CHESTThought Leader BlogDeath in the ICU: An Inevitable Ending

Death in the ICU: An Inevitable Ending

By: Audra J. Schwalk, MD

This post is a part of our Life as a Fellow blog post series. This series includes "fellow life lessons" from current trainees in leadership with CHEST.

I was an intern during one of my first shifts in the ICU. My team and I had worked diligently all day trying to save a patient, but our efforts were not enough. She died just before my shift ended. She was young and had several young children. Her parents stood at the bedside in disbelief as I searched for any sign of life. I was forced to tell them there was nothing else we could do, that she had died and would not be coming back to them.

In that moment and the days to follow, I was haunted by her death. So many questions were going through my head—thoughts like, what else could have been done, could we have acted more quickly, what if she came in earlier, did we make the correct decisions, should we have continued our efforts longer, and what can we learn from her? I also asked myself more personal questions like what did I do wrongam I still the best person for this job? Naturally, as a new physician, I began to doubt myself.

Everyone says death gets easier to deal with the longer you have been practicing medicine, but this doesn’t necessarily seem to be the case. I feel we just find our own way of coping with death. Even now, a year into my fellowship, each death takes a toll on me in a unique way: whether it is waking up at night after seeing the faces of my patients’ family members when I have to give them the news no one wants to hear, reliving the incident numerous times in my mind, or being preoccupied with questions about my capabilities as a physician.

As physicians, rarely do we get time to fully process traumatic or upsetting events while in the ICU. Time doesn’t stand still when these things happen as the pace of the ICU is just not conducive for this. Death in our patients is an unwanted but not unexpected consequence of being a critical care physician. We work day in and day out to aggressively treat our patients, hoping to save them and prevent death.

What keeps us going after experiencing death time and time again?

What keeps us going after experiencing death time and time again? I feel it is being able to know my life has meaning and I am there for a specific purpose. I am an ICU physician who can provide excellent care to critically ill patients and make a difference in their lives. Many of my patients will not make it out of the ICU, but I know death is a natural part of life. It is inevitable and often unavoidable.

I also know a large part of my job is to focus on establishing a supportive environment for the families of my patients, for the ones who are often left behind. I find meaning in being the leader of a team that cares for the sickest patients in the hospital while also providing support to their family members and friends.

I also try to find time to reflect after a difficult day in the ICU. After a cardiac arrest or any other significant hospital event we have a debriefing, why not do the same when we encounter a death? If I cannot take this time immediately after the event, I try to make the time later when my shift is over. I think about my patients and reflect on all our efforts in the ICU. I remember the support I provided my patients and their family members.

As intensivists we are programmed to keep pushing on, keep reviewing labs, keep completing procedures, and to see the next patient because we know time is precious for our patients, but sometimes we need to take a minute for ourselves. We need to remind ourselves we are humans with emotions and we need to confront these emotions at the appropriate time, rather than suppressing them. This is not taught in medical school, but it is a skill each of us must learn to do in our own way.

Having a high incidence of death in the ICU will easily take its toll on each of us in different ways. We must remember why we are practicing critical care medicine and what our purpose is in life. We must take the time to reflect on each of our patients and the deaths we experience in order to survive these times. We need to appropriately deal with death in order to fully devote ourselves to future patients.

Audra Schwalk, 2017Dr. Audra Schwalk is a first-year PCCM fellow at Texas Tech University. Her academic interests include lung cancer and improving mortality from sepsis. She is also interested in resident and fellow education. She hopes to purse an interventional pulmonology fellowship after she completes her current training.