Healthcare professionals and grief

    Death, suffering, panicked families – it’s all part of the work day for many healthcare professionals. As they care for patients and communicate with families in crisis – how do they deal with their own emotions?

    Death, suffering, panicked families – it’s all part of the work day for many healthcare professionals. As they care for patients and communicate with families in crisis – how do they deal with their own emotions?
    (Photo: http://www.flickr.com/photos/28177041@N03/ / CC BY-NC-SA 2.0)

    Note: Florence Gelo, Horace DeLisser, and Linda B. Welsh will take your questions and comments in an online discussion on healthcare professionals and grief Tuesday [11/03] at noon on Digest This. Click here to participate or read the archive.

    Listen:

    [audio:091103msgrief.mp3]

    It’s the death of younger patients that’s often the most upsetting.

    Resident A:
    Thirty year old lady, just had a baby six weeks prior, completely healthy, had just had a little infection, and no signs that this was going to go and progress the way it did.

    Dr. DeLisser: House staff were having a difficult time processing and handling the death of patients in the medical intensive care unit here at the Hospital of the University of Pennsylvania.

    Two years ago, Doctor Horace DeLisser started a monthly conversation about dealing with loss, the “Grief Rounds”. This session brought together a group of residents – young doctors completing their training.

    The conversation keeps returning to the young mother who died from a respiratory infection:

    Resident B:
    I didn’t know that she had passed away at that point, and I looked up and there was no one in the room, and the realization hit me then.

    Resident C: This came out of the blue, could happen to anyone, it could have been one of our own friends, this could have been any of us in the same situation

    Such feelings, says Philadelphia therapist Dr. Linda Welsh, are something health-care professionals take home:

    Welsh: You see all of this fragility, vulnerability and loss in the hospital, you’re bound to go home, feel anxious about whether your own family is safe, or how illness would be dealt with if you had to encounter it on a personal level.

    Welsh hosts discussion groups for nurses, doctors and other staff in medical centers all over the region. These sessions often focus on the death of one patient and how it affected various staff members.

    It’s a prescription against burn-out, says Welsh – which can happen quickly. With the high death rates in the intensive care unit, University of Pennsylvania hospital Resident Kelly Vranas finds herself questioning the value of what she’s doing:

    Vranas: Being in the ICU you sort of start to lose hope that you are ever helping people because here, the end point is often death, and so you start to wonder whether any of your efforts are ever worthwhile…

    Med students rarely get taught much about dealing with their emotions, says Florence Gelo. She teaches medical humanities at Drexel University.

    Gelo: The idea is to be scientifically qualified, to be clinically savvy, but how to deal with one’s emotions when constantly caring for patients where loss and grief are an unavoidable component is sort of rare.

    Even seasoned physicians like DeLisser grapple with these issues

    DeLisser: I have been a physician for close to 25 years, and I still struggle and have to deal with anger, grief, loss, disappointment, frustration, fear, the uncertainty of medicine

    In addition, there never seems to be any time to deal with emotions, Vranas says:

    Vranas: We have these pagers on us all the time that constantly go off…I found as an intern that stairwells were a very good place to go cry and let it out for a moment before you had to come back on the floor, or go into a patient’s room.

    Daily exposure to trauma, combined with work load and bottled up emotions, can lead to burn out, sleep loss, anxiety and depression.

    A hospital setting, says Dr. DeLisser, should allow for space to process traumatic events:

    DeLisser: You need to let it out now. It’s not a question of bottling it up and then waiting til later. I has to come out now. Let’s stop rounds for ten minutes and let’s go to the conference room, and talk about what we have just experienced

    Discussing emotions and grief used to be mostly taboo among hospital staff, but now conversations like the Grief Rounds are going on across the country, says Linda Welsh:

    Welsh: They are expressing their feelings, which we know is healthier than repressing them, and they are reflecting on the experience, they are giving it some meaning, they are understanding how it impacts them personally and how it impacts them professionally.

    That impact is what Resident Kelly Vranas worries about as she considers a career in Intensive Care:

    Vranas:
    I find being in an ICU extremely rewarding. My only question is, can I sustain this life because the cost is so high, personally….

    Linda Welsh says talking about emotions needs to become part of the hospital routine just like checking temperature and blood pressure.

    Note: Florence Gelo, Horace DeLisser, and Linda B. Welsh will take your questions and comments in an online discussion on healthcare professionals and grief Tuesday [11/03] at noon on Digest This. Click here to participate or read the archive.

    Thanks to Resonance Films and Seymour Levin for audio assistance.

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