Don’t Forget About The Second Victims, We Suffer Too

Don’t Forget About The Second Victims, We Suffer Too

Physicians go through a lot. We see a lot. And a lot of what we experience can be traumatizing. As an anesthesiologist, I come across life or death scenarios on a regular basis. The demands of our job can be taxing. We work extremely hard for the good of our patients and never want to see them harmed. But it’s not all rainbows and butterflies. Sometimes bad things happen. Adverse events occur from time to time. In many instances, no one person is particularly at fault. While events such as these are hard on the patient and their families, they can also affect the caregivers as “second victims.”

This is a phenomenon known as the second victim syndrome.

 

What is a Second Victim?

Second victim syndrome was first described in this article by Albert Wu in the British Medical Journal. Simply put, second victims are healthcare providers who are involved in an unanticipated adverse patient event, medical error and/or a patient-related injury. They become victimized in the sense that the provider is traumatized by the event.

Of course I don’t want to take anything away from the primary victims, the patient and their family. When there is an adverse event, it’s the patient that suffers the most. At the same time, we should not minimize the pain and suffering that clinicians feel when an event like this occurs.

It can be very painful.

Second victims often report a broad spectrum of destructive negative feelings. These include feeling personally responsible for the poor outcome, shame, anger, depression. Many second victim clinicians also feel as though they have failed the patient, second guessing their clinical skills and knowledge base. This leads to feelings of inadequacy, failure, and loss of confidence. Some even report symptoms of post-traumatic stress disorder.

Unfortunately, these negative thoughts sometimes lead to additional medical errors that may harm more patients. These thoughts could be self-destructive too. It’s not uncommon for second victims to feel stigmatized, socially isolated, and therefore suffer alone.

Sadly, some clinicians even succumb to suicide.

 

Recovery from Second Victim Syndrome

Fortunately, most clinicians recover.

Just like how there are several stages of grief, there are also stages of recovery for second victims.

This article describes the stages and below is an outline of these stages.

Stage 1: Chaos and Accident Response

The clinician experiences internal and external turmoil. While trying to determine what happened and manage a patient who may be unstable at the same time, the clinician may be in a state of shock. Because the clinician is distracted and in a state of self-reflection, others need to take over.

Stage 2: Intrusive Reflections

Clinician experiences feelings of inadequacy, self-doubt, and loss of confidence. Clinician engages in continuous re-evaluation of the situation through “haunted re-enactments.” The event keeps on replaying in the clinician’s mind on repeat.

Stage 3: Restoring Personal Integrity

Clinician seeks support from trusted persons, but may not know where to turn. They may be fearful of how others will react. Unsupportive responses from colleagues can impair recovery, as they may intensify self-doubt and make it difficult for the clinician to move on.

Stage 4: Enduring the Inquisition

Clinician braces for the institutional investigation, wonders about the impact on their job, licensure, and the potential for litigation. The clinician may be relucant to discluse information for fear of violating privacy regulations.

Stage 5: Obtaining Emotional First Aid

Clinician feels uncertain about who is safe to confide in due to privacy concerns and not wanting to expose loved ones to pain. In a study, most clinicians felt under supported.

Stagge 6: Moving On

Clinicians feel internal and external pressure to “move on”. This can take the form of:

• Dropping out: changing their role, moving to a different practice setting, or leaving their profession
• Surviving: “doing okay” after acknowleding mistake, but having a hard time forgiving self, finds it “impossible to let go”
• Thriving: making something good come out of the event

 

My First Personal Experience as a Second Victim

Almost every physician remembers their first patient death. Like they say, you never forget your first. I remember mine quite well.

It occurred in 2008 when I was an intern. I was taking one of my first nights on call. Where I trained, the anesthesia intern on call carried the code blue pager and responded to code blues throughout the hospital.

At first it seemed like it could be a quiet night. But all of a sudden the code blue pager beeps. The pager indicated a code blue in postpartum. While we started walking over to the postpartum unit, my senior resident and I were hoping it was a false alarm. It wasn’t uncommon for people (visitors, environmental services, etc.) to accidentally press the code blue button.

But it was a real code blue

When we arrived, I saw a young man and some family members sobbing outside a postpartum room. We entered the room where there was a lot of commotion.

A quick survey of the scene showed that the airway was secured and the code team was performing CPR on a lifeless postpartum patient. Several of us took turns performing chest compressions so that we wouldn’t tire out. We tried desperately to resuscitate her for more than an hour. But to no avail.

When it was apparent that our efforts were futile, the leader of the code called it. A new mother had just died.

It was rough

I took this one pretty hard. Not only was it the first patient death that I experienced as an intern, it was also a young patient who was probably around my age. I started to empathize with the  sobbing young man who was at one moment a happy new father then shortly later a grieving widower. And I felt for the baby, who will grow up one day learning that her mother died shortly after birth.

I talked to my senior resident, who was very supportive and caring.

Additionally, I talked to my co-interns. Being in the same shoes, they know what it’s like. Talking to them as peer supporter was very helpful.

Sometimes life isn’t fair. And while I had no direct responsibility for what happened, I was still a witness to the tragic event.

For a while, the scene continued to replay in my mind.

Eventually, I moved on. I healed. And the haunting re-renacments in my head were gone.

However, the images of that event still linger. 18 months ago, they resurfaced when my then-pregnant wife was in labor. I didn’t want to think about it, but for some reason I couldn’t help it. The traumatic memories from 10 years ago impacted me and for a moment they made me fear that I could lose my wife.

 

Final Thoughts

Last month, I joined my hospital’s second victim peer support program. As a peer supporter, the goal is to provide timely emotional support in an emphatic, confidential, non-judgmental environment.

Our hospital identifies unanticipated adverse events and unintentional medical errors as well as the physicians involved who may suffer from second victim syndrome. Once identified, peer supporters reach out to these physicians who may be in need of help and emotional support.

Looking at the stages of recovery from second victim syndrome, stages 3 through 5 involve peer support. As you can see, this support is vital for helping second victims recover and thrive.

That’s why I became a peer supporter. I know peer support  is valuable because it has helped me in the past.

Hopefully, my involvement helps to reduce second victim syndrome, burnout, and moral injury.