How to Support a Colleague Who Just Lost a Baby

The loss of a baby is an undeniably singular and terrible loss. And for those who haven’t experienced this type of loss, it can be difficult to know what to say or do or how to help. But social support is one of the ways that humans get through grief, and how you respond to your colleague affects their experience of returning to work and overall well-being. Distilled from the experiences of grieving parents, the author offers ways to best support team members who face this devastating loss. While there is nothing you can do to take away your employee’s pain, you can make their return to work more tolerable. By offering flexibility, compassion, and patience, and following their cues, you can help your colleagues feel both validated and supported.

by Dina Smith

Tragic. Heartbreaking. Unbelievable. Whatever words we may choose, they fall pitifully short of the devastating reality of losing a baby.

Sadly, this unthinkable heartache occurs more than we may care to know. In the United States alone, approximately 45,000 people lose their babies to stillbirth or infant death each year. Tens of thousands more lose wanted pregnancies to spontaneous miscarriage. Still others are faced with the gut-wrenching decision to terminate their pregnancy for medical reasons.

The loss of a baby is an undeniably singular and terrible loss. For pregnant employees, there is a physical experience that comes along with the emotional challenge. Even with losses before the 20th week of pregnancy, it can take weeks to months for the body to recover and return to normal.

Further, many people can’t understand or might not acknowledge baby loss as a real loss. It is a disenfranchised grief, a term coined by bereavement expert Kenneth Doka to capture the experience that comes from losses that are not openly acknowledged, socially mourned, or publicly supported. Worldwide, grieving parents often feel that they can’t talk about their loss and even unentitled to feel the way they do. It is a hidden, lonesome sorrow.

But as I know from losing our daughter, Anya, when she was only three days old, losing your baby can bring you to your knees. It is a trauma and full grief. Life after Anya died was heartrending, disorienting, and very lonely.

Amid the grief and the physical and emotional challenges that accompany this unimaginable loss, the return to work can feel daunting and nearly impossible. And for those who haven’t experienced this type of loss, it can be difficult to know what to say or do or how to help.

But social support is one of the ways that humans get through grief, and how you respond to your colleague affects their experience of returning to work and overall well-being. Distilled from the experiences of the many parents I’ve met as a member of the club no one wants to join, here are ways you can best support team members who face this devastating loss.

Express your condolences simply.

When someone experiences a loss, it’s human nature to want to alleviate their pain. This can lead us to reach for platitudes such as “Time heals all wounds,” or “You’ll have more kids,” or “I know how you feel.” While well intended, these statements are unhelpful. They minimize the person’s loss and can make them feel even more isolated.

Instead, express a simple message of condolence and don’t press for details. For example, you might say “I am so sorry for your loss, I wish there was more I could do. I’m here if you want to talk or if I can help with anything.”

Consider sending flowers or donating to a relevant foundation, such as the March of Dimes or one that plants trees in memoriam. And keep in mind that losing your baby is often a crisis at home. Grieving parents face unimaginable decisions and a cascade of painful communications, so consider practical support like organizing a meal train.

Offer flexibility.

This grief is unique and different for everyone. While your company may have an official bereavement policy, your best move is to take the individual’s lead on when and how they return to work.

The workplace often contains triggers, and your colleague may need space and time before returning. Pregnant colleagues, office baby showers, and photos of co-workers’ babies adorning their desks can be excruciating reminders of what they no longer have.

Others may be ready to return sooner but want to ramp up over time or prefer to start from home. According to psychologist Dr. Donna Rothert, some grievers find it satisfying to return to a job that they’re good at, where they have some control and their efforts lead to results: “It is the opposite experience of losing your baby, where so much is outside of your control.” Work can also provide a welcome break with something to focus on other than grief.

The simple fact is that one size does not fit all. Consult with your team member regarding a return-to-work plan and let them come back on a timeline and in the ways that they can.

Seek guidance on what to communicate.

