Witnessed a terrible death last night--pls help me...

Nurses General Nursing

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I think I just need to write. I am freaking out. As a new nurse, I expected to have to deal with death. And especially with the population I'm working with, who are mostly cancer patients in crisis. I chose this job because my grandmother, my angel, was once one of those patients--and on the very same unit where I decided to begin my nursing career.

I've been there 3 weeks and witnessed or heard about like 6 deaths already, which is to be expected. The first one I witnessed. She was my patient but I had just come on shift when she died. A caregiver was in the room with her. She had no family. I almost cried that night, but I didn't. I didn't linger on the subject too much after that either. Then I admitted a man with brain mets who was really anxious and in so much pain. I met his wife and daughter, who were grieving, and again I almost cried. I did cry when I left him that morning, and he had just died when I arrived the next night. I though a lot about him that night and the following day. I had trouble sleeping that day. I kept thinking about his family, and about the interactions between us after his family left the hospital the night he was admitted. I can remember word for word most of the things he said to me that night. I still feel sad for them, but I'm not thinking as much about it now. There have been other deaths that didn't really affect me so deeply.

But this morning I witnessed a terrible death. A really bad death. Woman dying of lung CA, unable to breathe, gurgling with each inhalation and exhalation for hours--anxious and trying to sob, but not really having the energy to do so. Her room was full of family, and they were all grieving. I was there when she died, and it was not a peaceful death. I was relieved when the end came, and then spooked to provide post-mortem care, but I did it. I didn't cry or anything like that, even after I left this morning, but I just keep thinking of her. I can see and hear and even smell the experience. I can't sleep. I just keep seeing her face in the horrific grimace and the anxiety just under the surface that she didn't have energy to properly display. The morphine we were giving her every 15 minutes didn't really work, but I think in the end she died more quickly because of it. It almost felt like euthanasia, to be honest, but we were following the orders. What could we have done differently? The sound was incredible, and I'll never forget it. It never seemed to phase the other nurses, but I guess to them it didn't seem to phase me either.

How in the world do nurses get over seeing such awful deaths? I'm freaking out. I've had a panic attack this morning. I just wish I could wash it out of my memory. Does anyone have any advice for me?

Specializes in Med Surg, Hospice.

Watching my Dad die was one of the hardest things I have ever had to do also. BUT... I am glad I did. I was the only child of his three that was there. As the oldest, I felt it was my responsibility to be there with him through his last breath, so I sat there and held his hand. Fortunately, he had a wonderful doctor and awesome nurses that knew our decision, and made themselves available to my Mom and me when we needed them.

Because of the care Dad received, I decided I had been sitting around on my butt for way too long, and it was time to go to Nursing School.

Fast forward 17 months... here I am, also working on the Oncology floor. Hospice is in for one patient. I took care of her for 2 days, but I also made myself available when the patient needed turned, bathed, bed changed, etc. I also stopped in frequently (even on days when I wasn't assigned to this patient) to check on the family members, get them coffee, rolls, clean sheets for the cot, the family slept on, etc.)

Yesterday, I got pulled from the floor to work on Stepdown (Which was NOT fun, but I did have a wonderful patient who was a retired Priest). I ran back up on my floor at the end of my shift to check in with my unit director, and as always, check on the patient. I had a chat with the patient's Mom, and I held her hand while she cried. I came in this morning, and found out that the patient had passed last night. Sure enough, when I saw the empty room, I felt the tears starting. I wasn't there when she passed, but I sure felt it when I saw the empty room this morning.

Everyone gave you good advice here. Please know that you did make a difference in your patient's last few days. Bless you for working Oncology. It is a tough field sometimes.

It is hard to remain clinical when your heart is squeezing. Remember your purpose--end of life with dignity. You aren't maliciously "snowing" these pts. in order to end their life. Follow the doctor's orders and your heart a winning combination. Remember that all of the medication and procedures in the world cannot give the pt. what he/she needs most and that is the compassion and full attention of their nurse. You sound like you are doing the best for your pts. Please do the best for yourself and evaluate if this is the kind of nursing that suits you. Get professional help--look into what your hospital has to offer you in terms of support.

Specializes in ER, TRAUMA, MED-SURG.
Okay, now I am crying, and I probably needed to.

No, I haven't come to grips with my own death, and I have no religious beliefs that help me to cope. Also, I'm a smoker, and so was the patient last night. Also, lung CA was what my grandmother died of. The difference in her case is that she was zonked out (I think on ativan and morphine) when she died, and there were never any secretions, just obvious air hunger.

The woman this morning did not just have secretions though. She had been coughing up blood, and she was drowning in it. It was a continuous coorifice gurgle, like a pot of boiling water. Her anxiety was obvious to me. I only wish that we could have made her comfortable. I think that's what bothers me the most.

