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How to Deal with Unexpected Patient Deaths

Reading time: 5 minutes

Intended audience: veterinarians or veterinary technicians/nurses

In my previous blog post, I wrote about mental health care tips for euthanasias. This blog post is about mental health care tips for unexpected patient deaths. These include fatal vaccine reactions, anesthetic deaths such as deaths caused by closed pop-off valves, and post-anesthetic deaths. The shock, guilt, self-doubt, and grief that ensue from these deaths make our jobs as veterinarians or veterinary technicians/nurses challenging.

It is hard to talk about and hard to write about losing patients unexpectedly. Nonetheless, I will share what I have experienced since graduating from veterinary school in 2010 to raise awareness, reduce stigma, and provide support. You are not alone if you have lost a patient unexpectedly. Chances are you will if you are in the veterinary profession long enough.

“We are not infallible; we are mere humans and cannot save the life of every patient we treat.”–KMarie Reid Lombardo, American gastrointestinal surgeon

Post-Anesthetic Deaths 

Last Friday night, I was planning to go to an ugly sweater Christmas party at an indoor dog park with my dog Penny. Picture all these little dogs wearing red, white, and green outfits playing. Sounds fun, right? I did not end up going to the party.

Why? I was in shock after one of my patients passed away a little over a week after I anesthetized it for a procedure that it needed. Most post-anesthetic deaths occur within the first 72 hours after an anesthetic procedure. None of us expected the pet to pass away, not me, not my colleagues, not the veterinarians at the emergency clinic. It was a rare post-anesthetic complication.

I could not think of anything that I did wrong, but I still felt guilty that I had healthy, live pets while my client’s pet was gone… never to see it play again or look into its eyes… I woke up in the middle of the night multiple nights in a row, thinking about the patient.

One of the things that helped me cope with the loss of the patient was looking up papers/case reports on similar cases. There were very few similar cases.

Tip #1: Do research; learn from the experience. 

Tip #2: Reach out to your mentor. Your mentor could bring experience or knowledge to the table as well as the ability to see things clearly without one’s judgment being clouded by grief.

Tip #3: Reach out to your friends. Even if they do not work in the veterinary field, even if they may not completely understand what you are going through, it is better for your friends to know that you lost a patient than for them to be left in the dark, wondering why you are being aloof. They can give you space if you need space, keep you company if you need company, and listen…

Anesthetic Deaths

I remember the very first patient that I lost under anesthetic. It was during my first year out of school which for most people is the hardest year of one’s career. The cat was so young, only six months old. While we were trying to unblock his bladder under anesthetic, he passed away.

Closed Pop-Off Valve Deaths

Old anesthetic machines with knobs that you have to turn to ventilate a patient without a breath alert monitor scare me. It is so devastating when a patient dies because of a closed pop-off valve. Never have I wanted to kick myself or turn back time as badly as the one time a puppy passed away near the end of a rectal prolapse surgery that I was doing because of a closed pop-off valve.

If I could turn back time
If I could find a way
I’d take back those [things] that hurt you
And you’d stay

If I Could Turn Back Time from the album Heart of Stone, Cher, the American “Goddess of Pop” music

Tip # 4: Putting tape on the valve does not always help because the valve can still be moved by accident or the tape can fall off. If you work in a veterinary setting with old anesthetic machines, there are newer anesthetic machines that allow you to push the valve down for temporary closure. There are also monitors that can be attached to the end of the endotracheal tube to alert you each time a patient takes a breath.

Vaccine Reactions

My worst unexpected patient death so far involved a cat that I had just vaccinated. I remember telling the owner that his cat looked good and recommended baseline bloodwork. Next thing I knew, the cat was in cardiac arrest on the treatment table after blood was drawn. It was the worst news to deliver to someone who less than fifteen minutes ago was expecting to go home with his cat.

Afterward, the owner said that I did not care and that it was just another cat to me. I beg to differ. That was one of the worst nights of my life (probably his as well).

Tip #5: Remember that sometimes people say hurtful things because they are hurting.

Tip #6: One of the best pieces of advice that a veterinarian gave me is to keep a box of thank you cards from clients, good reviews, pictures, or other mementos of cases that you handled well. It is so easy to remember the bad cases and to forget the good ones.

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Thank You, Penny

One of the women whom I had the displeasure of working with said, behind my back, that I hoarded my thank you cards. *Shakes head* First of all, I do not receive that many thank you cards for the word “hoard” to even apply. Second, I do not want to discard thank you cards or let them collect dust after people took the time to write them.

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Tip #7: The veterinary profession is hard enough. You do not need people purposely trying to bring you down at work or at home. Find a way out of a toxic work environment or toxic relationship.

“Where there’s a will, there’s a way.”―English proverb

…I got the will but I can’t find my way now, no, no
This is what she told me now
You got the will… you got the power now

I Got the Will from the album Seven Year Itch, Etta James, American singer

Tip #8: See a therapist if you are struggling to come to terms with a patient’s death, not a bartender, drug dealer, or croupier at a casino.

“Whether a person is spiritual or not, we all seek to get away from the stress, anger, and anxiety of everyday life. Some people drink, do drugs, or do worse to escape, and they hurt themselves in the process.―Yanni, Greek musician

“Common misconceptions:

  • As a professional, I am trained not to be affected [or not trained how to cope]
  • Grieving is unprofessional.
  • Just move on, there are other patients to serve.
  • My work is not personal.
  • I can’t do my work if I let myself grieve.”

VITAS Healthcare®

To take care of patients, we need to take care of ourselves. Pets and people need us.

Please share this blog post with your veterinary friends and subscribe to read more blog posts! Scroll down for the subscription box. Next blog post topic: how to set boundaries which I am still learning to do

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