death

**canoehead, BSN, RN** · Oct 25, 2001

My first death was a pediatric patient who was expected to be discharged the next day. When his parents came in I didn't know what to say, and as a result said all the wrong things. It took me a year to be able to think of that night without crying, but I got there.

When I called a friend to vent he said, "Well that's just part of the job, isn't it?" and was just not understanding why I would be upset. I couldn't explain it to him but part of the resolution came with thinking about how death is not "just part of the job".

I think that the "job" part for me entails all the routine tasks. Seeing a patient to death and counselling the family- well you just couldn't pay me enough to do that. So as nurses the tears and support we give to the people we come across I categorize as not my job, but something that I offer to them as a person. I don't know if what I am trying to express is coming through- nursing in the sense of counselling is a calling, and everytime you break of a piece of yourself to see someone through a time they feel is unbearable- that sacrifice is not a mandated part of any job. No employer can measure it or make you do it, but those of us with the calling to help do it without thinking. Eventually you will be able to do it without injuring yourself in the process, but it is a hard lesson to learn, not taught in a seminar.

I agree with all the replies on this thread, but at the same time want to say that if you are dealing with losing a part of yourself along with your patient you may find all the advice hollow. Just know that we can understand, but putting the coping mechanics in words is a very hard thing. You have our support, and the amount that you care (the amount this affects you) reflects your ability to support families in spiritual crisis.

Peace to you.

Researchnurse · Oct 25, 2001

While in nursing school 25+ years ago, I had 6 patients in 8 weeks die while I was caring for them. (No, it wasn't anything I did, just had some very sick people that rotation in Med-Surg). My instructor and fellow students were very worried about me, but eventually it became a joke...."doing post-mortum care for the first time?..... go get Jo Ann". It was a rough rotation, but I learned quickly that I could make a difference with helping the family through this ordeal. I cry very easily (maybe more now than then, but that is due to the hormones at age 47!) and never tried to hide my tears. I have gone to the services of my patients on occasion, and again felt it made the family very pleased that their loved one was in my care when they passed. I always tried to make them as comfortable as they could be, and tried to show the love I felt for them.

It wasn't until shortly after my own Father died however that I had my most difficult yet most beautiful death experience with a patient. (I was not there when my Dad died,something I miss to this very day, some 10 years later).

I had only been back a few days after his death when I was assigned to a patient who was terminal and had no family. I made up my mind I was going to be there when she died to hold her hand and let her know I was there with her. She was unconscious the last few hours, ( the rest of the staff picked up my other patients for me...I think they knew how important it was to me). I held her hand and spoke softly to her for a very long time...telling her it was "OK" to let go. After she drew her last breath I asked her to tell my Dad I loved him when she saw him. Somehow I knew he would be there to greet her on the other end.

I rarely cry when I think of my Dad since then. I know he is smiling down on me and my family....I know he loves the great-granddaughter he never got to hold (at least not here on earth)....but I also KNOW in my heart he was there for her when she was born 15 months ago and underwent surgery at 4 hours old for Gastroschisis.

I guess what I am saying is that there is a sadness when someone dies, but I do not believe that they are sad...it is those of us left behind. I feel my Dad's presence all the time, and it makes me very happy. Since then I too feel it is an honor to be present when someone dies...it is actually just as beautiful as seeing a beautiful newborn for the first time.

CATHYW · Oct 25, 2001

There are some excellent thoughts and feelings being shared here. Canoehead, your middle paragraph about "breaking off a piece of yourself" really hit home. That is why I wound up in ER, cath lab, and Occ Med. I just could not work where I would let myself get attached to pts and their families. There wouldn't have been anything left of me to continue to give!

I really admire peds nurses, oncology and hospice nurses, and especially peds oncology nurses, and think there must be a special place in heven for them. There must be a fantastic reward waiting for these fantastic folks!

puzzler · Oct 25, 2001

Get "used to it"? Never. But you will learn to cope with it. It helps me if I know in my heart I did all that I could do. It may have been CPR or just holding a hand, but if I did my best for my patient I am OK.

Sometimes I can just go on home after work when I lose a patient but other times I may need to see the sunrise from a special place or watch children at play (a park play ground is a good place for this). I may need time to myself or I may need a crowd. I may need to give a special hug and an extra "I love you" to my family.

When you lose a patient and you have completed your job for the day, I feel it is important to take a little extra care of yourself so you will be able to face tomorrows challenges with a re-newed spirit.