Consult with your colleague about what they would like communicated to the team and by whom. Ask if they would like you to send a message to the team or if they’d prefer to communicate directly or have a trusted colleague do so. Be careful not to make announcements you’re not authorized to share.

Especially in larger companies, news may travel slowly, and it can be helpful to share cues for what the person wants. For example, some people don’t want to be asked about their loss. Others want to be asked so they can say their baby’s name and remember them.

There is no right or wrong. Rather, it’s about respecting their personal needs and wishes and the rituals they have chosen.

Follow their lead.

Grief doesn’t operate in neat stages on a prescribed timeline. There can be a wide variety of responses to grief and a person’s needs and feelings fluctuate. Your best course of action is to regularly check in for how you can best support them.

You might say, “I’m glad you’re here and I imagine it’s not easy. Is there anything more that you need from me or the team?”

Some people want the welcome distraction of their work. Others might need a slower pace or fewer responsibilities for a while. Don’t make assumptions and alter their work without consulting with them first.

Returning to work can be an intense experience for grieving parents, so proactively communicate that it’s perfectly okay to take breaks, get out for walks, call their partner, or check in with trusted colleagues over the course of the day. And that if they need to suddenly leave a meeting or go home, to do so.

Remember, too, that at this point your employee may be questioning just how important work really is. While your team member will navigate to the other side of this crossroads in time, your support in the interim can ease their recovery and increase levels of organizational commitment.

Honor the memory of their child.

If your team member has expressed willingness and interest in talking about their loss, don’t back away from the conversation. But be there to listen, not talk. If they have shared their baby’s name with you, you might also ask simple questions such as, “How did you choose that name?” that allow them to remember and talk about their baby.

UCSF clinical professor of psychiatry Dr. Catherine Mallouh recommends continuing to check in every three months or so. Asking, “How are you doing?” or “Would you like you tell me more?” signals you care and haven’t forgotten.

Recognize that the anniversary of a baby’s death can be a very emotional day. Mark your calendar and proactively offer your team member the day off.

While there is nothing you can do to take away your employee’s pain, you can make their return to work more tolerable. By offering flexibility, compassion, and patience, and following their cues, you can help your colleagues feel both validated and supported.

Complete Article HERE!

Facing death

— A medical student experiences the first death of a patient

By

Every medical student has felt apprehensive about facing death at some point, right? Maybe you have experienced someone dying before, or maybe it is something you have never seen and only rarely contemplated. Regardless, there is a subtle tension lurking during your first two years of pre-clinical studies, during which disease and death are intellectualized and abstract. Then clerkships start. Working throughout the hospital, you feel that death is lurking just around the corner. It is palpable. It is hearing a code blue being called on the overhead speaker. It is entering the room of a comatose patient who is technically “alive” but not truly “living.” Whatever one’s experience has been with death, I am confident I am not alone in having felt apprehension and anxiety towards the idea of watching a patient die for the first time.

I managed to get through half of my third year without even being near a patient who died. As I began my rotation in trauma surgery, my anxiety about the experience had evolved into dread. I was certain that whenever I did finally see someone die, it would surely result in panic. In a weird way, I wanted to just get it over with. I could hear one of my professors saying, “We all go through it, it is best just to rip the band-aid off.” As it happened, on just my second night of trauma surgery, a level 1 rolled into the bay. Five gunshot wounds – one to the arm, one to the leg, three to the abdomen. He was in and out of consciousness by the time he got to us. When he was able to speak, he only sputtered out short phrases about being scared. In almost no time, he was sedated, intubated and on his way to the OR. We scrubbed in as fast as we could.

The operation lasted five hours, but it felt much longer. For the most part, it never really looked good. His bowels were shredded from bullet fragments and every time we closed one bleeding artery, we found another. It seemed no amount of epinephrine or fluids could keep his blood pressure up. About two hours into the operation, he coded. The attending surgeon barked an order at me and I started doing chest compressions. They defibrillated him. He still had no pulse. Back to compressions. I felt the crunch of his ribs fracturing beneath my palms. My face shield fogged up from my own labored breathing and I felt sweat building up in my skin-tight surgical gloves.

