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advise; how do you handle the loss of a patient?

Nurses   (1,932 Views 19 Comments)
by idnurse2b idnurse2b (New Member) New Member

414 Visitors; 2 Posts

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I am a fourth semester nursing student and last semester I experienced my first code (she actually coded three times). I felt like I had mulitple personality disorder after it. Part of me was really excited because I had never been involved in a code blue before and I had never seen CPR performed on a person. It was a learning experience and I took advantage of it. The other part of me was horrified at what I had seen. This patient was young and her children who were my age were in the waiting room. I managed to keep that side of me at bay until I got off from clinical and went home and started to process the whole thing and then I burst into tears.

So, my question; Am I supposed to have a "nursing" mode and a "normal human" mode? Or am I supposed to find a happy medium between the two? It almost felt like a defense mechanism so I could function through the situation.

I am planning on being a NICU or peds nurse, and sometimes I worry about how I will handle it when my patients don't make it.

Any advise or comments would be appreciated :)

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2,138 Visitors; 70 Posts

Working as a Cna i witnessed alot of my patients pass away, yes i do get emotional but i try to find a common ground, people pass away we can't keep crying for all of them, you gotta remember they are in a better place.

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casi has 3 years experience and works as a LTC RN.

17,037 Visitors; 2,063 Posts

I've found that in emergencies I do frequently shut down the emotional side of myself. In order to give the best most focused care to the patient it seems to work the best.

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1,305 Visitors; 21 Posts

As a cna, I've seen my fair share of death. While I've learned to cope with the long struggles and horrible disease death that can seem as a blessing, there are the patients who you become attached to, and the young tragedies.

During an emergency I definitely go into "function" mode, then after, I like to talk myself through it and try and learn from the experience, and then I usually go into "feel" mode. But once I get through the learning, I realize that I did everything I could and call it a night. Sometimes this takes a week, sometimes only a few hours.

Don't stop "feeling" b/c that's the basis of our profession: compassion.

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dthfytr has 30 years experience as a ADN, LPN, LVN, RN, EMT-B, EMT-I and works as a Disabled.

12,223 Visitors; 1,159 Posts

Everybody dies, it's the price we pay for living. It's a normal human bodily function. It's the situations that make it hard. There are infinite variables. The terminal patient whose family wont sign a DNR. They keep dying and we keep forcing them back to life so they can die again. Those whom we think die too young. The conflict between those whose lives we can prolong but whose suffering we can't control. Our own beliefs about what happens after death. For me every death is as individual as the patient, and I'm always reminded of the poem, For Whom the Bell Tolls. You'd think after all these years I'd have some magical reassuring and comforting answer, but that's the best I can do, other than to know I was there to give the person every chance to live if Supreme Management would allow it.

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Tait has 13 years experience and works as a RN-MSN Ed, Pain and Spine.

6 Articles; 28,072 Visitors; 2,093 Posts

Deal now, cry later. I however failed at this when my first patient passed a few months ago. She was a DNR with pneumonia and when I knew nothing could be done other than let the RT titrate her BiPAP I left and sobbed hard in the bathroom. My secretary and good friend called my phone and said "I know this is hard for you right now, but we really need you out here."

I wiped my eyes, dusted myself off and went back to watch her die in front of me, and then spoke fondly of the four hours I had taken care of her when her family arrived. They were so gracious, and left me feeling like I had done all I could (and I had, but that is more than needs to be said here).

I cried all the way home that day.

Tait

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PostOpPrincess has 19 years experience and works as a Ubermom.

11,901 Visitors; 2,211 Posts

I witnessed a death the other day that has impacted me. I didn't think I could "feel" so much after having part of a code team and having participated in a bajillion, zillion codes.

You never really learn to get "over" a code, you either compartmentalize or you reconcile in your mind the spiritual reasons for the death, and move forward. It's the unexpected deaths--the ones who were getting ready to go home, the ones who were having routine surgeries, the full term newborns who was perfect, and for whatever reason didn't survive--the child, the young mother, the young father, the kid next door.....those are very, very difficult.

