I am a new grad in the SICU. I had my first experience of withdrawing pt care. Pt was fine a week before. Walked in to ER with complaints of HA. Smoked for 30 years, was recently trying to quit. 54 y/o male, denies past drug use or medical hx. Had CT of head which determined a mass. Was admitted to med-surg floor. Coded twice on floor. Moved to ICU. Had another CT and biospy which determined LUNG CA w/mets to brain (which explained HA). Pt never been to doctor in past. Pt vented, on 5 drips, including vasopressin and levophed. Day shift nurse calls dr to request a family meeting per the family's request. Pt was made DNR by daughter who was DPOA. Family decides to withdraw care at 19:00, right when pt was handed off to me.
There are about 20 family members in waiting room. Called all of them to be present. Paged doctor. Doctor comes and speak with family. Paged RT. Then it happens.
My preceptor told me to turn off all drips (which were keeping pt alive at this point) and give a bolus of Fentanyl. Wants me to put the monitor on silence. My hands are shaking as I turn off all drips. I am getting very emotional, but hold it together for the family. RT shows up and extubate. Pt is now breathing on his own, but very apenic. Pt's vitals are going quickly via monitor. I'm writing vitals as I'm trying to keep my hands from shaking. I give another bolus of Fentanyl. Family is losing it at bedside. Pt's BP gets to about 20/10 and then HR of 15, pt is showing flat line on monitor. Pt's daughter decides at that moment she changes her mind. Pt's daughter is SCREAMING for her father to "come back". Everyone is screaming, some family members are on the floor. I am the only nurse in the room. I call the time of death.
I get daughter off the floor. Neice is hyperventilating. I asked some of the family members to help me get neice and daughter to hall way. My preceptor steps in and takes another family member who is screaming. I am walking with neice who is still hyperventilating. She says she has asthma. I go through her purse to get her inhaler. Meanwhile, the daugther has fainted. I rush over to her. I get a cold paper towel from bathroom to put over her forehead. Another nurse happens to walk by and helps me out. By this time, there are about 40 people in waiting room (other pts family members). The whole scene is so sad and emotionally draining. Nobody expected him to go so quick. Nobody knew he had cancer. In fact, they don't even think he knew himself.
I go back in and talk to the doctor. Give my vitals and time of death. I have to call the morgue and the transplant network. Tons of paperwork to fill out. Daughter calls back and requests an autopsy. More paperwork. Then I had to do postmotrum care. Pt had so many art lines and IV's, foley, chest tube, etc. This is when I lost it. I cried my eyes out. I remove everything and clean him up as much as possible. I had to call security to have the body taken to the morgue.
The whole entire night I was an emotionally wreck. I can't get that daughter screams out of my head. I cried so hard because I felt her pain, as I had also lost my father suddenly. I go out after work with some coworkers to debrief. I've been sleeping all day, then got up to go out with a girlfriend who is also a nurse, just to clear my head. I'm still emotionally and crying. Please any advice would be greatly apperciated.
Thanks for reading.