How do you deal with death?

[KyleKIR]

I'm just writing because I'd like to know how you guys as EMTs deal with death on the job, and in your personal lives.

I was just laying here doing some thinking about death. I'll start by saying I am 20yrs. old and have never lost anyone yet in my life. (Family, friends, etc.)

The reason I'm thinking about it is I was in California for 2 weeks and my last night there (last Friday) I went with a family member who was alone to put her dog to sleep. I never seen anything really besides bugs die (if that even counts), and yet I watched them kill a dog who was suffering with cancer right in front of me.

Was it sad sure, I even helped her take the 40pd dog home and bury it. I didn't cry or anything, but it was sad cause she was hysterical & that dog just lost it's life. I think I hid my emotion and tried to "stay strong" which idk if that's good.

Before I ask the questions I have for you guys, I also want to say I didn't even know what to say to my aunt. (lady who lost her dog) or comfort her really I kept asking "are you ok?" I mean obviously she wasn't... Though she kept saying she was.

So now to my questions.

How do you guys deal with deaths on the job?

Do you cry on scene if someone dies? Maybe a young kid.

Have you cried on scene?

Are you allowed to cry or tear up anyways... on scene or in the back of the ambulance when dealing with patients?

These are just some questions I have and hope you guys don't mind sharing your thoughts.

And if you'd like you can talk about how you deal with deaths in your personal life if it's different than on the job.

Also, I just read this book and one of the quote I read in there said:

"Death is not a tragedy. It's a certainty." "indeed, there are tragic circumstances surrounding many deaths. Some die too young. Some seem totally senseless. Some deaths negatively impact the lives of many people. The circumstances of death can be quite tragic, but death itself is not tragic. It is as much a part of life as is birth."

It just left me thinking.

Thanks for reading.. And thanks for any time reading and responses you may have.

-Kyle

[Timmy]

Hey buddy. Everyone deals with death in there own way. Im 20 as well and have dealt with quiet a number of patients who have passed away, fortunately most of which were palliative care patients but unfortunately I have been involved with death at motor vehicles accidents, sudden death in ED and so on.

Theres no easy way about it but in the end everyone has to die, its a fact of life, some die young, some die old. No one can stand here and tell you how to feel, how you will react or how to deal with your feelings because everyone is different.

Unfortunately living in a small community your more than likely going to know or know of most of the people who die so it makes it a little harder. I was involved in the care of an adolescent patient who was transferred from a tertiary facility in the city for palliative care management post failed excision of a brain tumour which had metastasised. He arrived at us fully alert and orientated, for pain and symptom management, he was with us for 4 weeks, in that 4 weeks I became pretty close with him and his family (being a similar age I guess it was easier to bond and get along). He ended up being on infusion of morphine, metaclopramide and midazolam. I ended up having to give him so much medication he was pretty sedated and unresponsive which was extremely hard for his family. We he past away we just supported the family, offered reassurance and what not… When I got home I spent 2 hours sitting on the floor of the shower crying, just my way of dealing with it I guess.

Youll never get use to death but you develop ways to deal with it both at the scene and once the situation is over. Theres nothing easy about seeing people who have past away in car accidents, helping the ambos extricate the body, patients who come into ED and crash and even palliative care patients who are expected to die.

Youll always remember the first deceased person you see. Its easy to forget about your welfare and state of mind, sometimes it takes a while for the adrenaline to wear off or youre busy looking after everyone whos around you and forget about what your feeling and when you get home it all hits you at once. Its important to talk about what youre feeling with someone you trust, work colleges or peer support and look out for symptoms of PTSD.

I wouldnt recommend crying in front of everyone, sometimes youre the only one who isnt hysterical and people really appreciated someone of sound mind hanging around to offer support. Of course you tear up on the odd occasion but breaking down into a complete crying fit would not be recommended.

EDIT - I forgot to mention anger! After some jobs you doubt your self and you often find yourself flashing back on how you could have improved or done something different. This is such a common occurrence for us, on the odd occasions I’ve beaten myself up over things I could have done better. The fact is sometimes little mistakes happen but what done is done and you live and learn. On some patients there injuries are just incompatible with life and despite your best efforts things don’t always have a positive outcome.

Hope this helps

Edited October 12, 2010 by Timmy

[HERBIE1]

Kyle, death is a part of life, but for anyone in this field, it is a FREQUENT part of our life. We see all manners of death- stupidity, tragedy, accidents, natural aging, disease processes. Some people can completely shut down their emotions and seemingly not be affected. I think those folks are few and far between. For most of us, it clearly depends on the circumstances. Your response can range from a "Gee, that was too bad", to "Oh my gawd, why did this infant have to die!"

