The death of a loved one in hospital is always traumatic for families. Dr Zoe Greaves, a GP trainee in Stockton and BMA medical ethics committee deputy chair, explains it also takes an emotional toll on doctors providing end of life care

A DOCTOR'S role is first and foremost to preserve and prolong life, but it is vital that while doing that, we accept that lives end and understand our role in providing as good a death as possible for patients and their families.

While medical school can prepare you for many things, such as providing some idea of the signs to look for when a patient is reaching the end of life, it cannot prepare you for that first time you realise death is imminent, and that there is simply nothing more that can be done.

I will never forget the first patient I saw die. I was a foundation doctor, only days into my first job, and working on a busy surgical ward.

My patient had cancer which had spread, and her death was sadly anticipated. Over the course of one day she deteriorated rapidly, and it became apparent that she was likely to pass away within a matter of hours.

The patient was not in pain or distressed, but her consciousness was waning rapidly, so her family were called. I called for advice on how to manage things over the hours ahead, but my consultant and his registrar were both in surgery operating on a complex case, so it was left to me to talk to the family, to provide reassurance and to help them prepare for the end. I felt completely alone and unsupported.

Sadly it seems that I am not alone in my experience. A new survey by the British Medical Association (BMA) has found that while more than nine out of 10 doctors feel that caring for a dying patient has an emotional toll on them, fewer than one in five felt that they get sufficient support.

In the years since my first death, I have supported a number of patients and their families as they approached the last days and hours of their life. Dealing with that pivotal moment when our outlook changes from one of fighting for life at all costs to acknowledging that a patient is dying, is still one of the hardest moments I face in medicine.

Death happens in different ways. Sometimes it is the anticipated end of someone with a terminal condition, where family are informed and patients have the opportunity to pass away peacefully.

Sometimes it is the more graphic and dramatic end of a patient who has suddenly and unexpectedly gone into a respiratory or cardiac arrest. Sadly attempts at CPR lack the glamour and success rates that shows like Casualty or Holby City would lead us to think, and despite a rapid and co-ordinated response, more often than not result in a patients passing away quickly in difficult circumstances.

A few months into my second year of training, I was working with the team performing CPR on a lady with severe respiratory problems.

As we worked quickly to try and restore the lady's heartbeat, I heard the quiet cries of the patient in the next bed as she listened to the ordered chaos and frenetic activity and I knew how she felt.

The helplessness, the loneliness, and the indignity of it all. The patient died. There was nothing that could be done and after around 30 minutes of trying, time was called.

One by one the team drifted away back to the jobs they had been doing beforehand. While a nurse was left to comfort the sobbing patient in the next bed, the rest of us simply continued; other patients were sick, other people needed our help.

There was no discussion, no reflection. I had not met or seen the patient before my emergency bleep summoned me to her bedside, and I must admit I don’t even recall her name, but I remember the feeling of helplessness, futility, and loneliness that struck me afterwards.

Although doctors are professionally trained to deal with death, the emotional toll from caring for patients at the end of their life should not be underestimated.

The BMA is calling for the use of support services to become normal practice across the NHS, to ensure doctors and nurses are able to cope emotionally and can provide the best possible care for patients and their relatives when they are at their most vulnerable.

Care of the dying is a crucial part of how we as doctors holistically care for the health and wellbeing of patients, and how we provide support for their families.

However, if we are to provide that care, we need to be able to acknowledge that we ourselves are human, and that we are impacted by the loss of patients, however familiar or unfamiliar they are to us.

As the poem by John Donne reads: ‘Every man’s death diminishes me, for I am involved in all mankind’.