Hi! In NYC w BF in MN. how to help deal with patient death?

Hello everybody!

This site is AWESOME! I just found it today after a couple months of a long-distance relationship with my boyfriend, who is a first year (PGY-1?) resident in general surgery at the University of Minnesota. I'm in New York, in a graduate journalism program at NYU.

Anyways, I found this site while searching on the internet for ways to help residents dealing with patient deaths. My guy just recently had somebody die and it was the first time he experienced a death that he felt could have been prevented. I won't go into details, but he treated a patient who was having an invasive but routine procedure was doing fine, then left after being on call and had a day off, and when he got back to work after his day off, the patient was near death. He says that if he had done phone rounds on his day off, he could have had a better handle on the situation and taken measures so the patient would have stayed healthy. (Sorry I can't be more specific).

So he was real bummed and when I talked to him I felt like I didn't have any idea what to say. I was sympthetic, of course, and I really felt badly for him. But as far as responding his feelings of regret and sadness and anger over a patient's death--I didn't have the words. I felt totally ineffective. If I'd been there in person, I would have just hugged him tight, but over the phone I needed words. What kinds of things do you say to someone who is depressed about a death he feels that he could have prevented?

Thanks for listening if you made it this far! Any advice would be appreciated. Oh, and please visit my blog (see below). :chat:

Welcome.

As far as your BF feeling responsible -- they all carry that load from time to time. IRL I'd have to say that as a surgical intern (1st year), there are so many people above him on the totem pole, both in training and in true practice, that it cannot / could not be his responsiblity. It's also highly unlikely that as an intern, 3 months out of med school, he would have been able to identify something that would be life-saving when all of the people further in training (and the attendings) did not.

A sad situation to be sure, but something that he will unfortunately have to learn to deal with as he continues. Different people deal different ways, he'll just eventually find his niche. It is lovely that he is so empathetic, tho. A very nice trait in a surgeon!

Good point. But the thing is, it could have been a simple case of not giving the patient enough fluids, which was noted but not acted upon. That's why he felt he could have prevented it. But I know what you're saying. Yet he still felt terrible.

He's doing better today, btw. I just want to be prepared to help next time

[Flynn]

Hi and Welcome!

Are you planning on moving sometime in the 5 years of his residency?
Will he visit on his time off or will he split time between you and family?
How long have you dated?
How much of your dreams and ambitions are you willing to sacrifice to make this work?

On your poll I checked "it will be difficult but possible" but there are so many other issues that go into that response.

Do you know anyone in medicine besides your BF?


Take it a week at a time and don't look to far ahead.
It's a very bumpy ride.

Hi and Welcome!

Are you planning on moving sometime in the 5 years of his residency?

Yes, that's the plan. To move once school is over (approx. Jan. 2007)

Will he visit on his time off or will he split time between you and family?

He already visited during his first vacation a couple of weeks ago and plans to visit next time he has a week off (end of January). I plan on being there during my winter break, and other weekends here and there. As far as the holidays go, since he only gets 3 days off surrounding either Xmas or New Year's (doesn't know which yet), I'll probably go to him.

How long have you dated?

Exactly a year. But it's been a rocky year--broke up for a month, have only spent a couple months in the same city.

How much of your dreams and ambitions are you willing to sacrifice to make this work?

I'm not willing to "sacrifice" my dreams and ambitions, but I am willing to alter them in order to be with him (i.e., instead of looking for journalism jobs in NYC, one of the major hubs of US/World media, I'll look in Minneapolis).

On your poll I checked "it will be difficult but possible" but there are so many other issues that go into that response.

Do you know anyone in medicine besides your BF?

My brother just finished his residency in IM in Boston.

Take it a week at a time and don't look to far ahead.
It's a very bumpy ride.

Thanks! But do you have any advice about the situation I wrote about? What's your story?

[Flynn]

I think the only thing you can do is be a good listener.

The doc needs to figure out how to deal all by himself (or herself). You can ask questions to get the whole story but that's really all you can do other than to say "I'm really sorry, that must be extremely hard on you."

Intern year is pretty challenging. Second guessing is common.

We did 5 years General Surgery, 2 years in the lab in the middle of residency, and just finished up two years of Cardio Thoracic fellowship. We're finally done and not a moment too soon. Residency and training in general is it's own special kind of hell.

