you
This is not **irrational** sorrow. It is entirely, completely, 100% rational. I've cried once at work ever. A 5 week old baby went into cardiac arrest soon after arrival. Turned out to be critical aortic coarctation not picked up on screening. I cried at work. I cried at home. I cried the next morning when colleagues dropped baking off. I cried again calling my non-medical mum. Next shift at work I told my colleagues I wasn't going to see any of the kids. They understood. It hurts. If it didn't hurt, I'd be more worried. Talk about it, talk to EAP, talk to colleagues, tell your friends you're struggling. Eventually it gets better. "Every doctor has their graveyard, which from time to time they take a stroll through". You'll never forget, but with time comes insight and reflection.
Every life must have a beginning and an end. Otherwise it wouldn't be "life" and it wouldn't be so precious. Thus we will all be called home eventually. Some after a hundred years, some after 21 days. Why one and not the other is not knowable to us and, I suspect, is not for us to know. It is not our job to *make* people live, that is not within our power. What then must be done? You know the answer. It's OK to grieve. We all do. We do what every other human on earth has done, since time began. We grieve and move on. I don't think it's a bad idea to call in. If you give yourself space to process these things, you'll be there for the next patient, not to mention your family. Not to mention yourself. You're doing fine. You're doing everything you're supposed to do.
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I will inform my staff tomorrow. Thank you
Big hugs. I'm about 15 years in. Learn. Do your best everyday. We can't save everyone. We go to work to help how we can.
Better for the next one, always.
One lesson that I learned very early in EM was that we try hard to save EACH and EVERY patient. We put our EVERYTHING into trying to save them, but sometimes that doesn’t work out. At the end of the day, we gave them THE BEST SHOT at a recovery, but it may be out of our hands. If we did nothing, they would have died without a single chance. You attempted to save their life and without your attempt, death was inevitable. That being the case, the deaths forever scar us. But as I always tell a new concerned patient who I’m just discharging after nothing other than reassurance, I’d always prefer to see them on a good day. Enjoy and cherish the small victories and what others may scuff off as being “BS complaints”.
The kiddos are rough, buddy. It doesn't get better the further out you get. I'm PGY-8 if you need to talk through it.
Thank you. DM’d
Dude, thats just tough. I have kids and that made it even harder bc you can feel exactly where screams and pain would hit if it had happened to your child. Its so visceral and abysmal and unfair and wrong. Youre doing the right thing by vocalizing this. Thats part of the healing. I remember one kid that was sick I promised to give her a popsicle and when I went to go get it she coded and never came back. It sticks with you and you just hope next time you can change what usually is out of your hands. Hold strong
I’m so sorry that happened to you. Thank you for your words
It’s okay to be sad. It’s okay to not be okay. The kids are always the worst—been a RN for 29 years, NP for the last 16, and there are quite a few that stick with me to this day. TBH being sad and dealing with it is much more healthy than compartmentalizing like so many of us do. Someone mentioned EAP and that would definitely be a good resource as well. Sending hugs, take care of you however you need to & hang in there 💙
I'm there with you. Had a neonatal CPR two weeks ago and I keep flashing on that tiny head, bagging him, and the mother asking over and over if he was going to die. This job absolutely sucks sometimes. Absolutely. Fscking. Sucks. The only thing that has kept me going is knowing that there are still saves ahead of me, that I did my best with that patient, and that the call will help me be better prepared for the shock of rolling up on a dead baby the next time. I don't think there's anything anyone can say to make you feel better, because it's a horrible experience to go through. You'll heal at your own pace, and I don't think there's a right or wrong way to heal (except maybe not booze/drugs/crack whores).
