The Heart-Wrenching Reality of Caring for Dying Patients

It was another busy day in the intensive care unit, and I was already feeling exhausted before my shift had even begun. But as soon as I walked through the door, I knew I had to put on a brave face and get to work. As always it was going to be a tough day. Mrs S, a dear patient, had been experiencing increasing shortness of breath for a few days now. She was wheezing and coughing, and it was getting difficult for her to manage her symptoms even with her inhaler. Her condition worsened over the hours and was brought to the hospital. Upon arrival, she was immediately given oxygen to help her breathe. I was passing by the Emergency Room at that time. The ER team had decided to shift the patient to ICU. Can you imagine how scared she must have been, struggling to catch her breath even at rest and looking at all doom and gloom around her?

The next day, in ICU, as I walked over to her bed, I could see the fear in her eyes, and it broke my heart. She was hooked up to a ventilator, and her breathing was shallow and labored. I could hear the beeping of the machines all around me, and I knew that we were fighting a losing battle. I took her hand and looked into her eyes, trying to comfort her as best I could. I had a thousand words to say yet my tongue seemed to deceive me. She tried to smile, but it was clear that she was struggling. Her daughter, who was sitting by her side, looked up at me with tears in her eyes. “Will she be, okay?” she asked, her voice trembling. Her mother had been feeling increasingly short of breath for the past few days. She had been wheezing and coughing but had been trying to manage her symptoms with her inhaler at home. However, when her symptoms worsened and she was struggling to catch her breath even at rest, she decided to bring her to the hospital. But despite the vigorous treatment, her mother’s breathing continued to be labored, and her oxygen levels were not improving. The decision was made to transfer her to the ICU for closer monitoring and more aggressive treatment.

I could feel the weight of the responsibility on my shoulders. As a doctor, it was my job to offer comfort and hope, but I knew that the reality was far from that. I took a deep breath and tried to choose my words carefully. Those words which I probably have said a thousand times but each time I have suffered saying them. “She is very ill, and we are doing everything we can to help her,” I said. “But I want you to know that she is not alone, and we are here to support her and your family in any way we can.”

The daughter nodded, and I could see the glimmer of hope arising. I turned to Mrs S and continued to speak softly to her, trying to offer her as much comfort as possible in her final moments. As the day wore on, her condition continued to worsen. We tried everything we could to keep her comfortable, but her body was shutting down, and there was little we could do to stop it. I could see the sadness in the eyes of the nurses and the other doctors around me. We were all doing our best to care for her, but we knew that there was no hope for recovery. We all wished that we could do more, that we could save her, but we knew that death was inevitable.

Her heart was failing. We started the support. There were echoes of doctors and nurses ringing in my ears. Her blood pressure was collapsing. Life was slipping away from her. Machines were beeping. Yet, somehow, I felt devoid of life and feelings. I had seen hundreds of deaths by now, yet every single one of them took something away from me. I remembered a starting quote from a lecture of mine from med school, which has stayed with me:

“The intensive care unit is like a war zone, except that it’s a war against death itself, and the enemy is always winning.”

-Dr Atal Gawande

I looked at her, taking her last breath, and then her body went limp. I could see the tears streaming down her daughter’s face, looking through the door of the ICU. I had to console her. I didn’t want her to bear the grief of watching her mother in those moments. I went to her but all I could muster was, “I am sorry for your loss”. She couldn’t speak. She was mumbling words which were incoherent, but the pain in her eyes and the grimace her face showed were speaking her story. I mustered the courage that was left in me, placed my hand on her daughter’s shoulder and tried to offer some comfort. “I’m so sorry for your loss,” I said. “Your mother was a fighter, and we did everything we could to help her.” I gave her the time to suffer in silence and left. I had tears in my eyes. Mentally I was shattered to the very core.

Mrs S came to us with an acute exacerbation of Asthma in the ICU. Indeed, she was facing one of her biggest challenges yet. Her medical history revealed that she had struggled with asthma for years, but it had never been this severe. As I looked at her medical chart, I saw that she had been admitted to the hospital several times in the past for asthma exacerbation, but each time she had bounced back with her usual determination and spirit. She was taking her medications as prescribed and doing everything in her power to manage her condition. But this time it was different. She was struggling to breathe, her chest heaving with every gasp for air. She was scared, and I could see the fear in her eyes when I placed the oxygen mask on her. Over the next few days, I worked tirelessly with my colleagues to manage her symptoms, adjusting her medications and closely monitoring her condition. She smiled at me whenever I came near her. She was indeed a fearless warrior or maybe she was putting on a brave face while facing death. I will probably never forget that smile. She had a gift. She knew it and she shared that gift even in her misery. Her condition deteriorated quickly. We did our best, as always.

It was time for me to break the news of a mother’s demise to her daughter, which she had already seen. As I approached her, I could see the despair and helplessness written all over her face. I took a deep breath and tried to communicate as empathetically as possible. I explained what we had done for her mother, the condition she had suffered from, and how bravely she had fought. I wanted her to know that her mother had been in the best possible hands and that we had done everything we could have to help her recover. As I spoke, she stood there silently, absorbing everything I was saying. Then she broke down in tears, streams of sadness and gratitude washing over her face. I could see the weight of her worry lifting, if only slightly, as she realized that her mother had been well taken care of. “Thank you, Doctor,” she whispered between sobs. “Thank you for everything you did for my mother.” At that moment, I felt a profound sense of purpose and satisfaction. Knowing that I had helped alleviate her worry and provided her with some measure of hope. It made everything worth it.

