The Psychological Toll of Patient Death in Procedural Settings: Impacts on Health Care Workers and Strategies for Support

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EP LAB DIGEST. 2025;25(11):24-26.

Rachel V Weise, RT(R)(CI)(ARRT), BSRS 
Atlas HealthCare Partners Banner Cardiovascular Center Arcadia, Phoenix, Arizona

For those of us who work in health care—particularly in procedural and surgical areas—we are intimately familiar with both the extraordinary endurance and frailty of the human body. Many of us have witnessed cases in which individuals survived circumstances that seemed unsurvivable—and went on to lead long, healthy lives.¹ Even with all the incredible medical advances of today, the human body is not meant to live forever. 

The first time I lost a patient was many years ago, when I was a few months into the beginning of my electrophysiology (EP)/cath lab career. I was young and inexperienced, and on a mission to save the world. We were told that the patient had coded several times en route to the hospital. With that first angiogram, everyone in the room took a sharp breath. A few millimeters of the left main coronary artery demonstrated patency; however, the remainder of the left coronary system was largely occluded or absent. After that injection, the patient coded again. We did everything that we could. Advanced cardiovascular life support (ACLS) was performed with high-quality compressions, a ventricular assist device was inserted, and an attempt was made to wire the vessel, but we never got a pulse back. 

We were devastated. We did everything we could, but the patient could not be revived. What went wrong? Did we miss an action or step that could have saved this person’s life? My mind was inundated with a cascade of emotions—most notably guilt, shame, and profound sadness. Our director called us into his office and let us vent. He then shared some words of wisdom that I hold true in my heart today: “We cannot save everyone. That is not how this works. We do our absolute best with every patient that we care for. But at the end of the day, if the Man upstairs is calling you home, there ain’t nothing any of us can do about it. It is just their time to go.” His words were helpful in providing perspective on the situation and allowed the team to being processing this patient’s death in a healthier way. 

Assessing the Mental Health Damage Across Health Care as a Whole 
During the COVID-19 pandemic, many front-line health care workers (HCWs) reported high levels of “moral injury” due to perceived institutional and government failings.² HCWs reported feeling they did not have the personal protective equipment (PPE) they needed to keep themselves healthy, and they lacked the supplies and resources needed to properly care for their high-acuity respiratory patients. Training was needed to “redeploy” routine and elective care teams to areas such as Intensive Care and Respiratory Care Units. Staffing shortages and a record number of patients overwhelmed many health care facilities. Having patients die became a forlorn and regular occurrence. 

Visitor restrictions during the pandemic created a new kind of burden. Family members and loved ones experienced unmet communication needs from the clinical team. Health care teams were overwhelmed with the increased amount of care needed per patient. Effectively communicating a poor prognosis was particularly challenging in the absence of family at the bedside, as they were unable to witness the severity of their loved one’s condition firsthand. Medical centers often restricted visitors to 1 or 2 people for a limited time if death was imminent. There were times I witnessed entire families of 10, 20, and 30 plus people crying in the parking lot because their loved one was dying, but they were not allowed inside the building. Witnessing patients die in isolation, while families faced the agonizing decision of designating a single final visitor during their loved one’s last moments, was profoundly distressing. 

There are multiple meta-analysis studies and reviews that attempt to quantify the number of HCWs diagnosed with post-traumatic stress disorder (PTSD), depression, anxiety, and unhealthy levels of alcohol consumption. Trying to find multiple studies that agreed on the statistics proved challenging. The literature suggests that pre-COVID levels of these mental health problems were around 20%, but increased to almost one-third of all HCWs struggling significantly with their mental health during the COVID-19 pandemic.³ Ongoing data collection aims to determine whether the prevalence of mental health disorders persists in the post-pandemic period, or if such outcomes were primarily associated with the acute and peak phases of the pandemic.
 
Mortality in the Lab and “Us” 
In the past 16 years working in the EP/cath lab, I have observed several different ways that procedural teams handle death in the lab. Most commonly, I have found that a patient’s death is met with minimal emotional acknowledgment. Sometimes there will be a short debriefing over what exactly happened if the cause of the code was not recognized immediately. How can complications that the team has not yet experienced be properly managed next time? What I have witnessed and personally experienced more often is that the staff feels demoralized and deflated but are often expected to “turn the room” and get the next patient on the table. Less commonly, the provider may pause for a moment of silence or quietly acknowledge the patient before exiting the room and cancelling further procedures.

