Com'on, you got one...What is your heart wrenching moment?

[CrunchBerries]

Mine was....

I was a very young, too young DON at a care home. I was working late one night doing paperwork. I heard odd noises coming from outside my office. I went out to investigate and I saw Marjean, one of my fav's sitting under a tree rocking back and forth.

I asked what was wrong, she kept rocking telling me she was just gang raped on the pool table of the game room.

Marjean was a hard core, paranoid schizophrenic. It never happened, while we had a game room we had no pool table and, we had cameras in that room. Naw, it didn't happen but SHE totally believed it did, it was one of her hallucinations.

While it did not *really* happen, it did happen in her reality and she was going through the same emotions as a true rape victim would experience.

I finally got it, I finally understood. Hallucination or not, it was still real for her. I just sat with her under the tree rocking back and forth.

We ALL have one or more of those moments, what is yours?

[AcuteCare4Life]

Ok, my turn.

My baby sister, 7 years younger. Sister was 32 yr with a 2 yr old daughter. At our grandmother's funeral, Sister told me she was going in for exploratory surgery to find the cause of her pelvic and lower back pain. This was scheduled for the Tuesday after Labor Day. When the Gyn Dr took our family into the conference room I knew it was going to be bad. Ovarian Ca; spread to her: lg & sm colon, liver, kidneys, ureters, bladder, uterus, lady parts, diaphragm, omentum and anterior abdominal muscle. My first thought was, "My God, she'll be dead by Christmas.". Sister fought and lived for 4 1/2 years!

To keep going, Sister had a Mediport and received TPN daily. I was a fairly new RN without experience with long term Ca patients. On the day Sister died, we did not realize it was the end. A different Hospice RN was covering for the weekend. Within the first 20 minutes she knew Sister was close to death. The Hospice RN and I managed to insert a foley catheter into Sister. She ordered a hospital bed and had it set up in the living room in 2 hours. What the Hospice RN did not do was make sure there was sufficient medication to ease Sister's pain while dying and educate our family on the dying process.

While Sister was dying, she kept saying over and over "Help Me Please! Help Me Please!" then it became only "Please. Please". I worked at a hospital where I knew I could get Narcs to overdose Sister, but Sister was dying and I did not want to leave her! The anguish and pain of watching Sister die was horrible! That was over 15 years ago.

Ever since, if I have a patient who is near death, I am their advocate for pain control and educate the family on what is and will occur during the dying experience. If there is any good from experiencing such an anguishing death of my Sister, it is that I'll do everything I can to prevent another person or family experiencing such horror.

[Amore1993]

This still bugs me to this day. I think they deserved to know what we did, but I was brand new, I didn't know anybody, and I didn't want to rock the boat. What to do when we killed somebody with straight up negligence wasn't exactly covered in school, either. I don't even know what I could have said. I really hope that somebody at least filed an incident report, but I don't know for sure.

This reminds me of my first code. It was during my med-surg II rotation in school and one of my classmates had answered a call light for a patient. This lady "Mary" said her back and neck hurt so to please bring her some pain medication. This was not a weird request since Mary had been in a mva a few weeks prior and was in a neck brace. My classmate went to the nurse and the nurse said just to ignore her and when she had a chance she would bring her pain medication if she remembered. The student freaked and was having a nagging feeling of something wrong happening so she went and got another nurse who was hesitant but went to go do a pain assessment on the patient. When the nurse went into the room, the patient was unresponsive and there was no pulse so a code was called. She yelled for someone to come do cpr as she needed to find the patient's nurse. Thats where I came in and started doing CPR. The code team came in after a minute or so, the patient became responsive but was screaming about how much pain she was in. She ripped out her IV and was thrashing around saying please give me something for my back, please give me something for my back! Her eyes rolled back and she became unresponsive again. I continued to do CPR again until she was shocked and became responsive again while people were rushing to get a working iv in her again. From that point on, I was able to stand back and observe as a student. Thats when the nurse finally walks in the room and the the house officer asked where she had been. She said she was behind on giving meds and needed to catch up before coming in. The house officer was obviously peeved but maintained his composure. He asked her to give report to him so that he could get some background on the patient. She said Mary is a 60 something year old woman who was here for observation for lower gi problems and was set to go home that day. She is 2 weeks post mva where she had a neck injury. She had no history of heart disease or diabetes. Thats when the patient codes again and the house officer tells the nurse to call her admitting doctor to let him know what is going on and if there is anything he wants us to do while he is in route. While on the phone in the room she stated the patient is having severe back and neck pain. She didn't mention anything about the patient actively coding so he just upped her pain medication dose and hanged up. The house officer got visibly angry as he then noticed the patient had a chest scar. The house officer ended up having someone bring in the chart as it turns out she had 2 quad bypasses and porcine valves inserted all over a span of a decade and half. The house officer ended up calling the doctor back explaining the scenario and a heart cath was ordered. The patient ended up coding again on the way to the cath lab and 3 more times in the cath lab. As we were wheeling her out to the cath lab, I noticed the family standing against the wall with the chaplain. The husband said through his tears, "I love you baby, you are going to make it through this my love. There is so much we have to do." And then he gave her a big kiss on the forehead. Her daughter was crying begging us to save her mother. Mary ended up passing away later on in the ICU (My instructor was very gracious allowing me to stay with the patient the whole time).

