Irecently had the privilege of serving as a visiting professor at the University of New Mexico (UNM), Albuquerque, at the request of Ashwani Rajput,
MD, FACS, chief, division of surgical oncology,
and John Russell, MD, FACS, professor of surgery;
chair, department of surgery; and dean, graduate
medical education. As part of this event, I participated in a memorial service for UNM patients who
had recently died. Bridget Fahy, MD, FACS, surgical oncologist and associate professor of surgery,
department of surgery, UNM School of Medicine,
and Erika Ketteler, MD, FACS, associate professor
of surgery and associate program director, residency program, department of surgery, UNM, and
a vascular surgeon with the New Mexico Veterans
Affairs Health Care System, have led this program
for the last two years.
A moving, memorable experience
The memorial service at UNM takes the place of the
traditional morbidity and mortality conference once
a year and provides an opportunity for faculty and
residents to spend an hour remembering the patients
whom they have recently lost and revealing how the
experience personally affected them. Participation is
voluntary, yet all of the residents and faculty from
the department attended. A total of nine cases were
discussed, and presenters ranged from interns to
attendings.
The participants shared their experiences in providing care to dying cancer patients, explained how they
used critical decision-making skills to treat trauma
patients and, perhaps most movingly, described what it
was like to lose pediatric patients whose lives were cut
far too short. Particularly noteworthy was the thought-fulness, introspection, and maturity that the interns
and residents displayed when telling their stories. All
of us were truly mesmerized as we listened to these
young health care professionals convey their personal
experiences. The reports were extemporaneous but
comprehensive, really cutting to the soul of what it
means to be a surgeon and provide care to a patient
who is dying.
In fact, these presentations were some of the most
honest and emotionally moving discussions of patient
outcomes and care that I have had the honor of hearing
in 40 years of surgical education, training, and practice. Even the most self-assured residents opened up and
articulated their feelings about the grieving process and
how they were able to find the resilience to continue
caring for critically ill patients.
Building on past experience
The organizers of the event, Dr. Fahy and
Dr. Ketteler, are among the only 65 or so U.S. surgeons board-certified in hospice and palliative
medicine, and both are members of the American
College of Surgeons Palliative Care Committee.
Unquestionably, both of these surgeons are deeply
concerned about the quality of care that end-of-life
patients receive. “With two surgeons with expertise and training in palliative care, our residents
have learned that speaking about patient death and
the impact that these losses have on our trainees is
acceptable and supported,” Dr. Fahy said.
The memorial service program builds upon a quar-
terly program called Surgery Death Rounds, which
Dr. Ketteler has facilitated since her arrival at UNM
eight years ago. “These death rounds have been well
received by faculty and residents and have contrib-
uted to an environment that allows our residents to
share their patient death experiences. Since Dr. Fahy’s
arrival here two years ago, the discussion that a patient
has died—not passed, expired, or some other euphe-
mism—is even more in focus,” Dr. Ketteler added.
“Palliative care input for our surgical patients is not
taboo at UNM, and the residents participate in provid-
ing that care and see such care as just a normal part of
being a thorough and competent surgeon.”
Dr. Fahy agreed, adding, “In the [death rounds]
program, residents present cases of patients who have
died, with an emphasis on the ethical, emotional,
and other nonmedical aspects of the case. We believe
that having this background has contributed to an
environment that allows our residents to share their
experiences of patient death.”
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by David B. Hoyt, MD, FACS
Looking forward