Having a really hard time after today

[Sonjailana]

Hi Everyone,

I had one of those days where I know I did what a patient wanted, but I'm still crying about it. I had an older male pt with respiratory disease (end stage). Pt was supposed to go home with hospice care today and was supposedly comfort measures. I come in to find a confused, hypercarbic?(high co2) pt on 6L nasal cannula, 02 sat at 83%.

So, I talk to the NP on his management team..and he's like, put him on Bi-PaP...and I say, BiPaP? (Because last I checked we let comfort measures patients go..not support them on BiPap) So I call my charge nurse and respiratory, verify that it's ok, and get it set up. Pt absolutely hates the mask, but is ventilating better. I talk to another RN working with NP's team..and she says, oh, so yeah, comfort measures is a grey area. This pt is supposed to go home today and was up walking around yesterday etc etc. So is the pt just DNAR? Full Code?

Beep beep beep...goes the Bipap. Incessantly. And since I work med-surg, where we supposedly never have Bipap, I'm not trained and am calling the respiratory team every 20 minutes..and neglecting my other four patients. Beep Beep Beep.

Pt becomes more alert and wants to eat lunch. I'm like, sure, anything you want, we can take that mask off for a while. I get pt's favorite foods and spoon feed him. I stay there for the entire time, not leaving his side. Pt starts to look more lethargic, cyanotic. I put BiPap back on..and despite connection to the wall not being messed with, No 02 is flowing. I call respiratory and get it set back up..but 02 sats are in low 70's.

NP from the morning that asked me to place BiPap starts freaking out..do we work him up? What do I do? Finally, I'm like, call the attending. Attending says, Do what the family wants. NP doesn't know..is so anxious and bothers me with questions. I'm like, call the family, you know them, I've never seen them.

Beep Beep Beep. Family is in the room taking off Bipap so patient can drink. Pt is smiling at everyone and appears to be saying goodbyes.

Beep Beep Beep. Family says, we know she does not want this and asks me to remove Bipap. I give pt ativan, scopolamine, morphine. The beeping stops.

45 minutes later..held by two adult children, patient takes his last breath.

I held it together at work..but now I've been crying. I know it's partly exhaustion, but I'm upset too.

[lamazeteacher]

I'm not sure why you're upset. It sounds like a harsh day, but in the end the patient died peacefully. That's something to feel good about, IMO.

Any time a patient died, with whom I had any kind of relationship, my emotions came to the surface. It's a great way of coping with sadness, because tension that brings tears, allows the toxin formed while we're stressed, to exit and bring relief. Also it could bring up earlier, similar experience(s) for us, that have not been completely resolved.

When a patient is obviously dying there's a dichotomy for most of us. On the one hand, life has become very burdensome for them; and on the other hand they'll be missed. It could be that a sort of "transference" occurs for nurses, wherein we feel similar to family/friends of the patient, feeling the sense of loss that they feel.

You had a very good grip on what you needed to do for your patient, and you did what was needed. I'd like to share a story about a young man who related a special insight he had, when he saw his baby born. I'll never forget how meaningful it was for me, too. He said that having seen his baby come from a state that appeared like death to him - blue, limp, seemingly lifeless - to having muscular strength, moving, breathing, reactive, with awareness. It would be impossible, this young father said, to view it as anything but wondrous; and if coming from death to life was like that, he wouldn't ever think that the reverse, going from life to death, was any less amazing and beautiful! :thankya:

[lisamc1RN, LPN]

What an emotionally exhausting day! ((((hugs)))) You done good! It can be so good to just release all that pent up emotion with tears.

[leslie :-D]

I'd like to share a story about a young man who related a special insight he had, when he saw his baby born. I'll never forget how meaningful it was for me, too. He said that having seen his baby come from a state that appeared like death to him - blue, limp, seemingly lifeless - to having muscular strength, moving, breathing, reactive, with awareness. It would be impossible, this young father said, to view it as anything but wondrous; and if coming from death to life was like that, he wouldn't ever think that the reverse, going from life to death, was any less amazing and beautiful! :thankya:

so very true, lamaze.

birth and death are the 2 life events that elicit such depth of emotions as they do.

both are truly an awe-inspiring phenomenon, that will evoke our most primal of responses.

there is nothing in life, that compares to the two.

leslie

[AlabamaBelle]

so very true, lamaze.

birth and death are the 2 life events that elicit such depth of emotions as they do.

both are truly an awe-inspiring phenomenon, that will evoke our most primal of responses.

there is nothing in life, that compares to the two.

leslie

And, as nurses, we are allowed to participate in the two most intimate moments of our human experience. It's a blessing to witness.

[JB2007, ASN, RN]

I feel for you. You had a very emotionally exhausting day and that is allowed. I work in LTC so I see a lot of death since I have started in healthcare. Some deaths seem to hit harder than others. I have not been able to figure out why, but some just do.

You did an excellant job taking care of your patient. Now do something nice for yourself. Something that will let you relaxe and destress. Take care and thanks for taking good care of your patient.

[meadow85]

I'm sorry. I think you handled the situation well though and he had a good death.

[Virgo_RN, BSN, RN]

I was upset because it was an emotionally taxing day..and I was grieving for a patient. That's allowed.

Thanks for the hugs!

I didn't mean to sound insensitive. I simply meant that because the culmination of all your efforts was a positive outcome, a peaceful death surrounded by loved ones, that perhaps some comfort could be taken from that.

[justiceforjoy]

Big hugs to you -- it sounds like you did an amazing job with this patient! I can only dream of getting a nurse like you if I ever find myself in that same position.

[SunnyAndrsn]

What a rotten day :-( Even though he didn't get to go home to die, he was able to have family with him, and how nice that they knew and understood the pt's wishes.