Most of us go to medical school (and nursing school, for my nursing friends who read the blog) with this idealistic idea that we want to be able to help people.  We want to be able to heal people.

Here’s the dirty little secret that gets left out when most of us are considering medical careers:

Sometimes we can’t heal people.  Sometimes the disease wins.  And sometimes…sometimes the best thing that we can do to help is to support patients and families when it is time for us to keep them comfortable and to stop trying to heal them.

Sometimes we don’t even get the opportunity to know the patients who come into our care and who die there; we see perhaps a small piece of who they were.  I often wonder what it would have been like to get a glimpse into their life and to know them in some way before they landed in my care.

Sometimes we grow to love the patient and their family because we’ve spent so much time talking about care, talking about prognosis, working together to try to do the right thing at every juncture in the care process.  Those are the losses that shake us more deeply, the ones that leave us wishing we had something more we could do, the ones that do hurt…but we keep coming back to help the new patients because we know that is what this patient and his family would want us to do.

Sometimes we struggle with moral distress when we care for patients who are nearing end-of-life, and we have to figure out how to mitigate that sense (hopefully with functional coping mechanisms).

I’ve written before about the tendency of Americans to not die how they really want to; so much of this is predicated on American culture, the denial that there may be things worse than death.  For the record, many of us who work in critical care (I might even argue most of us) would tell you that there are many things worse than death, and it breaks our hearts when we have to drive those processes.  See above about moral distress.

Culture is a tough thing to change because so much of it is unconscious.  All we can do in medicine and nursing is keep providing care with compassion and commitment, keep educating families honestly about prognosis and possibilities, keep teaching people that being comfortable and being supported by family- without heroic medical interventions- really is a good goal of care at times.

Because sometimes?  Sometimes life and death has nothing to do with how talented we are as a team or how great of care we provide.  Sometimes it’s not ours to control.

Sometimes our greatest work is for those patients who don’t survive.