First last dose of morphine

[Swellz]

A few weeks ago, I gave my first last dose of morphine. I couldn't really talk about it at the time because it was my first patient death as a nurse, which somehow seemed different than my patient deaths as a nurse extern and a nursing student. I felt more responsible for this woman I had never met before and more accountable to her family. I'm getting it out now because I'm about to come off orientation on an oncology floor and I know I have a lot more ahead of me, and I need to be able to process this.

My patient was DNR/DNI, a decision she had made months ago with her family. The week before she had been walking around, speaking English, and when I received her in the morning she was only able to wail in her native Cambodian to her sister, who was fortunately at the bedside. After her morning bolus and some Ativan, she was able to rest and ultimately fell asleep.

A few hours later, the patient's family left to make arrangements for her funeral. Shortly after, my preceptor called me to her room. Our patient was working hard to breath, grimacing even in her sleep with her inhalations. She wanted me to understand that just because someone is unconscious, it doesn't mean someone isn't still in pain. My preceptor doesn't want me to be the kind of nurse that is afraid to give a dying patient pain medicine, she wants to make sure I am comfortable giving it, and that I think it is appropriate. We agreed it was appropriate, and I assured her I was comfortable. 15 minutes later we reassess the patient and find her deceased.

Of course, all those logical thoughts about my poor, suffering patient who is dying of cancer are replaced by, 'oh my god I killed this woman with that morphine'. I was frozen and shocked and couldn't do anything but page her team. I was really thrown off the rest of the day, which bothers me now, because my other patients needed me to be able to function the rest of my shift. In retrospect, I know she died of cancer, and that she had made the decision to have a death without any further intervention. Her family told us later that she wouldn't move closer to them because she only wanted to be treated at our hospital. They were thankful to know she died in her sleep, but were disappointed they hadn't been there with her.

I've seen a lot of death on this floor, and know I will see more of it. I don't know how to handle it yet. My floor has grief rounds, which I haven't gone to yet. Maybe that will help. I just hope it is easier next time.

[chrisrn24]

You did not kill her. The morphine might've made it easier to her to go though.

Yes do give people pain medicine if they look uncomfortable when sleeping.

[Esme12, ASN, BSN, RN]

You didn't hurt her....you eased her pain.....she just happened to pass away. You did the right thing...her last conscious thought would be...."Thank god someone eased my pain".

God heard her....and eased her pain.

((HUGS)) it's hard to understand sometimes that there are worse things than death and no one dying should be in pain.

You did good Kiddo!

Talk this over with your grief rounds or your preceptor.