10 medical residents recount the heartbreak of their toughest patient cases
Key Takeaways
In medical school and residency, we're taught to become “experts” at evaluating, diagnosing, and formulating treatment plans for our patients. On the job, we learn to navigate the “difficult stuff”—the social aspects of a patient’s case, family dynamics, end-of-life cases, patients who are uncooperative, mistrusting, drug-seeking, or suicidal.
These are the patients we lose sleep over, the ones who break our hearts, and the ones who make us question our decision to enter into medicine in the first place. These challenging patients are our most excellent teachers, if we allow them to be.
We asked residents what their most challenging cases were, and what they learned from them. Here’s what they had to say.
End-of-life conversations with family
Tina Yang, DO: "There have been many challenging patients, but the most difficult encounters are having to explain to patients' loved ones and family members how they went from 'well and functional' to now being dead."
"It has taught me how to direct these conversations, and how difficult it can be for families to grasp the idea that their loved one has passed. "
— Tina Yang, DO, NewYork-Presbyterian Queens
Patients who don't want to live
Y Paul, MD: "Sometimes there are no 'right' answers in medicine. On our burns rotation, we often had patients who tried to commit suicide via burning. These patients would be 'saved,' meaning they were committed to months, sometimes years, of painful medical procedures despite wanting to have ended their lives in the first place.
"One patient with over 80% burns fit this story, and I assumed care on his second or third skin graft. As his status worsened, I felt more morally conflicted about what we were doing to him each time. His next-of-kin lived out of the country, and had no idea what “doing everything for him” meant—she just wanted full court press despite his futile state."
"There is an underlying expectation of saving all lives, but it’s important to understand the consequences of that, and sometimes allowing patients to go with dignity is more important. "
— Y Paul, MD
A preterm baby, and the ethics of a DNR
Gurinder Kumar, MD: "I remember a preterm baby with multiple anomalies whose parents did not want to sign the 'do not resuscitate' form. We had to manage this challenging baby and later involve the ethics committee to solve this issue."
"This case taught me that while managing patients, we need to have a holistic approach, think of ethical issues, and solve the patient's physical issues."
— Gurinder Kumar, MD, Metrohealth Medical Center, Cleveland, Ohio
Patients who mistrust the medical system
Shane Michael Hagen, MD: “One of my most challenging encounters was dealing with a patient needing a lumbar puncture to evaluate encephalopathy. This patient was hesitant to receive our services as they had previously dealt with discrimination in the medical system. I sympathized with this patient, and through providing easy-to-understand information, formed a bond that allowed me to stress the need for this procedure."
"Our patients' decisions are frequently a result of past interactions with medical professionals. Forming a bond with them can allow the trust to develop. "
— Shane Michael Hagen, MD, Baptist Memorial Hospital, Memphis, Tennessee
Other challenging patient experiences
Anonymous—"Covid 19, the first fatality I encountered with one of my young patients. Taught me that life is fleeting and nothing lasts forever."
Gaurav Patel, MD—"Losing a patient I really liked. Learned to control my emotions better."
Adil Mohamed, MD —"Suicidal patients, it taught me to love my live."
Nikhila Gandrakota, MBBS, MPH—"Convincing a patient who thought she had an MS flare but did not have it. Patients being upset is understandable but when they are illogical it gets hard."
Morgan Whitson–"Discussing goals of care with family when patient suddenly lost capacity, which taught me that it is important to always have a QOL discussion with loved ones while they’re healthy."
Olivia Sutton, MD—"The death of a patient because the hospital had no blood available to transfuse. It taught me that limits do exist outside of academia."
Parting thoughts
Are we ever fully prepared to deal with these difficult and often heartbreaking cases? Some of our most significant challenges are patients and their loved ones who need the most empathy, kindness, and care we can offer.
Over time, we may become more poignant with our words, but we may also find ways to bury our feelings and traumas associated with these difficult cases, which can leave us calloused and jaded.
By taking the time to take care of ourselves, reflect on these cases, and share our experiences, we can continue to show up and walk alongside our patients as they navigate difficult journeys.
Every medical resident has a question to ask and a story to tell—a comical moment, a prickly patient encounter, or a hack for staying sane during residency. We survey medical trainees for their best questions and answers and bring them to you in this column. Engaging, enlightening, and entertaining—from resident to resident!