Oncology physical therapy is a very rewarding career path. We help patients stay active and independent as they navigate a new, post-diagnosis normal. We maintain and restore mobility in patients that have been through surgery, chemo, radiation, stem cell transplant, CAR-T therapy, and/or Immunotherapy. However, the unfortunate reality is that over the course of your career, some of your patients are going to die.

I’m Adam Matichak, I have been a Bone Marrow Transplant (BMT) and Cancer Cellular Therapy (CCT) physical therapist for Stanford Healthcare since 2016. I did my last rotation of PT school on the BMT unit at Stanford. We lost two patients in the very first week of my rotation and I felt lost. I began to wonder if it was like this all the time and if I had it in me to do this kind of work without it weighing on me. As a clinical instructor for students on the very unit that I was once an intern on I have made it a goal to make sure my students are prepared for the death of a patient. I wanted them to be able to handle the loss of a patient without it affecting their learning, their work performance, or most important their personal lives.

It is easy to become emotionally invested in that patient’s care. You may have shared a piece of yourself with them and connected with them on a deeper level during your interactions with them. You may have put hours of your time into researching their disease, knowing the intricacies of their treatment plan, and creating exercise and activity programs to help them achieve their individualized goals. Only for your patient to relapse. Or have progressive disease. Or get hit with an inopportune infection. Only for your patient to run out of time. When a patient dies it affects everyone involved: their families and caregivers, their medical team, the support staff at the clinic, and you.

Facing the issues surrounding the loss of a patient is a natural part of oncology care. Depending on your setting or the types of cancer and treatments you see it can become a fairly regular part of your work. For example, the combined 5-year survival rate following an allogeneic stem cell transplant for Acute Leukemia was 30-50%. For some PTs the death of a patient can be one of the hardest things they deal with in their career. This can be a difficult time, but with the right approach and support you can become more resilient and manage grief appropriately.

By now you are probably asking yourself, “What can I do to manage the loss of a patient without it spilling over outside of work?” There are many different ways to deal with the loss of a patient, it is important to find what works best for you to destress and work through a wide array of emotions. Here are some strategies to help you manage the loss of a patient without losing yourself.

Practice Good Self-Care

Go for a walk or a hike. Get in a workout. Have dinner with friends or family. Read a book. To be able to take care of our patients we have to take care of ourselves. Grief has the ability to affect the body physically. Make sure you are getting adequate sleep, eating well, and exercising.

Acknowledge the Death of a Patient

Talk to your clinical instructors, mentors, and co-workers about your experience. Let them share their experiences and discuss how they handled things. Your peers are going to be one of your greatest support systems when it comes to managing the loss of a patient, especially those that have been through it themselves. However, it requires you to be honest about how you are feeling. If the loss of a patient is weighing on you, speak up. Your co-workers and CI’s can’t read your mind, but they will likely be able to notice through your behavior or work that something is bothering you. By owning and acknowledging the death of a patient it allows you to begin to process it and deal with it in a healthier way than keeping your emotions bottled up.

Seek outside help from a grief counsellor or therapist

Many hospitals have grief counsellors or therapists that are available to patients and their families. However, these services are not always available to staff. Talk to your CI’s or managers about the resources that are available at your work site. Other resources like the betterhelp or talkspace app (I have no affiliation with either app) are available. Again, it is important to have a safe place to work through your feelings.

It is okay to feel happiness

Losing a patient can be very difficult, but it is important to set boundaries for yourself and be able to leave that baggage at work and not let it carryover into your personal life. This is a skill that even seasoned therapists find challenging. Enjoying time with your family, loved ones, and friends outside of work is important. It is even possible to find joy in spending time with your patient that is nearing the end of their life and sharing stories and gratitude for the opportunity to have an impact on each other lives. Death is part of the human experience and there can be beauty in a dignified death after a hard-fought journey through treatment. Humor also presents itself as a way to relieve stress.

Heal in your own way

Because everyone handles their experiences differently, it is important to find what works for you as an individual. If you are able to develop strong coping skills early or have better coping skills through other life experience that is great. If you need more help processing these challenging emotions it does not make you any less of a person or therapist, it makes you human. There is no one-size-fits-all approach to dealing with death. Some situations can be more challenging, such as the death of a pediatric patient, a sudden death, or the death of a patient you had a deeper connection with. As hard as it can be to cope with the loss of a patient, doing this kind of work can be impactful and satisfying.

One of the most important things I stress to students is, there is usually very little that you could have done to prevent the death of a patient. You provide the best care that you can and do it in a safe manner. Working with these patients and helping them add quality to their remaining years through maintenance of mobility, pain relief, and independence is very rewarding. It gives us an opportunity to discovery the true meaning of life and brings deeper meaning to the work that we choose to do through our experiences with death and dying. The lessons we learn from our patients during these trying times shapes us as therapists and as human beings. It allows us to hone skills outside of the hands-on clinical aspect of our job. It allows us to connect and communicate with our patients on a deeper more personal level. Learning to manage death without letting it take over your life will make you a better therapist.

References

  1. McGrath, P., & Kearsley, J. (2011, February 08). Caring for dying patients can be a satisfying experience.

Sinclair S. Impact of death and dying on the personal lives andpractices of palliative and hospice care professionals. CMAJ 2011;183:180-7.