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?

scopalamine patches help with the gurgling

I am so sorry that you had to witness that. I have been an LPN for 13 years, and had a similar experiance.I was working in a locked Alzheimers Unit, and a man was dying..he had no family, and no one seemed to care about him. His death was awful, and the on call MD, was not much help, other than to give an order for O2. I vowed that day to do my best to never let anyone suffer that way, and alone on top of it. I answered an ad for a Hospice nurse. I applied and was very forward about my lack of experiance, but also my desire to make a difference, and never let anyone die alone. That was five years ago. I have been a Hospice Nurse for 5 wonderful years now. I wouldn't do anything else.It is not for everybody, and I was warned about that. I gave it a try,and the rest is history. I now work for my best friend, who owns the Hospice agency that I work for. This is not the answer for everyone, I realize, but it was for me. My wish it that more people would be educated re: hopice services. You can have hospice in a SNF,ALF, Hospital and or course, your own home. It makes a difference. Bless you, you will get through this. Jamie

Specializes in NTICU.

Sorry to hear you are having a rough time. Please the first thing never set yourself up to lose your compasion. I have consuled many a paramedic and nurse in this just last night I had to talk with a nurse with 27 years about a similiar subject.

First let me say when I was on the road, paramedic for 13 years, this happens a lot. The first thing we (healthcare workers) is that no matter how hard we try we will not stop the suffering or the dying process, no matter what we will try or bargin to stop this. The only thing we can ask ourselves is did we give the best care and compasion to the pt? I cannot tell you the most helpless feeling I have is to watch a pt die and I cannot help. But if I give the medications maybe hold a hand during this process and give comfort to a grieving family I did my job. I work in a neuro trauma unit and a nurse of over 30 years sat with this man well past the end of her shift holding the hand of dying pt. And when I came in she came out and asked for a hug and she broke down and started crying because the man just died a few minutes before.

So second, allow yourself to grieve over a pt it is okay and sometimes you need that closure. I can remember my wife's first amputation on the road (she was an EMT at the time) and my brother-in-law (paramedic) told her to just get over it, it is part of the job. I told her if she needed to talk about it and grieve we will. When are with the pt and it is time to "work" do your job. But you will know if it okay or not to grieve with a pt's family after the pt has passed on. And I will tell you from personal experience being a paramedic and nurse there are many tears shed behind a door and when the medic or nurse comes out of the room they went into the will apear to have the steel exterior. You will find out if you look tough on the outside it becomes a defense mechanism for what you can't see doesn't hurt you and dying doesn't bother me. It does bother most everyone with a pt from time to time. My wife and I where talking and we both do the same thing and talk to the person during the post mordem care sometimes this does help.

So please in the end don't beat yourself up and try to keep the coorifice.

Specializes in Travel.

Dear Grad,

I'm glad you wrote about this, and I'm really glad that you were able to get support from other nurses. I hope you're sleeping now.

We use a MSo4 drip with Ativan when patients are in a lot of pain.

Just remember: we are nurses, and it is our privilege to comfort our patients at the great gates of life. The first safe, loving, capable care that a newborn babe receives is rendered by a nurse, and it is a nurse who will hold the hand of a treasured grandmother at the gate that opens into the next life.

Sending hugs and healing thoughts your way-

Viv

When my mom was dying, her resps were 60/min and she said "Let me go". I used a healing touch technique called magnetic unruffling in her energy field. In less than 2 minutes, her resp decreased to 16 and was more comfortable. She died 90 minutes later. Also, you might go to www.emofree.com and see the techniques which can help you remove some of the turmoil from the memories.

Specializes in aged, palliative care, cardiac, agency,.

Hi there,

Havent read all your replies as yet and am sure others will have pointed out the obvious to you but here goes. You are working in an extremely difficult area of nursing, one that is draining emotionally and spiritually especially for someone who hasnt "come to grips with their own death" yet. Plus this is your first placement, your first year out. ANY first placement is difficult as you get used to the new roles involved in nursing, plus the responsibility, time management, shift work etc etc etc. SO stop being so hard on yourself! Plus this is the physical ward where someone you cared about died, so again you are asking alot of yourself. It doesnt mean you cant do this, it just means you need to be kind to yourself and accept that there are lots of reasons why you might be finding it tough going at the moment.

