ED Shocker

[MrChicagoRN, RN]

Matt,

It sounds like this was the 1st civilian death of a patient you were responsible for.

It's normal to feel upset when your patient dies suddenly & unexpectedly...especially the 1st one. Who you will never forget.

Add to that your combat experiences, TBI, and the effects of cumulative stress over the past 15 years.

What you felt is NOT abnormal.

It's normal to feel upset. Did you talk it over with your Manager or co-workers? Many times a debriefing or even an RCA occur after an event like this. I don't know if you'll feel & react this way the next time or not, but you might want to consider talking to an EAP or VA counselor. Find someone to talk it over with, talk it out.

Best of luck to you, and thank you.

[Susie2310]

There are certain nursing specialties I couldn't work in, from an emotional point of view, in part based on previous life experience. I don't know if this will turn out to be the case for you in the ED, but if it does, there are areas of nursing that don't deal with these types of situations. There is no shame in finding one is better suited to working in some areas than others.

I agree with MrChicago's suggestion to consider making use of whatever support systems, i.e. talking to co-workers, EAP, counseling, etc. are available to you.

Thank you for wanting to do your best to take care of patients and their families, and for doing your very best in the situation you described. Even though you weren't able to talk with the patient's wife or hug her, she watched you do your very best to save her husband's life and she knows what you did.

Best wishes to you.

[macawake, MSN]

I felt weird. I was uncomfortable in that post CPR moment. I remember the absolute shock of the patients wife's blank expression as she just didn't even process that I was breaking ribs and crushing her frail husbands chest trying to save him as the DR tried to intubate. After I wanted to go give her a hug and console her as she was waiting in The ICU waiting room for an update but I just couldn't do it. I had to go back downstairs and try to process what had just happened. I wouldn't know what you say anyway.

I have never had an adrenaline dump like that and soon found myself puking in the bushes and choking back tears. I was shocked! This isn't like me. Is it always like this? I felt like it was hard to let go of it. I am OK now but the impact was much more than I expected. Any tips to help process these moments?

I have always counted myself good in chaos and am seldom at a loss for words. I would be encouraged to hear your stories and suggestions so I can grow and learn to deal better in these situations. Much love ... Matt, RN

First of all I want to say that I was touched by your post and I can definitely relate to the feelings you describe.

I'm not an American and I live and work in Europe. I'm a second career nurse, former law enforcement, who started my nursing career with a brief stint in med-surg/tele followed by a couple of years as an ER nurse. After going back to school, I have now found my place in nursing and happily work as a nurse anesthetist.

I too was shocked by how I reacted to patients dying when I became a nurse. I came from a background where I was all too familiar with violence, sudden and violent loss of life, human suffering and grief. In my law enforcement role I was considered to be a tough, even-keeled and unflappable coworker. I was someone you could count on when the **** hit the fan and made good decisions under pressure. I saw many tragedies and comforted victims of crime and their loved ones. If I/we had a particularly rough shift I'd talk it through with the guys I worked with, a type of informal debriefing, and that would be enough to allow me to leave work at work and go home and enjoy the rest of my day.

Through the years nursing has become easier but the fate of my patients and their loved ones can still affect me emotionally. As I mentioned earlier I was surprised at my own reaction when I started my nursing career. I've spent some time thinking about it and processing it and at least for me, I think that I've identified the cause of the unexpected anguish that I felt. In law enforcement and I believe the military, the "enemy" is more clearly defined. In healthcare we are up against disease and trauma, a much more vague enemy. It's an invisible and fickle foe which cruelly strikes at random.

Another thing, in healthcare I sometimes feel helpless and I that's something I never felt in law enforcement. In law enforcement there was always something you could do. You couldn't undo a crime or bring someone to life, but you could at least derive comfort from investigating the crime that was committed and try to make sure that justice was served. I geuss I felt more in control in law enforcement. In healthcare you often have to accept that despite doing your very best, using all your and the team's professional abilities and the best that modern medicine has to offer, it did nothing at all to change the course of events. Something terrible still happens. People's lives are changed forever. And you feel powerless. I think that knowledge combined with the physiological reaction of your body "coming down" after a major adrenaline surge at least in part explains what you experienced after the code.

