A life-altering incident in the hospital left me grappling with a mix of anxiety and guilt, highlighting the onset of vicarious trauma.
"And who are you?" I hear a voice and realize it’s the nurse addressing me.
"I’m the doctor caring for this patient," I reply, drawing back the curtains to reveal my new patient slumped in her bed. I instinctively check for a pulse at her neck, wrist, and groin, but I find nothing. The nurse mentions that the patient had just been speaking moments before, which adds to my confusion and alarm.
"There’s no pulse; we need to start compressions," she urges.
This elderly patient, in her late 80s, is suffering from advanced kidney disease among other critical health issues. She has consistently declined dialysis treatments, expressing her desire to spend her remaining days peacefully at home with her husband. Her wish was solely to be kept comfortable during emergencies, yet here she lies unconscious, appearing serene.
In an instant, the room fills with medical personnel and a crash cart. "Hold on, she doesn’t want to be resuscitated," I shout, trying to halt the chaos.
"It’s not documented in her notes," the nurse responds, her hands poised over the patient’s sternum.
It seems the junior doctor on duty overnight had doubts about whether the patient truly meant what she stated regarding resuscitation and had not anticipated her condition deteriorating. For many readers, this might seem like a significant violation of her autonomy. However, such miscommunication is sadly common in hospital settings.
I quickly summarize the patient's wishes to the gathering team and manage to contact her regular specialist, who confirms her longstanding refusal of resuscitation efforts.
The attempt to revive her halts abruptly, but the air remains thick with uncertainty as decisions are made swiftly. An emergency physician wheels in a portable ultrasound and notes that the patient’s heart is barely contracting. Together, we decide to call off the resuscitation, but someone points out, "So you’re choosing to stop resuscitation?"
"Yes," I respond, feeling my own heart racing.
As the crowd disperses, only a few nurses remain to care for the patient, who is still taking shallow breaths.
In the hallway, a resident quietly types up notes while a nursing student watches closely. Feeling the need to connect with someone, I turn to one of the nurses and ask, "Are you alright?"
"Totally fine," she replies, though I sense otherwise.
"I feel awful," my trainee admits, and I can’t help but agree; there’s so much weighing on our minds. I offer a neutral comment, intending to address our feelings later, but, spoiler alert, that discussion never occurs.
Before I leave, I peek back into the room to ensure the patient is comfortable. To my surprise, she is engaged in lively conversation with the nurse, seemingly unaware of her previous brush with death.
This unexpected scene leaves me stunned. Had I acted too hastily in declaring her time of death? What could I have done differently? How will I explain this situation to her family?
My thoughts drift back to our numerous other patients until I catch wind of the fact that she, now awake and alert, has expressed a desire for "everything to be done" next time she faces a crisis.
While it might be easier to simply agree, we opt for a more challenging yet compassionate discussion about her healthcare goals. Ultimately, she reaffirms her original decision to avoid unnecessary interventions.
This particular chain of events is rare, yet not entirely unheard of. If the patient had passed away, it would likely have become just another routine incident, but her survival, against all odds, complicates our emotions.
In the following days, I find myself engulfed in a whirlwind of self-doubt, regret, guilt, and worry. Despite getting adequate exercise and sleep, a heavy feeling lingers. Because I can’t articulate what I’m experiencing, I struggle to cope. Even worse, when I choose to remain silent, my team does the same. Consequently, we all continue without addressing an event that any rational person would argue deserves reflection. It wasn’t until a friend pointed out that this is a pathway to vicarious trauma that I began to consider how those involved in emotionally demanding work can be affected over time.
In the realm of healthcare, the burden often falls on nurses, first responders, social workers, and physicians. Vicarious trauma not only harms the provider but also impacts the patients they serve; a caregiver who is not emotionally whole cannot deliver comprehensive care.
One of my friends noted that a particular hospital allocates resources for a skilled therapist to assist its staff in dealing with ethical dilemmas and interpersonal conflicts. While they rarely engage the therapist, when they do, it significantly benefits the entire organization. I find this approach sensible yet regrettably impractical; typically, the construction of new buildings takes precedence over the quiet hiring of a therapist.
To be fair, hospitals today are increasingly recognizing the importance of provider well-being. Nevertheless, the mental health sessions available tend to be brief and vary in quality. They might help in immediate crises, but they fall short for the long-term emotional challenges that contribute to vicarious trauma. Providers need specialists who invest time in understanding them, their colleagues, and their unique environments. This kind of ongoing commitment to staff wellness has not been prioritized, yet it could very well be part of the solution to combating burnout.
I regret that the planned debriefing session with my team never took place; I simply didn’t feel prepared for it. Eventually, we all moved on, but in doing so, I fear we may have shifted the emotional costs onto future patients.