I still feel angry to this day about the way the code played out. I don't know if Mary would have lived or died but to see her nurse not know that she was a severe diabetic and had an extensive cardiac history was inexcusable. Perhaps if she had mentioned the patient had coded 3 times already instead of worrying about the back pain could have allowed her to receive necessary care sooner. I feel the family who was apparently in the room for the beginning of the code (I was too focused on her to notice) deserves to know that the ball was dropped in her case. I feel angry that the nurse was angry at us the students getting a second opinion from another nurse when we felt hesitant in the patient condition. I did end up filing a complaint with my school so that the nurse could not precept us again in the future. That was towards the end of my rotation with that hospital so I don't know what became of it but to this day, "Mary" still haunts me. I tear up just thinking about it and thinking of her family crying in the hallway.

[xx_remix]

My first code was pretty sad. It was an extern day in the SDU. The patient was a man in the late 70s with hx of CHF and DM, among other things. His EF was about 15-20% per his chart. This was the first I had even heard/had him as a patient, although he had been on our unit for a while supposedly. GCS 14.

He was a dialysis pt, super swollen with extremely weak pulses that required us to use a doppler. Anyway, he seemed relatively stable the first and second day. His vitals did not indicate that he was going to code. First he had about 3 beats of vtach, then 5 beats fifteen minutes later.

This is where my charge nurse tells me that what happens to the patient determines whether I have a cloud over my head. She knew he was going to code, but I wasn't sure.

He has a few more beats of vtach maybe 10 minutes after this. His wife and daughter are literally walking in his room, and I'm picking up the phone to call the doctor about the increasing # of beats. I didn't even get to dial his number before the pt went into full blown VTach JUST as his wife and daughter walked in the room. The TELE alarms were going off the hook. They were scared because he wasn't responding and the alarm was dinging like crazy.

He just went unresponsive. That morning he was yelling out and talking like a GCS 14 would. And now, we were coding him while his wife and daughter were sobbing in the corner and making phone calls to loved ones. I tried to comfort them between rounds of chest compressions, but I didn't know what to do or say except to just put my arms around them.

He progressed to vfib fairly quickly. We coded him for 30 minutes with no luck. As the doctor called the time of death, the pt's daughter covered her mom's ears as they both sobbed. We cleaned him up to make him more presentable for the family to mourn. His eyes would not stay shut, unfortunately.

My preceptor had a stomach ache that day. He said it went away during the code (adrenaline). It came back afterwards and he ended up going home. My mind was in a blur the rest of the day. I had to hold in my tears and had a quick cry in the bathroom. I still think about the whole event constantly.

There was so much wrong with the code. Whoever put the AED pads on didn't put in the backboard when the back pad was attached. This was realized about 5 minutes into the code. I believe the AED pads weren't attached at the first shock attempt. There were too many doctors trying to run the code. I had a young doctor yell at me for stopping compressions to get the next person in line to continue (I asked the next person if they were ready, as I was getting tired).

The crazy thing is, we carry little walky-talky type things called "Vocera" so we can call other nurses, care assistants, or the monitor techs and vise versa. In my state of disaray upon entering the room, I tried to call the MT to call a code. I somehow managed to record the beginning of the code so it was my voicemail message.

All I heard was my preceptor yelling our preceptors unresponsive name when he ran in the room. My stomach dropped when my preceptor played the message to me when he was trying to call my vocera one day.

I feverishly changed my voicemail message that day.

[ArkansasLPN]

I went in to pass PM meds around 8pm. Shortly after I came in the room the patient had a 20-30 second Grand Mal seizure. The spouse was at bedside and I briefly explained what I believed was happening. The initial set of vitals about 2 minutes following the seizure were 50/20's, HR 40's, and SP02 70's. I had enough time to page the consulted neurologist and speak with the on call internal med APRN once. Apparently the whole hospital was chaotic at this time, so normal venues of help such as rapid response were busy. I called a code blue maybe 5 minutes after the seizure, HR was 18 and BP was 30/teens when I call. We started bagging and compression immediately after calling. I started a fluid resuscitation immediately after seeing his pressure in the pressure plummeting. We coded for 30 minutes and the patient was asystole the entire time. The spouse was at bedside this entire time. I was watching her face when doctor looked up and called time of death, her heart was broken. She just lost her husband of 40+ years and he was her only family too. It was a very sad night. Sepsis and meningitis were the culprits.

[pct333]

wow that almost made me cry!!

[SleeepyRN]

Or, maybe not. I'm pretty sure he is fully capable of explaining that himself vs. discussing his story if that is how he felt.

"Or maybe not." Did he tell the story? It's one thing to make a thread where we can share our "gut wrenching" stories. But to pry and insist a person who basically said "peds, flight nurse, nuff said" share his "gut wrenching" story is just....wrong. And in my opinion twisted.

[NICUmiiki, DNP, NP]

Coding a 2yo for 45 minutes whose skull was broken when it was crushed by a car tire.

[la_chica_suerte85, BSN, RN]

I don't cry very often, but these precious memories have tears streaming down my face.

I can't stop reading and I can't stop crying!

[Jmarty31]

I always feel bad for alcoholics, whenever I see one I feel blah, or heart issues, saddest part of my internship, second shift, guy had CHF

[gibsongirl]

I am so sorry for your loss. I don't have a sister. I can't imagine what that was like. How strong she was to live 4 1/2 years after that diagnosis..

[Jmarty31]

Probably tonight... Lost my first. Definitely one of the saddest moments I've experienced as a student.

[smile_through_it]

My first loss in the ER..

70y.o. comes in hypotensive and vomiting large amounts of blood. Alert and oriented x4. He was a DNR but wanted blood. I rapidly infused two units of blood... And his blood pressure continued to decrease. In a matter of 30 minutes he was confused and in 45 minutes he was unresponsive with a HR of 28. He had no family to be with him. So I stayed and held his hand and said a silent prayer. He was only in the ER for 56 minutes when he passed. That one was tough for me.