You have to learn and reconcile your own fears, your own thoughts about death and dying and what helps you cope. If you don't, you won't last long.

The code the other day has left me confused, and questioning my life philosophy. But at least I'm sleeping again....

J

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8,165 Visitors; 784 Posts

In the end, all you can do is hone your skills to be effective in times of emergency, understand the frailities of life in the times you could not help; and moderate your reactions when life ends beyond your wishes and expectations.

We are often angry, frustrated and powerless in the situations we find ourselves in. Do what you can, go home and live your life. Hug your kids, love up your partner; put your feet up and have a beer. Whatever it takes. Whether it is yoga or primal screaming, find an outlet and let it go.

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azhiker96 has 10 years experience and works as a PACU.

1 Article; 41,997 Visitors; 1,118 Posts

Focus on what needs to be done at the time and then give yourself time to de-stress later. I have cared for a couple of hospice patients and was fine when they died. What shook me more was the patients I had to fight to keep here who did well. The last one was a young child. We fought hard and managed to get his sats back up, and breathing on his own. Over the next few days I went through several of the stages of grief because it had been so close. We do our job because we're professionals. We shed tears because we're human.

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nurse2033 works as a RN, paramedic.

3 Articles; 28,148 Visitors; 2,122 Posts

It is fine to greive for a patient, once you get home. On the job you need to focus on your job which is treating the patient, and providing support for the family. A good friend worked peds ICU and I don't think I could handle it. Kids who die as the result of abuse and neglect were not uncommon and come of the injuries my friend described made my skin crawl. The hardest part was getting coffee and chatting with child abusers while they waited for the police to arrive. It is natual to be affected by death and dying and once you aren't its time to move on. Best of luck.

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tralalaRN has 21 years experience and works as a pediatric in-home care.

4,139 Visitors; 155 Posts

If you want to land in the NICU, this is going to be even MORE difficult when patients pass away, and it happens pretty frequently. . .dealing with death of an infant (and dealing with the anguish of the parents) is about the most difficult thing a nurse can do. The NICU has the highest turn-over of most nursing professions - not just dealing with death, but dealing with what some call "salvaging" babies - and inflicting pain upon these tiny ones. It's an ethical quagmire.

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Rabid Response has 5 years experience and works as a RN.

7,683 Visitors; 309 Posts

Two nights ago I had to call a code on a patient who I responded to as a rapid response call. The patient died. I thought that I had become really good at dealing with death, but this one has jarred me. I keep remembering how the man clutched at my hand crying "help me" before his eyes rolled back, and I lost his pulse. I started compressions immediately, the crash cart was already in the room, anesthesia was on the way anyhow (MDs had decided to intubate just to be safe), and two MDs were standing in the hall outside his door. After 30 minutes they stopped the code since we weren't getting a carotid pulse even during compressions, and the most likely cause of his arrest was a rupture of his recently repaired aortic aneurysm. When the MD first mentioned stopping the code, I could not help but whisper/blurt, "He's only 36." She snapped at me, "It would make no difference if he was 86!" Oh, but it does, it does.

I get a little twinge sometimes when daughters sons and grandchildren come in to pay their last respects to grandpa who died after a long drawn out illness. I bring them tea and tissue boxes and set up chairs next to the bed, but I am clear and professional and mostly unphased. When the 36 year-old man's wife showed up at the hospital and learned of his death, I was almost paralyzed. The most I could do was to hand the MD a box of tissues for the wife and scuttle away to focus on my charting. I couldn't tell his wife that the last five minutes of his life were spent calling for her. Yes, it was touching that he was thinking of her, but she might have felt guilty since she had decided not to sit up with him in his room that night. We had called her to come in at his request as soon as he'd become short of breath, but she arrived at the hospital a half hour after his death because she had to take time to find someone to mind their two small children.

I so wanted to tell the MD running the code, "It is so effing NOT the same as losing an 86-year old."

Sorry, I'm realizing that I'm not helping you with your question at all. I guess how I'm dealing with this is to vent to anyone who might have some inkling of empathy. In two days I'll be fully functional.

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