Death and the dying patient, what experiences do you have?

[madwife2002]

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

1/ Frightened

2/ Petrified

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'

So

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 life

[PRICHARILLAisMISSED]

I'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.

[ChaseZ]

I had a pretty steep learning curve when it came to death when I was an EMT. Before getting into medicine I had never really experienced death, I was fortunate enough that all my grandparents were still alive and well and I had never been to a funeral. I remember my first week on the truck we had 4 codes. First was a 12 day old infant dropped on his head by his mother (high on crack), next was a 17 year old drug OD; brain dead after a messy code, then a massive MI, and finally a 22 year old from a MVA with a traumatic aortic rupture; that code was just going through the motions. The physical death never really bothered me but the family memebers did. Especially the 17 y/o who was found at home, the parents were hysterical and the mother was screaming/crying. As far as the sick humor goes I have to agree, there is no way to survive dealing with death and dying everyday without having some type of coping mechanism and for many that is humor. Having said that, making comments about a patient on scene is totally disrespectful and unprofessional.

[nursebaldeh]

Maternal morbidity and mortality in developing countries remains to be issue for concern. All hands on deck to prevent the catastrophic effects our woman and families all over. Prevention of major complications such as pregnancy induced hypertension(PIH), Pre Eclampsia and even Eclampsia, Antepartum and Postpartum Haemorrhages as well as puerperal Sepsis should be advocated.

How can we prevent puerperal sepsis?

[lantanaRN]

Nov 3 by [COLOR=#003366]echoRNC711 Nov 3 by [COLOR=#003366]echoRNC711 A member since Sep '12 - from 'Bronx, NY, US'. echoRNC711 has '20' year(s) of nursing experience and specializes in 'Med/surg,Tele,CVRU,ASU,PACU,OR,Cardiac R'. Posts: 151 Likes: 333

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There 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 As a hospice nurse I truly agree and dailoy experience what you have posted. It can be a very spiritual peaceful experience for both the patient and the caregiver I feel truly blessed to be part of every one of my patient's final journey!

[brownbook]

I love your article but am very confused. I completely agree with the lecturer. I have told families their loved one is dead.

I would love some examples from you of your gentle terminology?

It seems your one unique experience, which I don't doubt happened exactly as you said, and I don't doubt would have been best NOT to say "he is dead" under those circumstances, although I would have handled it exactly as you did. Has left you and us with nothing more to go on than use "gentle terminology."

When you call families at home at 2:00 in the morning to tell them their loved one is dead, this would be an expected death of an elderly patient, what would you say?

When you are sitting in a private room with family whose loved one, again elderly patient brought in by paramedics to ER, probably massive MI, probably dead when the paramedics got to the home. anyway what gentle terminology do you use?

[madwife2002, BSN, RN]

Brownbook,

I would probably say I am really sorry but your 'family member' has died, which is a lot gentler that saying your family member is Dead.

I am not afraid to say it but I was trying to portrait that I took the lecturer literally, which was a harsh way.

I have had to inform a lot of people over the years and I never say the same thing it all depends on the circumstances.

I understand what you are confused about, and thank you for pointing it out to me

[madwife2002, BSN, RN]

There 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 As a hospice nurse I truly agree and dailoy experience what you have posted. It can be a very spiritual peaceful experience for both the patient and the caregiver I feel truly blessed to be part of every one of my patient's final journey!

I so totally agree with you, they are both privileges to be present at birth and death.

I would love to be a hospice nurse, and I envy you your great job.

When my mother passed away at a hospice, I was humbled by their kindness

[ElizabethGrant]

I don't think a family member should be told over the phone at any time. How do you verify they have the right to know and that you aren't violating privacy? As far as "gentle terminology" I would hope that this is another way of saying be compassionate. Culturally, I think it would depend, in America most people know without any confusion what passed away means. I would hate for someone to say to me "your dad is dead". How about in these situations, isn't it a physician's responsiblity? What do they say? Nurses are generally considered to have a better bedside manner and yet I have seen doctors tell people about the death of a loved one (I have worked general floor, transplant, newborns, and LTC) and they say something like "I'm sorry we did all we could but he did not survive". I think that is gentle. I think the distinction is the way it feels. If it is percieved as a slap in the face or as breaking it easily.

As far as telling a person over the phone how would you feel if they rush to the facility only to be killed in a car accident or kill another because they are overly emotional?

[OCNRN63, RN]

The first time I saw someone who had died was when I was a senior in nursing school in my ED rotation. One day someone came by and asked if any of the students wanted to go to the morgue because an autopsy was being done. I went; all I remember is the woman was frail, elderly...and that's it.

I saw lots of deaths when I worked in hospice. The only time I had a family member "freak out" was when a patient's granddaughter threw herself on the corpse and refused to get off.