Dealing with the death of a patient

RE: Dealing with the death of a patient

Hannah Wynne Richards — Fri, 21 Oct 2016 09:55:25 GMT

I can really empathise. Patient death is definitely the worst part of this job.

Wynne

RE: Dealing with the death of a patient

elizabethellison — Fri, 21 Oct 2016 08:26:21 GMT

Thanks for the replies everyone, you've given me things to think about. Maybe the issue is working for an OOH company that's trains their staff and professes to provide gold standard ECC, but the reality when working in a very busy clinic is so different. On top of which there is the issue of clients who might normally not opt for gold standard care and the cost of this in their day practice having to choose between 'all or nothing' by the OOH provider. But that's probably a whole new thread in itself...!

RE: Dealing with the death of a patient

Jill Butterworth — Thu, 20 Oct 2016 23:24:41 GMT

I think we all change as we get older, have more life experience, are subjected to our own hormonal fluctuations etc. I used to be hard as nails, but now am far more affected than I used to be. Unofficial counselling from good friends may be all you need, but get professional help if it doesn't go away soon.

RE: Dealing with the death of a patient

Nicola Lawlor — Thu, 20 Oct 2016 15:01:11 GMT

I think the pressure is even higher when you are stupidly busy. Things you would like to do but dont find the time for - you prioritise as best you can but ultimately if you have standards you want to work to and cant then you feel like you haven't done a good job. I know having qualified with you that I still feel very humbled by the knowledge of other vets around me and feel like I should have known, should have done, should have considered something else in cases - my colleagues are lovely and never set out to make me feel uncomfortable about my handling of a case when discussed - I am very capable of doing that all by myself and probably over think things at times. I imagine that many other people feel the same when they have spoken to me about a case and I have tried to help - not because I ever set out to make anyone feel bad but it is a common trait in our profession to want to get it right every time.

Great advice from above, you did your best in the circumstances that you had to work in. Neither of the cases you mentioned suffered for long before a kind if sad decision was made. One thing I have understood so much more since I became a partner but I could have understood better as an employee - it is not our job to fund veterinary care for our clients and if a client makes a decision based upon limited or no finance you must not take that guilt upon yourself. There are organisations out there who can and do help many pets where there are financial problems but they cant help them all and we do always have a kind option as you took for the cat. It's not the decision anyone hoped for but that little cat is not suffering now.

Give me a call if you want to chat more.

RE: Dealing with the death of a patient

Martin Atkinson — Thu, 20 Oct 2016 09:22:15 GMT

We set ourselves very high standards and when we don't achieve them we can feel as though we have let ourselves and others down. But we're not God, we make errors of judgement and mistakes and sometimes even when we do the best we possibly can we still wonder if we could have done better, if only we had a restrospectoscope. When we are thinking rationally we are able to put these things into perspective, learn and move on. We have to or we will go mad, it is all part of our coping mechanisms.

While I agree with what the others have said, these are things that we all have to deal with on a daily basis and put them out of our minds. That you can't do this and it is getting worse rather than better as it should with experience makes me fear that your concerns here are out of proportion and part of a bigger issue. I don't wish to appear blunt or condescending but I am concerned that you have mental health problems and need to have a long hard, honest look at other factors in your life at home and at work that may be affecting you. It may be that you should seek professional help over these matters before you are overwhelmed.

RE: Dealing with the death of a patient

Braden Collins — Thu, 20 Oct 2016 04:28:10 GMT

I'm not sure these things ever become easy, but developing some coping mechanisms is essential to survive.

You'll always have some cases that haunt you and you'll think "what if", but you need to focus on all the good you do and the great results you get. You'll never be perfect and get perfect results, but ensure you're always progressing and learning.

Money issues will always be tough, but there's no easy answer there. I guess just remember that someone has to pay for the care an animal receives, and it's not the pet or the practice owner's fault if the pet's owner has no money. In such cases, you can still stop them suffering with a caring and compassionate euthanasia.

RE: Dealing with the death of a patient

Sarah Wheadon — Wed, 19 Oct 2016 23:21:07 GMT

Having a a colleague to talk to, even in a semi-official way to 'debrief' you may help. You say that you've been over the case a hundred times in your mind, someone face to face may be able to convince you that you did your best, gave the dog your care and expertise, and although he couldn't be saved, you improved his last hours. We all expect too much of ourselves at times, and find it hard to deal with imperfect outcomes From difficult situations. This shows we care, but at the expense of our own wellbeing. The dyspnoeic cat is sad and frustrating, but in this situation, you need to try and focus on having relieved suffering, even if not in the way any of us would want. Be kind to yourself. Sarah.

RE: Dealing with the death of a patient

Kate Richardson — Wed, 19 Oct 2016 21:40:32 GMT

1st case- you did the best you could in the circumstances you were working under. What else could you have done without disregarding all other patients? Guarded prognosis even if you had dived into ex lap immediately. Dog didn't suffer for long. Might have suffered more if it had 'treatable' condition and pulled through ex lap only to deteriorate later and ten put down. Prolonged suffering.

Case 2- cat had immediate cessation of suffering, again likely guarded prognosis and potentially similar scenario to above case re treating then deteriorating (even if money available) but those cases are all or nothing treatment in my opinion so if very limited funds kinder for the animall to pts Than a half hearted approach to treating.

I rarely get upset about euthanasia now as it's the only thing I can guarantee will not cause any further suffering

some days it just gets on top of us. Hope that helps in some way

RE: Dealing with the death of a patient

elizabethellison — Wed, 19 Oct 2016 21:33:29 GMT

Thank you. I only work part-time now, so I do have breaks, and am very occupied by my kids!

RE: Dealing with the death of a patient

Eilidh Corr — Wed, 19 Oct 2016 21:22:12 GMT

[quote user="elizabethellison"] I have been over the case a hundred times in my mind with 'shoulds' and 'what ifs' and am feeling worried that I didn't do a good enough job.[/quote]

This is what makes you a good vet - you are trying to learn from experiences, and you care. The key is to keep things in perspective. If the dog was PTSUA a matter of hours after you saw it, one can only presume that whatever was going on in there was catastrophic. I doubt it is something a matter of a couple of hours could have changed.

Re the cat - I manage to stay quite emotionally distant from these where possible. In welfare terms, euthanasia is never the wrong thing for the animal. Ethically or morally it might make us squirm, but animals don't care about ethics or morals. A dyspnoeic young cat would in many cases have a guarded prognosis anyway.

I sometimes find it helpful to focus on the loss my clients are experiencing, especially if I've become very bonded to the pet myself over the years. It's OK and normal to be upset by this stuff, but the loss is much greater for those who lived with and loved them.

Make sure you get breaks from work and you occupy yourself with completely different things because I think emotionally we need a rest when we are going through a rough spell. I find cycling great for this - it's almost meditative and really helps with stress. And talk to someone - sometimes you'll be surprised by how much your colleagues feel the same way.