Good luck

KatWright · Nov 2, 2001

I will never get used to death. I have been a nurse for nearly 30 years. But I am honored that one of my patients will allow me to be a part of this VERY private moment. I am convinced that mant of our chronically ill patients are able to choose WHEN they die. (like as soon as the family goes for coffee after they have stayed awake for 3 days straight, or ONE minute before the wife of 50 years arrives!, or right after the last out of twon family member walks into the room)

I have cried with the family.....it's a real bummer if it's first thing in the AM, no mascara for the rest of the day ;-))

Now that you have been invited to be with a patient as he (she) died, YOU have been honored !! Congratulations ! Well done !!

newgirl · Nov 2, 2001

I have been a nurse for over 5 years now. I still remember my first patient death..I worked on a cardiac floor and this man was a DNR...he had been with us for two weeks dying the whole time...his family was with him..for some reason (one of my pet peeves) we had this patient on telemetry...i was called to the desk to tell me to go into the room because he was asystole (finally!..poor man suffered for 2 weeks) i turned to go to the room and just started to cry..i could not even do the post-care..i cried and i just felt so bad...I had the best doctor working that night..he was not on call but we called the on call and the on call called the mans primary to tell him the man past away and that "the nurse was taking it hard"....the mans primary doctor came in to the hospital at 3 am to make sure i was ok....how cool was that?? I will always remember that doctor and that patient.. I must say that to this day I still cry about patients..just not all of them..some of them I realize more now that it is so much better for them now they aren't suffering.....I work in the ER though and alot of the traumas are sad...I do not cry at work much, I can keep it til i am alone and try and deal with it in the back room or out of patient care areas...I never want to be a nurse who can not be effected by their patients deaths.

frannybee · Nov 2, 2001

I'm having a much-needed cathartic cry as I type this - thanks for the chance to vent!

I'm a very new nurse working agency in a new country (UK). I do a lot of shifts in a neurosurgical HDU/ITU which can be a highly stressful ward. A few weeks ago, I did a 14-hour day on Thursday followed by a 6hr AM on Friday. Thursday I watched one of my patients (traumatic subdural haematoma) fluctuate from barely responsive to completely unresponsive to even quite harsh painful stimulus administered by the surgeon. We were all convinced this poor woman was going to go off any second. That day was one of the longest of my life.

The next morning I looked after the same 4-bed bay again. My patient surprised me by waking up when I called her name, and she was also oriented and obeyed commands. She had gone from GCS 4 to 13 in 12 hours. She made my day when I asked her how she felt and she replied, "My head hurts. Where's my dinner?". I could have kissed her. I then had the wonderful job of answering a call from her 2 sisters (84 and 87) and being able to tell them that she was a LOT better than she had been the day before.

I went home from work that day floating on air - I felt as if I had actually done some good for a change instead of muddling along hoping I wasn't doing any harm. I was ready to write a column for the Nursing Times about the best day of my short career.

I didn't go back on that ward for a week. The next shift I did, I asked about her. "She died last Saturday" was all that was said, and nobody understood why I had to go off the floor for 5 mins and have a bloody good cry.

I love my job. I love being able to hold somebody's hair back off their face when they're throwing up. I love turning fragile old ladies in the dead of the night so they won't go back to their nursing homes with hideous bedsores. I love the fact that a woman once said thank you to me literally seconds before she died. I love knowing that, although I'm not family, there have been dozens of people who did not die alone because I took half an hour to sit with them and hold their hand.

I know I'm new, but I have plenty of time yet to get cynical and jaded. For now, I'm enjoying being able to make a difference, however small.

nicola · Nov 2, 2001

I think that the most lovely experience with death I've ever had was with my paternal grandmother - Grandma Sweetie. She was dx'd with stomach CA and refused chemo, figuring that it would make her too sick to enjoy whatever life was left her. At her request, I visited her weekly to spend time and to do healing touch. There's a technique called a chakra spread that is typically used with some one who's dying and I did that with her. She lived a good life for a year, doing what she felt like (or not doing what she didn't feel like!), eating as she pleased. About a month before she died, she, my aunt (who was living with her) and I went to the beach to see the full moon rise over the water. It was great!

This was a really grace filled time for me because we talked about everything. I learned stuff about her that I'd never known or asked about - her childhood, her sisters... people I've never known. I got to know her as a woman and not just the grandmother who spoiled us terribly!

When she did die, on her own terms (just after my father had gone to see her in the hospital. She only spent 2 weeks there before she died), I didn't cry. I never really felt the need. I midwifed her from this life into the next and said everything there could possibly be to say. I know how much she loves me (because I believe that death is a temporary separation) and know she knows how much I love her. I've never been particularly afraid of death, but now am more peaceful than ever about it...

Some one also asked how easy it is to get into heaven... I believe that when we die we look God in the face. If we turn towards him and embrace him, he welcomes us home. If we turn away, he doesn't force us. I believe that hell is the absence of God and that we consign ourselves to hell by turning away from our creator. This is the opinion of the poster and not necessarily the teaching of any particular church... *grin*

hoolahan, ASN, RN · Nov 2, 2001

Just wanted to say that I am thankful for all the wonderful nurses on this BB. I think that when nurses have troublewith death,it is b/c we don't talk about it to each other.

Canoehead, I know exactly what you are saying. It hit right home with me.

NurseDennie, BSN, RN · Nov 3, 2001

I'm sorry for the loss of your friend. It is very painful, isn't it?

I also have the attitude that none of us are going to get out of here alive. So I think that colors my attitude a bit. But my grandmother (who lived to be 97) had no intention of EVER going. It was kind of funny, in a way. At age 97, her heart stopped. Last rites... She rallied! Surprised us very much indeed.

