New CVICU RN.. First PT death... OUCH, this hurts!

  1. The following was originally written to a friend, but I thought I'd throw these emotions out there to you all, as I'm just kind of hurting right now.

    I am on the CVICU unit. (Also called CSU in some places). So we are supposed to get fresh open hearts, and cardiac cath lab pts. (Stents, angioplasty, etc..) As a student, I worked on this floor. (after having a year in the General OR at **) While I student I learned what the *normal* Cardiac ICU patient should look like. Our nurse to pt ratio is supposed to be 1:1 for a fresh OH post op, and 1:2 (tops 1:3) for cath pts. Well, this past month the *Powers that Be* decided that we were no longer in season, so they cancelled all their contract nurses, leaving us short since this year there appears to be *NO* season. We hold ten beds, yet this month (non-season)all beds are consistantly full. And THIS month, we have had FOUR pts who are way, way, way critical. We're talking renal and liver failure, blood pressures in the fifties without vasoactives, or pressures the other way. All four have been on CVVH (continuous Veno-venus hemodyalisis) Vents, eventually all four trached.. And IABP (Intra-aortic balloon pumps-- which prefuse the coronary arteries) These Pt's have 7 plus docs on their cases-- Neuro, cardiac, surgeon, hematology, pulmonology, nephrology, etc.. Not a ONE of these pts would have made it past a week without all these life support devices. Yet the surgeons insist they can get off them. (Yeah right, my pt is peeing 0-5 cc's an hour while we're pumping 1500 fluids into him-- nah, he'll make it and no longer need dialysis! YEAH RIGHT! Surgeons TRY soo hard, they honestly are the last to let go) That's just one of the many complications on only ONE pt. Meanwhile, the pt is comatose (and there are a LOT of things you should make a note to learn about that!!!) and I am watching a sweet old wife, husband, son or daughter hold on to all strings of hope possible, knowing that as soon as we remove any of these support devices, that person is going to die.

    Needless to say, in the past two days, I have been assigned two of these most critical pts. Yesterday, we pulled the vent off one, and she died later that night. I went home and cried.

    I was in for the suprise of my life today when I went in and the one pt I was assigned to (one I had yesterday, but also had weeks back and had hope for at one time) was given hospice orders. This was at 9AM, and the wife would NOT leave her husband of 52 years' side. I am in that room every hour, because the family says, keep him FULL CODE until his daughter arrives from out of state. All day, I am fighting PVC's, pressures that drop to the 40's, and my own emotions. My preceptor was there, but has all week given me a "test run" for flying solo. Since we are so short staffed, she had pts of her own, and was on the other side of the unit, yet always available.

    So I spend the day with this pt's wife, she's the most incredible, devoted, sweet, kind, and beautiful woman you could ever meet-- prefect wife, mother, and grandma, and she's telling me stories about the kind of man her husband is. She's stroking his hand, freaking out anytime one of the multitude of alarms ring, and hurting so much *I* can feel it. I spend 9 or more hours with her, as she is afraid to leave his side, despite my assurances that as long as he is on all this support, and I am watching him, he will NOT die.

    Daughter gets there at 6:50PM. Doc shows up then too. I had just given report. I wanted to get the hell outta there and have a good cry. Doc says lets pull balloon pump. Nurse coming in says I can't leave her like this, she is saddled with two other pts, and pulling from the femoral artery needs pressure for at least a half an hour. Family goes with chaplain. Nurse who took report doesnt give pt any narcs until pump gone and room cleaned. I get pissed. Not about having to stay, but about her ****** call not to make my pt comfortable. Doc last minute orders a fem-stop (applies pressure so you don't have to do it yourself) and so it's ok. I can leave, but oncoming nurses' stress makes me feel guilty.

    I clock out, find family, speak to wife, cry with her a bit, tell her what a privledge it was to be her husband's nurse, hug daughter, try to comfort her too, tear up some more. Hug son, ask if I can help anymore, and they all three tell me that they are so grateful that I was the nurse today, and that I was a comfort. I really wanted to bawl then. Leave, knowing as soon as the drips were stopped he would no longer have a blood pressure, and once the vent was d/c'd, it would be a matter of minutes.