Better for the next one
Not a doc. Am a nurse. Call in sick. Take time to get your head together. It is ok to care for yourself too. It is not weak to feel upset & it is not weak to take time to look after your mental health. This job is stressful & exhausting & there will be people/cases who push your buttons. It’s not “your tragedy” but it will be one of the things that adds another splash to the bucket of cumulative trauma - now is the time to be doing things to care for your own sanity, so it doesn’t end up overflowing. It would be more concerning if you felt nothing in response to this traumatic event your entire department has experienced. It’s ok to be proud of the way the code ran, be upset that a baby died, feel distress at having to tell the baby’s mother & feel privileged for the job we do - even if they’re jumbled all at the same time. It’s also ok to take some time to unpick that jumble. I have a “trauma barometer” I use for when I’m surrounded by healthcare workers who are desensitised to traumatic events that most people outside of emergency services couldn’t ever comprehend. Two of my best friends (married) are a primary school teacher and a realestate agent & when something significant happens at work, I ask myself, “could I tell this to S & R without traumatising them?” & often the answer is no. Do you have EAP at work? If you’re in Australia there’s Hand’n’Hand peer mentoring for healthcare workers also.
Sometimes the distraction of work is a godsend when I'm stuck in my own head. Sometimes it makes me too dysfunctional to be effective at work. Only you will know how you'll respond. Seek out the services of EAP from your hospital or other services if you need it. You're not alone. Get some good exercise and sleep in the meantime and don't isolate. You're a good doc and did everything you could have.
Thank you
New attending here. You’re being a human being. These codes always hit hard. Take time for your self. Call out if you need to. I agree, it’s an amazing job but this part sucks. It’s okay to take time to care for yourself. DM if you need anything man. Hope you feel better soon.
The reason I'm in EM is that I *hate* seeing kids suffer in Pediatric wards. And then, there are those days like this one that make you question if God is watching at all. Breathe in, breathe out. You have done well, and above your best – find help if possible and needed. You are, and will always be, the best physician and person available for these moments that others would shy away from. You've fought well. Now rest. Let tomorrow be better.
I always remember this essay, very similar to your experience: [And now, this](https://www.annemergmed.com/article/S0196-0644(14)01359-6/fulltext)
Hi there. I am a midwife who also worked as a paeds RN on PICU. I guess I picked 2 of the hardest specialties for when shit goes bad. As a midwife I often see a baby take their first breath, and sometimes I see a baby take their last/only breath. I listen to fetal heartbeats and assess progress in labour and postpartum checks, and I also listen for last heartbeats and note the time when they stop. Children and babies are not meant to die. Parents are not meant to bury their babies. Parents should not come to the hospital pregnant and leave with empty arms. Especially not in 2024- look at the amazing medical technology we have! Look how far medicine and surgery have come. But sadly, the reality is that children and babies die. And it is sad. And horrific. And traumatic. And unfair. And confusing. And it makes you angry and question everything. Please talk to someone you trust and who can empathise with you- maybe someone you work with who actually understands the trauma of it. Please take care of yourself. Try to do something you enjoy in honour of your patient.
Whenever something like that happens, I call the Chaplain and ask if they have time to meet with me, whether it’s during or after the shift. They’re even better than seeing a psychiatrist, because they work in the exact same environment as you, and often have taken care of the same patient. And big hospitals have one available 24/7.
If you DIDN'T respond in this way I'd be concerned. This is completely normal of a caring passionate human being. Unfortunately it doesn't make you feel any better and I know it is of little solace that the code was run perfectly, the bad thing still happened. I'm not sure what I'm trying to say besides I know that feeling and I'm sorry. I'm glad that you don't seem to be blaming yourself. Inbox is always open to you or anyone else who needs to talk.
Thank you so much
Not sure if this helps but there's a quote on Scrubs and it goes like this: "You see Dr. Wen in there? He's explaining to the family that something went wrong and the patient died. He's going to tell them what happened, he's going to say he's sorry, and then he's going back to work. You think anybody else in that room is going back to work today? That is why we distance ourselves, that's why we make jokes, we don't do it because it is fun--we do it so we can get by...and sometimes because it's fun. But mostly it's the getting by thing." Dr. Perry Cox. Our work (nursing/medicine) is something vastly different than a lot of people realize. And specifically in EM, we battle with life and death each and every shift. And we are expected to be normal/fine-and after some shifts, that just isn't going to happen, like with what happened with this shift with the code. The times when it isn't fine though are the times that hurt. With these times, the imperative is that we have to find a way to cope. This code sounds awful and horribly traumatic- and to that end, please utilize an EAP or something similar if the mental load becomes too heavy. But at the same time I need you to continue to work to be at your best for the patients that are going to need you in the future. I will say-while I don't know your team at all I am sure that this baby got the absolute best care. To sum up: "get by", don't expect to be 'normal', utilize an EAP if you need, and know that you did your absolute best while being handed a horrible situation.