I think that it's important to realize that all we can do is to try our best. Keep up with the latest evidence-based practice and work conscientiously. We won't always "win". It's just the nature of the beast. Sometimes diseases and trauma will kick our collective butts.

Hardly revolutionary advice but I find that plenty of sleep, healthy food and exercise makes me more resilient to the stressors that work brings. That and spending plenty of time with family, friends and hobbies outside of work. OP, I'm glad that you're feeling better now. I don't think that there was anything wrong with your reaction. It simply means that you're a human being and that the fate and suffering of other people affect you. I think that's a good thing. What wouldn't be good for you (in my opinion) is if those feelings become long-lasting and a pervasive factor in your life. We can't carry all the grief that our patient's and their families endure. That's too heavy a burden and I think it negatively affects how we are able to perform our professional duties as nurses as well as our own quality of life.

Perhaps what you experienced will turn out to be a one-off or at least an infrequent occurrence. If you find that what you experienced after that code is a recurring thing and that it's difficult to cope with, I think it's a good idea to use the sevices of a professional counsellor. I don't regard asking for help with how to deal with all the stressors that our profession throws at us as a sign of weakness. Instead I see it as a sign of strength and maturity.

Take care!

[moldyoldyrn]

My first thought, do not think you have to "say something" to any patient or family. Some of the most powerful connections I have ever had as an RN have been when I have hugged, held a hand, sat with and connected to a loved one who has just lost someone WITHOUT talking or saying anything. It's called presence. I have worked Hospice and palliative care for about the last 15 years.There are times when there are no words you can utter that will make a difference but your presence sure can. Don't be afraid of saying nothing, just be there for them. I lost my first husband to murder in the early 1980s and I remember so well one of the dentists who I knew well (he was married to a fellow RN). He approached me and just stood there and said "I do not know what to say to you, I know I cannot make it better" and with that he wrapped his arms around me and just hugged me. It was probably the most honest reaction I had during that time. I will always remember him for that and I think he was right.

[midgeypoo, LPN]

Dear Matt:

I appreciate your post and your honesty. You sound like a brave man, very brave !

I too started nursing career at a later age 53 for me. I knew I'd be dealing with the good, bad and the ugly. Up front I told myself that I would not let this upset me since I've already dealt with my own family loss; newborn son, Father when I was 9, Mother when I was 39. Heck what could be worse than that - I said to myself.

My first loss was in assisting another Nurse with her code, yes breaking & cracking of ribs, bleeding from the mouth, just the sounds are awful. But I heard the HO say pulse 18, and thought briefly OMG we got her back - no sooner I hear the HO say "time of death ___". That shocked me more than anything - not sure why.

As for how you should deal with your emotion? Yes, talk, talk and talk more. You seem to know yourself very well and I am certain you'll do what is best for your own mental health. I'm not suggesting you leave the ED just see how you feel after (if/when there's a next time) and again re-evaluate yourself. I'm hoping for your sake things get easier emotionally. I'm sure you will make the right decisions necessary for yourself and your patients.

Good Luck to you and hang tight, we've all been there in various ways.

[DeathAngelRN]

Dear Matt,

As my username implies, I have had more than my share of losses in the hospital. I am a critical care nurse and worked @ a level 1 trauma and stroke center. The feelings you experienced are normal unless you ask a psychiatrist who doesn't know or understand what you are going through. Ask a psychiatrist who did a residency in that environment they will say it's a good coping mechanism. Yes talking does help, so does talking and hugging and yes even crying with those family members. Being human, loving and caring is never wrong. I have a picture of one of my young patients that I lost on my mirror at home to remind me everyday why I do what I do! Her family gave me the nicest card and her high school senior picture. I cherish those items because I not only did my job but made her family feel better by caring! It's a hard job to love but I assure you if you give it time you will LOVE it and will find your peace with the sad times. Best wishes.