But it didn't help her mental status at all, as you can imagine! She'd been pretty demented for a while anyway. After she "came back," she laid in the bed, looking up saying "I don't want to go. I want to stay here. Leave me here. I don't want to leave. Leave me alone....." and on and on like that. Some of the nurses thought she thought she was being moved to another room, but I had a different take on it.

I truly believe that if someone is having a hard time crossing over, that someone comes to help them out. I think that someone - maybe a group of spirits was there, probably in the light, calling for her. The priest had said that having had last rites sometimes helped old, very devout women like my grandmother - giving them "permission" to go ahead and die. I was alone with my grandmother at the time, and I felt like I needed to tell her (so I did) "Grandma, I think it's okay - I think you're supposed to go with them."

So that experience helped me with the families of patients who were dying. Some families have wanted me to stay with them, and I do that whenever possible. Sometimes you have to confirm to them, "Yes, it does look like she's leaving us now." and try to keep THEM from panic. They've had the discussion, Grand-dad is DNR but if he starts to look distressed, then Something needs to be done!!! I tell them that we probably can't keep him with us, but we can keep him comfortable. I put them at bedside if they can, and remind them to hold his hand, touch him and tell him goodbye.

Ah. But you notice I'm not sharing much about my mother's death at age 36 from lung cancer. I'd just turned 12 and my youngest sister was about 2. It's been 36 years and 6 months, and I still can't talk about it without weeping.

Love

Dennie

semstr · Nov 3, 2001

Dear Dennie,

you just talked about it, didn't you?

and I was here and listened in, and now I want to know more.

so cry, please do.........................but talk to us:)

Renee

NurseDennie, BSN, RN · Nov 6, 2001

Hi Renee -

What a nice thing foryou to say. I don't just go to pieces, you know, but it does still cause a bit of angst.

I think it was just a tragedy all the way around. She was in her 30's and just a beautiful woman. She was a heavy smoker, and had been a dental hygienist. In the olden days, the hygienist didn't leave the room when they did the x-rays.

She started having chest pain when we were all on holiday in the mountains in Colorado. They couldn't really figure anything out there, so we went home and they diagnosed lung cancer. Pretty advanced too, from what I gather. And she'd had a clean bill of health, including cxr before we went away.

But for some reason, it was all a huge secret. From what I've been able to piece together after I grew up, they took her to surgery and then just closed her up, saying that they couldn't do anything. But nobody said anything to the kids. And she wasn't visibly ill to kids, if you know what I mean.

Anyway, the interesting thing was that even though you can't really say that something like that is a Good thing in any way, but looking back, I sure can see the hand of God protecting us from it being even worse than it was.

She had a little sort-of hospital room at home. On the main floor, so she didn't have to try to go upstairs to sleep. And she was on Oxygen at home. So the ambulance people would come and change out the O2 cannisters from time to time. Also, my grandmother, who lived in another state was there, visiting.

So on the day that my mother died, which was 3 days after my 12th birthday, the ambulance was there, trading out the oxygen cannister. The cancer weakened her aorta and the poor thing just broke. As you can imagine, it was a very spectacular death.

My grandmother was at the bedside, I was outside playing and the rest of the kids were in other rooms in the house. I remember the ambulance guys came out and grabbed the gurney and took her to hospital, and I went inside to help clean up.

So - nobody got to tell her goodbye, but that was I guess a choice that she and my father made. Obviously she was sick, but I don't think any of us (kids - 6 of us - 12 through 2) thought she might die. Maybe they thought the whole saying goodbye thing would be too traumatic for her or us. I have no idea. I wonder if my grandmother happened to be there because she had an idea that this might be coming soon? Again, I'll never know that, either. It doesn't seem to me that there was any change in my mother's condition in the weeks before she actually died.

But anyway, can you imagine how horrible it would have been for me as the oldest kid and always in charge (my father called me the deputy mama. When he tried to call my daughter that, I wouldn't let him. I wanted her to be the KID and that's all) if she'd bled out like that and it was just me and the other 5 kids and her??? I mean, it is a bad situation to be a kid whose mother has died, but to have her die and be in charge of trying to get help for her.... wow. I'd never seen so much blood everwhere - and still haven't, for that matter.

And if my grandmother hadn't been there when it happened, can you imagine the doubts she would have had to live with afterwards? There's no way that somebody who wasn't there could have described the scene to her in a way that would make her KNOW that there's nothing she could have done. And the ambulance guys were right there when "it"happened, so there were people there who had much more capability than she did, so she didn't have to beat herself up thinking she could/should have done more.

So the ambulance men took her away, and she looked pretty peaceful. We called my father, and he went to the hospital, but she was dead on arrival. Well, truthfully, she was dead when they put her in the ambulance, no doubt. He stayed at the hospital for hours and hours, waiting for a minister he knew that he'd called, which kind of gave us false hope. They'd had to come and take my mother to the hospital quite a few times before, and she'd always come home again, so we didn't know this was going to be so different.

So. the tragedy part of it. Tragedy in that nobody learns a lesson from the sad stuff.... Of the six kids, would you believethat FOUR of them smoke?

So that's the story.

Love

Dennie