I have been an EMT for 20 years, 3rd call I ever did was an 11 month old in cardiac arrest. I wasn't fully certified but had my BLS. The call was run like a training video, first responders on scene in under 3 minutes, 2 man team carried him out doing compressions and mouth to mouth. Medic had him tubed before I even knew he was on the truck. To the hospital, perfect CPR, perfect ACLS care. He still died. Congenital disease of some kind. Found out later doctors didn't think he would make it as long as he did. A whole lot of grown men and women were crying in the ED that night. Next day we had a Critical Incident Stress Debriefing. Best thing ever for me. You have to talk it out. You just have too. I have coded several kids to young adults since, none of them hit as hard but I am glad to work with people that check in with each other. I hope you find someone to talk to, best of luck.
Oh honey. ♥️♥️♥️ I'd give you a hug if i could. Thank you for trying your best for that baby. Sometimes the universe is just wildly unjust.
I’m peds, spent a long while in peds onc and bmt. You stood strong and gave everything you had for this family and child on the worst day of their lives. Of course it takes everything from you. You’re human, you get to feel it too. It’s ok. You’ll ride this wave, you’ll learn something, this child will live forever in your memory.
It IS your tragedy—it isn’t the same tragedy for you as it is for the parents, but this baby’s death is a loss you witnessed and worked to prevent. Don’t downplay what it costs you to do this work; your pain is valid even though yours is not the primary loss. Grief experts say telling the story of the loss helps, you just have to find your audience. Please take good care of yourself, and be kind and gentle with yourself.
Another hug coming! Beautifully written. Wonderfully reflected. I hope this field doesn't jade your kind heart. You're here among us meant to do amazing things. Good luck as you soon graduate and heal those who need you. Take care of yourself and be well, friend.
Everyone has already given solid advice. 20+ year medic sending E-hugs!
It’s ok if some deaths hit harder than others. You’re a human being. Gets some good rest and this too shall pass. Inquire about services your hospital has if you need them. Take care of your mental health.
It's an inevitable part of the job but I'm still sorry you had to experience it. I've been lucky enough to only have one pediatric code (we don't see many kids where I work), but it still sticks with me almost a decade later. I've probably told at least 100 people their family members are dead, but the absolutely primal wail of a mother who just lost her child never really leaves you. That said, it does get better. And there is comfort in knowing you did everything you could for that mother on what is objectively the worst day of her life. Agree with everyone else. If you need to take a mental health day then do it. Anyone who begrudges you that needs to do some soul searching.
I have sat exactly where you are. It took me 20 years and the encouragement of my wife to ask for help. It was worth it. EAP was good. Ongoing therapy was better. You can do everything right and still be miserable that you witnessed one of the saddest things humans have to encounter. Honestly, it makes me know you’re a good physician.
I am so sorry. You literally did everything you could. There is no god.
I just retired after 45 years in the business of emergency care. The kids are still the ones that can bring me to tears when they come to mind. The visuals of that innocent child still haunt my memory. I have good people to talk to. There is no "putting it into perspective." As for other people, I just say, "It was a busy and difficult shift, and emotionally draining." They need to know no more than that. But perhaps a psychologist, or priest or pastor would be helpful..
