Trainee surgeons and death

It might seem trivial to say but death is one of the first things junior doctors have to learn about. What it looks like, what it feels like, how you break the news to a family. It's one of the first things that they need support with.

When training to be a Surgeon there are two types of death - deaths that could be your fault and deaths that weren't your fault (failure to save). Being able to differentiate between them is critical because it allows you to filter some of the negative emotions associated with the latter type of death. The patient would have died anyway, you did no harm.

In Western hospitals mortality rates are generally quite low and, with time, the 'failure to saves' relatively easy to identify. It is slowly dawning on me (watching and listening to Geoff) that things are very different out here. A great many of his patients (including several he operated on late on Monday night) have died shortly after surgery. These people would not have died in the UK. But what type of death are they? The first sort (Geoff's doing procedures he's not familiar with, in less than ideal conditions) or the second sort?

I spent an hour or so in Theatres this afternoon but didn't see very much operating (I will go back). I left with Geoff who'd been called to the ward to see a patient from the morning list. She's 12 and presented yesterday having fallen from a tree. She'd damaged her spleen 24 hours earlier but Geoff and the Prof were hopeful that it wouldn't need operating on (it had stopped bleeding of its own accord). Unfortunately, and unusually, over night she started to bleed again and they removed the spleen this morning. But here she was on the ward looking distinctly unwell. Her spleen had been inflamed (suggesting that she was fighting infection) but so damaged that it needed to be removed. Now, without the spleen to help out, she is very septic. It's not clear of the cause and Geoff is not hopeful.

He asked advice of one of the medics (there is a strange wailing sound coming from his ward when we find him). He teaches Geoff how to treat for malaria and which antibiotics he would give (although we are still short of the most useful one). The wailing? That's the families of two patients that had just died. Both came in over night - one with renal failure, the other meningitis. How long will they wail for? Until the body is removed. How long might that be? Up to an hour.