After the death of one of our paediatric inpatients last week some of the non-clinical staff of the ward have made remarks about how easily we took the news and got on with life. The nurses are making plans over which ones will attend the funeral and sorting out a card for the family. The absence of the child from the ward has been noted not just by clinical staff but also by porters and cleaners as he'd been on our ward for several months.

I was off work on the day he died, so came back to an empty cot. I initially asked which hospital he had been transferred to before I was told he had passed away. As it was time for the ward round the nurses saw me take this unexpected news and get on with my day "as if nothing had happened". I was accused later in the afternoon for having been heartless at not showing any emotion that he had died, "was he just another patient to you doctor?". I stopped to think later that evening, was I truly heartless, or just hardened?

I've dissected a human body at medical school, and then attended his funeral and paid my respects to the man who gave so much to my education. I've worked a variety of jobs in the 4 years since I graduated, including adult medicine, surgery, T&O, A&E and a variety of paediatric and neonatal placements. I've seen expected and unexpected deaths in both children and adults and had countless discussions with relatives before and after death. I can recall details of all the patients under my care who have died on my shifts, and of more who died during my days off whose care I'd been heavily involved in. I take some memory and learning point from every patient under my care who dies.

In my current placement death is not as much of a stranger as I may wish, but death is part of life and in many cases in not the enemy you may think. When you have watched a patient you have cared for decline, then there comes a point when death allows the patient the peace and removes the pain that my medicines cannot. I've heard the expression used by a range of physicians of "best outcome" and for some cases death truly fulfils that description.

So am I truly heartless? When death has claimed a patient of mine I do take the time i reflect and add mentally add them to my  list, but when there are more patients whom I can help there is no benefit to me breaking down. My partner describes me as being like an egg... Capable of withstanding great force from the correct angles, but once the shell is broken it takes a lot to put me back together again. So I prefer to think of myself as having a hardened exterior, to protect the soft heart within