How the pain of unexpected and tragic deaths lingers with physicians [PODCAST]

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“The memory of these patients, and their families’ utter anguish, stays with me. There was nothing I could have done to save them, nothing I did wrong. I’ve lost sleep, questioned my career choice, and sought mental health counseling to manage the stress of their loss. But the pain of their unexpected and tragic deaths lingers, like the torn knee tendon that heals but still throbs. I can walk on it, but it will occasionally start to ache—a reminder of trauma.”

Shira Shiloah is an anesthesiologist and can be reached on Twitter @ShiraShiloahMD. She can be reached at her self-titled site, Shira Shiloah, MD.

She shares her story and discusses her KevinMD article, “Second victim syndrome: The pain of unexpected and tragic deaths lingers with physicians.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Shira Shiloah. She is an anesthesiologist, and she wrote the KevinMD article “Second victim syndrome: The pain of unexpected and tragic deaths lingers with physicians.” Shira, welcome to the show.

Shira Shiloah: Thank you, Kevin, for inviting me to speak with you. It’s absolutely an honor to be here.

Kevin Pho: We’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Shira Shiloah: Sure, happy to. I’m an anesthesiologist and an author. I went to medical school at the University of Tennessee in Memphis. I completed my anesthesiology residency at Northwestern in Chicago. I’ve been in my hometown practicing private anesthesia at Medical Anesthesia Group for the past 17 years since graduating residency. I practice general anesthesia as well as obstetrics, regional, thoracic, neuro, and pediatric anesthesia. I also teach resident doctors as well as student nurse anesthetists from the University of Tennessee.

During my time as an anesthesiologist, I’ve also pursued my passion of writing. The first short story I wrote, Kevin, was about a patient encounter before surgery, and it actually won third place at this national writing conference for physicians, and it encouraged me to continue my writing and take it more seriously. So I attended multiple writing conferences and novel-writing intensives, and I immersed myself in the writing community, which is the best community, in case you’re wondering, the writing community.

My most recent conference, before the COVID lockdown, was Dr. Julie Silver’s Harvard writers, which you’re probably familiar with. She helped me utilize social media as well as begin a blog that combines my passions of health and writing. So yeah, I went part-time in 2017, and it allowed me to write, finish, and complete my debut medical thriller, Emergence.

Kevin Pho: Wonderful. And tell me about how being a physician and your experiences being a doctor, how does that influence your writing?

Shira Shiloah: So, you know, it was the short story of my patient encounter that kind of started the whole writing journey for me. And you know, doctors, we see a lot, we experience a lot. I didn’t see that the anesthesiologist’s story was told very well in any kind of fiction or any kind of thriller. There are lots of physician authors out there that are extremely talented, Tess Gerritsen, for example, who is one of my heroes in the community, but there’s not an anesthesiologist’s perspective. So I wanted to share that and share my story that way.

Kevin Pho: And how hard is it to write a novel? Did you have an English background, or?

Shira Shiloah: Yeah, I did. I always was a reader. I think to be a writer, you have to be a reader. You have to be an avid reader. And I was one of those kids who, you know, would go to the library as a child and take 10 books home and read the first two within the day, and I was constantly reading my whole life. So as far as the difficulty level, it’s very high. It’s a huge learning curve. It took me 13 years to become an anesthesiologist, and it took me another 13 years to become a published writer. So I kind of joke that 13 is the lucky number, especially for Jews. So yeah, English was always my pride; it was my first language.

Kevin Pho: All right, so let’s transition now into your KevinMD article, and you can see that your writing skill shines through in this article. It’s titled “Second victim syndrome: The pain of unexpected and tragic deaths lingers with physicians,” and I want to start by reading a short excerpt from your article. You write: “We worked on you for hours, Terrell. I swear we tried with 14 units of O negative. Surgeons explored your wounds. They clamped your major arteries until your heart failed, and we watched you leave us. I was a medical student. ‘Close him. Learn how to suture.’ Tears rolled down my face. Your blood had not yet dried on my legs. Tomorrow’s paper would bury you on A22. North Memphis man shot.” Now, those are powerful words. For those who haven’t read the article, can you just walk my audience through it and share the story of why you decided to share it?

Shira Shiloah: Yes, thank you, Kevin. So that was written as a medical student in 1998 at the University of Tennessee, at the Med trauma unit, and it was the first patient loss I’d experienced, and I wanted to share with the audience what it was like. I actually wrote that down in the call room that night and never thought about that piece again, and stuck it in. I think I found it recently because of the COVID lockdown and the spring cleaning. I literally found it stuck in my yearbook from medical school. So I pulled it out and I looked at it, and I really just wanted to give that younger version of me a big, giant hug, you know.

These occurrences happen to medical students, to residents. They happen to physicians in private practice. You had a recent, really wonderful guest on who talked about the shame after a patient loss, and all of that is part of our culture, unfortunately. There is a medical culture of silence. There is a medical culture of stoicism and kind of sucking it up. And I wanted to share with the audience that a lot of people in my community, in the medical community, don’t even know that there is such a thing as second victim syndrome. I didn’t learn about it till two years ago. And I wanted the audience to understand what nurses and doctors and anyone in the health care field can actually see and feel when there’s a loss. And we really need to do a better job taking care of those people who have no outlet. And I wanted to, you know, talk about that.