IM residency is extremely challening as well.
It's good you are somewhat aware of the challenges during residency through your brother.

Welcome and good luck!

[SuzySunshine]

My husband did a year of general surgery for internship and while your BF may feel responsible for this patient - he can't go through all of his training like that, he won't make it.

Of course doctors feel responsible for their patients - but who was watching his patient while he was post-call? That is why there are attendings, nurses, and other residents. Your BF has to learn that his post-call time is his time, he needs to be able to seperate himself from his patients during that time so that he can recharge.

I know its hard - I remember when my DH lost his first patient. They all take it differently but have to know the next day there is someone else the needs his help. All we can do is be supportive, its not our place to tell them how to deal with it.

Welcome to the boards!

[Vanquisher]

I'm not willing to "sacrifice" my dreams and ambitions, but I am willing to alter them in order to be with him (i.e., instead of looking for journalism jobs in NYC, one of the major hubs of US/World media, I'll look in Minneapolis).

I wish you the best of luck with that. I hope you can make it work. Unfortunatley, I have found (especially when kids are added to the mix) that surgical training is not conducive to the supporting spouse having an ambitious career of his/her own. I'm not saying it is completely prohibitive, but close.

If your SO is the #1 priority in your life, and you are okay with being #10 in his, and you are willing to sacrifice and be very resiliant, independant, strong, and often lonely, it can work, but I do think there are bumps and tears and hell and back moments in even the best of surgical marriages.

As far as the patient's death, there is nothing you can do to help him except listen, be supportive, and assure him that it was not his fault. He has to realize, though, that his time away from the hospital is valuable, and he cannot dwell on the "if onlies." There are nurses and residents and attendings at the hospital too, and he is not ultimately responsible when something terrible happens (or inevitable).

Good luck and post often!

The only way I envision it possible for me to be independent and strong is to have my own career that I am just as passionate about as he is his. He would not want me to sacrifice career goals for him. I'm only unhappy and lonely when I've got nothing else to think about but him. When we have kids, I imagine this will be slightly different, but I'm not planning on having kids for at least five years. Maybe even after his residency. The thing about being #10 priority for him is a little daunting. In fact, that's one of the things that freaks me out the most.

I'm not willing to "sacrifice" my dreams and ambitions, but I am willing to alter them in order to be with him (i.e., instead of looking for journalism jobs in NYC, one of the major hubs of US/World media, I'll look in Minneapolis).

I wish you the best of luck with that. I hope you can make it work. Unfortunatley, I have found (especially when kids are added to the mix) that surgical training is not conducive to the supporting spouse having an ambitious career of his/her own. I'm not saying it is completely prohibitive, but close.

Ditto. I have experienced first hand giving up a career to stay married to a surgeon.

I am going to play devil's advocate and throw in a few questions that cover the worst of the worst senario.

If your BF choses to do 2 years of research starting PGY4 in another location are you willing to move and change jobs? And then change jobs again to move back to finish residency? You said he was ambitious and doing 2 years of research in the middle of residency is not uncommon for ambitious academic surgeons.

Are you willing to work to pay the bills AND manage your life together when he can't support you because of a long residency + fellowship?


Can you handle a significant other who works 100 hours a week for the rest of his life? Trust me, the 100 hours a week doesn't end after the first year. It may get better as an attending but surgery attendings I know work 80+ per week.

My husband did a year of general surgery for internship and while your BF may feel responsible for this patient - he can't go through all of his training like that, he won't make it.

My sentiments exactly. Unfortunately, he will have to develop a thicker skin and move on.

Well, yes. I would like to work to pay the bills and manage a life together. That's what I'm arguing. I want to focus on my career.

As far as research years go, he'd stay in Minnesota for that. I kind of hope he does that because then he'll be able to moonlight and choose his own hours for two years.

The fact that his life isn't going to get any easier has dawned on me. So how do you guys do it? Don't you get sick of never getting to see your man (or woman) and when you do see him having him (or her) be tired and cranky? Everyone sounds so discouraging of entering into this lifestyle with any ambitions of my own. But I think having career ambitions is going to be essential so I'm not just his trophy wife (not that anybody here plays that role, because I highly respect SAHMs and women who make sacrifices for their families, but I'm just stating the extreme other end of the spectrum).

