Brittany Goetzel

Goetzel 1

Ms. Brandi Bradley

ENC 2135
02/18/16
Matters of Life and Death with Oneself in Pediatric Oncologists
There are many communities that makeup the medical field, but one of the most hardworking communities
averaging at 55 hours a week (WebMD), is the Pediatric Oncology community. A commonly noted issue in this
community, is whether the Pediatric Oncologists (PO) medical practices are affected after the death of a patient that
they worked with or not. Others outside of this community dont actually think about this problem as a whole,
because they dont see the doctors emotions eat them up, nor do they know how different the doctors performed
before meeting them. This community helps to cure babies, children, teens and adolescents from serious diseases or
illnesses. The primary focus in this medical field, is on cancer and hematology, which is the study of the blood. No
matter what, communication is always a key requirement for any community to function well, but issues can arise
whether its from a lack of communication or various other reasons.
In the pediatric oncologist community there are well over 1,000 doctors throughout the world. Several of
those doctors are in hospitals in the United States. The United States of America contains 3 hospital programs that
are in the top 10 throughout the world for Pediatric Cancer. Those hospitals are St. Judes, Childrens and Aurora
(Ranking Web Hospitals). The reason these hospitals are ranked so high in the world, is because they have low
mortality rates, high cure rates, good patient-physician relationships, and a well working community as a whole
(Ranking Web Hospitals). In order for a community to work properly, it starts with its members. This community
can contain many members throughout its structure. Some of those members are the physicians or doctors, nurses,
radiologists and surgeons. All of these members have to communicate effectively with one another, in order for
everything to go smoothly throughout this field. If one part of the communication goes wrong, then major
consequences can happen. For example, performing wrong surgeries or giving the wrong medications to the wrong
patients. Although those are worst case scenarios, the mishaps are still very detrimental to a hospitals ranking
system.
Since this community relies on communication significantly, that means the communication has to be
immaculate; whether its with the patients, families or other colleagues. There are different types of communication

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within this community, which is otherwise known as the genres. Some specific genres within this community for the
issue, is talking with psychologists or other colleagues. The first genre, is talking to psychologists. Psychologists are
there to listen to what the doctors want or need to talk about. This helps the doctors cope with the death that has
occurred. Although, sometimes some doctors dont want to talk to a trained professional and feel that they are a
failure if they do. If the doctors dont want to talk to a professional, then there are other ways of communication
about this issue, which is with other colleagues. This genre can help, by talking to someone that has been in the
same exact place that the doctor is at right now. Hearing how other people coped, can always make another person
feel more content or know that they arent the only one that has been in this position before. Although these are very
good ways to communicate with others about this issue, but these communications dont always help with the
coping. With that being said, a common conception is that all doctors or soon to be doctors have to realize, is that
Pediatric oncologists will not be able to save all of their patients lives. Death for a Pediatric Oncologist can cause
problems for the doctor and their work ethic. With that said, the issue within this community is whether a Pediatric
Oncologists work ethic and medical practices change after the death of a patient in general.
Dr. Ofri states in her Introduction of her book What Doctors Feel: How Emotions Affect the Practice of
Medicine, that emotions exert the strongest influence on medical practices (Page 1). A common misconception that
is viewed throughout the world, is that doctors are emotionless (US News and World Report Ratings). That
statement is truly false. Elizabeth Stewart, whom was interviewed, stated that she has felt so many emotions
throughout her career. Some of those emotions corresponded directly with what is in the book that Dr. Ofri wrote.
Those common emotions which can affect medical practices are: anger, nervousness, jealousy, fearful, ashamed or
burned out/tiredness (Ofri, 1). Students in the medical field are told throughout their education, that emotions will
always cloud judgement. People can make irrational decisions if they are in distressed emotional places, but doctors
have to overcome this problem somehow.
The most challenging aspect with empathy to a doctor, is when the sufferings dont make sense; for
example, a tumor (Ofri, 15). This relates completely towards the Pediatric Oncologist community, since this field
deals with finding tumors all of the time. Finding a tumor can be distressful, especially if the tumor is incurable,
which then means the patient most definitely is going to die. When distress is settled in from a death of a patient and
there is no grieving time given, thats when things can go wrong. When there is no time or space to give grief its

