Twenty years ago, I lost a five week old to meningococcemia. (Well, she passed when she got to the tertiary care center, but, still.) We were fortunate to have a hospital team debrief and a clinic team debrief. Unfortunately, the hospital team debrief was a disaster. Suffice it to say that most of us didn't feel cared for. The clinic debrief, on the other hand, was excellent. We were able to go through the process of what went right (getting the baby seen immediately, escalating care from NP to MD) and what could have gone better and how we were managing our emotions. I still think of that case all these years later, even though I'm no longer practicing medicine.
It’s odd that, when lead poorly, debriefs can begin to feel a lot like firing squads. I’m sorry you went through that. I’ve also never been a part of a debrief that was lead by a chaplain. I’m a believer as well, but there are clinical points that need to he covered systematically, and that is best accomplished with a healthcare leader.
There were two things that upset me. Unfortunately, I was not in a position to confront either of them at the time. First of all, one of the team members began to blame others (i.e. me, as the team leader) for decisions that were made. The chaplain that was leading the debrief did not redirect the conversation or otherwise deal with the accusations. Then, the chaplain (from a humanist tradition) said, "We know that life has no purpose, but we can still find meaning." For me, as a Christian who was in deep pain, this was devastating. I was not in a position to confront him about this statement. Looking back, he could have said something like, "No matter our religious or philosophical beliefs, we can still find meaning in this situation." As it was, I went home and ranted to my husband that if life has no purpose, why did I even try to save a 5 week old. When I got my wits back about me, I was able to see things more clearly, but a chaplain knows that they are ministering to those of many and no belief systems. That debrief just didn't go well. And it's unfortunate because the only thing that the clinic handled was getting the baby in the door and recognizing that we needed to get her to a higher level of care. When we got her to the ER (the buildings were connected), we actually were taking care of a baby who started to crash and had to wait far too long for the helicopter from Children's. The hospital debrief was with people who were dealing with iv lines that wouldn't stay, a baby in respiratory failure, a transport team that told us that our et tube was in the stomach (no, it wasn't, if it was, she wouldn't be ventilated), and on and on. It was traumatic. Looking back, we made very few mistakes, but we all needed support and we didn't get it. I spent time talking with some of my partners which really helped. We talked through the choices that I made. But, damn, that debrief sucked.
Beyond all of this, I know what it’s like to lose a child patient. It’s a difficult pain to process. We do our best to save lives, and leave various parts of ourselves in the background to do it well. You did everything you could have.
I was fortunate to have excellent partners who helped me process the pain after that bad debrief. And the rest of the clinic staff in the clinic debrief were also a source of strength. The Second Victim concept is very helpful to take care of clinicians. Not every death or patient trauma is traumatic for clinicians. I took care of many patients whom it was my honor to stay with them and their families as they passed from this world. But, there are times when health care workers are traumatized and I appreciate your post bringing that to light.
Thank you for your candid story and telling of the prevalence of the second victim phenomenon.
It raises awareness. I worked as a medical assistant in my 20s, and that experience has benefitted me in so many ways over the years.
One, being the fact that doctors are like everyone else—human—but the stakes are higher when you have a bad day—and you likely have to keep it contained so much of the time, whereas others of us can talk about emotions and stresses—you have to carry the heavy decision-making and heartbreak.
I hope your article helps people extend generosity of spirit to their doctors and other medical professionals.
Hi Judy, thank you for your comment. This is certainly an aspect of medicine that I want people to understand. In this way, the grieving family member can know that their loved one’s physician does care and may have been affected by the loss. Many of us carry these stories for the rest of our careers. Setbacks, losses, and difficult cases are inevitable. I want other providers to know that they’re not alone in this.
This may not be germane to your exact point, but I had a good relationship with my PC P and I was going through 5 colonoscopy screenings in 2 years.\n At this HMO and my doctor's mother went through the same procedure, and they missed her: cancer for some reason. And when I went to see my semiannual visit , she just could not contain her tears because her mother was dying.
I was also at that same time , under the care of a psychiatrist in the same building and send him an email describing doctor s's problem. Knew each other and he appreciated the email and he said he go see how she was doing. What?\n Business did I have as a patient to bring her problems to another doctor but I was in my mid-seventies and been around a long time and suffered from chronic depression. I think I recognize when people need a shoulder to cry on and what better shoulder than the resident psychiatrist?
Hi Pam, thank you for your story. It sounds like your experience with this effect enabled you to recognize with the other doctor was going through. I think it’s wonderful that you showed them support and offered them more help. We need more people like you in this industry.