Do you get the chance to rotate to other areas of nursing in your grad year? If so this may help you put experiences into perspective. Having worked in Hospice I know that it can skew your perception of the world. You start to think that every patient is going to die, and die horribly, tragically. Just like when you work in Aged Care you believe that everyone will end up with dementia, and cardiac nurses believe that every one is a walking time bomb. Perhaps once you have more experience under your belt you will be better able to put your experiences into context.

So treasure your time there, but aim to get some balance in your nursing so that you see patient death as a part of nursing not the entirety of nursing.

Also, ask for work based counselling de briefing services that are available. No one will think any the less of you, in fact it shows a maturity to know that these things need talking through with a sympathetic ear.

Best of luck, and keep caring.

Maggie

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 aged, palliative care, cardiac, agency,.

Couldnt agree more, and I particularly like your analogy of the Vietnam nurses. I feel that every new grad needs a few years of variety, to get your feet wet, in a range of placements. It is a wonderful opportunity to experience a variety of specialties, and allows us to reinvent ourselves as nurses many times over in one career.

Maggie

Specializes in telemetry, hospice.

That is a common question, I think. I feel like the person is going to die anyway, I don't believe giving that person morphine, ativan, or even phenobarb to alleviate suffering is euthanasia. We are not overdosing them, but we are also not trying to save their lives. The happy medium is comfort and peace, both for the patient and families. If medication provides that, then go for it.

I was freaked out at first, too, in dealing with the whole post mortem situation, but as time went on, I started seeing things in a completely different perspective. I began seeing that death is natural, and that a peaceful death with the family at the bedside can be an extremely spiritual experience, especially if the patient and family have accepted what is happening. They don't grieve any less, but they grieve "healthy".

Specializes in Trauma, all Peds.
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?

And so there you go...... it really hit home w/ you. If you stay on this floor you are probably going to see alot of smokers. You have a huge monkey on your back w/ that smoking. And it's totally in your face now. Are you ready to deal w/ this at this time? Maybe, or maybe not!You get to choose. This is about your own life. That's why you are so effected. There are lessons here for you. Life is speaking to you. And it will continue to speak to you as you go through your nursing career. You are really in it when you are a nurse. Make no mistake about that. There is a reason you were there for that particular death.

Also let me say, everyone wants a good death. Not everyone gets one. As far as your nursing goes, now you know to campaign for Ativan.... and focus on the fact that you are relieving suffering. You were not going to save that patient. She was actively dying. You can only help the suffering of the actively dying patient.

You have the compassion and empathy of a great nurse. Hang on to it!

It's your cross and your friend.

Specializes in Trauma, all Peds.
That is a common question, I think. I feel like the person is going to die anyway, I don't believe giving that person morphine, ativan, or even phenobarb to alleviate suffering is euthanasia. We are not overdosing them, but we are also not trying to save their lives. The happy medium is comfort and peace, both for the patient and families. If medication provides that, then go for it.

I was freaked out at first, too, in dealing with the whole post mortem situation, but as time went on, I started seeing things in a completely different perspective. I began seeing that death is natural, and that a peaceful death with the family at the bedside can be an extremely spiritual experience, especially if the patient and family have accepted what is happening. They don't grieve any less, but they grieve "healthy".

I think that in some cases, you get to witness a person and their family in their final stage of development, and it is spiritual development for the pt, and their family. It's an incredible thing to watch and be a part of.

Specializes in midwifery, NICU.

Just remember: we are nurses, and it is our privilege to comfort our patients at the great gates of life. The first safe, loving, capable care that a newborn babe receives is rendered by a nurse, and it is a nurse who will hold the hand of a treasured grandmother at the gate that opens into the next life.Viv

oMG.great big lump in the throat time!:saint::cry::cry:

Specializes in Geriatrics, LTC.
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%?

This person was going to die whether you gave the morphine or not, by giving the morphine you made that person that much more comfortable. Quit beating yourself up, you were in that person's life at one of their most precious moments and helped them.

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