For some reason it still bothers me immensely when someone comes into the ER breathing (even if gasping for air) and we are unable to save them...although if an ambulance comes in with CPR in progress, it bothers me less if we are unable to "fix" them.

Maybe it's my mindset? If CPR is in progress by medics, I assume that we are lucky if we can bring them back in any capacity. However, it eats at me if someone is breathing, talking, and heart beating, but the end result is death. I find myself running over the process in my head...what could we have done differently? Why did this person irreversibly code in our presence? Did we do something wrong? I think I am being naive in believing that we can fix almost anything that comes our way. Does anyone else feel this way?

This bothers me too - I have had someone look me in the eye and beg me to not let them die, and then they did. It is the worst! And knowing that we did everything possible doesn't really make it all better, sometimes it takes time + using CISD resources, and talking about it with those who were there or whom you trust. I encourage you to reach out to those resources in your facility, don't let something like this fester, ever. It is one of the hardest parts of what we do. *hugs*

That's why pulling someone back from the brink is so awesome. Some people have terminal conditions that nothing can fix. It's sad, but you should feel that you did everything that was in your power and abilities, but sometimes that just isn't enough.

Long ago I came to the realization that our job is to give people a nudge (sometimes a good shove even) toward life, but if their body's too sick, too broken, or just too worn out to keep going, we're not going to be able to make someone survive. Those on the brink we may be able to rescue, and that's awesome when we can do that.

Until we figure out how to become immortal, death is something we'll all have to face.

Perhaps my most disturbing code was also my first as the only nurse in the room at a tiny, critical access hospital.

The patient was brought in by the family and immediately placed in a wheelchair which is how she rolled through my door. She was talking to me and with obvious signs of impending respiratory failure... very anxious (terrified is probably a better word), accessory muscle use, cyanotic lips and nail beds...

As we progressed through our workup and treatment, she ultimately went into cardiac arrest. We did get her back and ultimately loaded into an ambulance and off for the 45 minute trek to a higher level of care where she was ultimately pulled off of life support about 18 hours later.

I think what most bothered me was that she had been a (reasonably) healthy person prior to this event, that her family was in the room during the entire time (and uttering things like, "come on, mom, you can do it... hang on"), and that I later came to realize that I was friends with some of her family members...

And that she is the only person so far that I have had that eye-to-eye contact with in her last moments of full awareness just before she crumped.

She was the patient who showed me just what an emergency sepsis truly is. I still think about her when we do sepsis training or when patients present with s/sx of SIRS.

She was the patient who showed me just what an emergency sepsis truly is. I still think about her when we do sepsis training or when patients present with s/sx of SIRS.

I think over time we all end up with those primary examples we immediately recall with perfect clarity for the major ER cases - sepsis, STEMI, CVA, bacterial meningitis, etc. They are in my mind like a deck of cards to shuffle through when teaching newbies about ER bread-and-butter. Unfortunately a lot of the ones that stick are the tragedies, but every now and then a triumph gets mixed in the deck.

Wow, music in my heart…that is what really bothered me. My terrified patient, struggling to breathe, looking me in the eye for comfort, trying to talk to me…then subsequent intubation and cardiac arrest. My last words "try to focus on breathing, we are going to help you breathe." I felt so helpless as the situation deteriorated…family in room during code. I felt horrible that he couldn't talk to me. I felt even worse because he was so scared in the moments before he died.