[KateFF]

Matt,

You are human and your heart is alive. We all have had hard hits like that. It does hurt worse when you don't expect it. Death comes sometimes and no matter what if it's that persons time, it'S their time. I remember my first surprise code. I received a patient with SOB/dyspnea that resolved to the floor, no tele. Vitals were stable lungs clear. His wife was at bedside nervous. They were tired she asked if he would be okay. I was reassuring and told her go home we'll call if anything changes. Two hours later he got up to go to the bathroom and coded. Code lasted 30 min he never came back. His wife's eyes haunted me for a long time. Ended up being a saddleback emboli in autopsy. I questioned what different I could have done...nothing at that time mid 90's before TPA. Another time another code doing chest compressions feeling bones break on a 90 yr old woman hoping she didn't feel that pain. All the while hearing her daughter cry save my Momma. It was hard. My little sister said it warning other family members ' She'll tell a work story sometimes and give you nightmares'. Nurses see the bad, horrible, and tragic. We also see the good, heart warming, and miracles. Cases like the one you had happen nothing could have changed it. Don't wall off the emotions work through them. Take care of yourself feed your well of compassion. Live enjoy your family, hobbies. Talk to others you feel comfortable about experiences like this. You are strong and a good nurse believe it. Remember one loss the grief can wake up other griefs. Allow yourself to be human it's okay. I worked IMCU, CCU, and ER in the past it's part of the territory experiences like that. I work as a Hospice nurse now helping people through it in a different way much less traumatic

[Lamharr]

This just proves that you have a caring heart and you're a true nurse

[marylou5]

The first is the worst...for everyone....the one you never forget. It doesn't mean your reaction will be better or worse next time. Reaction quite often depends on how much you interacted with the patient and/or family. Only time will tell. Your decision, whether or not to move on, will be if you think you will/can handle it better next time..or not...or even want to, but death is part of nursing Talk is irrelevant..A simple, 'I'm sorry' or 'we tried so hard'. Just sitting with the family, holding a hand or putting an arm around the one that needs it most. What you feel is always mirrored on your face if you really care. I've had families hugging me instead..it's just human, not weakness, to grieve a death...losing a patient is never easy!

[NickiLaughs, ADN, BSN, RN]

The hardest patients are the ones who come in walking and talking and them decompensate and die under our care. The first time is the hardest, we think, what did I miss, what could I have done differently. The reality is they came to the hospital sick and we can't stop everything.

I would take a breath, get some counseling and play it by ear. It may just be that initial shock, but it could be a tough time department for you. Is there someone you trust that you work with that you could vent to off hours? One of the most healing things for me was going and having a drink with a bunch of my coworkers for us to process the shift, let it go and move on.

I believe most good nurses have been there and have felt exactly what you feel. Hugs to you.

[klcrn1987]

First off... Thank you for your service Matt... all Veterans are heroes in my book...

it is normal to be upset by a sudden death... one I distinctly remember was within the 1st year of me becoming a RN. I had the sweetest elderly lady who was in wonderful shape for her years... late 80's. A&O x3... very mobile with a walker... a real gem. I had assisted her to the BR and was making her bed. She came out of the BR and was walking over to the other side of the room to look out the window. Suddenly her face went stone blank and she just fell face first over her walker onto the floor. I launched over to bed to try to get to her before she fell but....

We coded her but she didn't make it. I went out of the room into a little alcove and BAWLED.... I was so shocked that she went down like that. The DR said she must have had a sudden cardiac arrythmia...

Even tho we often try to "harden" ourselves against getting too involved with our patients there will occasionally be ones that will reach your heart in ways you can't explain... those are the ones that hurt....

If you continue to be upset or concerned, please talk to someone...