Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Dropping Out, Surviving, or Thriving


The practice of medicine inherently involves intense emotional experiences. Instead of avoiding these feelings, we must embrace them if we want to grow.

“May we come in?” I said.


We walked into the room to meet our newly admitted ICU patient, a middle-aged man who leaned forward in his hospital bed, his shallow breaths quickening as he spoke. Tripoding. He’s having difficulty breathing. My co-resident and I looked at each other briefly. We need to ask him about his code status in case he needs to be intubated. He and his wife wanted everything to be done.


“You’ll feel a pinch in your neck,” I warned as I steadied my hand, ready to inject numbing medication before inserting a central venous catheter.


He lay in bed with a light blue drape placed carefully over his head for sterility. The drape started fluttering, then shook violently.


“Sir, can you please try not to move? Please?” I asked.


There was no response.


He sat up, “Help me!” and then slumped forward.


I checked his pulse, lay him supine, and started chest compressions. We couldn’t bring him back.


Until that day, I was certain I would become an intensivist. I’d chosen anesthesia residency with the goal of specializing in critical care. After my patient’s death, the guilt and self-doubt were unshakeable. I was in his room when his heart stopped. How could I have not seen it coming? Over the next few months, I felt a sense of dread every time I entered the ICU. Ultimately, I decided against specializing in critical care. In hindsight, this career switch helped me find my true passion, pediatric anesthesiology.


Dropping out, surviving, or thriving

It wasn’t until years later that I heard the term “second victim” and learned about three potential trajectories after an event—dropping out, surviving, or thriving. I realized I’d clearly dropped out after my patient’s death during residency. I felt disappointed in my younger self, but I also felt a sense of relief. I wasn’t the only one who felt these emotions and I was certainly not the only one who had made the decision to walk away.


When I lost my first patient in the operating room as a newly minted attending, the feelings of guilt and self-doubt returned full force. What could I have done differently? Would this patient have survived if someone else had taken care of them? Someone with more experience than me? One of my colleagues, who had been my advisor during residency, pulled me aside.


“This patient was very sick. You did everything you could. It’s normal to feel what you’re feeling right now,” he said.


I then realized I had a normal response to an abnormal event. His words were powerful and gave me pause. He knew exactly what I was experiencing. I thought back to the three trajectories and decided things would be different this time. I was going to thrive.


These events have fueled my passion for clinician well-being. The practice of medicine inherently involves intense emotional experiences. We shouldn’t hide from these emotions, but instead embrace them and allow them to help us grow. Here are a few lessons I’ve learned:


1. Stressful events can trigger a fight-or-flight response.

This response is called “amygdala hijack.” When the amygdala takes over, the prefrontal cortex shuts down, making it difficult to think clearly.


2. This is a normal reaction to an abnormal event.

It takes time to heal. It may take longer than you expect. Seemingly unrelated events may suddenly trigger you. This is all normal.


3. Show yourself compassion.

Try not to self-criticize. This event does not define you as a person or clinician. Treat yourself as you would treat a close friend.


4. Don’t suffer alone.

It may be tough to reach out for support. Remember, people want to help.


With the COVID-19 pandemic, we’re relying on new ways to stay connected and provide support. In these challenging times, we must all be there for each other. We’re stronger together.