I became a nurse (because of my grandmother's experience) to ease suffering. To ensure that folks died peacefully at least. This woman did not. That's what's getting to me. When we zipped up the body bag, she still had that horrible grimace on her face. I'm having such a hard time with this. Almost as bad for me is the way it didn't seem to bother anyone else. Am I going to become as seemingly cold?

To Grad - I fel your pain, and the feelings you are having show that you try to do all you can for your patients and their families. Sometimes when a terminal patient gets to that point, the family needs you in some ways just as much as your patient. They are scared, already mourning, angry, and on and on. The patient needs their pain and anxiety meds and of course compassion. The family needs their "medicine", which is a shoulder to cry on, an ear to listen to them, someone to find them a snack or meal if they cannot leave their patient and a comfortable area, even if it is just a small corner of the patient's room to rest.

Not long after I finished nursing school, I had a code on a patient that I had cared for for an extended pd of time and gotten to meet the family. I held it together during the code, but after the event I cried and another staff member saw me. She laughed and told me I was a ''sissy''. One of the md's I had worked with for quite a while told me something that made me feel better then and it still holds true. He told me that "You don't need to feel bad about crying. It shows that you are a caring person and you give all you have to each patient. That is something to be proud of." I am a true believer in this.

Some facilities where I have worked in the ER have had debriefings, which helps also.

Good luck to you, and God bless. You are one of God's angels, and you genuinely care. Please always keep that in mind during trying times.

Feel free to pm if you would like.

Anne, RNC:balloons:

I still have moments but I'm feeling so much better now. Thanks so much to everyone who responded. I knew this would be hard, and I signed up for it anyway. Also, I am going to stop smoking. I can't be an oncology nurse and smoke.

Morphine, ativan, scopalomine--these will be used generously (as allowed) by this nurse in these types of situations. I get that we are not ending life by using them.

Some of your stories were really incredible--I hope that you all feel some peace in telling them. Getting on this board and writing it all out was so so helpful for me.

THANK YOU!

Emmanuel,

Luckily I was not the primary nurse for this patient last night. I was like a runner--more morphine...I'll get it, etc. I totally see what you're saying. As sad as I still am over my own experience, I don't think that if I had been the primary nurse that I would have been unprepared emotionally to care for the family--this feeling didn't really hit me until I got home this morning. I think that's a good place to be.

I will definitely talk with the resources--chaplain, etc--at my hospital. It can never hurt to do so.

I might be able to sleep now.

Thank you so much!

Please do speak to those resources. They have all experienced what you're going through, I promise. You've received some excellent advice and support on this thread; you're going to be ok *hugs*

Check your pm's btw :)

Specializes in orthopaedics.

I am so sorry for what you are feeling right now. I can read that you are a compassionate nurse. Bless you for the kindness and loving care you are giving to those at the end of their lives.

When I was a new grad 9 years ago, I too was drawn to oncology; and although I only worked there for 11 weeks (due to an evil head nurse), I probably witnessed and experienced more heart-wrenching situations on that floor that I have in the years since then (in med/tele and dialysis). Nowhere else have I felt so needed and useful as a nurse, all despite the fact that I was very green and definitely lacking in technical skills; however, what patients need more than that is compassion, caring, comforting, reassurance, and yes, effective management of pain and anxiety (some call it "snowing", but there is nothing wrong with effective analgesia, even if it "helps things along". After all, the only thing that less aggressive pain management does is to prolong suffering. We are talking about terminal patients here!)

I will always remember when I was assigned to a terminal lung CA patient who was suffering greatly with air hunger. She pleaded with the oncologist to try one more round of chemo; he convinced her that it was futile and suggested comfort measures only. She and her family agreed, and her morphine dose was increased (she was on a drip, which is more effective than intermittent dosing). This relieved the air hunger and helped to make her comfortable. Not for a moment did I hesitate to increase the rate of the morphine drip (as ordered, of course). For the rest of my shift, she was calmer; there was no more air hunger or pain. She died during the night (after my shift), surrounded by family.

I understand how you feel; it is very difficult to witness pain, suffering, and especially dying. You will never get used to it; neither should you (if you ever feel indifferent, you will have burned out and need to get out of this field!) Nor do I think that your coworkers don't empathize and suffer with each death; many will just keep it inside. Talk to them about it, I'm sure they can give you good advice.

Oncology is a very rewarding specialty of nursing, and you seem to be just the kind of nurse that is needed there. It will get better, I promise.

Wishing you the very best,

((( hugs )))

DeLana

P.S. Another patient I cannot forget is a young (42!) man with lung CA; he was in horrible shape, getting palliative radiation for spinal mets which had left him paralyzed. His wife and 2-year-old daughter came to visit... it was clear that the child would grow up without a father. All I can say to all the smokers out there: Please, please, please QUIT!!!