Beliefs surrounding death and dying vary widely among individuals. From a psychological perspective, Elisabeth KÜbler-Ross’ work over 40 years ago outlining the 5 stages of grief remains highly relevant and continues to be widely referenced across multiple professional disciplines.⁴ The 5 stages of grief are denial, anger, bargaining, depression, and acceptance. KÜbler-Ross noted in her research that an overwhelming number of adults have difficulty acknowledging death as a normal part of life and feel the need to do anything and everything possible to prolong life no matter how painful or unrealistic. This dynamic is frequently observed in surgical and procedural settings, where families may struggle to accept comfort-focused care and the inevitability of death, instead favoring continued interventions. These final interventions often contribute to significant moral injury among clinical staff, who recognize and accept that the patient has reached the end of life. The administration of aggressive or painful interventions at the end of life can be perceived as potentially traumatic by health care teams that prioritize acceptance, comfort, and compassionate care at the end of life. 
 
How Can We Better Support Our Teams? 
Hospital administrations have tried to come up with many solutions on how to provide support and prevent HCW burnout in their facilities. One of the most utilized and beneficial resources is an Employee Assistance Program (EAP), which offers access to support services such as childcare, eldercare, pet care, and a limited number of counseling sessions with a licensed therapist—typically 5 or 6 visits. An EAP can be used to help team members deal with specific issues or start them on a treatment path for longer term mental health care. Additional commonly offered resources include recharge rooms, aromatherapy carts, and virtual or in-person wellness classes, all designed to support employee well-being. Though well-intentioned, many HCWs report that overwhelming workloads often keep them from exercising stress-reduction opportunities during their most stressful work hours.⁵ 

The book What Happened to You?: Conversations on Trauma, Resilience, and Healing integrates personal narratives with neuroscience to explore the effects of trauma on the human brain.⁶ Reframing the question of “What happened to you?” serves as a foundational shift in understanding PTSD and other trauma-related mental health conditions, promoting healing through compassion and empathy. Learning strategies to support self-regulation of the body and emotions is a critical first step in the healing process. One of the best ways one can start healing from repeated trauma is through connection and relationships with one another. Despite unprecedented digital connectivity, genuine human connection is often hindered by technological barriers.⁷ Meaningful emotional support may come from trauma-informed therapists or peers with shared experiences. In clinical settings, colleagues often serve as the most accessible and effective support system for processing patient loss. Encouraging peer empathy and shared reflection can facilitate healthier coping with difficult clinical outcomes.

Once clinicians have had the opportunity to process distressing events in a healthy manner, they may develop what is described as “trauma wisdom”⁶—not the erasure of harm, but a cultivated resilience, strength, and compassion that informs future responses. Normalizing these conversations and creating space beyond routine debriefings is essential for supporting the mental health of HCWs, mitigating burnout, and promoting sustained team engagement. Empowering clinicians to serve as sources of strength and hope for one another offers a practical and impactful path forward. 

Disclosure: The author has completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest, and has no disclosures to report.

1. I’m Very Lucky to Be Alive. Heart Foundation New Zealand. Published May 2019. Accessed October 14, 2025. https://www.heartfoundation.org.nz/journeys/im-very-lucky-to-be-alive
2. Hegarty S, Lamb D, Stevelink SAM, et al. ‘It hurts your heart’: frontline healthcare worker experiences of moral injury during the COVID-19 pandemic. Eur J Psychotraumatol. 2022;13(2):2128028. doi:10.1080/20008066.2022.2128028
3. Halsall L, Irizar P, Burton S, et al. Hazardous, harmful, and dependent alcohol use in healthcare professionals: a systematic review and meta-analysis. Front Public Health. 2023;11:1304468. doi:10.3389/fpubh.2023.1304468
4. Kübler-Ross E. On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy and Their Own Families. Macmillan; 1969. 
5. Kober M, Chang YP. Healthcare workers’ perceptions of work-related stress and burnout: strategies and barriers for self-care. Am J Lifestyle Med. 2024 Jan 29:15598276241230043. doi:10.1177/15598276241230043
6. Winfrey O, and Perry BD. What Happened to You?: Conversations on Trauma, Resilience, and Healing. Flatiron Books; 2021.
7. High AC, Ruppel EK, McEwan B, Caughlin JP. Computer-mediated communication and well-being in the age of social media: a systematic review. J Soc Pers Relat. 2022;40(2):420-458. doi:10.1177/02654075221106449