When my kids were little(infants), I went through a stretch where I saw 6 dead infants in a month- mostly SIDS, but a couple were homicides and accidents. I was almost afraid to go to work. That was tough- I kept envisioning my own kids. You go home, hug the kids a little tighter, and be thankful they are OK. You get through it.

There is no right or wrong way to deal with it, as we each develop our own coping mechanisms based on our own personalities and our psychological make up. You are young, which means in many ways you are at a disadvantage- your lack of experience personally dealing with death can be a problem. It also can be a golden opportunity to start off on the right foot. You are doing the right thing- asking questions, looking for advice. Take what folks tell you, realize the good and bad of what you hear, and then adapt these ideas to make them your own. Until you begin to amass the experiences on your own, it's all you can do.

How we deal with the death of a patient also depends on where we are at emotionally. If we are having our own personal issues, you may not be able to cope quite as well as other times. Sometimes the strangest calls get to you. Maybe you form an immediate bond with a family member and empathize with them more than usual for some reason. The thing is, DURING the call, you need to shut out the emotions and do your job. Sometimes that is easier said than done, but you have no choice. We are called to help someone because we CAN do something about a situation, and falling apart during a call won't help anyone. I worked with a girl- good medic, with plenty of experience. Saw plenty of death and dismay. One call we had was an elderly man who suddenly arrested at home- nothing unusual. I noticed my partner was not doing well during the call- slow, confused, tentative, needing to be prompted to do her work- totally out of character. The man died, and afterwords, I asked her what was wrong and why she was out of sorts. She broke down and cried, and told me that her grandfather had just passed away last week, and the emotions suddenly spilled out. It happens.

Afterwards you can sit back, reflect on the call, critique your actions, and deal with any associated emotions that surface.

Bottom line is now is the best time to examine this idea- better to develop POSITIVE coping skills, then later on when things start to catch up with you and you turn to negative behaviors. Figure out what works for you, and start working on those skills now- they take time to develop. Some folks turn to religion, others to meditation, others take vacations to remote, quiet, peaceful places to clear their heads. Others get relief from just talking about things with coworkers. Others like to keep a separate group of friends who have nothing to do with the business. Everyone is different, and what works for me may not work for you.

Good luck.

[KyleKIR]

Thanks a lot to both of you above for your responses. I like hearing what you guys have to say, and for me I feel that talking to people would most Lillkely be my coping method. When I talked about crying I was meaning more like shedding a tear. Not break down crying.

I was thinking how someone would go about controlling their emotions EMT wise while dealing with certain deaths, but you guys I think pretty much helped me understand that. I now understand that as an EMT the people on scene who may be all frantic about a death, or maybe just a bad trauma are counting on you guys to be together mentally to help a patient the best you can. They have time to focus on the injured/deceased person which can probably add to the emotions, while you guys are probably so busy trying to help someone, keep everyone calm, and do your job right that it makes sense you may block everything out and then actually reflect on things later when things are calm.

Thx for the replies.

[Chief1C]

How do you guys deal with deaths on the job?

Depends on what kind of day I'm having. If there is other stress, sometimes etoh becomes a factor in getting my mind to another place. However most of the time, I just move on mentally, and accept the fact that not every life can be saved.

Do you cry on scene if someone dies? Maybe a young kid.

Depends who and how they died. I've had quite a few pedi arrests, infants, toddlers and young children. Blank slates, to poorly cared for, to parents that take religion over medicine. Take a step back some day, and look over the stages of how people are believed to handle grief. If you summarize it, you see that we (EMS) do the same, only more briefly.

Have you cried on scene?

In a small town, I've seen a lot of people I've known all my life, die tragically. I tend not to cry, I do a lot of deep sighing. I do the bottle it up approach, which is terribly unhealthy. So, when it comes to the point where it can no longer be held in, it's not pretty.

Are you allowed to cry or tear up anyways... on scene or in the back of the ambulance when dealing with patients?

We're only human.

[Bieber]

Hi, Kyle. I'm just a student, and I haven't seen the number of code blues that probably the majority of people on this board have, but if it's not too presumptuous I'll share my opinions, such as they are.

So now to my questions.

How do you guys deal with deaths on the job?

To be honest, I guess I don't. I've had, if I'm recalling correctly, a total of eight codes that I've been involved in. On all but one, I took part in performing CPR at some point, and in the two I've had thus far in my field internship, I intubated both of them, and on the second one was leading the code. I say this just to clarify that I wasn't merely a passive observer (or maybe I was?), but involved in their care in some fashion. Now maybe I'm too green in the job to be affected by it yet, but to be honest they haven't interrupted my day or otherwise affected me emotionally. In the EMS/Police/Fire TV series, Third Watch, there's an episode where one of the new paramedics recounts also feeling nothing for his patient who coded, to which the senior paramedic "Doc" replies something along the lines of, "You didn't know them when they were alive, so it's hard for you to miss them when they're gone." I think this is very true in a lot of ways, at least for me. Now, maybe this will change as I get more experience and run more codes, maybe it won't. In the end, who is it for anyone to decide how we should react to death? We all experience it differently, and hopefully we process it in a healthy way.

