Death and the dying patient, what experiences do you have?
What is your fear as a student or a new nurse? Mine was death. Here I share a couple of stories of what happened to me during my early years as a student nurse. My greatest fear as a new student nurse was how was I going to cope when I saw my first dead person?
My greatest fear as a new student nurse was how was I going to cope when I saw my first dead person?
I had never even had a relative who had died nor been to many funerals.
In the UK we don't really have open coffins or calling hours so I had never even seen somebody, who had been beautified for viewing.
I also imagined that I would be exposed to copious amounts of blood and guts, and what would I do if I couldn't manage it?
So when 6 weeks into being a new student, somebody came to me and asked if I had ever seen a 'dead person' I replied no. So she asked me would I like to see one, and would I like to help her lay the person out! I was petrified but I said yes, I knew that this was a fear I had to face sooner or later.
So 20 some years later I still remember this, I went into the room with my heart beating so fast I was sure it was going to jump out of my chest, I was also holding my breath preparing myself to either be
3/ Run from the room
Of course I didn't do any of the above!
The curtains in the room were closed, it was the middle of the morning and a lady of about 50 was lying peacefully on the bed. I walked over to her and the other nurse said 'touch her don't be afraid'
So I held this ladies hand and it was soft and cool not cold to touch, and I realized that although this lady had died she was still just like any other patient I had ever looked after and I was no longer scared.
We have a few rituals in the UK back in the late 80's, we let the patient rest for 1 hour, open a window and then we prepared the body to go to the morgue.
It was made into such a special occasion my introduction to death, that for the rest of my time in a hospital I did the same thing for other students and staff that had never faced death.
Unfortunately, I did not always have such pleasant experiences and if I have not bored you already I would like to share another story with you about, what not to do!
After my first experience with death, I found I was able to be supportive and understanding with pts and their family, ensuring that patients dignity was kept and that for their families I was able to make it as pleasant as is possible.
I was into my second year as a student and we had a lecturer come in and talk about death and the dying. (yep 2 years too late for most of us!)
This lecturer talked about how to inform families about their loved ones death. He said that we shouldn't confuse relatives with certain expressions like
Passing away-it would confuse
Left-relatives would think they had discharged themselves
Gone to the other side-moved floors
Kicking the bucket-inappropriate
Sorry we lost him-the pt has got lost in the hospital
The lecturer also said that we 'hospital professionals' were horrible when we informed relatives that their loved ones had died. He said that Doctors especially were the worst, often going around the houses allowing the relative to guess that their loved one had died before the doctor actually voiced it.
The lecturer said we should be honest and direct and we should use the word 'dead', then there would be no confusion.
I listened intently to this lecture, as only a naive young person can, making a mental note of how I would inform a pt's relative if I was ever in that situation.
So a few weeks later I was working on medical unit, remember in those days student nurses worked alone and were part of the staffing numbers.
One of my patients was actively dying and his wife had been called into the hospital, now we are talking about the UK here, where at that time most of the floors were 'Nightingale wards' so pts would be nursed on long wards with beds either side. Curtains were the only thing that separated the beds.
We often would put patients who were really sick or dying into side rooms if one was available but on this occasion we also had another patient who was very sick in the side room.
So picture this in your mind I was stood on the right side of the patient, and his wife was stood on the left.
I was talking to the patient to support him, and his wife was stroking his face and crying softly. After about 30 mins he quietly 'passed away'. His wife noticed the change and turned to me saying 'What is happening now'
Remembering the lecturer saying to us, be direct and informative and use the word 'dead'
I said in a straight direct voice 'He is Dead!" there I had said it no fluff, no going all round the houses, I was proud of my ability to do just what the lecturer said was the best way.
Just as I was patting myself on my back, telling myself a job well done-his wife opened her mouth and started screaming and screaming.
I think they heard her screaming 5 floors away! It took the charge nurse and myself about 10 mins to calm her down.
The charge nurse who knew I was due to go home, and could see I was visibly upset and shaken said go home.
I turned to go and leave the floor and as I was passing the side room, a woman came running out and dragged me in. I could see as soon as I went into the room that the man on the bed had died.
So when she asked me if he had died?
I thought OH NO this cannot be happening again, what do I say now?
Yep you guessed it, I turned to the woman, I held her hand and I said 'I am really sorry but I think he has passed away' in a soft gentle, calming voice.
I have never ever in 23 years ever told a loved one, that their relative is dead ever again!
