A patient died today. . . .

bestblondRN · Jun 17, 2003

Ted,

What a beautiful way to honor this gentleman--not only did you help him make his transition by being at his side, but the way you write about the experience is so deeply personal and caring. Of course, he honored you by allowing you to with him at the time he died--no doubt a result of the trusting, caring, wholistic realtionship you established with him in his final hours. You exemplify the real definition of a nurse.

domgo · Jun 17, 2003

Hola, soy un estudiante de la licenciatura de enfemería de la Universidad Autónoma Metropolitana, en la ciudad de México.

Solo quiero decir, la muerte es para nosotros un tanto diferente, si bien es triste, también es alegre, por que la gente descansa y no sufre más, pero además, los que trabajamos muy cerca de ella debemos entender que es parte de un proceso natural, en donde la recompensa esta formada por nuestra historia y lo que dejamos en cada uno de nuestros seres queridos.

Hi, Im student of nursing in the University Autonoma Metropolitana in México, city.

Just i want said, the death for us is little diferent, is sad but is a happy time too, because the people don´t feel more pain in his body and rest, I´m think the death is a natural process of the life, and the important is all what we done and all what we can give to other people and family.

(sorry for my english).

Ted · Jun 17, 2003

Originally posted by BSNfromMCN
A big hug to you Ted. I am feeling the same grief today. I experienced my first death last night. I have another year of school left and am currently in my second week of an externship. My first "real" nursing experience outside of clinicals. A gentleman I cared for the past 3 nights went unexpectedly in his sleep. I pretended to be able to continue working while my insides were collapsing. I hid in the bathroom to cry about a dozen times and avoided eye contact at all costs. 15 hours later, I'm still weepy. I've been teased by classmates of being too soft hearted to be a nurse and now I'm wondering myself. How do you find that balance between compassion and competency? Am I of any benefit to patients and families if I am emotional? Does it ever get any easier? I know that I did my best for my patient but I still feel so guilty for not being able to fix everything. The doc was even shocked, and I don't think anyone knew what else we could've done. I am haunted by the fact that I reassured his daughter to go home and get some rest. That we'd take good care of him. 3 hours later she got the call. It just seems so horribly cruel and unfair. I knew that this experience would come sooner or later, I just wish I knew how to deal with it. Thanks for sharing and expressing what is also on my mind today.

BSNfromMCN:

Warm thoughts and a heart-felt (((HUG))) your way on the loss of your patient. Your first patient. . . that you cared for for three days, no less.

Are you a new nurse? Coping with a death of a patient coupled with the emotional and "feelings of confidence" swings of being a new nurse seems like a lot to manage to me! Heck, coping with a death of a patient coupled with a very busy shift involving the responsibility of providing care for a lot of patients is a HUGE load even for the "seasoned" nurse!!!!

Which ever the case it is for you, now's the time do exactly what you're doing now. Reach out for support to talk, vent and reason. Do it through correspondence like you're doing via a bulletin board, or through some kind of counceling (spiritual counceling if you're active in a religion), or through some kind of supportive staff meeting, or through some kind of memorial service. . . . . . .

Don't forget to take care of YOURSELF!

I ask myself, where does burn-out come from anyway??? Well, there's a number of reasons, actually. Many reasons that's non-related to this thread that can and should be dealt with through other threads. But, with regards to experiencing frequent deaths of patients, a nurse can very well find him or herself ripe for the burn-out.

Someone responded to this thread who work on a cancer unit. I used to work for a cancer unit too. I've seen a lot of death there! Our hospital used to have a quartally non-denominational memorial service for those who've died on our heme/onc unit. This support service was not only beneficial for the family of the loved ones they lost, but for the nurses and other healthcare professionals as well. I used to play piano for these memorial support services. It was a very healing time for me in many ways.

Balance between compassion and competency? I see no relationship on how one effects the other. To me, they're "apples and oranges" for the "fruit salad" of a well-rounded nurse. (Does that make sense? :chuckle ) As stated before, one needs to take care of him/her self in order to remain compassionate and not become ripe for the burn-out. With regards to competency. . . quite frankly, I believe it's every nurse's responsibility to maintain some kind of on-going educational process in order to maintain competency.

But there maybe something more I can share which might help you keep the responsibilities of nursing in perspective with one's life.

Like I said, I used to work on a heme/onc floor. Saw a lot of death. Young people, older people, people with families and children, people starting out in new relationships and jobs and other areas of life. I cared for these individuals. . . many times. . . for weeks on end. For months, sometimes!!! Got to know them PRETTY WELL!!! And became emotionally attached.

There was a time, fairly early on in my nursing career, when I was well ripe for the burn out because of the deaths I've experienced! Heck. . . I gave many of these patients chemo therapy which, MANY TIMES, knowing that this treatment could be and was a contributing factor to their deaths!!!! (Although!!! I balance that one with the realization that it was their very deliberate decision to undergo these sometimes harsh chemo and radiation therapy treatments! To me, it was their way of FIGHTING and FIGHTING HARD!!!)