Do you cry on scene if someone dies? Maybe a young kid.

Have you cried on scene?

Are you allowed to cry or tear up anyways... on scene or in the back of the ambulance when dealing with patients?

I don't and haven't, and to be honest I, in my humble student opinion, don't think we should cry in the presence of family. Not that it's inappropriate to be sad, or to cry later in the ambulance or back at station or wherever, but for two reasons. First of all, we are there to be calm and collected when no one else is. Family is there and is freaking out and they need to know and see that we are calm, that we are doing (or have done) everything possible to save their loved one, but were unable to. And secondly, and this is more of my own personal take on things, because I feel like if I were to cry in front of family that I would be stealing something from them. It isn't our tragedy, it's theirs. I don't have any definable reason to feel that way but it's how I feel and maybe it will change someday, but not today.

And if you'd like you can talk about how you deal with deaths in your personal life if it's different than on the job.

Like I said before, I think that, at least for me, dealing with the death of someone you knew and loved is different from dealing with the death of someone else. Losing someone you were close to is putting the back cover on a book of memories that will never grow any bigger; precious memories that you held dear and had an expectation of adding to. You have no fond memories of the patient (unless you've run them before or otherwise had the opportunity to really enjoy their company before their passing, even the idle happy chit-chat after you've done what you needed to and now have time to kill en route to the hospital), and no expectation to continue to grow upon them. Again, that's just my take for myself.

"Death is not a tragedy. It's a certainty." "indeed, there are tragic circumstances surrounding many deaths. Some die too young. Some seem totally senseless. Some deaths negatively impact the lives of many people. The circumstances of death can be quite tragic, but death itself is not tragic. It is as much a part of life as is birth."

It just left me thinking.

Thanks for reading.. And thanks for any time reading and responses you may have.

-Kyle

No, thank you. I hope what I've said helps, or at least makes some semblance of sense. As I continue through my internship and later in my career in medicine, I wonder if my opinions will change. I haven't had any peds code on me yet, and I understand that for a lot of people those are the heartbreakers that tear down even the toughest of medics, so I really don't know how I'll react to them. Either way, thinking about death now helps me try to make sense of it and my role in it, both in the death of my patients, my family and friends, and myself.

[emtannie]

This thread caught my eye. Kyle, the questions you raised are good ones, and as others have said, everyone reacts differently. I will try to give my two cents worth.

I formally got into EMS later than some, and have been in for almost 15 years.. I have seen a lot of death, both on the job, and in my personal life.

I work both in a small community, and in a larger centre. Deaths in the small community are harder, because I am not only EMS, but am also a friend, a neighbour, or a relative to the person who died, or one of their family members. As EMS, they look to me for support and guidance during the situation at hand. It is difficult, but it is also an honour to be able to help them during one of the worst times of their lives, and know that by supporting the family, I was still able to do something positive, even if I couldn’t save the family member. Some of those calls are very hard, when it is someone I am close to, or it is a child that I know – but in those cases, for me, it helps for me to remind myself that I didn’t cause the problem (illness or injury), but I am just there to do my best to provide care. If I can provide compassionate care, and respect the emotions of family members, I am doing my job.

Have I cried on scene? Not that I can think of. Have I cried after, in the privacy of my own home, or at work when I could have some privacy? Absolutely. Some calls just suck.

You are very lucky to have reached the age you are without losing someone very close to you. I have lost family members and close friends throughout my life, including friends who died when I was in school – I lost a close friend to cancer just after Grade 12, and several friends at university. Two of my grandparents had passed away before I was born, and the other two died within 6 months of each other when I was in junior high. I lost several uncles and aunts when I was very young, two of whom I was very close to, as I lived with them when I was very small.

The worst losses I have had is the loss of my parents – my dad in 2002 from cancer, and my mom this past January from complications from surgery, due to kidney failure. I was very lucky to have been very close to both my parents, closer than most, I think, but that also made the loss harder to bear.

As hard as it has been, I do think in the long run, it makes me a better EMS provider. With the losses I have had, I think I am better able to understand the anger, the terror, and the incredible sadness of losing a loved one, and respect that everyone grieves in their own way. Can I say I know how they feel? No – everyone feels differently, and I would never say “I know how you feel.” I have seen practitioners say “oh, that family member over-reacted,” or “how could they be so calm?” I think it is important to respect their grief, not question it.

You will find your way, and you will figure out your way of dealing with death, both on the job and personally. Death is a fact of life – sometimes it is a terrible thing, and sometimes it is a blessing, and it is up to us to decide how we are going to deal with it.

