My first patient death

[katielam616]

Tonight I had a patient who I admitted last week for change in mental status. Unfortunately, this patient had been declining steadily since admitted. The family was unsure of what to do, so Full code remained. Today I have this patient again (4th time I have personally cared for this woman). The woman is making the horrible gurgling sound (everyone knows what I mean). I call respiratory therapy and we implement the order for deep suction. I call the doctor on call to "please just take a look it would make me feel better". The pt vital signs were stable, slight fever corrected with tylenol, and bp was normal in range. 02 is within normal limits but I just didn't like how she looked and sounded. The poor daughter has been at her mother's bedside for this whole week, watching her mother decline. She didn't want to make the wrong decision by placing the pt on a DNR. So tonight I get the doctor on call involved we continue the original plan (suction, HOB up, Lasix which she received 160 of and not putting out nearly enough fluid). I give the pm medications. The daughter (thankfully) was in the room came out and said "I think she's gone".

Enter in flustered and frantic here. While initiating the code blue, the daughter decides to make this pt a DNR. Some parts of me feel responsible for this woman. I know I called the doctor, respiratory, and did my best to not let her drown in her own secretions. I know she was elderly with multiple organ failure. I know she wasn't going to get any better. Everyday I would think how this poor woman should just be left alone. It's easy to judge the family and their decisions, but I am not the one who will have to live with that decision the rest of my life. The daughter had very little support from other family members. She was receiving conflicting information from different doctors. She was lost, and for that I feel sad for her that we as her mother's caregivers couldn't help her make the decision.

This was my first patient who died. I am relieved the woman was able to pass on peacefully, and that her daughter was with her, and saw that she was at peace. I am thankful the daughter told us to stop before starting the compressions and making this poor little frail lady suffer further. I am thankful she passed with dignity. I have been a nurse for over a year and just experienced my first ever patient death, and it really sucks Thanks for listening!

[TopazLover, BSN, RN]

I agree, death is not my enemy. Not my friend either. Sometimes it is right to fight it. Other times it is a kindness to allow the body to stop being badgered. We do not control the outcome. We play an important part. The OP did a fantastic job of nursing the ill and caring for the family. Both are unique challenges.

To the OP. Death is not easy to accept when we work with the same patients and hope for a better outcome. You did well. Learn from this how to make the next death, and there will be more, one you can handle as well or better.:hug:

[gcriado]

When you have such a big heart and compassion for people, that's when you know you did the right thing when you decided to become a nurse!! Great job!!

[Ruas61, BSN, RN]

You did good.

It s never easy.

Surprisingly, there will be some deaths that will be remembered as being 'good'. You will feel blessed or privledged to have been a part of them,

[RN58186]

The first one is the hardest. You did well, glad you were able to help the daughter through it all.

I have worked renal for 22 years. In some ways that makes it easier, but in some ways harder as well. Harder because we have known our pts over many years and do become attached to them. Easier because we have seen them deteriorate over those same years, sometimes to the point of them just being a shadow of who we once knew. I had one pt I had nursed for about 7 years on and off, (more on than off), he was well liked by all the nurses, and he chose to stop dialysis. I came on shift the morning he chose to stop treatment, went in and spoke to him and his wife. I left to go pour meds and see my other pts, and said to the other nurses along the way that "You know, I really, really don't want to be here when he dies". I got back from lunch and was just putting my purse away when his wife came to the desk and asked me to come check on him. He was gone. She said they were talking, and he just closed his eyes. I think all the nurses on that day cried. A couple of months after he died I ran into his wife at the mall and was chatting with her. She mentioned to me how much he had thought of the staff. Then she told me that after my initial assessment that morning, when I left the room he said to her "______ is my nurse today. That means I can die today." She said he was horribly afraid of dying with a nurse he didn't know looking after him and that it meant a lot to him that it was me that day, and because he knew me well, felt that it would be okay to go on my shift. She said he was so pleased that it was my shift, and said if he could have chosen his last nurse he would have asked for me. As much as I didn't want to be there when he died, her conversation a couple of months after the fact left me with a peaceful feeling knowing that just me being his nurse made his journey out of this life a little easier.

I won't say it gets easier, because I am not sure it does. But it sounds like you made a difference to the daughter that shift and she will no doubt remember you for a long time. Well done!

[katielam616]

Thank you everyone for the kind words! I am sure it won't ever get easier (and if it does I will need an extremely long vacation :) ) I hope I was able to help the daughter. She was, understandably, very upset. It happened much sooner than I think she had expected. I expected it to happen, but I thought the pt would last at least a day or two. I had just been in the room, suctioned her, given her pm medications through her NGT. Then she was gone within ten minutes. The daughter had told me earlier she thought it was very hard to make the decision for DNR, that she didn't want her mother to suffer, but was afraid of making the decision with the hope she would recover. Obviously what I and the doctor spoke to her about worked because when the moment came for her to the make the decision, she made it. I and the doctor sat with her after her mother had passed, reassuring her that the decision she made was the correct one. Her mother had been suffering, had been declining, and no one wants to see family that way. By the time she left I think she really understood what we had been trying to tell her for some time. We also told her her mother had known she was there, knew she loved her, and was ready to go. Needless to say when I was offered the day off today, I took it.

Btw, I love this website!!!! Thanks again everyone.