“This is it, this is the first patient I will see die.” The thought crept into my head for a split second, but there was no time for those thoughts or feelings — I had to do more compressions and another shock. Suddenly, he had a pulse! A brief wave of relief came over me. We operated for another hour, but despite our efforts, his pulse continued to become slower and weaker with each passing minute. Eventually, we found a hole in his aorta and it became clear to everyone in the room that there was likely no way to prevent this man’s death. Yet, we recognized the importance of striving towards the one-in-a-million chance to save a life; so, we continued to work.

But after another hour, the surgeon received a call. A child had fallen from a tree and required the team’s attention in the operating room across the hall. There was no longer the time or resources to work toward that minuscule chance of survival for the person on the table in front of us. The surgeon called off compressions. We stopped plugging holes, most of which at this point had little blood left to spurt out. Most of the team ripped off their surgical gowns and hurried off to start the routine over again next door. Suddenly, the only people in the room were me, an intern, a nurse and this man on his literal death bed.

His heart was barely beating, a mere technicality keeping him alive for a few more moments. My job was to keep my hand on his aorta and notify the surgeon when there was no longer a pulse so he could call the time of death. All of the monitors had been turned off and the room was silent. I held the now deflated tube of tissue between my fingers, closely focusing to detect the weak, irregular pulsations coming from a desperately failing heart.

Now, there was much more time and space for that dreaded thought to creep in. Surely, this is when I would recognize the reality of the situation and panic from the experience of witnessing death so intimately. Yet surprisingly, fear and dread were hardly present. Rather, I was simply sad. I was sad for this man I knew nothing about whose life was violently cut short. I was sad for his friends and family. At the same time, however, I was proud. I was proud to be feeling for this dying stranger rather than wrapped up in my own anxieties about death. More importantly, I was proud to have been part of what felt like the best effort possible to save this man’s life. My thoughts were interrupted when I recognized the stillness of the aorta. It was over. The surgeon came back to call the time of death and we sutured his wounds as neatly as we could. Even throughout this routine, I felt the gravity of the task at hand. My sense of pride persisted, knowing that we were still working hard to make the coming experience for his loved ones at least slightly less traumatic.

What made facing death more tolerable that day was the efforts made along the way. Feeling powerless is perhaps the most overwhelming aspect of death. But it is now abundantly clear that small efforts in the world of medicine provide a certain sense of empowerment and peace even in the face of horrific and inescapable outcomes. What I will remember from my first death is that we worked to provide a fighting chance and maybe even some eventual comfort to his loved ones. Efforts like these provide clinicians hope for a better outcome next time or, at least, help a family find some peace knowing that everything possible was done. They preserve patients’ dignity in both life and death. Now, I am sure that feelings like fear and anxiety will oscillate throughout my career — after all, medicine is imperfect, things go wrong and people suffer despite our best efforts. I recognize now, however, that the best way to combat our sense of powerlessness when facing outcomes that are out of our control is to appreciate the small differences we are able to make. Ultimately, these seemingly-minimal differences give medicine its meaning, make the hard times more tolerable and, more broadly, make this a field I am proud and confident to be joining.

Complete Article HERE!

The finality of saying yes

By Martie Moore

“I do not know that you understand what it feels like to say, ‘no’ to treatments, aggressive interventions or medications and ‘yes’ to the finality of death. It isn’t until you have to speak the words, make the decisions that the impact of your actions hit you like a tsunami of emotions.”

Those words were spoken over cups of tea that led to glasses of wine.

Sitting around the table were healthcare providers, leaders of palliative care, who had to walk the pathway they themselves had designed for others. The care plans were designed to ease the way into the final phase of living. Except all found the pathway was much harder even with in-depth knowledge and experience when it became personal.