Are you planning on moving sometime in the 5 years of his residency?

Yes, that's the plan. To move once school is over (approx. Jan. 2007)

I meant January 2008. I always mess that up

[SuzySunshine]

So how do you guys do it? Don't you get sick of never getting to see your man (or woman) and when you do see him having him (or her) be tired and cranky? Everyone sounds so discouraging of entering into this lifestyle with any ambitions of my own. But I think having career ambitions is going to be essential so I'm not just his trophy wife (not that anybody here plays that role, because I highly respect SAHMs and women who make sacrifices for their families, but I'm just stating the extreme other end of the spectrum).

We're not trying to be discouraging - we're trying to be honest. We have scared people away from this site because they think we're negative, but we're just honest.

I have a career - is it the career I had planned out of college? No, but I also don't plan to have a career forever. I've never found my "true calling" so I will give up my career in a heartbeat to raise my children in a few years. I don't consider any wife that went through the residency process with their husband to be a trophy wife - regardless of what you choose to do after residency (work or stay home) you lived with him through the hardest part of this lifestyle and if anyone ever calls me a trophy wife I'll deck them. 8)

There is a resident in DH's program who's wife is very ambitious (MPH/JD) and they have a two year old son. Their life is very hard, not impossible, but hard because she works her 60+ hour job and takes care of their son. They are lucky in that they have family close by to help. However I worry about her on an ongoing basis because she is always SO negative about the program here (a program which DOES stick to the hours rules)and pissed at her husband. IMO you can't live like that. You need to accept that life isn't going to be all roses for the next x number of years and hope it gets better after.

Truly everyone find their own way to deal with it and I hope you're able to find ours. Please post often and delve into some of our other areas for some good information.

[houseelf]

Suzy,

As much as I want to say, "You guys can do this!" I just can't go there. What everyone is trying to say here is that this is a damn hard to go.
There will be sacrifices. Big ones. No one day in surgery is that bad. Add seven years of crap days together and it can take its toll on the most dedicated physician and the most in love couple. None of us is telling you this to bring you down, but to tell you that there will be a certain amount of heartache that you will both bear. It is simply unavoidable if this path is chosen. With that being said, I wish you and yours every luck in the world.

Kelly

[Flynn]

Please forgive our brutal honesty. The people here are good people and are only asking these questions to be helful and share their experience. We all came into this life with a bit of optimism and some of us had blinders on.

I was so naive it makes me chuckle now. I had heard this lifestyle described to me and I just thought the people telling me these awful things were exaggerating because if they weren't, why the heck would anyone be a doctor. I was wrong wrong wrong wrong wrong.

Having your own career (one that you care about and value), being married to a surgeon AND having kids is almost IMPOSSIBLE . I think it is reasonble to hope for two of these but not all three. That's my two cents on that topic.

You mentioned that your BF would just do research where he currently is? Does he have that in writing now? I ask because one of the rules of thumb to this life is NEVER believe anything unless it's in writing. Your life is not your own and verbal promises don't hold water. We have never been burned, but we know PLENTY of docs and their significant others and/or spouses that thought they could stay in one place for all of their traing, had promises from highly placed attendings, and it fell through.

One couple I am thinking of had to move for residency, lab time and fellowship. That's three moves in 9 years and NONE were paid for by the institution. Also, don't count on moonlighting. Many programs go through times where moonlighting is NOT allowed. Again, don't count on anything in this life. Just when you think you've figured out the rules, they change.

I'm not saying this will happen to you. What I am saying is BE CAREFUL and don't count on too much unless it's in writing.

Picture what your "worst case scenario" is and see if you are willing to go the distance. Then, take it SLOW. Your BF is going to go through a lot of changes during his training and General Surgery is very HARD on relationships.

Residency will change your BF and hopefully it won't be permanent. Lack of sleep, pressure, too much to do not enough time changes ANYONE. It will effect your BF too. Dealing with someone who is impatient and crabby -- sometimes for YEARS is part of the deal.

I'm not sure how we made it through. There were times when I thought there was no way we would. There is no recipe for making it. You muddle through it and do your best.

It can work but don't, even for a moment, think any of it will be easy.