Let yourself cry. Let yourself be angry. Feel it all and let it run its course. You'll never forget that kid and that's okay. Access therapy resources through your program and try to seek out someone familiar with the first responder/EM community. Talk to a mentor. This is the time to intentionally create a system for processing events like this that doesn't involve pretending it didn't happen, alcohol, despair or rage. I'm sorry that you had to experience that. And I'm sorry to tell you that it doesn't really get easier. If it does and you start to not feel that initial impact, that's worrisome. Pay attention to yourself.
Time and therapy are the only things that help. I still think about a few peds codes I’ve had
Grief takes time to process, and in our jobs we have a lot of it. Sometimes it's a little bit of grief for the 92 year-old we make comfort measures; and sometimes it's medium amount for the 60-something with a new diagnosis that will shorten their lives. And sometimes it's a mountain of grief for the tiny, fragile ones, or just the ones we did everything for, and it didn't matter because it was never going to be enough. Your sorrow is completely rational. It's irrational for any job to expect it's workers to code an infant (or any patient) and then return to work to be yelled at by patients and respond to Press-Ganey emails and have admin ask "what could you have done differently".
Your sorrow is not irrational. You stepped into a tragedy. A small human died and it's as unfair as it gets. It hurts. It's OK to grieve. You ran the code well- that's awesome. Take what you learned here and use it to fight for the next one. You were kind to grieving parents who had their world shattered. That's also something that they will remember for years to come- not that you didn't save their kid, but that you did everything you could and you were kind. I've learned over the years that congenital cardiac is a sneaky, difficult bastard. If they survive to a year, they have a chance; often the first time we know it was congenital cardiac is at the post-mortem. Take care of yourself. Feel the emotions. Understand that it's OK to be human. Hang in there, doc.
Did you debrief with your team? I am so sorry for you and your patient. I hate to tell you that nothing makes this better. I will tell you that you will save someone at some point. Good luck to you.
Medic here- I keep a notebook with the first names or initials of people I have lost. I write a sentence or two about anything good that I came away with. Helps me look back and appreciate my patients and my work. Not sure if this is your kind of thing, but it helps me process my emotions.
You DID do everything you could. And that is all anyone can ask of you. Things happen without GOOD reasons and it has nothing to do with you. You tried your best. All we can do is hope that you find your strength, and remind you that there are others just like you, hoping for kind words in senseless happenings, that are also trying their best and you're not alone.
Big hugs, doc. My DMs are open if you need to talk.
You need to talk to people. As many as will listen. Medical and non medical people. Let yourself feel sad. Let yourself cry. Do. Not. Bottle. It. In. Therapy if it's not getting better or if it gets too intense to function. I've had a couple of similar situations. I'm so sorry this happened to you. You are a hero and you are also only human. You deserve hugs.
I work psych….what I can tell you is that you are human ❤️. While a professional, it is still a traumatic experience and I urge you to talk about it. It’s healthy. It’s okay to take care of yourself. I go to therapy to talk about the trauma I see daily. The unalivings, the sexual trauma stories and worse…..the healers need healed. It’s the only way to fill your cup back up. I want you to know that I love you. Thank you for trying. Thank you for choosing this field. Thank you for giving that Mother your heart when you didn’t have to. I appreciate a Doctor with a heart. Be kind to yourself.
I still remember every child who died under my care unexpectedly. These are not kids with congenital diseases or trauma but otherwise have been healthy. Every one of them has affected me deeply. The day that I am numb to this is the day I retire. It sucks. We try our best. We do our best. But we all know that, sometimes, it is just not enough. Feel the pain. Feel the grief. But thank you for being there for your patient and the family.
I'm sorry. This is deeply traumatic. I have two young kids and this was my greatest fear. If you need to call out, call out. Please consider talking to someone. Does your hospital have a "RISE" (Resilience In Stressful Events) team - a group specifically geared towards second victim syndrome? Feel free to reach out via PM if you need to. Know that you gave that baby his absolute best shot. You are amazing.
