As a surgeon, how do you cope with the death of your patients?

This is an excellent question and a complex answer. As a neurosurgeon, I deal with so-called "high acuity" patients frequently such that many die or are left with moderate or severe disability as an anticipated outcome from pathology like intracranial hemorrhage, severe traumatic brain injury, and spinal cord injury. While it is infrequent that poor outcomes are directly attributable to technical or medical error, just because a poor outcome was foreseeable or anticipated does not make it any easier. I believe that fact is one of the things most graduating medical students don't understand when entering high acuity specialties like neurosurgery, trauma surgery, critical care, etc.

I think the first thing we tend to do is revert to a sort of root-cause analysis. What I mean by that is, I typically will study the case by re-reviewing imaging, pouring over labs and other results, and re-watch operative videos when present to try to find learning points - things I could do differently in the future or perhaps markers that things were higher risk than anticipated. Next, you tend to turn to your colleagues and mentors to see if they've experienced similar scenarios and what they have or might have done differently. Then, you turn to researching it in the literature to, again, seek ways to change practice in the future.

I would add that the thing of paramount importance is that while the patient may have died you have a responsibility to that patient and their family to give them an honest, forthright appraisal of what happened and why. One of the most important things is to just make the time to answer all of their questions to the best of your ability, even if that means changing your schedule, staying late, handing off a pager, etc. This is especially important when an unanticipated bad outcome occurs. I've been on the patient/family side of the equation and definitely appreciated the doctor's candor and walking us through what they think happened and how those decisions were made.