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due, burnout, callousness, PTSD and skewed treatment decisions are at risk (Ofri, Chap. 4). Doctors in the Pediatric
Oncology field never get the time to actually grieve, since they have so many patients to deal with every day. Thats
when medical practices can start to diminish. One change that occurs after the death of a patient that can impact the
Pediatric Oncologists medical practices, is sense of belonging. One doctor stated in the Nature and Impact of Grief
Over Patient Loss on Oncologists Personal and Professional Lives, that I come in and I dont really want to be
here at all. Its an effort to drag myself down to the hospital. From this study, it was found that 55% of doctors
agreed to this statement. This study then correlates with the rest of the Pediatric Oncologists, by saying that at least
half of the doctors say that emotional distress from their job makes it hard for them to go to work. If they lack the
motivation that much, then they arent fully there during their jobs, which ultimately concludes that their medical
practices could be affected and worsen. With this same study, it was found that a lot of emotions came out, that
arent ideal in a medical situation. An example of one of those hurtful emotions, was feeling like a failure, which
then could also make it hard to come to work.
Another study that was conducted, is called Memorable Patient Deaths: Reactions of Hospital Doctors
and their Need for Support. In this study it was only about patients that were memorable to them, and it talked about
how the patients affected more than one person in the hospital. If more than one person was affected by the patient
after the death, then a lot of horrible things could come with that. For example, the doctors answered highly on being
overly sensitive, an increase in dependence on others, and withdrawn or slowed thinking. In this kind of
environment, having those kind of characteristics could be a life or death situation. This just shows that their
practice has most likely changed from being on top of their practices, to now being a weak link in the hospital
setting. No family nor patient would want to see their Pediatric Oncologist like this, because then it is hard to trust
them to be able to cure another patient.
Pediatric Oncologists dont deal with death just when they become a doctor. They also experience patient
death during their fellowship or internships. Internships allow the future doctors to figure out if the specific career
pathway is right for them. In the study Challenges Faced by Pediatric Fellows When Patients Die during Their
Training, it talks about all of the challenges that these interns faced. Some of those challenges dealt with structure,
themselves and their relationships. An example of structural challenges, was with ward duty. A ward duty, is like
being on call throughout the whole training, which means that the intern has to come in no matter what time in the

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day it is. During this training, the interns are surrounded by death because they are the ones pronouncing time of
death (TOD) of the patient. Another emotional challenge with ward duty, is that relationships could be strongly
developed because they would care for the patients that others didnt really care for. The second challenge, was with
themselves. Some examples of the challenges that the interns have with themselves, were feeling vulnerable and
inexperienced since at this point in their career they really dont know anything in the actual field yet. Also, the
interns stated that they felt alone, since they felt like they needed to be strong and not talk about any patient losses.
The last challenge that was touched on in this study, was dealing with relationships. Some examples of these
challenges were with patients/families because during the rotations they never knew how much time they would
have with that patient whether if it would be days, weeks, months or years. Another challenge in relationships, was
with their superiors, since the superiors never helped with ways to have them cope with the deaths.
A very common theme that explains why medical practices would be affected after a death, is emotions.
Although, there could be possibly some other reasons for why medical practices could change after the death of a
young patient, besides just emotions. One of those other reasons, was stated in the research study called Exploring
Moral Distress in Pediatric Oncology; A Sample of Registered Practitioners. In this study it mostly touches base on
patients that share several doctors and nurses. During this study, it was found that once the patient dies or is about to
die, then the communication lacks greatly, which then gets in the way with work. Sometimes the doctors didnt even
want to work together anymore because of what happened previously. When the doctors start to despise one another,
then a lack of communication is noticed within the team and the physicians or nurses in the pediatric oncology
community would withdraw themselves from difficult situations. All of these facts above greatly show for why
emotions can really affect the medical practices of pediatric oncologist doctors after the death of a patient.
The other argumentative side to this issue, is that there is no difference in the medical practices of pediatric
oncologists after the death of the patient. For this side of the argument it was also stated, that the amount of time
knowing the patients didnt matter at all, because a good pediatric oncologist should be able to overcome any kind
of death they face and not allow it to get in the way with their career. The three main arguments for no medical
practice change after death were: the doctor thinking positively, noticing that they tried their hardest or having
previous experience.

