I just witnessed my first clinical death

Double-Helix, BSN, RN · Mar 22, 2017

I am so sorry that you witnessed such a tragic event. Your feelings and reaction are normal and understandable. You're doing the right thing by recognizing that you need help to work through this event and your emotions. Your therapist will be able to give you coping strategies tailored to you and your needs. There really is no wrong way to cope, provided you're not doing something dangerous or unhealthy. Remember that as a new student, you are worse equipped to deal with a code and death than a seasoned nurse. While it may seem counter intuitive, experience with tragedy and loss does help you manage each one better. I do believe there are times that you do have to force your brain to separate the human side from the medicine side, at least for the time needed to do your job. This doesn't only apply to death, but to a new cancer diagnosis, when a complication has caused a patient harm, when you're caring for someone who reminds you of a loved one, etc. But as a student, and an observer, I wouldn't expect you to be able to do that yet.

As for your HIPAA question, you can say whatever you want to your therapist. It's probably good practice not to share full names of patients, but talking to your therapist about the code and death of child breaks no rules whatsoever. Don't worry about that.

Professional boundaries between health care providers and patients get very blurry when it comes to death and funerals. While opinions about this vary, the general consensus is that the funeral services are for the benefit of the family. Health care workers who have established a relationship with the family should go to a funeral/viewing to express condolences and support to the family members IF the family has extended an invitation. Health care workers who want to go to because they think it will help them personally should reconsider their intentions. No one who met the patient in the healthcare setting should attend any services if the family did not invite them (either directly, or indirectly, by informing the unit of the date/time, etc.)

To your question about donating to the funeral funding... while there is nothing wrong with doing so (anonymously), I would ask yourself why you feel compelled to donate. Would you be donating to a family you had never met or heard of before? Are you hoping that it would make you feel better? Are you feeling guilty because the hospital couldn't revive the child? Those are normal feelings, but you're going to encounter countless situations in which you will feel badly for a patient and want to help them in some way that toes the line of professional boundaries- giving money, buying a gift for a patient in need, bringing in special food from home for a patient, etc. While I understand your desire to help, unless donating money or going to the viewing is something you would have done even if you hadn't cared for this child or witnessed his death, I would strongly encourage you to find another way to honor his memory. Something very simple you can do is light a candle in your home on the day of the service instead of attending.

Again, I'm very sorry you had this experience. I don't know how I would have reacted had my first unexpected death occurred in my peds clinical. I'm glad you're seeking help. It's true that time is a healer. You will feel better.

BubbyBoogs · Mar 22, 2017

I am not in nursing school yet but I can kind of understand how you must be feeling now. I once found a man that had been murdered and was dropped off in an empty lot naked. Like you this was highly unexpected for me and I did not know how to cope. Since they did not know who this man was at first for some reason my mind thought it was my responsibility to mourn for him. The one thing that I had to come to terms with is that there was nothing I could do to bring him back. I did what I needed to do by calling the police so they could cover him up and find his family. Therapy will help you. I only went to one session and it helped me a lot. I could get it out without judgement. There will always be people that will tell you to just get over it but that's easier said than done. I am so sorry you had to witness a child as your first death. I hope that you find peace with it soon so you can continue school without distraction.

jj224 · Mar 22, 2017

I stopped my short stint as an ER nurse after I saw a little kid die. Nope. Can't do that ****. Back to adult MICU I went

Here.I.Stand, BSN, RN · Mar 22, 2017

(((Hugs))) I'm so sorry for what you witnessed. That's one reason why I can't do peds...it's hard enough watching a young adult die, and their family.

I personally wouldn't take the tell-myself-he's-a-sim-dummy approach. He was a child, and besides we know full well we'd be lying to ourselves.

I will be honest: sometimes I shed a few tears at work. Usually my eyes tear up and I control it from there. I do make the effort to focus my brain, and while allowing the tears I restrain my full-out crying -- voice neutral, no sobbing muscular activity etc. I work in trauma so see quite a bit of unexpected death, which is tragic no matter what our profession. Telling myself otherwise doesn't change facts.