I could see the pain and loss in her eyes, but I also saw a glimmer of hope. A hope that her mother’s spirit would live on, even in death. I took her hand and squeezed it gently, offering what little comfort I could. “Your mother was stubborn in the face of death,” I said softly. “She faced her illness with courage and strength, and she was never alone. She had you, her family, and us by her side every step of the way.” I could see that my words had brought some comfort to the daughter, but I knew that the road ahead would not be easy. Grief is a difficult burden to bear, and it takes time to heal.

As I left the hospital that day, I couldn’t help but feel a sense of sadness and loss. The patient I had worked so hard to save was gone, and her daughter was left to pick up the pieces. But I also felt a sense of comfort knowing that we had done everything we could to make her final moments as comfortable as possible. I have always wondered why I chose this, yet I get up every day with a new ray of hope that I am making someone’s life easier and maybe someone’s death. I have witnessed the fragility of life and the courage of those who face death. I have seen patients fight for every breath, and families hold on to every hope. I have also seen patients let go peacefully, and families find closure and acceptance. I have learned that every life is precious, and every death is meaningful. I have empathy for those who are suffering because I have suffered too. I have lost colleagues, friends, and loved ones to illness and tragedy. I have struggled with grief, guilt, and burnout. I know what it is like to feel helpless, hopeless, and alone. But I also know what it is like to find strength, support, and resilience. I know that there is always a reason to live, to love, and to heal.

The Emotional Toll of End-of-Life Care: A Personal Perspective

I have realized that the care at end-of-life is not just about providing medical care. It is about providing comfort, dignity, and respect to patients and their families. It is about creating a safe space where patients can spend their final days surrounded by loved ones and without the pain and discomfort that often comes with aggressive medical treatments.

As an intensivist, I have seen the end-of life care process far too many times. It is a process that often leaves us, healthcare providers, grappling with mental and emotional turmoil. Many people in non-medical professions as well as patients and families may assume that doctors have a professional detachment from death and dying, but the truth is far from it. Doctors, too, are human beings who experience grief, loss, and sadness when a patient dies. The emotional toll of caring for a dying patient is overwhelming and it is not something that can be easily put aside. We find ourselves struggling with our emotions and grappling with feelings of inadequacy, guilt, and failure. We ask ourselves if we did enough, if we could have done something differently, or if there was something we missed. These thoughts can be suffocating and can lead to burnout, depression, and even suicide.

One of the most challenging aspects of care at end-of-life is the feeling of helplessness. As doctors, we are used to being able to fix problems and make things better. But when it comes to end-of life care, there is often nothing we can do to stop the inevitable. It is a feeling of powerlessness that can be overwhelming and frustrating.

We should show compassion and sympathy for ourselves. End-of-life care is an emotionally challenging and mentally exhausting process for healthcare providers. We experience the same emotions as everyone else, and the guilt and helplessness can be overwhelming. It is a critical part of our job, and we have to provide comfort, dignity, and respect to patients and their families. As healthcare providers, we must find a way to balance our emotions with our duty to provide the best possible care to our patients.

Prioritizing Mental Health: Advice for Fellow Doctors Struggling with Emotional Turmoil

“As a profession, we need to recognize that caring for the dying is emotionally taxing and that we are not immune to the psychological challenges it presents. It’s essential to prioritize our own well-being so that we can continue to provide compassionate care to our patients.”

Dr Ira Byock, palliative care physician and author.

Through my career, I have learned some valuable lessons on how to cope with the emotional toll of end-of-life care. I would like to share some advice with my fellow doctors who might be struggling with similar issues. Taking care of ourselves is crucial in maintaining good mental health. This means making time for activities that bring us joy, whether it’s exercising, reading, spending time with loved ones, or pursuing a hobby. We also need to make sure we are getting enough sleep, eating a balanced diet, and practicing relaxation techniques such as meditation or deep breathing. Surveys have shown that 85% of physicians have experienced some sort of mental health issue.

So, I have a few pieces of advice to share, some of which helped me in those arduous days:

• Prioritize self-care: Taking care of ourselves is crucial in maintaining good mental health. This means making time for activities that bring us joy, whether it’s exercising, reading, spending time with loved ones, or pursuing a hobby. We also need to make sure we are getting enough sleep, eating a balanced diet, and practicing relaxation techniques such as meditation or deep breathing.
• Seek support: It’s essential to have a support system of family, friends, or colleagues whom we can talk to about our feelings and experiences. It’s also important to seek professional help if needed, such as seeing a therapist or counselor. Mental health should be treated just as important as physical health, and seeking help is a sign of strength, not weakness.
• Practice mindfulness: Mindfulness is a technique that helps us focus on the present moment and be more aware of our thoughts and feelings without judgment. It can help manage stress and anxiety.
• Accept our limitations: As doctors, we often feel like we need to be perfect and have all the answers. However, it’s important to recognize that we are only human and that we have limitations. It’s okay to ask for help or to admit when we don’t know something. We also need to be able to accept that sometimes, despite our best efforts, we may not be able to save every patient.
• Find meaning in our work: Our work as doctors can be incredibly meaningful and rewarding, but it can also be emotionally challenging. It’s important to find meaning in our work and to remind ourselves of the positive impact we have on our patients’ lives. Focusing on this can help us stay motivated and connected to our purpose.
  

Remember, taking care of our mental health is just as important as taking care of our physical health. By prioritizing self-care, seeking support, practicing mindfulness, accepting our limitations, and finding meaning in our work, we can better cope with the emotional toll of end of-life care and prevent burnout.