I have I confess used much more gentle terminology, I can assure you even if the family member is not expecting it, they soon understand and know the reality without somebody using the word Dead.
There is direct and then there is real lifeLast edit by Joe V on Nov 4, '12
About madwife2002, BSN, RN
Joined: Jan '05; Posts: 10,272; Likes: 6,107
Director of Nursing Services; from US
Specialty: 26 year(s) of experience in RN, BSN, CHDNNov 3, '12You eventually come to see the death as a possitive thing, in most circumstances where the death was either expected, or a blessing in disguise. When you've seen a person actively dying, even if their symptoms were well-managed, or watched a slow deterioration in which the quality of the person's life diminished by the day -- then yes, death was the best thing that could have happened.
You don't end up looking at the body as "a dead body". You look at that peaceful face and are grateful that their pain, confusion, etc, are over and they can finally rest.Nov 3, '12My first experience with death was in an ICU during my clinicals in nursing school. I was charged with removing the IV and "making him look nice." The family stayed with the patient until he expired. They made the decision to remove artificial support after the doctor did some neurological tests. At first, they were going to try and donate his organs, for some reason the doctor decided the patient wasn't eligible. It took a lot longer for the patient to die than I thought it would. The heart monitor showed a heart rate for a long time, even after the family had decided he had died and left. The most disturbing moment was watching the doc remove the trach... the patient had no reaction and it was obvious he was braindead. The patient was a quad who had had a stroke at home. The most memorable moment for me at that point was seeing someone from the coroner's office to come in and take him away. That made it rather final. He was a very obese young guy in a suit and looked rather out of place in the ICU.
My next experience was in my first job in organ transplant. A coworker had him and he was a new nurse as well. The hospice orders weren't quite written yet and the patient was actively dying (his transplanted liver had failed). It was really disturbing. The patient had the death rattle for hours and it made it really hard for the rest of us to concentrate on our charting. The family was still at the bedside. The patient attempted to stand and pee several times in a dysphoric confusion. I felt horrible, but he wasn't my patient. If he were, I would have made sure he got the meds of comfort for dying so the family didn't have to witness all that stuff. It bothered me so much that I requested that our floor get an inservice on hospice and end-of-life care, but that went over like a lead balloon and I was eventually chased out of there for being so bold.
My third experience was as a temporary private duty nurse. A friend of mine's husband was diagnosed with pancreatic cancer and had hospice care at home. He fell one day and hit his head and had a rapid decline. His wife (my friend) was JUST diagnosed with lung cancer and was in the hospital to have a lobe removed. She called me up to see if I could be at her husband's bedside as she knew that he didn't have long and she couldn't go home to be with him. I went to her house and gave him all the proper medications. He died on my watch. It was a really rewarding experience... he wanted me to hold his hand for a while, and I encouraged him by telling him how much his wife loved him and talked about his daughter and stuff. Sometimes, he would look rather upset and I couldn't tell what he was saying. However, towards the end, he got a big smile on his face and gazed at the window. At one point, he decided he wanted to be alone and he shooed me off. I listened quietly in the next room until I could no longer hear him breathing. It took about 20 minutes. I feel like I gave him as good a death as he could have had given the circumstances. Although it was sad, I look back to that night with fondness.
My mother died last year and I found her in the bathroom, face down in front of the toilet. That is an experience I'd rather forget. I really wish she could have had hospice care for her CHF... but she wanted to go the way she wanted to go, and she got her wish.
Hospice is really my passion. I think I'd like to move into it someday.Nov 3, '12I decided to go into nursing because of the hospice death my grandmother had at home. It was nice to be able to be at home surrounding my grandmother as she took her last breaths. I just started nursing, but I hope to move to hospice care eventually. I've had a few patients die. Some surrounded by family. The hardest one for me thus far was a patient who's family seemed to be wondering when their loved one was going to start improving. I figured the doctors may not have explained the severity of her terminal condition to them. I let the family go home to take care of their own needs, read the chart and realized the family had been informed, they were just in denial. So, then she passed away peacefully, but alone. I do wish I would have felt like saying "she looks like she can die at any point now, I'd stay or come back quickly" so she wouldn't have to die alone. I didn't. It wasn't terrible, just sad.Nov 3, '12Quote from PolaBarEven though family wasn't there, you were. Sometimes that is enough. Sounds like she was waiting for them to leave so she could, too.I decided to go into nursing because of the hospice death my grandmother had at home. It was nice to be able to be at home surrounding my grandmother as she took her last breaths. I just started nursing, but I hope to move to hospice care eventually. I've had a few patients die. Some surrounded by family. The hardest one for me thus far was a patient who's family seemed to be wondering when their loved one was going to start improving. I figured the doctors may not have explained the severity of her terminal condition to them. I let the family go home to take care of their own needs, read the chart and realized the family had been informed, they were just in denial. So, then she passed away peacefully, but alone. I do wish I would have felt like saying "she looks like she can die at any point now, I'd stay or come back quickly" so she wouldn't have to die alone. I didn't. It wasn't terrible, just sad.Nov 3, '12I am in my final semester of nursing school and about to start my Senior Practicum. I am 36 years old and have never really experienced death, I have never lost anyone I was close to, never been to a viewing, As a member of the military I was on special duty to the Honor Guard and participated in 300 funerals for our service members but that was always "graveside" with a nice, safe nonthreatening casket or urn.