If I need to have a good cry **after** my work is done, I allow myself 5 minutes. Once it was in the BR at work, after my pt had died and I had escorted her family to the PICU where her children were. Other times it's in the car on my way home.

Then I focus on self care. Sometimes it involves singing in the car on my commute home, sometimes I do something fun with my kids, sometimes I eat ice cream in bed. After the really sad deaths like the mom and kids ^^^ I get physically tired for a couple of days -- so I ask my husband for extra help. After that shift I told him that it has been a very difficult day, and can he get breakfast in the a.m.? That's maybe a once a year occurance, so he knows I mean it.

Other times I leave work feeling good, such as after a death following a planned transition to comfort care. Of course I feel for the family, but at the same time know that the family had acted in accordance with their loved one's wishes, and feel good knowing that I helped the pt die peacefully and was there for the family. I've been told I'm good at that kind of thing, so...

Overall, while it doesn't get **easy** it does get better. How to act, what to do etc. will come more easily with experience. But don't worry about the fact that you were affected. The people who have so compartmentalized as to feel nothing, are in danger of burnout -- if not already there.

If you need to talk to someone (such as your therapist), you should. It's a good thing that you are identifying your self care needs. Leave identifiers off if you're concerned about HIPAA, but remember deaths are public information. I don't see any issue with discussing what happened to a 5 yr old boy, and how it made you feel.

Sometimes nurses go to the funeral. Whenever I've seen it, it was following a lengthy relationship, and at the family's invitation. Earlier in my career I took care of adults with CF -- these pts we had gotten to know over a period of years.

Monetary involvement, you need to be careful with since there are boundary issues. It's one thing if this child/family happened to attend your church, and the deacons announce the congregation will be taking a collection; it's another if you'd come across a crowd funding page when Googling the child's name.

Esme12, ASN, BSN, RN · Mar 22, 2017

Oh honey....I am soooo sorry. ((HUGS)) That is tough. Sadly...children do die regardless of meticulous care. I was very young when I started nursing and I walked around with my mind reeling at the reality, and the brutality, of life.

I think it is different for all nurses...for me it is my spiritual beliefs (not necessarily religion per say) that helps my heart heal. I learned that even the most sophisticated medicine cannot save everyone if it is just...their time.

When I graduated nursing I was BARELY 18. I went to work at a community hospital in their peds/adult unit which meant we put adults in the beds until we had kids to care for. In those days there really wasn't all of the sophisticated peds assessments and intervention protocol we treated them like "little adults". One night I was working alone, maybe 3 months off orientation by now, and we had the usual croupers and our one "frequent flyer" that was a 3yo little guy with multiple issues. He had a trach on a vent (on a regular floor:nailbiting:) he had several birth defects, he had heart surgery, a VP shunt, cystic fibrosis...in those days a very limited life span.

One night...he coded. I did everything right. I started CPR and called a code. People came out of no where and charged into the room. They took over and they were so smart.

I NEVER felt so dumb.

The sweet little angel that I had cared for over and over again and rocked to sleep many many nights...died.

I cried and cried. They sent me home. I was inconsolable. I cried to my Mom and my older sister (who was a nurse) and in the end I realized he didn't die because of me. Nor did he die because I failed him. He didn't die because those smart people failed him....It was his time. I realized that there was something greater then I that makes decisions...be that God, Budda, Allah, the Son God, Karma, the universe....it didn't matter. I did not control the time clock and that comforted me.

My Mom and sister (as well as the nurses I worked with) told me how smart I was and that I was a good nurse and that I needed to think about what I was upset about. I realized that I was upset because I felt that I failed due to the lack of knowledge. It change the course of my career.