I was ripening for burn out, alright!

There was a relatively new RN on our floor. She was a very seasoned LPN who worked hospice as a career prior to becoming a hem/onc nurse. She was scattered brained! Very unorganized! Very knowledgable! Very competent! Very compassionate! Very giving! And VERY UN-BURNT OUT!!!!!

I thought the world of her! (Though I hated following her. She used to work the evening shift. . . . way to messy and always finishing her charting 'till last, which got in the way of me starting my night shift sometimes.) She was . . . is . . . . the model patient advocate! A mentor of sorts for me.

I approached her one night when I was feeling very burnt out. A young patient . . . another one. . . had just died. I was pissed! We all worked so hard to try to save his life. HE WORKED HARD to try to save HIS life! It was to be expected that he die, actually. He had AML; had tons of chemotherapy; was septic. . . a very, very sad and familiar story.

Yet this "scatter-brained", compassionate, very competent nurse was. . . continuing on. . . . moving one foot in front of the other. . . doing her work. . . smiling, even! Always, always attuned to the patients' needs! And always, always working hard to meet those needs to the best of her abilities!

I approached her, one sad day after a patient's death, and asked her, "How do you do it?" "How do you maintain your composure?" How do you not be burnt out after all of 'THIS'??" (And I pointed to all of the sick heme/onc patients in their reverse isolation rooms who. . . more than likely. . . . were not going to make it! Their chances of living were next to nill!)

And what she said was simple and very profound. "Ted," she said, "I give them the best darned eight hours of my professional life and then I go home and forget. I leave work at work."

It actually took me a while for that simple gem to sink in!

But I hold on to that simple philosphy to this day. Yes! There are times when I do bring home some of my work. . . like I did the other day! But it is the norm for me to give the patients the best darned nine hours (actually) of my professional life. Go home. and live life with my family.

The down side. . . at least for me. . . is that I truly forget patients' names! I really do. I suck at remembering names! And I think this is partly because I make a HUGE effort to leave work at work! The hospital is out of my mind the moment I get into my car and put my foot on the gas pedal.

Am I of any benefit to patients and families if I am emotional?

That's a good question. I've cried with families a few times. I guess I was emotional, if you call that emotional. We all worked hard to help someone live. I became friends to the patient and their family. I was sad and I cried. . . with the family. . . when "THAT" patient died.

There is this concept of "Professioanal Detachment". I agree with it. But this does not mean that there are times when I . . . to a certain degree. . . become emotionally involved with a patient.

Remember, we are humans who emote!

There's a balance there between "Professional Detachment" and forming friendships with patients. I dare say, lean towards the side of "Professional Detachment". But not to the point of being emotionally void and totally empty of empathy.

Again, I cared for patients on this heme/onc floor for weeks on end. Then they would go home and come back again in a month for me to take care of them for another few weeks. It is hard NOT to form friendships and emotional ties with this type of hospitalization. Still, I need to "keep things in perspective". I need to know when to stand back and be the objective third party sometimes. This is very important in providing effective care at times! And if I can't, I find a nurse who can!

Another point to remember. Keep home life at home! This will help keep objectivity and help from getting so emotional as to not to be able to provide the support a patient or family may need.

Again, as stated before, as healthcare professionals, I truly believe we need to take care of our own selves. . . the physical, the emotional and the spiritual.

Does it ever get any easier?

:chuckle :roll :chuckle

No.

And yes.

And no.

And yes.

It depends. There's always something that will challange us. There's always something new that can be learned. Sometimes we're receptive to challanges and change. Sometimes we're not.

Remember, we're human. Wonderfully, gloriously human. With ups and downs who meet challanges sometimes and . . . sometimes we shy away from them, or need extra support to meet them.

I know that I did my best for my patient but I still feel so guilty for not being able to fix everything.

To me, seems like you did do your best.

Feeling guilt for not being able to fix everything?

Remember this. We're humans!!!

We're not gods! :kiss

Ted

Ted · Jun 18, 2003

Was my last post a little too long winded or what?!?!?

Sorry. . . :imbar

(I got carried away. . . .)

luv-my-dal · Jun 18, 2003

efiebke, you have a wonderful way with your words....it obviously reflects your remarkable nature and your patient was very fortunate to have you by his side.

To be dying and have someone with you who has all the time to spend with you...I think the most frightening part is the thought of being alone when the last breath is taken.

I pray I am lucky enough to have someone with that same compassion and committment by my side. I am still wiping tears from my cheeks. Your words express so much that I can almost picture being there.