I have always been a proponent of palliative care. I have designed palliative care systems for adult and pediatric hospitals. Palliative care defined by the Center to Advance Palliative Care (CAPC) is specialized medical care for people living with a serious (or chronic) illness. This type of care is focused on providing relief from the symptoms and stress of illness. The goal is to improve the quality of life for both the patient (resident) and the family.

Those with chronic diseases can use the guidelines of palliative care to aid in an approach that improves the quality of life for individuals for years. In my personal life, my mother-in-law was on a palliative care plan for more than 10 years. Her providers, friends and I worked together to address her needs. To weigh the risks, benefits and alternatives of each proposed medical decision.

The last few weeks of my father’s life, we were blessed that the hospitalist who cared for him in the hospital was also board certified in palliative care. We had to come to terms with his inability to not aspirate into his lungs when he ate and drank. We discussed the risks, benefits and alternatives of proposed care for him. A PEG tube with 24/7 care was discussed. I, being his designated decision-maker for healthcare, knew that was not what he would want but asked him anyway. I explained the procedure and what would happen if he decided that he wanted it. Before he was ill, he was clear about no tubes in his stomach. Now as I asked him again, he grabbed my hand and said, “Whatever you think is best.”

That is the moment that I will never forget. The decision that I was being asked to make was to either sustain my father’s life or make the decision that would end it. Sustain did not mean that he would not have complications, further deterioration of his health. It did mean that his total nutritional intake would be through the tube in his stomach. Because of the injury to his neck, he could not swallow fluids or solids without aspiration. The answer was to move him to palliative care or comfort care with hospice support.

I have spent my career as an advocate for palliative care. Championing that the right conversations occur before they are needed. I held the accountability for healthcare for my mother-in-law, and my parents. I had those right conversations beforehand with all three. In the space of under 20 months, I was faced with the reality of what it means to the decision-maker(s) and the circle of people that love them. Holding the right conversations beforehand, helped me to have a pathway to navigate when my emotions were raw. When I was trying to explain to others, the why of what was being done, I leaned into those previous discussions, to answer questions.

Looking back upon the kitchen table conversation, there was a theme that emerged like a brick being thrown through a window. The comment that you “do not know that you understand what it feels like to say, ‘no’ to treatments, interventions or medications and ‘yes’ to the finality of death.” You are saying, ‘yes’ to the finality of death.

What was not said, but understood: You will never forget that you said yes.

We, as healthcare providers, have worked hard to double check that advance directives are on file. We look for the POLST form upon admission. If the form is not completed, we work to get it done. We work hard to make sure that the right actions and forms are completed to ensure that wishes are respected.

Now we need to expand our actions from checklists to think about how we include the designated decision-maker(s) to understand the following:

  • They might feel guilty as they struggle to make decisions that respect their loved one’s wishes and say yes to the finality of death. (We are here to support you as you grieve. We will connect you to grief counselors.)
  • They might second guess their decision-making after their loved one passes. (We are here to talk and answer any lingering questions, even after their loved one is no longer with us.)
  • They might feel fearful that they will make the wrong decisions. (We are here to share our knowledge, until they gain a level of comfort and understanding.)

I have always promoted that we have the right conversations with individuals and families before care decisions are made. Today, I promote that we have the right conversations beforehand, but we understand that those conversations are just the start of many conversations as we journey together.

Complete Article HERE!

What Oncology Nurses Should Understand About Medical Aid in Dying

Lisa Vigil Schattinger, MSN, RN, discusses her experience with medical aid in dying, and what oncology nurses need to understand when supporting patients at the end of their lives.

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For patients with cancer who are at the end of their life, being afforded the same level of autonomy in death as they experienced is life can be a vital component in providing quality care for the patient and their family, according to Lisa Vigil Schattinger, MSN, RN.

Schattinger is the founder and Executive Director of Ohio End of Life Options, a nonprofit organization that advocates for and provides education on medical aid in dying laws. In addition to being a nurse advocate, she also brings a unique personal perspective to her career.

