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Re: Coping with death of neonates

Dear Editor,

This articles highlights the emotional response of resident doctors to a death.I would like to pen down my experience of neonates with adverse outcome.

As a young resident doctor i used to suffer a lot in csae of neonatal death in the unit , for many a days the mood used to be off and parents wailing used to haunt me.Often after a neonatal daeth I found difficult to face parents. Years later as a faculty member in a teching hospital ,the unit policy was to see parents of all neonates admitted to nicu within 24 hours by specialist,who will find out details of perinatal events ,inform parents about condition of naonate and at the same time give emotional support to parents and other family members, In such cases most of the time parents were wellaware of treating doctors, being satisfied with management will take death as God's will. At this time I made a policy for my self to concil parents after death in unit about cause of death, and prevention of such events in future. The parents were told about antenatal care, where to deliver next child, danger signs (like bleeding, edema feet, anemia, preterm labour)during pregnancy ,next delivery after cesarian section in a health facility,and in case of preterm delivery given a knowledge of cervical stitch and good hygene. Also advise was given to mother to postpone next pregnancy for about 6-9 months ,so that she can recuperate from physical and emotional trauma.

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Re: A fundamental change in mindset is required.

Dear Editor,

The articles by Dr Reynolds, and Drs Baverstock and Finlay helpfully illustrate 3 significant gaps in the professional development component of training for many hospital doctors.

Firstly, as a medical profession we often collude with the view of modern western society that death equates with failure. The old adage of the 3 certainties in life being birth, death and taxes, is quoted, but ignored. The temporary nature of the human condition is forgotten, along with the inevitability of death. Although we may have enhanced life, alleviated suffering, given the opportunity of a future by our medical care, we still feel that we have failed when patients die. Development of and internalizing an understanding of the fundamental nature of humanity, and therefore also death, whether founded on religious beliefs or secular philosophy, is fundamental for any professionals who routinely face death as part of their work. Otherwise, any "support" after death will simply be papering over cavernous cracks. I have yet to see this covered in a professional development programme.

Secondly, as with all other humans, doctors are emotional beings. Being able to manage ones own emotions in a healthy manner is a pre- requisite of offering effective emotional support to others. This aspect of medical training is now common-place in General Practice, but less often the focus of attention for hospital specialties (outside psychiatry). Training in breaking bad news should explore the emotions and responses of the doctor, not just the patient. At our hospital the PICU induction programme covers the effects of bereavement on both the family and the doctor.

Thirdly, doctors (again, like all humans) are not perfect, but often are perfectionists. Internal conflict and feelings of failure are therefore inevitable. Accepting this dilemna as normal and learning to work constructively with it would have positive consequences both for the doctor and for patient care. Genuine no-fault critical incident review processes cannot work unless the inevitability of mistakes and imperfection is accepted by all invovled.