Thank you for sharing.....

cwazycwissyRN, RN · Jun 18, 2003

Ted,

No the post was not too long, this is the stuff we just never talk about or unveil. This is the stuf that make nurses who we are....and you are a great example of who most of us strive to be. Thanks so much for sharing the inner makings of us so nicely.

jude11142 · Jun 18, 2003

What a beautiful post and how wonderful that this gentleman has such a caring person with him as he left this world. It is still sad though you know that the person is no longer in pain. To be able to feel such compassion is so special and makes one a special caring nurse. I would of and have stayed beyond my shift to stay with a patient who was in bad shape and needed somebody with them.

Isn't is wonderful that we have such caring, loving, compassionate nurses. Never lose that.

JUDE

RNFROG3, BSN, RN · Jun 18, 2003

Ted-

I came on shift the weekend of the 7th and 8th. (night shift 1900-0700) to absolute chaos. We knew when we left that am that days were short so it might be bad and it was. All three shock rooms full -placing a pacer in #1, bad lunger in #2 and Gi bleed/bowel obstruction in #3. I asked what could I do to help the nurse in that area --he said get #3 to a bed if they have one.

AI noticied they had not gotten their antibx hung yet started into the room and realised I hadn't looked at the pt name. Lo and behold same last name. It briefly crossed my mind it might be a relative. It was -- my grandma. She was 87. Bp was in the low 100s/40s. She was in pain and hadn't had pain meds since1440. I fixed that and got her to her room. She went to the floor I used to work on so I called and made sure she had a good nurse. She had been in the ED since 0725 that morning.

To make a long story short she was trf to progressive care around 2300 due to her bp she was in renal failure and had pretty strict DNR order in place. My fantastic co-workers let me leave make the family calls and be with her when the nurse called me at 0200 and said it wouldn't be long. She passed peacefully away at 7:30. She stayed long enough to get past the coroners time (less then 24 hr) and long enough to get last rites. The nurse there let me do the aftercare for grandma it was so cathartic. It was the first time I had ever had a family member here. She is at rest and I got to be there with her my dad and uncle till the end.

cookie22039 · Jun 18, 2003

Ted, prayers with you. Just know that when a child of God dies, they don't die, they live on forever, in a much much better place, a place of streets of gold, where to sun always shines, there is always peace and happiness, what a wonderful thought, such a better place then where we live now..... if your heart is right with God you will live forever.

HISSYTHECAT · Jun 18, 2003

Ted, I am sorry for the experience you had. My heart and soul are with you. I am deeply sorry for the gentleman and his family. I admire you for being the kind and passionate person that was willing to go out of the way to make this mans last moments easier. May GOD Bless you.

Hissy ^..^

Liddle Noodnik · Jun 18, 2003

Originally posted by efiebke
Isn't this wonderful that we can do this for each other! ! !
With the warmest regards and the deepest respect to you all!
Ted

It IS wonderful... It is exactly what I was looking for when I came here.

I lost a patient recently too but it was a guy I knew. He was in AA with me and tho' I didn't know him well he had a profound effect on me in my early days of sobriety. Every time I saw him at a meeting he was neatly groomed and wearing a blue sport coat and tie. He always said hello with this reserved smile and he ALWAYS REMEMBERED MY NAME!

He lost his daughter to cancer 10 years ago (she was also in AA) and he was devastated! But he stayed sober and he coped. Was a power of example to me.

I didn't see him for about 2 years and when I saw him recently he was in the hospital bed dying from cancer of the mouth and emphysema. I recognized the name on his chart but that was about all -- long straggly hair and unshaven and his hair was mostly white instead of mostly red. Wearing big thick glasses. I chose to switch assignments because I didn't feel comfortable being his nurse. Of course when I walked in to see him he knew my name! Where I hardly recognized HIM.

I was hardly able to spend time with him; it was hard seeing him like that. But I did offer a few words of encouragement here and there and instructed my friends in front of him to take good care of him, LOL! One nurses' aide gowning up in front of his room didn't know I knew him and was going on about how he looked like a street person and how he smelled, etc. I calmly explained that one can't assume anything, that he was a very dignified gentleman and should be treated as such. (she is the same problem child I've spoken of elsewhere). Shoulda seen the look on her face when she found out I knew him. Should have heard the fake greeting as she walked into his room!

I felt so bad that I couldnt' spend a lot of time with him, I was busy but more than that I could hardly be with him, I felt so shy and uncomfortable, (VERY unusual for ME, trust me!) I read that he died on one of my days off and I felt horrible that I hadn't said more to him about how much he'd meant to me. I did ask him if he wanted me to call anyone in aa and he didn't (his obit did mention AA BTW).

Later, recriminating myself for not doing more, I realized it had a lot to do with my Dad's coming up in years and how I don't want to deal with that. Dad has had cancer twice in the last 4 years and it's been totally eradicated. But one day there will be the inevitable.

Thanks again for providing the forum for this, you are a love! and I am glad you are feeling better!

Liddle Noodnik · Jun 18, 2003

Originally posted by spacenurse
Your post should be sent to a publication.
I'm thinking one for the general public, not just nurses.
THANK YOU!

I was thinking that too! Great minds, LOL!