When Hospitalists Have a Bad Day

Medscape

26-05-2025

It was early in the pandemic when hospitalist Ethan Molitch-Hou treated a woman admitted with COVID-19 who was severely ill.
'We had kept her going, but it reached the point where I knew she was not going to make it out of the hospital,' said Molitch-Hou, MD, MPH, now an assistant professor and director of the Hospital Medicine Sub-Internship at the University of Chicago, Chicago.
Molitch-Hou joins a few other hospitalists sharing with Medscape Medical News their most difficult day in the hospital, from saving lives to losing them, missing family to second-guessing procedures.
Ethan Molitch-Hou, MD, MPH
'As it was the beginning of the pandemic, we had restrictions on visitors,' Molitch-Hou recounted. 'I had been talking with the woman's son every day. Unfortunately, it was Mother's Day when she passed, and I had to hold the phone during their last conversation.'
While he served as an intermediary for other patients in this way, Molitch-Hou said the mother-son scenario hit him harder that day because he lost his own mother a year earlier.
'I had been practicing as an attending for 9 years at that point, and I have lost several patients over the years. The pandemic was filled with one sad story after another as we struggled to figure out our best treatment plans, and the day she passed brought a sense of hopelessness. The isolation made it so much harder for patients, and unfortunately, we had many stories like this,' he said.
'In general, any day that you lose a patient or have a bad outcome is challenging, but the frequency of those bad outcomes during COVID made this loss that much worse.'
Bearing Witness
For Nikhil Sood, one of his most difficult days was bearing witness to a couple in their final distressing hours together.
'I work in a cancer hospital where I care for vulnerable and terminally ill patients,' said Sood, MD, a hospitalist at Banner Gateway Medical Center in Gilbert, Arizona. 'I was caring for a young patient with metastatic cancer who had failed all treatments. The oncologist had recommended hospice care the day before I met him,' explained Sood, who is also an assistant professor and clinical scholar at the University of Arizona College of Medicine in Phoenix.
It had been a long, stressful night for the patient and his wife as they grappled with their harsh reality.
'I entered the room and observed a young cachectic patient sitting in bed with tears rolling down his cheeks. Leaning onto his shoulder, I saw his wife, with fear and sadness in her eyes, hoping for a miracle,' Sood recalled.
'I sat down, and we talked about their life and their cancer journey. At the end of our conversation, I asked them, 'How can I help?' The wife hesitantly responded, 'Can you order something for us? We have not eaten in more than 24 hours.' I replied, 'I most certainly can.''
Nikhil Sood, MD
The woman broke down in tears while Sood struggled to maintain composure, he recounted. 'As I walked away, I reflected on the difference I made by showing empathy, making them feel heard, connecting with them, and relating to their situation. We transitioned him to comfort care, and he passed away within 24 hours, surrounded by family, in as much peace as we could provide.'
That day made Sood evaluate the 'emotional weight of being a hospitalist in a cancer center, not just managing critical illness but shepherding families through the darkest moments of their lives,' he said.
'I carry her memory with me and often think about how we, as hospitalists, hold space for both suffering and grace. It reminded me that medicine is not always about curing; sometimes it's about bearing witness and easing suffering with humanity and humility.'
Even the Saves Bring Stress
Saving lives also can create a difficult day for a hospitalist. Andrea Braden, MD, recalled such an experience one Christmas Eve.
'I arrived that morning at 8 AM for my shift,' said Braden, an OB/GYN hospitalist and lead clinical educator for TeamHealth in Atlanta. 'In the midst of laughing with a pregnant patient I was caring for about the fact that we would be spending Christmas together that year, I got an emergency call from the labor and delivery charge nurse asking me to come check on a laboring patient,' Braden said.
'From the moment I walked in the patient's room, I knew something was very wrong. I took her back for a stat C-section just in the nick of time. Her uterus had ruptured, and both mom and baby's lives were imminently at risk.'
Andrea Braden, MD
While Braden was relieved to save lives, she admits the emotional toll of the event lasted much longer than those few tense moments of surgery. 'I have seen countless obstetric emergencies in my 18-year career. But for some reason, this one broke me. I couldn't sleep. I kept waking up with a startle every time I did fall asleep. And I couldn't close my eyes without seeing replays of that delivery. I couldn't stop crying.'
Braden also admits the honor of saving lives comes at a cost to hospitalists like herself. 'What continues to haunt me is the duality of feeling grateful that I was there that Christmas Eve morning to save a mom and baby's lives and simultaneously resentful for — once again — giving up the opportunity to make precious memories with my own family.'
It's the career path she chose, she concedes. 'I have grown accustomed to the fact that I have always been expected to sacrifice nights, weekends, and holidays for the safety of my patients. But it still hurts.'
On Your Own
The most difficult day for Monique Nugent was her first one after residency without a supervisor. 'I had 18 patients, and I did not get to the last one until 7:30 PM,' said Nugent, MD, MPH, a hospitalist at South Shore Hospital in Weymouth, Massachusetts.
'I didn't eat lunch, and I didn't take a break,' recalled Nugent of her more than 12-hour day caring for patients. 'I was really on my own for the first time, and suddenly I lacked confidence. I was a confident and efficient resident and chief resident. Yet, that day, I was very aware that no one was checking on me, and that realization suddenly made me doubt myself, and I became inefficient.'
Nugent said she second-guessed her decisions. 'I was getting stuck on basic information and decisions. I felt overwhelmed. I did not get home till close to 11. I cried to my husband: There is no way I can do this job. I'm not going to be good at it if I can't get through the first day.'
Monique Nugent, MD, MPH
She even considered not going back to work the next day. 'It was the realization that I was truly a doctor. I truly have to make decisions. There is no one to double-check my work or encourage my professionalism or keep me motivated.'
But the next day she gained her confidence back. 'I got much better at what I do. I'm a totally different physician than I was 13 years ago. I was a scared new doctor, but I made it through, and that makes me proud.'