Dealing with death: personal self-care

Melissa B. Lesko, DO

June 25, 2015

This post is a part of our Life as a Fellow blog post series. This series includes "fellow life lessons" from members of the Training and Transitions Committee Trainee Work group, who are current trainees in leadership with CHEST. 

As I walked into the room, I was greeted by the expectant gazes of several family members hoping against all rational thought that my stethoscope would detect some form of life in the chest of their loved one. When I announced the time of death, their faces fell again, and the sobbing commenced anew.

Regardless of the circumstances, this is the face of death that I will always remember. The unrelenting hope that families possess that their loved ones will recover. The physician’s challenge of keeping a calm, measured voice when speaking with families after witnessing personal tragedy while trying his or her best not to be callous or overemotional. Your pager buzzing continuously with your next emergency as it fails to realize the significance of what has just occurred. Where in this equation can you dedicate time to process the loss of your patient? When are you allowed to grieve?

Doctors often say that death becomes easier to handle the longer you have been in the medical profession. Compared with my intern year, I personally do not have as many dreams about my critically ill patients. There was I time when I often awoke in the middle of the night emotionally raw and wondering how a family could continue aggressive care on certain patients or how others were dying without any family or friends with which to surround them. When I realized there was a change in my behavior, I was initially worried that I was becoming insensitive and emotionally hardened, but now I am not so sure.

Death is a constant in my life, yet it is one thing I know I will never completely accept.

I am uncertain if we as physicians really feel less or rather try to refocus our sense of powerlessness. Maybe we recognize that we have to concentrate our energies on helping those patients whose outcomes we can potentially change. After all, if we truly allowed ourselves the appropriate amount of time to grieve for the lives our patients we would be incapacitated. As a result, the only people potentially impacted by our inattention would be our other living patients.

After one of my patient’s dies, I am allowed 10 seconds in which everything around me ceases to exist. Time to look, to process, and most importantly compose myself before burying any emotion I have somewhere deep inside. As I see the bloodshot and tear-laden eyes of the relatives, I am quickly reminded that this is not about me. Suddenly, I refocus my attention on being a support for my patient’s family. I then channel my grief into action, diligently caring for my patients, yet knowing that I am purposely avoiding any downtime that may force me to deal with my own thoughts.
After I arrive home, a wave of exhaustion sweeps over me. Immediately, I fall asleep, only to start the cycle again tomorrow.

Death is a constant in my life, yet it is one thing I know I will never completely accept. The best I can do is to move forward each day with my scars, some burning deeper than others, with the hope of using the knowledge I have gained to ameliorate the lives of others.

Melissa Lesko, DOMelissa B. Lesko, DO is a graduate of the Philadelphia College of Osteopathic Medicine. She trained in Internal Medicine at St. Luke's - Roosevelt Hospital Center in New York City. She is currently beginning her third year as a Pulmonary and Critical Care Medicine Fellow at New York University Medical Center.

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