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When doctors think positively, it tends to help them cope with the recent loss. One of the common positive
thoughts that is stated in the study Doctors Emotional Reactions to Recent Death of a Patient, is that the patient is
in a better place. Yes, this might sound horrible, but when dealing with cancer, patients can experience severe pain.
Another reason that the doctors think like this, is because for a kid to go through all of the chemotherapy and
radiation, it can really harm their little bodies. Doctors believe that putting the young kids through these medical
practices more, is just unethical if it isnt working. One doctor stated in this article, If you saw some of the kids
reactions after treatments or from the pain you would then understand the reasoning behind this, it was
heartbreaking because you couldnt do anything to get rid of it even if you tried your hardest. No one can
understand this, unless it is experienced first handedly.
Sometimes Pediatric Oncologists have tried every single medical practice of cure, but nothing seems to
work. This argument was stated in the study called General Practitioners Beliefs and Attitudes about how to
Respond to Death. What the anonymous pediatric oncologist doctor meant, is that sometimes the physician will try
every medically known way to try and cure the patient, but some types of cancers just cant be cured. Coming to this
conclusion might be hard on the doctor at the time, but the pediatric oncologist doesnt want to the young patient to
be put in any more harm. The last and final argument for noticing no change in medical practices after the loss of a
patient also came from this same research study. The argument, was that experience helps to make the loss a little
easier. When a person first starts out in this specific community, everything will hurt so much, because the first year
doctors arent used to the occupation yet. Although as time goes on, the grieving process does become easier,
because the doctors are more experienced and understand what helps them to get through the loss of a patient so
they dont have their emotions get in the way with work. As time goes on people gain more knowledge in this career
field, and understand that sometimes it just happens and it isnt their fault.
No matter what side of this issue a person is on, there will always be the need to cope with the situation.
Some of those coping strategies, are bereavement debriefing sessions and examples of personal ways to help cope. If
a person copes, then the chances of the Pediatric Oncologists medical practices being affected after the death are
slim. Although if a doctor does not deal with each loss, then previous losses can be intertwined with their recent loss
and just make the doctor a complete mess (Keene, 185). The first coping strategy, is bereavement debriefing
sessions. A bereavement debriefing session, is specifically aimed at providing emotional support and increasing

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ones ability to manage grief (Keene, 185). In order for a bereavement session to work properly, the session has to
occur within the week or next couple weeks after the death of the patient. In the bereavement debriefing session, the
physician gets to answer questions related to that specific patient death that is causing distress and is with a
bereavement coordinator. Only some hospitals have this as an offering to their staff; for example, John Hopkins is
one of those hospitals. During this study, the Pediatric Oncologists that took part in it resulted with 98.4% of them
finding these sessions helpful, 97.8% thought they were informative and 97.8% also found them meaningful (Keene,
187). Based off of these results the bereavement sessions tend to have high turnover rates from emotional distress of
the patient deaths.
There are then several ways to cope for a pediatric oncologist. One of the ways is stated in Oncologists
Protocol and Coping Strategies in Dealing with Patient Loss. Seeking out social support and attending activityoriented coping techniques were the top two ways that doctors got better (Granek, 941). Some given examples for
social support, were talking to spouses or family members, friends or other health care professionals. Although, it
was noted in this same article that the best social support, is one that can relate to what the doctor is going through at
the time. Granek also states on page 944 to be careful for what colleagues the doctor talks to, because not everyone
will agree with certain medical practices. The second main coping strategy, was attending activity-oriented
techniques, which consists of the doctor doing their hobbies, conducting research, taking time off or exercising
(Granek, 941). One doctor stated that engaging in activities that dont involve thinking about the patient or
remembering anything about the patient, gives an ease of mind (Granek, 946). The next article that gives different
coping strategies, was Dealing with Stress, Burnout, and Grief in the Practice of Oncology. This article states that
some common coping strategies, are to sleep, laugh, and make a change or share responsibility with other doctors
(Lyckholm, 754). What Lyckholm meant for making a change, is by joining in groups that will help. For example,
doing clinical research for maybe the specific cancer that killed the patient (Lyckholm, 754). Dr. Stewart also
believed in these coping practices by relying on others too, but there was one very interesting one. Elizabeth Stewart
also liked to rely on her dog as support, because her dog would always show love and affection to her; yet also let
her get a breath of fresh air on their walks.
As one can see, this career field can become heartbreaking, and wonder how these people can even stay in
this career field. Elizabeth Stewart is a Pediatric Oncologist who primarily focuses on treating children with solid