Schattinger’s stepfather electively chose medical assistance in end-of-life care under Oregon’s Death with Dignity Act1 after he received a myelodysplastic syndrome diagnosis and learned he was not eligible for blood marrow transplant. He opted not to start chemotherapy but enrolled in hospice and received palliative packed red blood cell transfusions before electing to pursue a medically assisted death.

Her stepfather’s death was incredibly peaceful and in accordance with his wishes: he was able to walk himself into his room, sit down on the bed, and be surrounded by family as he took the medication.

“He felt empowered,” she recalled, noting that the family was grateful that the state of Oregon had allowed them this option.

At that moment, Schattinger and her mother, who is also a nurse, recognized that this option is potentially groundbreaking for certain patients and their families. As a result, they decided to learn more about the processes in place and to share their own personal experiences. Recently, the duo presented on the topic at the 47th Annual Oncology Nursing Society Congress , specifically on the role of oncology nurses in end-of-life care and the key components of medical aid in dying (MAiD) or dying with dignity laws.

In an interview with Oncology Nursing News®, Schattinger provides a quick overview of her presentation and key takeaways for nurses seeking to provide quality care.

Oncology Nursing News®: Please provide a brief overview of medical aid in dying.

Schattinger: Medical aid in dying is a law that allows terminally ill and mentally capable adults the ability to request a prescription that will hasten their imminent death. The process is patient directed; it is a voluntary process that has multiple safeguards. It is for an [individual] who understands that they are at the end of their life, understands that they are dying, and wants to determine the time and the place and [the company present] at the end of their lives.

Each state can determine if they are going to pursue the process of passing an aid [with the establishment of a] dying law or medical aid in dying law. The first one that [was passed] was in Oregon, and it is called the Death with Dignity Act. I always consider that one as kind of a baseline. As other states passed [similar] laws, they put their “thumbprint” on that law— they made it work for their state.

Currently it is legal in Oregon, Washington, California, Hawaii, Colorado, New Mexico, Vermont, Washington, DC, New Jersey, and Maine. [In addition], there was a Montana State Supreme Court decision that allows [MAiD], but it is not exactly the same as in places that have actual laws.

[To qualify], patients have to be capable of making decisions. If there is any concern that the person is not capable of making decisions, then they can be referred for a mental health evaluation. Then there are timeframes in place [these vary by state, as well]. A patient also needs a written request that is witnessed by 2 people, of whom at least 1 cannot be related to or benefit in any way from the person’s death. Then, after qualifying for the prescription, they must wait 48 hours before filling. Patients must also be able to self-administer the medication.

Anybody involved in this process can opt out at any time, physicians, pharmacists, nurses, [or] any other care provider can opt not to participate [in the process]. Of course, the patient themselves can change their mind at any time and stop the process as well.

It is also important to note that when a physician gets this request, they must inform the person of all [available end-of-life options], including hospice care.

[Interestingly] we have learned that [approximately] a third of the [individuals] who get this prescription never end up taking it. There are a combination of things going on there. [Some] say that they can relax knowing that they are able to determine if [and when] their suffering becomes too great. Others, [unfortunately,] do decline in health. And [those] who are not able to self-administer, are no longer capable of making that decision.

Should oncology nurses only be familiar with these laws if they live in a state where it is legal? How might nurses support a patient who wants MAiD, yet lives in a state where it is not an option?

The American Nurses Association put out a statement saying that because so many people now have access to this option at the end-of-life that they feel nurses are ethically bound to be knowledgeable about it. This means being able to have non-judgmental conversations about MAiD, and to be able to [inform individuals] about what end of life options are available [including hospice care and pain management].

So if, as a nurse, you live in a state without a [MAiD] law, and someone asks you about it, [best practice] is taking a moment to really focus on that person and that request and ask: What does this mean to you? What does that request mean to you? Do you understand what all your options are for care at the end of life, and that we live in a state that does not have a law?