P.S. I still miss oncology, and may just go back to it one day (the horrible head nurse is long gone!)

Specializes in Travel Nursing, ICU, tele, etc.

The first time I had to deal with death was my Mother's. It was a very good death. She had her family around her and she died peacefully. For me it brought about an unavoidable process of dealing with death (that many people never have the opportunity to do) and it eventually lead me to nursing as a career. Death is not dealt with well in our society. I'm sorry you had to see such a bad death soon after your Grandmother's passing.

I have come to view death with profound respect. It is a privilege to be with someone as they die. It is a birth. They are going home, their journey is over. Life and living and the dying process is the hard part, death is peace and rest. From our perspective, it can be such a tragedy, especially in a hospital setting where death is the ultimate enemy. I don't think we will really truly understand it until we too have left this plane of existence. It boggles our mind, we can't wrap our minds around it, it is too terrifying, there is too much unknown. Confronting death was the single most important growth experience of my life. Coming to my own sense of peace was incredibly powerful. It touches on every basic question of human existence. Why are we here? etc. etc. etc.

Personally, I ask for the angels to help... to help the person who is dying, to help the family, to help me... when my Mom died she saw the angels come for her, she said goodbye to us and that she loved us and then she was gone.... it was heart wrenching and beautiful and the most incredible gift I have ever received... as you come to terms with this, it will change your life, you will take the incredibly compassionate and sensitive caregiver you already are and become even more. I promise. There are no accidents, you have experienced this for a reason, do you know what that reason or reasons are? You are the only one who can answer that question. I believe you are special and have been put there for a special reason....

There are some good resources out there on death and dying, Elizabeth Kubler-Ross is one. I am sure other people will have ideas as well.

It is OK to grieve, grieving is healthy, let yourself take the time to go through this process. Get the resources and help you need. You will never be the same. Let yourself be open to the process that you are being led to experience. Miracles await you.

Tweety, I hear you, and thanks for your message.

Maybe the horrific grimace on her face was O2 deprivation and not anxiety, but she was grasping weakly at her daughter's hand, and I could almost make out "oh god" at times along with all that terrible gurgling.

ATIVAN--yes indeed. I wasn't her primary nurse and I don't know if there was an order for ativan, but that would have worked I think.

How do you resolve the euthanasia issue though, when giving morphine and ativan to someone whose sats are like 40%?

Giving MS04 & Ativan to a dying pt w/ sats is the 40% will not kill them. This is proper pain & sx mgmt. The pts on your unit should not be suffering like that. Where is the pain control and sx mgmt? Many hospice pts are routinely on 15 l of 02 and MS04 20mg/hr without any problems. Respiratory pts are sometimes prescribed nebulizer tx w/ MS Elixir in them. Atropine and scopolomine are given to dry up secretions.

I don't mean to sound critical or harsh, so please don't take it that way. But are the staff and docs on your unit poorly educated in palliative care?

As a former hospice nurse, I have witnessed hundreds of deaths, none were "horrible" and none were "euthanasia" as the staff and docs were well educated in palliative care.

i know grad said they provided palliative care on her unit, but it doesn't sound this way.

comfort care and palliative care are not the same.

actually, it's a rather new trend in onc units providing palliative care.

just because oncology deals w/dying, doesn't equate with providing the specialized care that eol necessitates.

as an aside, providing hi-flo o2 isn't going to do squat, if the lungs/airways are partially obstructed with tumors.

i personally don't like nebulized morphine.

its' effects are too variable.

leslie

Specializes in Hospital Education Coordinator.

Regarding the medication dosing issue - that is called "Double Effect" when the bad side of the med is known but we give it anyway for the good side of the med. Even though morphine causes repression of respirations the DISEASE is what caused the death. The medication assured she did not die in agony. Double Effect is legal in my state if the patient is dying and needs pain meds till the end.

See if your employer has an employee assistance program where you could talk to a counselor. Maybe a professional could give you some steps to work thru to help you in these stressful times. Good luck.

I agree. I wouldn't be surprised if the deaths of lung cancer pts continues to affect you more than others, that doesn't mean you won't still be a great nurse to all pts on the floor. I witnessed a struggling death from a woman in respiratory distress on my floor years ago( she was on the stroke floor?) and she fought for hours and died right before her son got to us from Fla. That tore me up! No family here, her begging me to help her ( I was only an aide then) and the horrible look on her face I couldn't fix before her son saw her. I still think of her a lot, but it does get easier, trust me. I know you don't profess to have a religion, but prayer is very comforting in itself, you might try it. :balloons:

Yeah, wow. I can imagine if you are still grieving your grandmother, this patient's death comes pretty close to home. I think it's good you are recognizing this as a contributing factor in how you are feeling now.
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