1357. A Dance With Death- The Neurosurgeon’s Daily Interface With Death and Tragedy

Authors: Gary Robert Simonds, MD, FAANS; Cara Rogers; Chris Busch; John Entwistle (Black Mountain, NC)

Introduction: We are interested in the many stressors faced by neurosurgeons that may contribute to burnout, compassion fatigue, and other maladaptive responses. We hypothesize that neurosurgeons are routinely exposed to an unprecedented array and volume of death, mayhem, and tragedy. Methods: We asked our residents and APP’s to tally all unique interactions with patients who were dying or at substantial risk of dying over an assigned period of time, and to log in the nature of human tragedy encountered with all new consults. We surveyed and held focus-group discussions with all faculty surgeons, residents, and APP’s on the team about their exposure to death and tragedy. Results: Subjects tallied an average of 65 unique interactions with dying or at-risk patients in a week (high of 120). All subjects reported profound exposure to tragedy and mayhem, often unremitting over several hours in a day (e.g. ICU rounds, emergency call). Scores of unique tragic circumstances were encountered. Most subjects reported a sense of going numb and even indifference to patient tragedy and suffering. Many reported nighttime ruminations about the tragic events witnessed during the day. Most reported sleep disturbances and related nightmares. The majority did not discuss tragic events with friends or loved-ones with any sort of regularity. Many subjects could readily cite specific circumstances that were particularly troubling (death of a child, hit and run victim, etc.). Uniformly, subjects were profoundly affected when they felt they somehow contributed to the unfortunate circumstances of their patients (i.e. complications, oversights, etc.). Conclusion: We found that they were routinely subjected to high rates of death and human tragedy, and that related maladaptive responses were surfacing in most. Neurosurgeon exposure to death, mayhem and tragedy should not be underestimated and strategies to ameliorate the associated effects should be considered at all busy programs.