A Patient Made Me Cry Today

My skin is really thick. I've seen a lot of things between being a nurse and a paramedic. I've seen abuse, neglect and death before. Today, I got a patient from the emergency room with a massive infarct. The report I got never could have prepared me well for this patient. He truly broke my heart. Nurses Relations Article

When he arrived to the floor, I couldn't honestly tell if he was breathing. His gaze was fully deviated, he was contracted to one side, and had incredibly shallow, labored mouth breathing. I pulled him from the stretcher to the bed, got down to his eye level, held his hand and said "I'm allison, I'm going to be your nurse today." he pulled his hand away from me, completely frightened, and yelped out. I asked him a series of questions, but he had no answers. Just a wide eyed, terrified, deviated stare.

He was 88 years old and he looked like he was a survivor from auschwitz. He was so emaciated, he may have weighed 80 pounds soaking wet.... Upon assessment, I could actually see his guidewires from his pacemaker bulging through his skin. His skin turgor was so poor and he was so dehydrated that we were unable to place a peripheral line... And after two sticks from me, I gave up. He had been hurt enough.

His body was covered head to toe in bruises, in various stages of healing. They looked like palm prints and hand prints. His skin was totally ecchymotic and he had so many skin tears it took 12 pages of wound photos to document them all. His skin peeled back like the skin on a banana just by touching it... And on his back and his shoulders, a purple hand print that was probably very fresh.

I turned him over to assess his back. He yelped out again. His orifice was excoriated and bleeding and was probably the size of an apricot or small plum... It appeared that something was forced in it. He shook in fear and moaned loudly as the cna and I gave him a good bath, combed his matted hair, put him in a clean gown and applied lotion to soothe his dry skin.

I called the abuse hotline. I never intended to point a finger of blame... But someone had forgotten to treat this man like a human being. Social services came and did their own assessment and took lots of photos. He continued to moan, louder and louder. He pulled away every time we touched him as if we were going to hurt him. What happened apparently was he was at a nursing home until his medicare ran out... But made too much for medicaid, so he had been paying a "caregiver" to see to his needs at home. I didn't see this caregiver.. And I'm glad I didn't.. Because I may have said something very bad.

Lab called.... His troponin was 17. His infarct had spread to over 4 leads. His bp was dropping and his urine output was 0. I chased the doctor down to the icu to get a hospice referral and a dnr. I was not about to have to call a code on this man. The least I could have done was to get him a comfortable death. Paperwork was signed and hospice came to see the patient and agreed to take him at the end of my shift this evening.

I documented and documented. I turned him every hour, swabbed his mouth, made sure his skin was clean and dry, and went and sat for just a minute by the bed, to make sure he knew that if I he wanted to go, I would be there to sit with him. I didn't want him to die alone, not like that.

The paramedics came to pick him up and bring him to the hospice home. I signed his papers and helped them place him on the stretcher. He just kept moaning, and letting out these yelping noises. I walked them to the elevator and grabbed his hand and said "they are going to take you to the hospice house, so you can be cared for and comforted. It's ok to let go now." his eyes didn't move, but I knew he knew I was there.... Because tears started rolling down his cheeks.

And without saying a word for 12 hours, my patient made me cry.

May god bless him. I hope his ending is peaceful and that he is moved on to a much better place than was ever provided to him here. Today, I remembered why I became a nurse.

You obviously misunderstand my posts. I am sorry that I am not clear. I actually am stating the *opposite* of what you are thinking. I felt that by assuming the 'stereotypical' nursing role I am actually doing more *harm* to the patient. I am as disgusted by neglect as you are, so please don't put me in that category.

I understand what you are trying to say, but you can't judge me on one (OK, a couple) 'confused student' post. If I were to judge you so rapidly, I would ironically assume that you are as compassionate as you assume me to be, judging by your last comments.

I understand that I may have differing views than some of you, but since we are not all robots, that should be expected on a public forum. Please, can we let this go? If you are trying to help, thank you for your advice.

To the OP, I'd like to get back to your original post, and I'm sorry for all of this.

P.S. For anyone who actually cares about nursing retention (you do want to retire one day, right? :)), I think it's important to let students ask questions and address REAL issues in nursing. If you can't ask questions here, where else would be best? If every nurse says that they have never felt conflicted, frustrated, or confused with their job, I'm willing to bet that at least some are lying.