I then began my journey into critical care. I had a voracious appetite for knowledge. I never looked back. I became a critical care queen, a trauma flight nurse, cath lab, open heart, peds open heart, the Emergency room. There was life...and death but it was Okay because I was no longer stupid and I knew I gave each and every person my best.

So all in all, I have these questions for whoever can share their wisdom with me:
1. How can I cope with this? Especially that I feel this is already too much death that I can handle and I haven't even started my career yet!
2. How can I help myself handle it better in the future? (ex. I've had people tell me that I should just tell my brain that they were just a simulation dummy)
3. What how can I be HIPAA compliant and still share my experiences with a therapist? What can I share?
4. Is it inappropriate as a nurse/nursing student to donate to their funeral funding page? What about going to a public viewing funeral service (I'm not planning on doing this, but I was interested in what is considered normal)?
Thank you guys so much in advance, as I know you will all provide me with invaluable knowledge I can use going forward.

So.....

1) Yes, you can cope with this messy thing called life. Realize that life and death is NOT in your control. What you are in control of is becoming the best nurse you can be...always learn and improve and when you stumble...forgive yourself. You are human.

2) Educate yourself. It will come with experience. Eventually think about ACLS. Realize death...is a part of life.

3) Of course you can tell your therapist. HIPAA is a need to know basis...that is need to know.

4) Be careful of donating money...it really crosses the line. Maybe donate to a local charity you believe in and in your heart it would be for them. I have gone to a handful of funerals....a very small handful of those I developed a close relationship with.

I hope this helps some...((HUGS))

Esme12, ASN, BSN, RN · Mar 22, 2017

akulahawkRN, ADN, RN, EMT-P · Mar 23, 2017

OP, you would do well to read Esme12's post, especially the last part of it. You can't control death, it's a necessary part of life. I made my own peace with it long ago. I'm only a relatively new RN but not new to healthcare. I worked in the field as an EMT and a Paramedic starting back in 1997 and saw, participated, and ran codes. The saddest ones were always the kids, especially the ones that were too injured to survive. I always gave them the full-tilt boogie anyway. They don't haunt me as I have made peace with it all.

One of the best things you can do is talk through your experience and reactions with someone that can help you process this.

wonkknow · Mar 23, 2017

@Esme12 WOW. I'm not even a Nursing student yet but I wanted to thank you for sharing your wisdom and knowledge... that was really inspiring and touching.

amzyRN · Mar 23, 2017

I'm so sorry to hear that. I've never seen a little one die (thank God). I've seen adults die and assisted in several codes where the patient didn't make it. They youngest was a 21 year old. We coded the patient for about 45 minutes or more. I'll never forget that one, the physician held the patient's hand during the end of the code. I cold tell that it upset him to have to call the code on such a young person. It' so sad when someone, especially a child, who should have their whole life ahead of them dies. To witness the grief of the parents would be devastating. I remember the 21 year old's patients family come in sobbing. It was hard for me to hold the tears in that night, but if I let them out I was afraid they wouldn't stop.

la_chica_suerte85, BSN, RN · Mar 23, 2017

So all in all, I have these questions for whoever can share their wisdom with me:
1. How can I cope with this? Especially that I feel this is already too much death that I can handle and I haven't even started my career yet!
2. How can I help myself handle it better in the future? (ex. I've had people tell me that I should just tell my brain that they were just a simulation dummy)
3. What how can I be HIPAA compliant and still share my experiences with a therapist? What can I share?
4. Is it inappropriate as a nurse/nursing student to donate to their funeral funding page? What about going to a public viewing funeral service (I'm not planning on doing this, but I was interested in what is considered normal)?
Thank you guys so much in advance, as I know you will all provide me with invaluable knowledge I can use going forward.

Peds hemonc nurse, here. I'm a new grad but worked on the unit I was in prior and we had several deaths over the summer prior to orientation so, when I went back and it didn't seem like it was ever going to stop, my mental health took a pretty big hit. In answering your questions, I hope to give a bit of a glimpse of how I got back on track.