    Went home, grabbed my husband, and did what my pt's wife told me to do-- cherish every second together. I told her earlier in the day that 50-some years was something I hoped I would get, and you know what she said, "You'll want more. You'll be greedy, and you'll want more in the end. Cherish every second, it goes by way too fast." THAT made me cry, but she said so many things like that from the heart, and was just so beautiful, devoted, and strong, I actually thought to myself, "Maybe I cannot handle an ICU-- maybe I should go back to the OR where your pt is anesthetised, and no family to get attached to." But her words, her children's words to me at the end of the shift, were some of the most rewarding things anyone has ever said to me.

    I will NEVER forget this family, or this pt that I had so much hope for in the early days of his stay with us-- This remarkable, incredible strong mountain of a man who I learned so very much about these past few hours from a devoted, intelligent, strong, beautiful and unselfish lady who's love story of 50+ years stole my heart today, and the lessons of strength, dignity and unselfish, TRUE love will always stay with me. I pray God is kind to her as she begins her new journey in life. And yes, I know I am a sap, leave me alone!

    But that's just me as a new RN.. Everyone is telling me what I already know-- Ya gotta let it go. It's gonna happen where you work-- a LOT. Get a tougher skin. You did great today, but don't take it home with you, Caroline. Oh, OOOKay. I guess they have all forgotten their first losses, or families' confessions and pain. I, simply have not. Just happened tonight. Nor will I ever forget. I owe it to this man (pt) who I have faught to keep alive for 10 out of 31 days to not treat him as "just a lesson" in fatality. I did my part, I kept him alive until the family was ready to let go, but I wish I had been there at 9:15 tonight, when I found out he took his last breath.

    Get the bitter irony of THIS one--- His wife, who wouldn't leave his side or leave him alone long enough to go to the bathroom for fear he would die while she was gone (while he was still full code, b4 daughter arrived) finally says, "take him off everything" (about 8:45P-- all family there) She couldn't even choke out the words, she had son say them, from what I am told.

    I call about 9:30P to check on him, and find he just passed about 5 mins ago. NUrses are choked up, but professional. Yet get THIS-- Wife was persuaded to LEAVE the building, and her beloved died alone. This is going to be so hard for her. If I were the RN, I would have told RT NOT to remove vent until I was sure where family was.

    First they removed the epi-- which at .3 mics was barely holding his pressures in the 50's, That's when family took a break. Pt 's pressure continued to drop, as expected, but RN let RT come in and DC vent. Pt DIED 10 mins later-- alone.

    Maybe its a fitting end. He'd been wanting to go for some time. He had already coded twice in the past month. He was fiercely protective of his wife. (their life was straight outta "green acres" -- he loved the farm they shared, and she loved the city life, was pampered, and never in 50 odd years learned to balance a checkbook or pay a bill! ) Seems like he was the kind of guy who would want to spare his beloved any more pain, and would want to die "alone," as he did when the RN stepped out for a few minutes.

    Anyone reading this, believe me when I say I know, I know, I need to detach myself emotionally. But understand at this stage in my new career, I prefer focusing (and have been until the past two days) on SAVING lives. God BLESS the walking angels called hospice nurses, as I suspect one actually intuitively diagnosed my pain today, and took several moments to quite subtly "assist me." (No, I wasn't a VISIBLE emotional mess, she just knew!)

    Helping families is exceptionally rewarding, but emotionally draining, and I don't want to face it anymore this month!

    Please share some of your stories similar to mine, and help me know I will be ok.

    Thanks for taking the time to listen. Looking forward to this thread.
    Last edit by CarolineRn on Jun 11, '04
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  2. 12 Comments

  3. by   jemb
    You sound like a wonderful and caring nurse. ((((((((Hugs)))))))) I cried with you as I read your post.

    Oncology nurse here for over 2 decades. I know what you must be going through. I can't say it gets easier to see grieving family members, but I have learned to accept that I cannot do the impossible. I hope that you will learn, as I have, that your caring as well as your nursing skills make the patient's passage easier for family as well as the patient as they face the inevitable.
  4. by   KIMRNNYC
    Anyone reading this, believe me when I say I know, I know, I need to detach myself emotionally. But understand at this stage in my new career, I prefer focusing (and have been until the past two days) on SAVING lives.