Specializes in Med-Surg, LTC, Rehab, HH.

Canuckstudent wrote:

You obviously misunderstand my posts. I am sorry that I am not clear. I actually am stating the *opposite* of what you are thinking. I felt that by assuming the 'stereotypical' nursing role I am actually doing more *harm* to the patient. I am as disgusted by neglect as you are, so please don't put me in that category.


I am sorry. Please accept my apology. I came in on a conversation and missed your first posts.

You will be a fine nurse. Dont worry.

Specializes in ICU/LTAC.

Canuck Student

Understood. Your first response explained. I know you are giving exceptional bedside care. I understand not "having nursing in your blood". Understand 2 am ramblings also. I appreciate the route you are taking to get to your goal, your hard work is commendable. Again Best Wishes to you.

Specializes in Med/Surg.

Canuck, I keep coming back to this, only because you insist on continuing to insinuate that morphine is given to dying patients to hasten their death. It just is not, I'm sorry. You keep phrasing it slightly different, and saying that if we don't know if we're giving it for pain, etc........pain and comfort is the reason it is ordered and administered and that is IT. Period.

Specializes in LTC, CPR instructor, First aid instructor..
CanuckStudent said:
My interest lies in the best way to manage palliative patients, although not through providing direct hands on care. The nursing role in palliative care is not for me. But I would like to learn more about what works best for patients, and how to allow patients to die with dignity on their terms. I also would like to know how I can work with nurses to streamline care for patients who are dying and also make it easier on the nursing staff. Basically, I am asking how I can improve the 'team'. Because that in turn will help the patients.

You are very correct, it is the nurses who are with the patient for the majority of the time. They are the MD's eyes and ears (and I'm sure some of you would say 'brains' as well). ;) So I want to know the best way to provide streamlined care for these patients and work WITH the nursing team. MDs need that input. MDs focus on diagnosing and treating disease (my interest). Nurses have to focus on everything else, including response to illness and treatment. These other numerous factors impact the course of a patient and thus affect disease process and/or treatment as well.

Each person deserves to have a dignified death on their own terms, if possible. I want to know how to make palliative care the most 'efficient' for patients (for lack of a better term). As an analytical person, I like to look at data and try to find solutions. Although I may come off as abrasive, please do not mistake me for someone who does not care. I care a lot, perhaps too much.

Canuck student, I like your intent, and I admire it. I believe I understand what your are saying. I wish you success in your endeavor. Your are a very ambitious person, who only wants to improve palative care for the dying patient. I am currently in palative care, and have been in hospice care. I would much rather die at home in my own surroundings than in a hospital or a nursing home where I would be shoved on a shelf in the morgue like a piece of meat.

Flightnurse did give TLC care to that poor old man. I know she didn't want to make him hollar or cry out. Remember, his condition made her cry, and she is a well seasoned nurse who has seen a lot of trauma cases. What was done by her and investigators was what was needed to investigate further into his case. I know that former caregiver who abused him so much will get her/his reward for hurting him that way one day too.

Respectfully yours,


Specializes in -.

OP, You are an Angel :redbeathe

I really agree with those people who commented above.. You are such a good nurse.. You made the last days of that man a wonderful one.. Your story really touched my heart.. I am a nursing student and I also experienced some heart wrenching stories about my patients which motivated me more to pursue my studies.. Thank you for your story.. This inspired me more to pursue my profession..

you are a very good nurse. i know that if the man was able to speak. he would surely thank the kindness you've shown him hours before he died :)

Upon reading your story, it inspires me a lot regarding the true essence of being a nurse. It's not just about caring but assisting our client to face death with dignity. I am a nursing student , and I am motivated by your story to continue my passion in caring. ?

That story made me so mad at the person who was supposed to take care of this guy. I am glad I do not know who it was. Did this person end up getting thrown in jail, do you know. I hope he had a peaceful ending.

Specializes in PICU now, Peds and med-surg in the past.

God Bless You! You are truly an awesome nurse and this man was lucky that you were the one to be there caring for him and advocating for him. I hope he found his peace. Your post brought tears to my eyes - it's been several years since I cared for adults and that was a bold reminder that caring for those adults can be just as heartbreaking as caring for the kids. Keep up the great work and remember to take care of you, those types of situations can easily burn a nurse out! :yeah:

Wow. This story brought tears to my eyes.