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.”