    Focusing on helping patients to die is just as important as focusing on saving lives. You are doing great and you will, over time, detach emotionally a little less each time until you get to a more "comfortable" level of involvement and detachment. You will eventually notice that you find a way to come to terms with the heartache of similar situations. Writing in this forum... or writing and sending a note to the family after the patient's death -it will help them and perhaps be therapeutic for you-... or perhaps each time reminding yourself that you did make a huge difference in how the family was able to cope during their loved one's process of passing as well as helping the patient to be as comfortable as possible. Eventually, you will find your own individual way of handling these emotions. It just takes time.

    I read a great book about nurse's in these situations and, unfortunately, it is in storage right now so I don't know if I am giving you the correct title. I think the title is "Stories for Nurses: Acts of Caring". I love to read each story over and over again. It reminds me that all our struggles are not in vain and that caring is always one of the greatest parts of nursing.

  5. by   suzanne4
    This is what nursing is all about. There will be patients that you will save, and unfortunately there will be those that don't make it. And I have seen it from both ends, working OR as well as CVICU and all of the other specialty areas.

    Always remember that the patient's family are also under your wing. And it looks like you did a marvelous job with them.

    I promise that things will get easier on you, but those feelings will never disappear and I don't think that you would be comfortable if they did. That is why we are doing what we do........................
  6. by   CardioTrans
    Every death will be hard on you. Some a little more so than others. The day you dont feel any pain when one of your patients die, is the day you need to leave nursing. You did everything that you could for this man and his family. Thats what nursing is all about.
  7. by   Tweety
    Thanks for sharing your story with us.
  8. by   CVnurse08
    What a heartbreaking story ! I feel for you and only hope that when I am a nurse and in that situation, I can be as caring as it sounds like you were. Thanks for sharing.
  9. by   wonderbee
    Thank you for choosing to be a nurse. I'm proud to enter a profession with compassionate people such as yourself as my colleagues. Please be good to yourself and be just who you are. Don't let others tell you how to feel.
  10. by   Energizer Bunny
    Thank you for sharing this wonderful story. It made me cry as well and I cannot even imagine what the family (and you as their nurse) have been going through.
  11. by   CarolineRn
    Quote from KIMRNNYC
    Anyone reading this, believe me when I say I know, I know, I need to detach myself emotionally. But understand at this stage in my new career, I prefer focusing (and have been until the past two days) on SAVING lives.



    Focusing on helping patients to die is just as important as focusing on saving lives. You are doing great and you will, over time, detach emotionally a little less each time until you get to a more "comfortable" level of involvement and detachment. You will eventually notice that you find a way to come to terms with the heartache of similar situations. Writing in this forum... or writing and sending a note to the family after the patient's death -it will help them and perhaps be therapeutic for you-... or perhaps each time reminding yourself that you did make a huge difference in how the family was able to cope during their loved one's process of passing as well as helping the patient to be as comfortable as possible. Eventually, you will find your own individual way of handling these emotions. It just takes time.

    I read a great book about nurse's in these situations and, unfortunately, it is in storage right now so I don't know if I am giving you the correct title. I think the title is "Stories for Nurses: Acts of Caring". I love to read each story over and over again. It reminds me that all our struggles are not in vain and that caring is always one of the greatest parts of nursing.

    Thanks Kimmy. I did not know if it were ethical or professional to send a card and/or flowers to a pt or his family. For some reason, I thought I was taught not to contact pts/families outside work. Thank you for answering yet ANOTHER question I did not think to ask. (I am finding as a new nurse, the questions I do not THINK to ask are the ones that most frustrate me!)
    But it'll get better, as I get more experience, right?

    I'm going to look for that book you suggested. As of now, I have focused on books that deal with pathophys and such. But after this experience, I think a good "emotionally uplifting self-help book" is in order.

    Thanks for your reply, and I love that John Lennon quote in your signature.
  12. by   Truly_Blessed
    This brought tears to my eyes. I am only a student, so I have never experienced anything like you just described...but I thank you for sharing this with us. You are exactly the kind of nurse I would want looking after one of my loved ones. God Bless You.
  13. by   CarolineRn
    It means so very much to me right now. I returned to work yesterday and my
    co-workers were great, but all of your words of kindness and experience really helped so much.

    Thanks to all who replied for being there for me. You are all walking inspirations, and I hope to make every one of you proud. (Yes, I already admitted I am a SAP!)

    {{{{{HUGS}}}}
  14. by   Gompers
    Quote from CardioTrans
    The day you dont feel any pain when one of your patients die, is the day you need to leave nursing.
    I've heard that before, and it remains some of the best advice ever.

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