1. What do you normally do in life that gives you joy? As someone who also deals w/ depression and anxiety, finding things that make life seem beautiful, if only for a fleeting moment, help take you out of your own head for a minute and help you distance yourself from the emotional response and subsequent pain. For me, it was reconnecting with nature. I live very far from where I work and, during residency, I would drive home through the mountains (also, to get away from traffic) and marvel at how beautiful the Angeles Mountains are. I would stop and take pictures, look out for deer and just take in the beauty. When I wasn't able to do that/didn't need to do it anymore, I would take my dog on exceedingly long walks and take in all the nature around me and feel grateful that I had to opportunity to work somewhere awesome but also could live somewhere so devastatingly beautiful. I have been additionally blessed with all the rain we've had. For you, it's important to find these things for yourself now while you're in school because it doesn't get much better from here.

2. I wouldn't take the "just think of it as a sim dummy" route. That completely ignores what it is that is so bothersome about your experience and that won't help at all. This was a 5 year old. This was someone's child. In that death was all the hopes and dreams the parents had for their kid's future. What you can do in regards to this is find a way to be thankful that you were there to witness the tragic end of this child's life. Your presence was a privilege and it is enough that you were there to see and bear the pain of the tragedy along with the code team, bedside nurse, family, etc. This is nursing. This is what we have to confront every day. We frequently have the distinction of sending off families who will have gigantic holes in their hearts for the rest of their lives. Ultimately, though, this is not your pain. It is their pain. Do not make their pain your own. You were a witness and this was a hell of a learning experience, but this is not your heartbreak. Know that, in the future, you will be regarding these things more clinically. With sudden-death situations, it is shocking, it is jarring, but you will know you did all you could and you will find a way to live with that because these things happen.

3. To be HIPAA compliant just means you remove any details that could be identifying. Don't mention the facility, the day, the child's age, name or gender and you're fine. You aren't the only nursing student who has needed to talk out an experience with a professional. At my hospital, we are strongly encouraged to meet with the wonderful professionals through our EAP (employee assistance program) that keep all things confidential (because of course they will very likely know many of the above details). So, don't stress about that but good on you for keeping it in mind.

4. I don't think it would be inappropriate to donate. It might be inappropriate to go to the viewing and/or funeral. In hemonc, we see our patients for many years at times and we always try to make sure someone from the hospital is there at the funeral, though. But, this is because we know the families and the patients very well because huge portions of their lives were spent with us and it makes more sense as opposed to a sudden loss. Always make sure that, in the future, if you choose to go to a funeral, that you are doing it for the right reasons (do it for the family, not for yourself, and only as long as you know you won't be internalizing the grief and bringing it back with you instead of leaving it where the patient is laid to rest).

With all that in mind, know that what you experienced is a hard thing. It is entirely appropriate that, as a student (or, even a nurse who has never witnessed this type of event), you are really taking this one hard. After the initial shock and terror wear off, though, try to see it as a learning experience. One other thing I was doing when it seemed like we weren't going to stop losing patients was to write it out. I wrote a journal entry on each one and for each experience that was particularly painful for me. Write through the pain and then write after the pain subsides and see what you learned and what you're going to take with you as you continue down your path. The next time won't feel like the first time and so on and so forth.

((hugs))

she244 · Mar 24, 2017

So sorry you had to experience what you did. As you continue with your Nursing career you will continue to see death and then you will see the amazing recoveries where no one expected someone to survive. I worked in the ER. A 5 month old baby was brought in after the baby aspirated on its milk. We worked on this beautiful baby for over 40 minutes until the Physician called the code. The horrible part was finding out the babysitter had drugged the child with Benedryl and then propped a bottle against a pillow to keep the bottle in the child's mouth. When she discovered the child not breathing instead of call 911, she called her daughter to come to the home. So care was delayed for this child and she did not make it. Good luck to you as you continue on your path.