That first death is difficult, but you can make it worse by taking "blame" where there isn't any. I'm not saying this to be harsh. I'm saying it so that you can keep being a nurse.
To say that you were a failure is to imply that you had a whole lot more power than you actually did. It's tough to comes to terms with the fact that there are so many things we just can't control. This was an elderly woman with end-stage
COPD, hence the DNR. She showed signs that she was getting ready to check out. Other than turning back the clock a decade or so, I don't see much you could have done about those things.
It was my failure for not noticing sooner, my failure for not being with the patient when it happened.
Short of standing a death watch and neglecting your other patients, I can't imagine anything you'd do differently. Can you?
When you speak of "my failure," all I can think of is that this isn't a test that you somehow blew. It's part of your life as a nurse. These things happen. It wasn't really about you at all (except that you do need help to process this milestone first death, and that's normal). It was about a woman who was ready to go. And so she did.
I called the UC md to pronounce her, he did, but stated she must've died some time (he said at least a couple hours) ago.
Pure speculation on his part. You KNOW that you had last started cleaning her up around 0615. So you probably finished at 0630 or later. Do not let the inaccurate comment of someone who wasn't there talk you out of what you know to be true. She was alone, at most, for an hour.
I've heard of many cases where a last clean-up is a stressor that brings about the end. Should nurses then let patients lie in their own incontinence? If I were the patient, I'd rather pass twenty minutes sooner clean, dry and with a measure of dignity. If someone is that close to death's door, we really are just talking a matter of minutes. You didn't fail her. You let her know that even in her final moments, she was cared for. I call that a success.
Would it be nice if you had been holding her hand as she breathed her last? Certainly. But real life has a way of intruding and rewriting the Hallmark Channel scripts.
It sounds like you did everything you could for her. I'm thankful on her behalf that she had a nurse who cleaned her up one last time and cared about her passing.
Have a good cry. The first death is the worst. But then dry your tears and realize that this is not a story of your failure but of your patient's good fortune to pass in a place where she was cared for until the end and found quickly instead of many more unpleasant alternatives.
This is part of your growth as a nurse. You never want to get to the point where you don't give a flying fig about someone dying, but you have to be able to take it in stride or you won't be completely available to the living.
Here's a hug.