Kevin Pho: So what is second victim syndrome? What does that mean to you?

Shira Shiloah: I’m going to just, if it’s OK with you, to get it correct, I just wanted to tell you exactly what second victim syndrome is. It’s basically that feeling that you have of grief and of loss and of sadness that occurs when there’s an unexpected or tragic event in the OR, and people take it to heart, and they bury it inside them. And you’re kind of not really given an avenue of what to do with that. And you come home, and your family tries to, you know, console you, but you’re still dealing with everything else that you have in your life: other patients. You’re still a mom, a sister, a wife. You still have to take care of your parents. You’re always being pulled in lots of ways.

And I feel like the work stress isn’t necessarily addressed the way it should be addressed at work. I don’t think that we cohorts talk about it with each other. I think you move on to the next case. Like in that situation that I wrote about. I did address in the article other instances, where there was a baby that died of necrotizing colitis, and I also talked about an unexpected middle-aged man who died on induction of anesthesia. I talked about the shaken baby syndrome, of seeing a two-year-old who was the age of my niece, who was there for organ harvest, and that tore me up. There are things that we see that stay with us, and I wanted to talk about it with the audience and maybe give some ideas and suggestions on how to handle it.

Kevin Pho: So tell me about some of the feelings that you had, some of the emotions that you had, and what you thought after these tragic events occurred.

Shira Shiloah: I would say grief, and knowing, and empathy, and thinking of my own family, and hurting for the families that lost that patient. That would be number one. There’s always the shame. There’s always the “Could I have done something different? Is it my fault? What did I do wrong? What would I do different? Did I miss something?” You know, there’s an obsession that occurs, honestly. There’s an obsession that you go back over the chart, and you just, like, so carefully go through every little thing. “What did I miss? Did I miss something? Could I have prevented this? If I had been a better doctor, would this not have happened?” These are all feelings I think everyone shares. They just don’t talk about it.

Kevin Pho: So you mentioned that the culture of medicine generally doesn’t talk about second victim syndrome. It doesn’t really address these emotions that you’re sharing after a tragic event. So in an ideal world, what should medical institutions do?

Shira Shiloah: That’s such a good question, Kevin. That’s such a good question. So I can only tell you what helps me and what has happened for me that has been the most helpful with us. Number one, I think everybody in medicine should have a therapist. I have had a therapist, not a psychiatrist but a psychologist, who I’ve talked to my entire medical career. She was actually one of my teachers in medical school, and then she went on to become my therapist throughout 15 years or so. She’s wonderful. I honestly think everybody should have a therapist to talk to, and especially now, during this time of COVID, we owe them a huge debt of gratitude for helping manage the stress of the job.

I think that we should be more open when we are hurting at work. I think it should be allowed to cry. I don’t know why we’re taught to be stoic and not to be empathetic. If you need to cry at work, you shouldn’t apologize for it. It’s a lot of sad stuff that we see. And if you need to go off in a corner with a friend, with a colleague, and talk about it, do it. It’s OK.

Kevin Pho: We’re talking to Shira Shiloah. She is an anesthesiologist, and she wrote the KevinMD article “Second victim syndrome: The pain of unexpected and tragic deaths lingers with physicians.” When a physician undergoes a tragic event, or if they have an unexpected event happen in the hospital, whether it’s their patient or whatnot, what’s some advice that you can share with them as to what to do next?

Shira Shiloah: OK, number one: Allow yourself to grieve. Allow yourself to grieve any loss, be it a patient, be it a family, be it a friend. The culture of medicine, like I said, is the culture of silence, and this is what’s hurting our physician mental health. I wanted to share with you, Kevin, that the statistics currently are 300 physicians die by suicide a year. That’s two full medical school classes a year that die by suicide. They don’t commit suicide. It’s not a felony. They didn’t commit a felony. They die by suicide. And it’s so upsetting, on so many levels, that we’re not doing a better job to protect physicians, and to protect nurses too, who are dealing with these stressors.

So I would say, number one, grieve. Allow yourself grief. Allow yourself to feel that loss. Acknowledge it. Talk to someone, if you need to address it, with somebody in the hospital, like a chaplain, or your rabbi. Those avenues are available. I can tell you, right now, I had a very difficult situation where we lost somebody at the hospital, someone I knew very dearly, and I was so emotional, and the chaplain came and he sat with me. And I’m a Jew. It didn’t matter to me that he was the chaplain. He was so comforting, and I highly recommend that avenue if you need it. There’s no reason not to take advantage of the people that are there to comfort you and help you.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Shira Shiloah: I think I said it. OK, my take-home message is take care of yourself. Take care of yourself. Allow yourself to put your mental health as a priority, your health as a priority. You can’t take care of others without taking care of yourself first. I can’t stress that enough.

And also, I want to tell the young people out there, the medical students out there: Don’t stop creating. Don’t stop being, outside of the hospital, something besides a physician and a medical student. Don’t put all that on the back burner. If you’re a creative person, continue to write. If you’re a musician, continue to play music. If you enjoy reading, make time to read. If you enjoy painting, make time to paint. Don’t put everything on hold. You’re allowed to be a whole person, not just a physician or a medical student.

Kevin Pho: Well said. Well, thanks again for sharing your story, time, and insight, and thanks again for being on the show.

Shira Shiloah: It’s just such an honor. Thank you so much, Kevin. Thank you for what you do to share our stories.

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