Twenty years ago, I lost a five week old to meningococcemia. (Well, she passed when she got to the tertiary care center, but, still.) We were fortunate to have a hospital team debrief and a clinic team debrief. Unfortunately, the hospital team debrief was a disaster. Suffice it to say that most of us didn't feel cared for. The clinic debrief, on the other hand, was excellent. We were able to go through the process of what went right (getting the baby seen immediately, escalating care from NP to MD) and what could have gone better and how we were managing our emotions. I still think of that case all these years later, even though I'm no longer practicing medicine.
It’s odd that, when lead poorly, debriefs can begin to feel a lot like firing squads. I’m sorry you went through that. I’ve also never been a part of a debrief that was lead by a chaplain. I’m a believer as well, but there are clinical points that need to he covered systematically, and that is best accomplished with a healthcare leader.
Thanks for sharing, Catherine. If you don’t mind me asking, what could have gone better with the hospital team debrief? I’ve been in a few myself.
There were two things that upset me. Unfortunately, I was not in a position to confront either of them at the time. First of all, one of the team members began to blame others (i.e. me, as the team leader) for decisions that were made. The chaplain that was leading the debrief did not redirect the conversation or otherwise deal with the accusations. Then, the chaplain (from a humanist tradition) said, "We know that life has no purpose, but we can still find meaning." For me, as a Christian who was in deep pain, this was devastating. I was not in a position to confront him about this statement. Looking back, he could have said something like, "No matter our religious or philosophical beliefs, we can still find meaning in this situation." As it was, I went home and ranted to my husband that if life has no purpose, why did I even try to save a 5 week old. When I got my wits back about me, I was able to see things more clearly, but a chaplain knows that they are ministering to those of many and no belief systems. That debrief just didn't go well. And it's unfortunate because the only thing that the clinic handled was getting the baby in the door and recognizing that we needed to get her to a higher level of care. When we got her to the ER (the buildings were connected), we actually were taking care of a baby who started to crash and had to wait far too long for the helicopter from Children's. The hospital debrief was with people who were dealing with iv lines that wouldn't stay, a baby in respiratory failure, a transport team that told us that our et tube was in the stomach (no, it wasn't, if it was, she wouldn't be ventilated), and on and on. It was traumatic. Looking back, we made very few mistakes, but we all needed support and we didn't get it. I spent time talking with some of my partners which really helped. We talked through the choices that I made. But, damn, that debrief sucked.
Beyond all of this, I know what it’s like to lose a child patient. It’s a difficult pain to process. We do our best to save lives, and leave various parts of ourselves in the background to do it well. You did everything you could have.
I was fortunate to have excellent partners who helped me process the pain after that bad debrief. And the rest of the clinic staff in the clinic debrief were also a source of strength. The Second Victim concept is very helpful to take care of clinicians. Not every death or patient trauma is traumatic for clinicians. I took care of many patients whom it was my honor to stay with them and their families as they passed from this world. But, there are times when health care workers are traumatized and I appreciate your post bringing that to light.
Thank you for your candid story and telling of the prevalence of the second victim phenomenon.
It raises awareness. I worked as a medical assistant in my 20s, and that experience has benefitted me in so many ways over the years.
One, being the fact that doctors are like everyone else—human—but the stakes are higher when you have a bad day—and you likely have to keep it contained so much of the time, whereas others of us can talk about emotions and stresses—you have to carry the heavy decision-making and heartbreak.
I hope your article helps people extend generosity of spirit to their doctors and other medical professionals.
Best to you, Dr. Joe!
Hi Judy, thank you for your comment. This is certainly an aspect of medicine that I want people to understand. In this way, the grieving family member can know that their loved one’s physician does care and may have been affected by the loss. Many of us carry these stories for the rest of our careers. Setbacks, losses, and difficult cases are inevitable. I want other providers to know that they’re not alone in this.
Thanks for sharing this, I had never heard about it.
Thank you for writing this and giving such a vulnerable insight into a healthcare professional's life.
This may not be germane to your exact point, but I had a good relationship with my PC P and I was going through 5 colonoscopy screenings in 2 years.\n At this HMO and my doctor's mother went through the same procedure, and they missed her: cancer for some reason. And when I went to see my semiannual visit , she just could not contain her tears because her mother was dying.
I was also at that same time , under the care of a psychiatrist in the same building and send him an email describing doctor s's problem. Knew each other and he appreciated the email and he said he go see how she was doing. What?\n Business did I have as a patient to bring her problems to another doctor but I was in my mid-seventies and been around a long time and suffered from chronic depression. I think I recognize when people need a shoulder to cry on and what better shoulder than the resident psychiatrist?
Hi Pam, thank you for your story. It sounds like your experience with this effect enabled you to recognize with the other doctor was going through. I think it’s wonderful that you showed them support and offered them more help. We need more people like you in this industry.