Quote from RN_1_2008
I am a new nurse and a critical care intern. I have been training for 5 months and have 1 more month before I am on my own. I am having a difficult time with death. About 5 weeks ago I did chest compressions for the first time on a real person. I do not know her history, she had only been at the hospital for about 20 minutes before the code was called and she was in a different area. She died and it was very difficult for me. When the breathing tube was removed, I swear she was gasping for air. It was all very confusing for me. I didn't understand why everyone was leaving while the patient was gasping for air. There was a de-briefing and I was told that it was natural. I read "On death and dying" by Kuebler-Ross. It didn't help much. I am looking for details on what happens to the body during and right after death.
Sometimes the patient will have gas built up in their abdomen - whether from compressions or misplacement of the ET tube. When the code is called and the tube is removed that gas can slowly escape. It makes the person appear to be gasping.
Also when we do compressions we are attempting to keep the heart beating oxygenated blood to the vital organs. However, the heart might be so diseased or damaged that it can not continue on its own. When we stop compressions the heart stops beating. This is cardiac death - however if our compressions were sufficient the brain may continue to live on a bit longer trying to force the body to do what is needed for life such as breathing - these efforts are almost always noted to be agonal gasps.
In both cases the patient is not really "gasping" for air. The patient is dead, the body just does not quite realize it yet. They are not hurting, or anxious the way we are when the wind is knocked out of us and we gasp for air.
Quote from RN_1_2008
Now fast forward to a week ago. Another code was called on a pt that I had taken care of the week before. It was a very intense code. Again I did chest compressions. As I was doing them I saw that her lips were blue. Family was in the room and the pt was 21 years old. After the code was called and the time of death was stated there were no dry eyes. I am having a very hard time with this. I know we did everything that we could but I am feeling guilt. What if I had done the compressions better. Are these normal feelings? Does it get any easier? I am looking for advice, any advice. I really appreciate it! Thank you in advance.
The younger a patient is the harder it is to come to grips with their death. I believe this is hardwired into us to care for the young. When we have a 90 y.o. whose life ends we can say "she lived a good life" or "it was his time". This becomes much more difficult when the patient is young - they haven't had that chance to live a good life.
How do we deal with this? Everyone is different - meaning everyone must find their own way of dealing. Mine is my family. I hug my wife, play with my kids. A lot of times I cry on the way home. I am ok with feeling bad that someone died, that someone's family is grieving. I allow those feelings and then put them aside to care for the next person.
Are your feelings normal? Yes! Does it get easier - sometimes, but then comes along that case that brings you back to square one. As you grow in your practice and learn more about disease and injury you will know what factors truly contributed to a patient's death. The guilt feelings will lessen (unless you truly do something very wrong) but the sadness will hopefully always remain.
Hope this helps