Death- Do you ever get used to it?

  1. I have been working as a CNA for almost 2 months. About 2 weeks ago I had a resident die. That was the first time I accually had that happen to me on my shift. I have never seen anyone die, and only had 1 great grandma die in my recent memory.

    I knew that the resident was going to die any day. I could feel it. Everyone else said that she just had a UTI, that they all act like that when they get uti's. I disagreed. She was 93 years old. Anyway, when I began my shift at 11pm I went to go check on her because she had just gotten back from the hospital and she had a folley cath. put in. When I went in her room, she was sleeping (first time in 3 days) but her breathing was very forced and had a gurggley sound to it. It also smelled like she had a bm, wich she never used to do in her pants. We checked in on her every 10-15 mins that night.

    Around 3am I was toileting another resident when the other CNA came in the room and said that I better come and check on this one patient, she said that she was cold and had white foamy stuff comming out of her mouth. I grabbed the vitals kit, but knew I didnt need them. I went in her room and instantly knew she was dead. She was pale white, cold to the touch and I couldnt find a pulse. From there we called 911, they came, hooked her up, verified that she was dead, then the med examiner came, the family, then the funeral home took her away.

    Ever since this happened, I have been thinking about death and dying. Mostly when I cant get to sleep. I get scared at work a lot now. I work 3rd shift, and I am always hearing things, or seeing things that scare me. I think her death did something to me. I am not thinking about her lifeless body, its more a mental picture of her lying there, taking those gurgly last breaths. We had to wipe the foamy stuff off of her mouth before the family went in to see her, The other CNA handed me a washcloth, I told her that I couldnt do it. I kept thinking she was just going to jump up and be alive again.
    Will all this go away with time?

    Do you ever get used to it?

    Thanks for listening to me!
    Last edit by jb2u on Sep 3, '06 : Reason: Edited out name of pt.
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    About CJolin

    Joined: Jul '06; Posts: 18; Likes: 1


  3. by   ktwlpn
    Quote from CJolin
    Ever since this happened, I have been thinking about death and dying. Mostly when I cant get to sleep. I get scared at work a lot now. I work 3rd shift, and I am always hearing things, or seeing things that scare me. I think her death did something to me. I am not thinking about her lifeless body, its more a mental picture of her lying there, taking those gurgly last breaths. We had to wipe the foamy stuff off of her mouth before the family went in to see her, The other CNA handed me a washcloth, I told her that I couldnt do it. I kept thinking she was just going to jump up and be alive again.
    Will all this go away with time?
    Do you ever get used to it?
    You don't really "get used to it" but you will not be frightened of it.You are never too young to think about death and dying-you should let your loved ones know what your wishes are and you should encourage your parents and other family members to do the same. Think of her body as a glove and her spirit the hand-when she was making those gurgling noises she was past the point of feeling anything.The hand was already pulled from the glove...Everyone dies in their own way-some gently and some kind of ...not gently.You can expect the bowels and bladder to release (not always-if the person has not been alert and was unable to eat and drink for days this may not happen) You may see fluids from the mouth-sometimes the body fluids contain blood.You'll see changes in the respirations and changes in the skin color.You may sometimes get a feeling that death is near but sometimes you'll be surprised that a resident lingers for 12 or 14 days. Also sometimes after death the body may make noises that sounds like it is breathing.I know of one instance where a resident died,was pronounced by the nurse,the doctor and family were notified.The staff went in to do the post mortem care-when they turned him he started "breathing "again...They all freaked! I don't know actually what he was doing-but it stopped in a few minutes.It sounds like your facility did not really talk to you about death and dying-maybe you can ask for an inservice? It sounds like you have a bit of post traumatic stress and need to relieve it..Talking helps-good luck
  4. by   jb2u
    Some people "get use to it" others do not. However, if you are having difficulties coping then I'd suggest that you speak with your supervisor or DON about your fears and possibly receiving counseling. I believe that this is your best course of action at this moment.

  5. by   Thanet
    When I started as a nursing assistant (Many moons ago), my second placement was with the elderly.
    I said to the DON that I didn't want to work there as they would die on me.
    She looked me straight in the eye and said,
    "Your job is to make their last days as good as possible. Let God take care of them when they die."

    Do you ever get used to it?
    No, I don't think you do.
    But I always like to think that we did the best for them that we could have.
  6. by   leslie :-D
    the first few deaths are extraordinarily hard on anyone.
    you should really read and reread ktwlpn's post.
    what she speaks of is very true.
    we usually give meds to (dying) pts specifically to dry the secretions-the gurgling and foaming you witnessed.
    not really for the pt, but for the family members present.
    the pt is not in any respiratory distress and is totally unaware of the gurgling.
    since they are no longer swallowing, their secretions pool in the back of their throats.
    as the body shuts down, muscles relax.
    thus the reason for fecal and urinary expulsion.
    not all pts do this.
    as for the official pronouncement of death.
    i remember one time i pronounced a pt...prematurely, or so i thought.
    she had no pulse, respirations, pupils fixed.
    but every 2-3 minutes, she kept on how i would describe as an expiratory gasp.
    kind of blowing out air.
    being a new hospice nurse, this was a first.
    it was later explained to me that the pt had indeed died, but her body continued to expel, if you will.
    just like when the muscles/sphincters relax enough to expel feces/urine, the body can still expel air, through these 'gasps'.
    it certainly does not happen often, but it's something to keep in mind.
    but please, keep in mind: just as the physical shell shuts down (ktwlpns' glove), the spirit is released.
    i don't have the time or energy to share my many yrs as a hospice nurse, but it truly is a spiritual experience.
    in ltc, you will see more deaths than in other specialties.
    perhaps hospice, icu being exceptions.
    i would suggest examining your personal thoughts on dying, and if/when you come to terms with what your belief is, that you will hopefully find more comfort in the dying process itself.
    i know that when i did work ltc, there were cna's that never became comfortable, but that was more of a cultural belief, rather than personal.

    best of everything.

