Brittany Goetzel

Goetzel 1

Ms. Brandi Bradley

ENC 2135
02/18/16

Matters of Life and Death with Oneself

There are many communities that makeup the medical field, but one of the
most heartbreaking communities, is the Pediatric Oncology community. This
community is very special, because it helps to cure babies, children, teens and
adolescents from serious diseases or illnesses. Although, this field primarily focuses
on cancer. No matter what, communication is always key for a community to
function well, but issues can arise whether its from lack of communication or
various other reasons. A commonly noted issue in this community, is whether or not
the Pediatric Oncologists (PO) medical practices are affected after the death of a
patient that they were super close with.
In the pediatric 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 patientphysician relationships, and a well working community as a whole. 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

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consequences can happen, like performing wrong surgeries or giving the wrong
medications to the wrong patient. Although those are worst case scenarios, they are
very detrimental to a hospital ranking system.
Since this community relies on communication greatly, which then means the
communication has to be immaculate; whether its with the patients, families or
other colleagues. There are different ways to communicate within this community,
which is otherwise known as the genre. Some specific genres within this community
is consultations, end of life conferences and diagnosis. The first genre that occurs
once a patient is newly admitted to the hospital, is diagnosis. After, the patient
explains all of the symptoms that they have, then the Pediatric Oncologist will do
whatever tests that they think is needed to figure out what kind of cancer the
patient has. Once the diagnosis is figured out, then the Pediatric oncologist has to
communicate to the patient what the actual results are. This type of communication
is strictly informative, since it is informing the patient about their situation. The
audience for this genre of communication, is the patient and the family because
both are qualified to know about the situation, unless the child is too young to
understand, then it is mostly directed to the parents or guardians. During this genre
of communication, the rhetorical appeals would strictly be pathos, because the
doctors have to emotionally appeal to the family since it is hard to explain to any
family that their child has cancer and could die, depending on how bad the cancer
is. The mode of this communication is auditory and visual. The reason that this
genre could be both, is because the doctor will mostly explain what is going on,
which is auditory, but some Pediatric doctors will also bring in scans, which then
incorporates the visual aspect. A common type of media used for this genre, is faceto-face communication.

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A second form of communication, is consultations. A consultation is a

discussion between two or more medical professionals about the diagnosis or
treatment in a particular case (Consultation). When this genre of communication
occurs, the rhetorical appeal is logos because each doctor is trying to make a case
on what the actual diagnosis is based off the facts or known items in the case. In a
consultation that mode of the communication is audio and visual, because the
doctors listen to each other on what their stance is. The mode is also visual,
because the doctors have to prove with visual statistics, charts, diagrams or scans
for why they came up with this specific diagnosis. The media of this communication,
is face-to-face, because the doctors are in a room together debating with each other
about the issue and who is right. This type of communication is very effective,
because it helps give different perspectives to certain cases to help consider all
possibilities that the cancer could be.
A third common communication, is end of life conferences. An end of life
conference is a very unbearable situation to be in. An end of life conference is the
verbal communication with the terminally ill patient and family about what is going
to happen now, since no medical practices or medicines are helping eliminate or
shrink the cancer. The audience, would be any family members that are present and
the patient. During this communication, a strong rhetorical appeal that needs to be
used, is pathos. Pathos is used, because in an end of life conference emotions will
be very high, because of death is the only answer now, which the doctor has to
emotionally care for both the family and patient to help show that the doctor truly
cares and that they tried everything they could possibly do to try and heal the
patient. The mode of communication that is prevalent in this situation, is only

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verbal. A media for this type of communication, is only face-to-face since the doctor
is in a private room with the family that is present and the patient.
With that being said, a common conception 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 truly be heartbreaking and
arise problems for the doctor with their work ethic. With that said, the issue within
this community is whether or not 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, she states 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). Dr. Ofri although states how that is strictly a myth. The common
emotions that are touched on throughout her book, which can affect medical
practices are: anger, nervousness, jealousy, scared, ashamed or burned out/tired
(Page 1). Students in the medical field are told from the get go that emotions will
always cloud judgement, which is totally true. People can make irrational decisions
if they are in a distressed emotional places, but doctors have to overcome this
problem.
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, if the tumor is incurable, which then
means the patient most definitely is going to die. When distress is settled in from a

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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 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 affect with death 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. That then shows, that at least half of the doctors say that the emotional
distress that their job puts on them, 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.
This study was simply asking Pediatric oncologist doctors about the death situation.
With this same study, it was found that a lot of emotions came out, that arent the
best like feeling like a failure, which then could also make it hard to come to work.
Another study that was conducted, 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 most of the time. 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, withdrawn and slowed thinking. In
this kind of environment, having those kind of characteristics could be a life or

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death situation. This just shows that their practice has most likely changed from
being on top of thing and being able to do things themselves, 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.
Now Pediatric Oncologists dont deal with death just when they become a
doctor, they also experience it during their fellowship or internships. This is the time
for when doctors can really figure out if this career pathway is for them. In the study
Challenges Faced by Pediatric Fellow When Patients Die during Their Training, it
talks about all of the challenges that these interns/fellow face. Some of those
challenges dealt with structure, themselves and 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. During this training, the interns are surrounded by death because they
are the ones pronouncing time of death (TOD). 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 these challenges, were feeling vulnerable,
inexperienced since at this point in their career they really dont know anything and
feeling alone since the interns felt like they needed to be strong and not talk about
any patient losses. These feeling can eat anyone alive and make them not want to
come back anymore either. The last challenge that was touched 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.

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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 are some other reasons for why medical
practices could change after the death of a young patient. 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, 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. Then after
there was a lack of communication noticed within the team, then 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.
Although there is another side to this issue that was found. This
argumentative side stated that there is no difference in the medical practices of
pediatric oncologists after the death of the patient for several different reasons. 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 thing 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 thinks positively, they tried their hardest or from experience.

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The first argument that is brought up, is that the doctors will think positively.
This helps a doctor so much. 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 with cancer patients
can be in severe pain, which is even worse. Another reason that the doctors think
this, is because for a kid to go through all of the chemotherapy and radiation is
really harmful for the body, and to put the kids through this 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
experience first handedly.
A second argument that is brought up, is that the Pediatric Oncologists have
tried every single medical practice of cure, but sometimes it just isnt enough. 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 ways to cure,
but some types of cancers just cant be cured. It might be hard on the doctor at the
time, but the physician doesnt want to put the young patient in any more harm
than good. 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 future
doctors arent used to this kind of grieving process. Although as time goes on, the
grieving process does become easier, because the doctors are more experienced

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and understand what helps them to get through the loss of a patient, so they dont
have their work get help up because of their emotions. As time goes on people gain
more knowledge in the career field, and understand that sometimes it just happens
and it isnt the pediatric oncologists fault. Overtime people will notice this too, but
it will hurt at the moment in time.

*still need to include coping ways, interview and conclusion*