Then, if [end-of-life medical assistance] is important enough to patient, they [might consider if they’re willing] to move to a state with a law? This is a very big question. At the end of a person’s life, that is a really big step: to decide to pull out roots from their community, their community of support, and their healthcare community of support, and move to another area, to go through the process of establishing residency–depending on where you’re living—and finding 2 doctors who will participate in this program [is a big commitment].

However, some will decide that it is important enough to them and they do want to do that. But others [will not] and so everyone needs to understand what end-of-life care options are available to them. It is important to have that full conversation to understand that their personal beliefs, values, and goals are, and to see what types of care match their needs, as well as what is available in their community.

What are some misconceptions or things that nurses may not understand about MAiD that makes it difficult for them to support it?

A lot of times [individuals] do not understand [how it is] a self-directed process. This is the patient who wants this and it is vital that they determine what the end of their life looks like.

I remember a person who said, “When I got this diagnosis years ago, I knew that my treatment options would probably run out at some point. So, I became a partner with my health care team in making medical decisions moving through the course of my illness—I made decisions on what type of treatments [I took], what surgeries, and everything else that was possible.” When it came time for [the health care team] to say, there are no longer treatments for you, [the patient] said, “I made all of those decisions as a partner up to that point, why would it change?”

Please elaborate on the ethical value of medical aid and dying and the impact that it does have on the patient.

I think that concept of autonomy and self determination to some [individuals] is paramount. Its who they are. They want partners in their health care [team] who will work with them to provide that care. Some health care providers also believe that providing compassionate care is one that meets the [patient’s] goals.

Ultimately, the concept of suffering is for the patient to determine, not for us to judge.

Until we get to know these [individuals] and fully [understand] why they are making these requests [we cannot fully understand their needs]. Whatever a patient’s definition of suffering is, compassionate care means granting their requests to manage it.

Complete Article HERE!

A word about the word too many of us are afraid to say

Hospice care is a necessary part of life


By Mary Mitchell

Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light …
  — Dylan Thomas

It’s time to call hospice something else.

According to the American Cancer Society, hospice is “a special kind of care that focuses on the quality of life for people and their caregivers who are experiencing an advanced life-limiting illness.” That organization describes hospice as “compassionate care for people in the last phases of incurable disease so that they may live fully and comfortably as possible.”

But hospice, as well as palliative care, the specialized care for people with serious chronic diseases, has gotten a bad rap.

Although hospice has been around since the 1980s, prevailing myths prevent families from accessing the help they need to provide their loved ones with quality care as they “rage against the dying of the light.”

For instance, a persistent myth is that hospice is a place and can only be provided in a hospital or nursing home setting. Not so. About 70% of hospice care takes place in the patient’s home. And while half of hospice patients nationwide have a cancer diagnosis, the other half have other diagnoses, according to the American Hospice Foundation.

Other myths include: Medicare won’t pay for it. But Medicare beneficiaries can use their Medicare hospice benefit anytime. Another common myth is once you are in hospice you can’t get out alive. The truth is, patients are free to leave hospice and return to treatment if they choose.

After all, miracles do happen.

But death is certain.

We don’t know when it will come for us. But we know it is coming.

Still, for many, the very mention of hospice is enough to destroy relationships.

Maybe it is time to rebrand and educate the public about what hospice really is.

The concept of specialized care for terminally ill patients began with the work of Dame Cicely Saunders in 1948.

“During a talk at Yale University, Saunders, who earned her medical degree in 1957, showed pictures of patients who were terminally ill with cancer before and after receiving ‘hospice care.’ The difference in the patients’ appearance and overall well-being was remarkable.”

Still, it was almost 30 years before the Medicare Hospice Benefit was enacted, and states were given the option to include hospice in their Medicaid programs. Hospice care was made available to terminally ill nursing home residents as well, according to the California Hospice and Palliative Care Association (CHAPCA) website.

What a blessing.