  7. by   chadash
    No, you never get used to losing your patients. When you lose one you have had longterm, it really is so have lost a friend.
    But, you do focus on the patients family, they have lost a lifetime of relating, so what you feel is so very small in comparison.
    Your ability to deal with grief will become better and better.
    Each life is so precious. Every soul matters to God. Every passing is sacred. But, it is the natural course, and seems merciful when someone has suffered. It is about them, not us. That helps alot.
  8. by   Maverick80
    Is it possible to get used to it?

    I'm a nursing student, and about a month and a half ago started working as a nurse tech at a local, level one trauma emergency department. On the last day of orientation, i lost my first patient. But he had only been in the ED for 30 minutes or so. He came in as a full arrest. i did chest compressions on him for about 5 minutes (the longest five minutes of my life it seemed). It was strange when the resident called it. Mixed emotions, i had had no contact with this patient prior to him coming in.

    Doing post mortem care was different too. I learned about it in school, but actually doing it, prepairing the body, and taking it to the morgue....nothing really prepares you for that.

    I actually took it better then i thought. But i'm in the ED so i really don't have much contact with these patients. I haven't been taking care of them day in and day out. (one reason why i don't believe i'm cut out for long term care, and i have the utmost respect for the people who can do it).

    Don't ignore your feelings, try to get help, or just talk to someone. It won't go away until you actually deal with the situation. i lost a grandfather when i was 12 and didn't actually deal with it until i was a senior in high school.

    I'm new at loosing patients, but i also have a feeling there's a reason i love the fast paced craziness of the ED. I don't think i could emotionally deal with losing patients i had cared for day in and day out, i can become attached fairly easily.

    Just remember everyone has there own way of dealing with it, so always do what's best for you.
  9. by   niko1999 RN BSN
    No, it doesnt get easier. I saw my first patient die before I was actually out on the floor. Needless to say, it was a very sobering experience. Some people, after the person dies, when youre doing postmortem care, are able to turn off every connection to the fact that that was indeed, just minutes before, a living breathing person. As crass as it sounds, Im glad Im one of those people. Makes post mortem much easier to attend to. But if it bothers you THAT much, see someone and talk about it. Feel free to cry about it, to say a prayer., whatever you need to do to make it easier for you, becuase being in the position youre in, unforutnalty there is no way to get away from it.
  10. by   Motherpain
    My advice is accept it. Embrace it. There is nothing more beautiful than to be with someone in their final moments of life. Sure, the gurgling and the other messy stuff is traumatic, but this person is dying......We want to view it like "movie" death where they close their eyes and they are gone...Well, it doesnt always happen like that. I try to look through their eyes, i am at the END of my life. I am scared and I have no idea what may lay in store for me....(you get the picture) I am not trying to sound morbid i am just sharing what works for me...
    Please note: for terminally ill patients seek out Hospice, they are wonderful and assist in making death a lot easier for the dying and deaths survivors (family)..thanks, willie p.s.-- Good Luck!
  11. by   BabyRN2Be
    There is a great post with a link to a Medscape article over in the Hospice nursing forum. The post is titled "The Last Hours of Living: Practical Advice for Clinicians."

    It's on Medscape so you have to register, but registration is free. It's really a great article. In fact, I've saved it to my computer for future reference. This might be of great help to the OP as well.
  12. by   Arkansas RN
    I have been a nurse for 36 yrs mostly in critical care so have lost many, many pts. You never get "use" to it but the one person who said you cope better is right. Someone told me when I first got into nursing that if things don't still bother you, if you never get scared, and you don't cry at times, you need to get out of nursing. I think that is true. I am glad that it is still hurts at times to loose a pt. While I view death as a miracle of life, it can still be very sad for those of us still here.

    Do find someone to talk to because that will help you a great deal.
  13. by   One Flew Over
    My first patient was going downhill. I said to my mother (the charge nurse, funny eh?) "I don't want to be there when she passes on, I know I can't handle it." I knew with my luck I woud be though. So I'm in there making her roomate's bed when I hear her breathing strain moreso than it had been that morning. I walk over to her and kiss her on the cheek and brush her forehead a bit to calm her down. 'You can let go if you want to Catherine, it's ok.' I swear it was only a minute later, when I finished the other bed, her breathing had stopped. The charge nurse came in, being just outside the hall, confirmed she was gone and we positioned her. I handled it better than I thought I would. A little later as I cleaned up her room, I was grabbing her comforter and I brushed her chin by mistake. The coldness grew to be something that haunted me for a few days after. So my anwser would be, no, I'll never get used to it.
  14. by   augigi
    I think you do get used to it, but it doesn't make it much easier. In ICU, it happens a lot. Most of the time, it doesn't bother me. Sometimes, it does, and that never gets easier. When something about a patients just "gets you", all you can do is look after them and their family, then leave the room and shed a tear.

    My first experience of death was a gorgeous old lady named Lizzie at a nursing home I worked at as a nurses aide during nursing school. She was a dear old thing I got to know, and I was a blubbering mess. Sometimes I still am. Most of the time, you are glad they are not suffering anymore.