I will be working in a PICU for my practicum and as strange as it might sound one of the experiences I hope to have is death. I don't WANT any of the children to die; however, if it is their time and God is going to call them home anyway I would very much like the honor to be present to understand the process and to understand personally how I am going to cope with death as a nurse.
Thank you so much for sharing your stories.Nov 3, '12Quote from PolaBarI have talked to many nurses who have told me that often a patient will wait until no family is in the room to pass so I don't think you did anything wrong or bad and as the previous poster said YOU were there so she wasn't aloneI decided to go into nursing because of the hospice death my grandmother had at home. It was nice to be able to be at home surrounding my grandmother as she took her last breaths. I just started nursing, but I hope to move to hospice care eventually. I've had a few patients die. Some surrounded by family. The hardest one for me thus far was a patient who's family seemed to be wondering when their loved one was going to start improving. I figured the doctors may not have explained the severity of her terminal condition to them. I let the family go home to take care of their own needs, read the chart and realized the family had been informed, they were just in denial. So, then she passed away peacefully, but alone. I do wish I would have felt like saying "she looks like she can die at any point now, I'd stay or come back quickly" so she wouldn't have to die alone. I didn't. It wasn't terrible, just sad.Nov 3, '12There are two great privileges in life to be present at a birth or a death. I consider it both an honor and a privilege to stand as a witness to a pt life as they transition past death into new life. In my own head (because I have learned it need not be said aloud )I tell them thank you for all the lives that they have touched and I stand as a witness for all the people whose lives have touched. I tell them that they mattered, that every smile "counted " .I tell them that they are worthy and I thank them for their presence here. I also tell them what I see....that in them I see a soul that is beautiful. Sometimes I have been blessed to feel them as they "lift ". I have met pt I didn't like but I have never witnessed a pt dying that I did not feel God looking back.Nov 4, '12thanks for sharing your stories! I still have a long way to go but I'll remember this for when I do become a nurse in the near future.Nov 4, '12Quote from DSkelton711Lots of our terminally ill patients die when the family go home or out of the room for a while. Too many to be a coincidence.Even though family wasn't there, you were. Sometimes that is enough. Sounds like she was waiting for them to leave so she could, too.Last edit by JDZ344 on May 14, '14Nov 4, '12I've been to many funerals. Mostly family members whom I had expected to pass due to their health. Perhaps this is why I feel I may be a bit odd toward the subject of death. It always saddens me-even when I don't know the individual who passed. But I'm still always very calm around death. Very little emotion shows, though I do feel some. I've gotten very good at not showing it, however. To the point that I fear that many of my future deceased patients families may see me as uncaring. Here is my experience of seeing a man die in front of me for the first (and so far, last) time in my life.
I was a customer service supervisor at an airline in Las Vegas, and as a man was walking off of the jet bridge, he started panting and then collapsed. I didn't know what to do. I immediately had one of the clerks call 911 and inform them that a passenger is having a heart attack. I asked the flight attendants if they were trained to used a defibrillator. None were. I held the mans hand, and I looked him in his eyes and told him to "Relax." I debated in my head whether or not to tell him that "Everything will be ok, and help is on the way." I told him that help was on the way. I didn't tell him that he will be ok. I just knew that he wasn't going to survive. I knew that. I didn't want the last thing he heard to be a lie. He died a few seconds later.
I still remember his name to this day. I also remember the paramedics making jokes about his weight and that infuriated me! I pulled them to the side and not so politely let them know that what they were doing was inappropriate. What they told me was that the jokes were a habit that many health care workers pick up as a way of dealing with death. I don't know, maybe they're right.
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