[Don1977]

I haven't had too many patients die on me, I did however had a 3 month old die on Christmas Eve morning 3 years ago from SIDS, it was an Inter-facility emergency transport with Children's hospital of Pittsburgh critical care transport team.

This was a terrible way to end a 12 hour shift, I admit I did get a bit teary eyed for a few minutes, but mostly because it was a day before Christmas and the fact the child died at home and the mother was at work at that time had no idea what happened.

I have cried over family death my step-mom and grandfather were ones I did not take well, especially my step mom who was 30 when she died of diabetic complications, I just spoke to her 3 hours prior to my dad finding her dead in there bed, she said she didn't felt good, but she had dialysis that day so that was nothing new for her to feel like that.

I have had a handful die after we transfer them to hospital bed, I feel sad, but never down, just clean truck up change the linen on the cot and continue to next call......nothing more you can do....it happens...

Edited October 13, 2010 by EMTDON279

[Vorenus]

So now to my questions.

How do you guys deal with deaths on the job?

Do you cry on scene if someone dies? Maybe a young kid.

Have you cried on scene?

Are you allowed to cry or tear up anyways... on scene or in the back of the ambulance when dealing with patients?

And if you'd like you can talk about how you deal with deaths in your personal life if it's different than on the job.

In the EMS you treat patients not that long (depending on whether you load and go/stay and play and how long your trip to the hospital lasts). The average time I spent with my patient is possibly an hour (+/-).

Therefore I don`t really have a deep relationship to the person who dies. Of course it`s tragic, but there`s a certain distance involved.

But there are, of course, cases that affect you more than others. That could be patients you know over a longer period, children, suicides, younger patients, etc.

[DwayneEMTP]

...How do you guys deal with deaths on the job?

Peraonally? I don't really. In most cases I still have pts to attend to and that holds my focus and I've been lucky in my EMS career that as long as there are patients to take care of then nothing really phases me. Men, women, children, sometimes the effect that the death has on the family hurts my heart a little bit, but I don't think that I've ever had feelings for those that have died.

...Do you cry on scene if someone dies? Maybe a young kid.

I haven't, but I would if I felt like it.

...Have you cried on scene?

I haven't but I might some day. As I get older it seems like I turn into a bigger and bigger baby by the month. I bawled my eyes out the last time I left Babs and Dylan at the airport to go back to Afghanistan. I cried the last time I talked to Dylan and he asked me to come home early, yet I knew I couldn't. If you cry for effect, then you should knock that shit off. Otherwise crying, though many find it embarrassing, is good and healthy.

...Are you allowed to cry or tear up anyways... on scene or in the back of the ambulance when dealing with patients?

Grin, if someone needs to cry, there is no allowing it or not. I've had partners and coworkers cry and it's always given me great respect for them as human beings, though again, the reason for their tears was emotional and not theatrical. There is an adorable little nurse at the ER in the last town I worked. Smart, kind, compassionate, always seemed to be there when my partner and I brought in someone that was destined to die, which is usually CPR in progress periodic return of pulses. She was a stud! Always in the middle of things, quiet, efficient, smart...but after each pronouncement of death you could find her in a little corner somewhere crying for the person who'd died.

Near the end of my tenure there a had come to know her well enough that I would stand next to her, with our shoulders/hips touching, and I'd just be with her, and her with me for a few minutes. It was a gift... Until you've been there and done that it will be hard for you to see that she showed her strength in her tears, not her weakness. Many can deal with pain/suffering/death by building walls that won't allow it to effect them, in her tears I saw that she refused to do that. She'd decided to do her job yet leave herself open to any of the feelings that came with it when the time was appropriate, and it was obvious in her care. I've thought of her often and try and model her emotional behavior...I liked it a lot.

I'd not heard a single derogatory word spoken in regards to her way of dealing with things, and I believe it's because most saw her the same way I did.

...And if you'd like you can talk about how you deal with deaths in your personal life if it's different than on the job.

Much too complex to do here brother. I've helped many people that I love near and through the end of their lives, but this has nothing to do with those that I help as a paramedic.

..."Death is not a tragedy. It's a certainty." "indeed, there are tragic circumstances surrounding many deaths. Some die too young. Some seem totally senseless. Some deaths negatively impact the lives of many people. The circumstances of death can be quite tragic, but death itself is not tragic. It is as much a part of life as is birth."

To me this seems self evident. If you were born, and I'm guessing that most of you reading this were, then you must die. There are no other options. Again, the death of someone has no effect on me that I have ever noticed, but caring for those that have just, or are just about to see their deceased loved ones is sometimes difficult. But they are my patients now, physically and emotionally I am there to care for them and that keeps my little pea brain occupied...

Great questions Kyle...I'd be interested in your continued thoughts...

Dwayne