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tumors. Solid tumors are considered high risk tumors that can spread throughout the body or relapse in a patient
making it harder to treat (Stewart). Dr. Stewart has been awarded several great achievements in the Pediatric
Oncology world. Some of those awards, were the Phoenix Childrens Hospital Intern of the Year, Tri Delta Woman
of Achievement Award and St. Jude Childrens Research Hospital Employee Spotlight (Stewart). All of these awards
she won for a great reason, because she is a determined woman in this community. Her interview was heartwarming
for why she became a doctor after she was awarded the Tri Delta Woman of Achievement Award. Personally one can
see that these doctors have the personal drive, and that is what helps make them stay in this community. Not only
that, but as Stewart said in her interview, Of course there are good days and bad days, but the good days far
outnumber the bad ones. As the doctors go through their career the best way to be able to stay strong, is by focusing
on those numerous good days. Some examples of the good days, are when former patients get married, go to
medical school or graduate (Stewart). These good times help to know that the doctor is what helped put those
patients in positions of where they are today, and that is what pushes a doctor to still pursue this type of a career.
This issue should be noticed, because many doctors are dealing with the stress of their job, which is causing
them to burnout. Even if some people dont believe that the pediatric oncologists practices have changed from the
death of a patient, they still experience burnout. The more doctors that experience burnout because of the job, the
less there will be. If we start losing all of these amazing Pediatric Oncologists, then more children will die from
cancer. Kids should have the right to live, because they never chose to live with cancer, it sometimes just happens.
Having specific doctors helping out in the world for kids with cancer is the greatest thing to have to help decrease
childhood mortality rates in all countries. Babies, kids, teenagers and adolescents all deserve to get a second chance
at a normal life, and thats exactly what these doctors do.

Works Cited
"Memorable Patient Deaths: Reactions of Hospital Doctors and their Need for Support." Medical education 41.10
(10): 942; 942,946; 946. Print.

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Granek, Leeat, et al. "Challenges Faced by Pediatric Oncology Fellows when Patients Die during their
Training." Journal of Oncology Practice 11.2 (2015): e182-9. Print.

Granek, Leeat, et al. "Oncologists Protocol and Coping Strategies in Dealing with Patient Loss." Death
studies 37.10 (2013): 937,952 16p. Print.

Granek L, Tozer R, Mazzotta P, Ramjaun A, Krzyzanowska M. Nature and Impact of Grief Over Patient Loss on
Oncologists' Personal and Professional Lives. Arch Intern Med.2012;172(12):964-966.

Keene, Elizabeth A., et al. "Bereavement Debriefing Sessions: An Intervention to Support Health Care Professionals
in Managing their Grief After the Death of a Patient." Pediatric nursing 36.4 (2010): 185,9; quiz 190. Print.

Lyckholm, Laurie. "Dealing with Stress, Burnout, and Grief in the Practice of Oncology." The Lancet Oncology 2.12
(2001): 750-5. Print.

Ofri, Danielle (MD). What Doctors Feel: How Emotions Affect the Practice of Medicine., 2014. Print.

Pye, Kate. "Exploring Moral Distress in Pediatric Oncology; a Sample of Registered Practitioners." Issues in
comprehensive pediatric nursing 36.4 (2013): 248-61. Print.

Redinbaugh, Ellen M., et al. "Doctors' Emotional Reactions to Recent Death of A Patient: Cross Sectional Study of
Hospital Doctors." BMJ: British Medical Journal 327.7408 (2003): 185-9. Print.

Saunderson, Eric M., and Leone Ridsdale. "General Practitioners' Beliefs and Attitudes about how to Respond to
Death and Bereavement: Qualitative Study." BMJ: British Medical Journal 319.7205 (1999): 293-6. Print.

Stewart, Elizabeth, Dr. "Interview for Pediatric Oncologist Community." E-mail interview. Mar. 2016.