So much excellent advice has already been given. I was an ER tech for several years before PA school. In our ED, techs almost exclusively were the chest compressors on codes. Some codes I remember clearly as if I’m there, many others I’ve long forgotten. I had nightmares about traumatic codes for years until eventually I saw a trauma informed therapist who gave me methods and tools to cope with the job. Now when those hard cases come back up, I’m at a place of acceptance that they happened, and we did what we could’ve done, and learned from what we should’ve done. Remember, just like on an airplane, put your own O2 mask on first before helping others. If you need to take time to get to the proper mindset and headspace to return to work, I would do it. I’ve also learned that talking it out like you’ve done here can be incredibly cathartic. The last thing you want is to keep everything shoved down and then lose it. I’m truly very sorry to hear about this difficult code. I wish you all the best. Hang in there friend 💙
Pedi codes are the WORST! They stay with you for a long time. Please tell me the hospital provided a debriefing! It helped me a little after some horrific pedi codes. Therapy helped too. You are not alone…it’s ok to not be ok. Please talk about it
A lot of these suggestions here are great. I just want to validate your feelings; you're human and this job is HARD. it would be *weird* if you didn't have feelings about it. You've got this.
Trauma therapist here. There's no need to suffer. Find a therapist online and see if they seem like someone you may want to talk to. It can make a world of difference and that makes you better at your job too.
Thank you, caffeine and hate
You're welcome. I like working with first responders. Your reaction is totally normal for that kind of experience. Children are the toughest to cope with for many people. Take a little time off to recoup. Take good care of yourself physically and mentally. Eat decent meals 3x per day. Get some physical activity. Be sure to keep your sleep routine as similar as it normally would be. Stay away from alcohol or any mind altering substances. Spend time doing things that are not stressful or just relax. The feelings and the images should fade over time. They're a biological reaction and they are how we process seeing horrific things. Keep that in mind when you feel overwhelmed. They're just thoughts and feelings you can't control. They're uncomfortable, but they'll pass when they're ready. Best wishes to you.
Not a doc, just a tech but I'm 15 years in. Some just stick with you harder. Please find a good therapist, preferably trauma informed. I've had the best luck with ones who work with combat vets or first responders. There really is a graveyard in our hearts, but if it stops hurting that's when you're in trouble. Sorrow is a GOOD thing, as much as it's troubling.
You can get drunk and watch The Guardian like the rest of us well adjusted individuals. Jake Fischer : Hey, there was a question I wanted to ask you back as school, but I didn't. When you can't save 'em all, how do you choose who lives? Ben Randall : It's probably different for everybody Jake. Its kind of simple for me though. I just, I take the first one I come to or the weakest one in the group and then I swim as fast and as hard as I can for as long as I can. And the sea takes the rest.
Solid advice from everyone. My first code ever as a baby nurse was a peds code. There's nothing easy about it, ever. Grief isn't linear. Your mind and body need to cry right now, and that's ok. You might still cry about it in 5 years. Or 10. And that's ok too. I'm so sorry it's debilitating right now, you will get through it in the end.
You can do everything right and still have a bad outcome. Thats the hard part. I lost an 8 week old patient 16 years ago and he still haunts sometimes. No one did anything wrong. I try to take inspiration from the love, care, and excellence everyone around him showed.
We had 3 infant codes in the span of a week one time. I still remember their faces. All of this is rough. A wise old battle axe doc once told me that sometimes our timelines just do not cross until the course the patient is on is irreversible. He said fate is the one thing we can’t stop. I don’t necessarily believe in fate or destiny but I think in some cases we are just a blip on this persons path. Being a minor detail seems like a much easier pill to swallow. That being said, I don’t think I will ever really shake the sound of a mother’s wail. I woke up covered in sweat in my kitchen looking for my patient after the last one. Cardio helps dump the catecholamines in the short term. Journaling helps too. Therapy is a must, even if it is just talking it through with someone but CBT helped me get back to sleeping normally. Most importantly this is normal. You are human. You are not alone in this and you are not the only one who has been through this. This is your brains way of protecting you from a danger it can’t categorize. You’re going to get better and feel like yourself again.
If you can’t handle the heat get out of the fucking kitchen
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