Personal and Professional Development
8.2 Demonstrate healthy coping mechanisms to respond to stress
As a nontraditional student that has worked in a high stress full time job in the community; I have in general been able to manage the stress of medical school without too many issues. However, there are certain situations and stressors that are fairly unique to physicians and other healthcare personnel that work in higher acuity settings where patients can very quickly decompensate and encounter poor outcomes. On my emergency medicine rotation there was one patient who had come in for a fall on the ice and was found to have a broken femur but was otherwise stable. She was evaluated and found to be in no acute distress pending an admission so that orthopedics could take her for surgery the next day. She was asking for food and doing well when the attending last saw her, but approximately 20 minutes later the orthopedics resident came to consent the patient for surgery and she was found to be unresponsive. A code was called and I participated by assisting with compressions and pulse checks. She was found to be in PEA and unfortunately despite extensive efforts she expired. I had seen patients expire before as a medical student, but in general they were extremely sick patients where it was not completely unexpected that they eventually passed away despite our best efforts. This was different in that it was a patient whom we were talking to only shortly before with essentially no life threatening concerns from her history, exam or workup thus far. That fact made the situation much more affecting and stressful to me, and also to the rest of the ED team that had been working with her. All of us kept going through the scenario in our heads and wondering if there was something that we had missed or should have done differently.
The best thing that I found to deal with that stress was to talk through the situation with the rest of the team, and the attending did a great job facilitating a debriefing session to help all of us process what we were feeling and what questions we had. I think one common mistake we all make is to think that as physicians we should be able to deal with that kind of stress by just internalizing it and going on with our job because we are supposed to be the leaders of the team and infallible. However that attitude of ignoring our own needs can adversely affect not just our own health but the quality of care we give other patients. Simply talking through the thoughts and feelings we were all having as a team was immensely comforting by just showing that all of us, including the attending, were feeling the same things and that it was OK. I felt like seeing that attending’s leadership in facilitating that conversation really helped me grow and gave me a great framework for how to talk through these types of scenarios with any teams I lead in the future.
Another thing that helped was to use social media to read about other medical students, residents and even attendings experiences about losing patients and how to cope with that stress. I think essentially all of my classmates and really just about every medical student eventually takes care of a patient that ends up dying, and participating in some of those conversations on platforms like reddit really helped me realize there is a whole community of people out there that are processing the same feelings that are willing to help. One goal I have is that throughout my residency I intend to help any medical students I work with come to the same realization and help them with any stress they are dealing with; there are many great tools out there, I particularly like Dr. Abraham Verghese’s talks about physician burnout and self-compassion, which are all related.
Above: A talk with Dr. Verghese about empathy and physician self care, available at https://www.youtube.com/watch?v=ywRGNi82kfo&ab_channel=ZDoggMD