Because in the midst of the prayers and the tears, I want to make sure my loved one is not suffering the shrieking pain that my mother said her mother suffered as they lay dying from inoperable cancer.

Despite the many benefits, a lot of eligible families have rejected hospice. In fact, a 2019 study published in the Journal of the American Geriatrics Society estimated “2,700 Americans a day experience non-sudden deaths without the benefits of hospice, and the utilization rate was only 52.4%.”

“The fact that Medicare pays 100% of hospice costs should be a big inducement, yet many who are eligible do not take advantage of end-of-life services,” according to an article on Debt.org titled “Hospice Costs and End-of-Life Options.”

It is time to rebrand and rename hospice care or at least launch a public awareness campaign to debunk the myths about this program.

Hospice is a way to provide quality care for someone who is suffering from an illness that medical science is not yet able to cure.

Tragically, the stigma surrounding this life-affirming treatment is depriving thousands of families from getting the care that could make the inevitable a lot easier to bear.

Complete Article HERE!

Small Differences in the Face of Death

by

Every medical student has felt apprehensive about facing death at some point, right? Maybe you have experienced someone dying before, or maybe it is something you have never seen and only rarely contemplated. Regardless, there is a subtle tension lurking during your first two years of pre-clinical studies, during which disease and death are intellectualized and abstract. Then clerkships start. Working throughout the hospital, you feel that death is lurking just around the corner. It is palpable. It is hearing a code blue being called on the overhead speaker. It is entering the room of a comatose patient who is technically “alive” but not truly “living.” Whatever one’s experience has been with death, I am confident I am not alone in having felt apprehension and anxiety towards the idea of watching a patient die for the first time.

I managed to get through half of my third year without even being near a patient who died. As I began my rotation in trauma surgery, my anxiety towards the experience had evolved into dread. I was certain that whenever I did finally see someone die, it would surely result in panic. In a weird way, I wanted to just get it over with. I could hear one of my professors saying, “we all go through it, it is best to just rip the band aid off.” As it happened, on just my second night of trauma surgery, a level 1 rolled into the bay. Five gunshot wounds – one to the arm, one to the leg, three to the abdomen. He was in and out of consciousness by the time he got to us. When he was able to speak, he only sputtered out short phrases about being scared. In almost no time, he was sedated, intubated and on his way to the OR. We scrubbed in as fast as we could.

The operation lasted five hours, but it felt much longer. For the most part, it never really looked good. His bowels were shredded from bullet fragments and every time we closed one bleeding artery, we found another. It seemed no amount of epinephrine or fluids could keep his blood pressure up. About two hours into the operation, he coded. The attending surgeon barked an order at me and I started doing chest compressions. They defibrillated him. He still had no pulse. Back to compressions. I felt the crunch of his ribs fracturing beneath my palms. My face shield fogged up from my own labored breathing and I felt sweat building up in my skin-tight surgical gloves.

“This is it, this is the first patient I will see die.” The thought crept into my head for a split second, but there was no time for those thoughts or feelings — I had to do more compressions and another shock. Suddenly, he had a pulse! A brief wave of relief came over me. We operated for another hour, but despite our efforts, his pulse continued to become slower and weaker with each passing minute. Eventually, we found a hole in his aorta and it became clear to everyone in the room that there was likely no way to prevent this man’s death. Yet, we recognized the importance of striving towards the one-in-a-million chance to save a life; so, we continued to work.

But after another hour, the surgeon received a call. A child had fallen from a tree and required the team’s attention in the operating room across the hall. There was no longer the time or resources to work towards that miniscule chance of survival for the person on the table in front of us. The surgeon called off compressions. We stopped plugging holes, most of which at this point had little blood left to spurt out. Most of the team ripped off their surgical gowns, and hurried off to start the routine over again next door. Suddenly, the only people in the room were me, an intern, a nurse and this man on his literal death bed.

His heart was barely beating, a mere technicality keeping him alive for a few more moments. My job was to keep my hand on his aorta and notify the surgeon when there was no longer a pulse so he could call the time of death. All of the monitors had been turned off and the room was silent. I held the now deflated tube of tissue between my fingers, closely focusing to detect the weak, irregular pulsations coming from a desperately failing heart.

Now, there was much more time and space for that dreaded thought to creep in. Surely, this is when I would recognize the reality of the situation and panic from the experience of witnessing death so intimately. Yet surprisingly, fear and dread were hardly present. Rather, I was simply sad. I was sad for this man I knew nothing about whose life was violently cut short. I was sad for his friends and family. At the same time, however, I was proud. I was proud to be feeling for this dying stranger rather than wrapped up in my own anxieties about death. More importantly, I was proud to have been part of what felt like the best effort possible to save this man’s life. My thoughts were interrupted when I recognized the stillness of the aorta. It was over. The surgeon came back to call the time of death and we sutured his wounds as neatly as we could. Even throughout this routine, I felt the gravity of the task at hand. My sense of pride persisted, knowing that we were still working hard to make the coming experience for his loved ones at least slightly less traumatic. 

What made facing death more tolerable that day was the efforts made along the way. Feeling powerless is perhaps the most overwhelming aspect of death. But it is now abundantly clear that small efforts in the world of medicine provide a certain sense of empowerment and peace even in the face of horrific and inescapable outcomes. What I will remember from my first death is that we worked to provide a fighting chance and maybe even some eventual comfort to his loved ones. Efforts like these provide clinicians hope for a better outcome next time, or at least help a family find some peace knowing that everything possible was done. They preserve patients’ dignity in both life and death. Now, I am sure that feelings like fear and anxiety will oscillate throughout my career — after all, medicine is imperfect, things go wrong and people suffer despite our best efforts. I recognize now, however, that the best way to combat our sense of powerlessness when facing outcomes which are out of our control is to appreciate the small differences we are able to make. Ultimately, these seemingly-minimal differences give medicine its meaning, make the hard times more tolerable and more broadly, make this a field I am proud and confident to be joining.

Complete Article HERE!

Guns have become the leading cause of death for American kids

By Caitlin Owens

Firearms were the leading cause of death for kids one and older for the first time in 2020, the most recent year for which CDC data is available.

Why it matters: The firearm death rate among children is steadily rising, as more kids are involved in gun-related homicides like Tuesday’s mass shooting in Uvalde, Texas, as well as suicides and accidents.

By the numbers: Nearly two-thirds of the 4,368 U.S. children up to age 19 who were killed by guns in 2020 were homicide victims, per the CDC. Motor vehicle crashes, formerly the leading cause of death for kids one and older, killed nearly 4,000 children.

  • Another 30% of firearm-related child fatalities were suicides, 3% were accidental and 2% were of undetermined intent.
  • Male youths were significantly more likely to be killed by guns, while vehicle crashes claimed more females.
  • There were also stark racial disparities. The firearm death rate for Black children was more than four times that of white children, and white children were still more likely to be killed by motor vehicles than guns.
  • D.C. had the highest firearm death rate, followed by Louisiana, Alaska and Mississippi.

Of note: Among children younger than 1, congenital anomalies — or birth defects — were the leading cause of death in 2020, resulting in 4,043 fatalities, per the CDC.

What they’re saying: “As the progress made in reducing deaths from motor vehicle crashes shows, we don’t have to accept the high rate of firearm-related deaths among U.S. children and adolescents,” researchers recently wrote in a New England Journal of Medicine article that highlighted the trend.

  • The study noted that while the National Highway Safety Administration could take the lead addressing road-traffic fatalities, firearms are one of the few products whose safety isn’t regulated by a designated federal agency.
  • It has taken 20 years to build a database of firearm-related deaths that includes data from all 50 states, the researchers wrote.

The bottom line: School shootings have become tragically common in the U.S., but constitute only a small fraction of gun deaths among children.

Complete Article HERE!