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?

[twinmommy+2, ADN, BSN, MSN]

One time that hits me in particular was my first difficult pediatric SANE case. One two year old little girl was found wandering in the street with no shoes in the winter and was brought in to be checked out. She made the local news, but her four year old sister didn't. Both were brought in together. The younger was otherwise well kept and in good condition. As I walked into the exam room they were playing and dancing together and it was immediately apparent who my focus was. The four year old couldn't dance as well as he sister. Her hair was matted badly and bald in spots. Legs and arms were rail thing while her stomach protruded a bit. The local fire department had found her new clothing to wear since the diaper she had on and the clothes were soaked through with days of urine and feces.

Surprisingly she was trusting of the new strangers in the room. She came and sat on my lap to play for a bit but said few words. While we waited for the police officer to arrive I was able to complete the interview with the emergency foster parents who knew of the story. When the police arrived we quickly performed an examination and was the only exam where I called in the police to take pictures along with me because there was so much bruising. The child went from loving and playful to crying and very fearful at any attempt to look at her diaper, rolled into a ball and froze in place. There was diaper rash old on new. New and old bruises where someone forced her legs open. Old and new scars on her thighs.

Once the exam was over the foster mom had to walk out with the other child, so I was left to chart while watching this angel. She climbed into my lap and clung to me, hugging me. I figured that this was the only way charting on this would be completed so we sat in a private part of the nurses station together.

I recently heard that none of the cases I worked on ever were called on for testimony. That was the only thing that sucked about that job was not knowing the outcomes of these cases, especially this one. I still think about her.

[jenrak]

I was an ER nurse years ago and my parents had vehicular accident and they were sent in the hospital where I worked. I didn't know they had accident until they arrived in the unit. My dad passed away in ER unit on that same day while my mom only lasted for 3 months as she sustained cervical SCI. I stopped nursing for 6 months. I thought I cannot go back to nursing because of the trauma.

[calivianya, BSN, RN]

Mine is my first code as a nurse. I'd had a couple of codes while I was a student, but I knew we had done everything we could for those, so I'd been fine with them. This one was different.

We'll call him Jim. Jim had end stage heart failure and end stage COPD with histories of multiple MIs. He was a pretty sick guy. He had developed the habit of telling his family goodbye before any hospitalization, just in case, because he knew how sick he was and there was a chance one of his diagnoses would do him in at any time.

I never got to meet him, really. That day, as I was walking through the door, night shift was coding a patient. I asked the charge nurse whose patient that was going to be and she said, "Yours!" Oh cool, I thought, second week on the job and I was going to get to see how this hospital ran its hypothermia protocols, etc., assuming the patient lived. It was going to be a good day! I was obviously going to have a great orientation because I was getting some really sick patients!

My preceptor and I immediately jumped in to the code and got some compressions in, gave some drugs, etc. and we got Jim back - sort of. We got a heart beat, at least. Jim's pupils were blown and he had no spontaneous respiratory effort. Since Jim was temporarily stable, we started getting report. We got report from a different nurse than the one who'd had him. It turns out that Jim had been having arm pain all night. Jim had told the night shift nurse that he'd had arm pain like that the last two times he'd had a MI. She'd labeled him as a complainer, gave him Tylenol, and told him to go back to sleep. Multiple times. A few hours later, his pulse ox wasn't picking up well. "You know those COPDers," she'd apparently said, "Sometimes it's hard to get a good pulse ox on them."

Somebody else finally walked into the room at 0620 or so, and Jim was gray and unresponsive. He had a rhythm on the monitor but they couldn't palpate a pulse, couldn't get a BP to cycle either, so they started coding him.

I started to get a really sick feeling about all of this. Jim might have an extensive history, but it was immediately clear to me that we killed him, and he might have been alive this morning - really alive - still if he'd gone somewhere else for care that night. The thought of it just about took my breath away.

My preceptor and I went back to get his family. There were at least ten people in that waiting room. We let all of them come back to speak with the physician about Jim. This was in the deep South, so we had a lot of young strapping farmer-type grandsons and sons in there, what you typically think of as very strong men's men. When the physician told them Jim had a massive heart attack and there was no chance of him recovering, some of these men's men fell out in the floor, so overwhelmed with grief they couldn't even stand up. The women weren't much better - they had those glazed-over looks like someone had hit them over the head with something while tears were running down their faces. They decided to withdraw support.

Withdrawing support on Jim was the worst experience I have ever had. It took him at least 20 minutes to die after we pulled the ETT. The group tried to start out strong, singing hymns and his favorite songs, but most of them had petered out into just pure sobs about ten minutes in. Finally, the only one with any strength at all to talk to him was his daughter. She just started talking to him, stroking his forehead as he was agonal breathing. She said, "Daddy, I know you can see momma now. I know how much you missed her. I'm so glad you get to be together again. Dance with her for me and tell her I love her and that I can't wait to see her again one day."

I was already having trouble keeping it together but I looked at my preceptor and saw tears running down her face, and I just lost it. I had to step out and cry in the bathroom for a few minutes before I could come back out. The family didn't stay for long after he finally went into asystole and stopped gasping, but I will never forget the daughter talking so lovingly to her father as he was dying. It was clear to me that we destroyed that family's lives, and they just accepted it because they knew Jim was so sick that they didn't question anything. He was so bad off that he'd even said goodbye, after all, what was there to question?

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.

[rowrowyourboat]

Am sorry jenrak. ((((HUGS))))

[Oedgar]

Oh... wow.. It was 1992, and I was in my first and only hospital job on Pedi/Pulmonary floor. I was all of 21 years old, and taking care of a lot of end-stage CF patients who were of similiar age. We all got to know these kids and teens well. We hugged them and joked, and shared treats at the nurses' station. This was back before all of the privacy laws and infection control policies for CF patients. There was one special guy.... loved by ALL the staff, nurses, RT's, etc. He had wonderful, somewhat older parents. His mom and I would discuss the latest on The Young and the Restless while she watched in his room. He was one of my very first patients during orientation, and he kindly allowed me to learn to draw blood without one snarky remark. He began coming more often for tune-ups, had to use oxygen at night more frequently, then all the time. He arrived on the floor, too soon after his last tune up, and flatly stated, "I turned blue at school." (He was a college student).

I worked Good Friday one weekend, evenings, and had the rest of the weekend off. We had a rather intense report that day. "David" is not doing well said the charge nurse. Do you want to take him tonight, Oedgar?" He will be pretty hard.. Ampho drip, TPN, Foley, BIPAP, unconscious, not at all like the usual "David" we all loved. Sniffles could be heard around the room as we finished report. I was still a fairly new nurse, often felt in over my head, but without hesitating I said yes. That shift I did his care, with his parents in the room, knowing I would never see him again. His parents were silent, the room dark. There was no more laughing with his mom or smiles from him. He passed away the next night.

Most of the available staff went to his funeral service. I had an hour commute, but left my apartment extra early to be at the funeral and then on to my evening shift. Tears poured out of me as the priest grabbed my hand while we exited the church. "Are you ok?" he asked as I tried to make a quick exit. He lingered an extra second while holding my hand, and I felt very awkward. I just wanted to escape his concerned look, the funeral, the job. I never went to another patient funeral after that.

Somewhere I have a couple of photos of "David" .. again, taken before privacy got so strict. His chin rests in his hand, big smile, how he will always be remembered.

[No Stars In My Eyes]

Have told this one before, but....I was a student nurse in 1970, a patient on the floor had bone mets and her entire hip and leg had been amputated. The CA was sill spreading, though and she was in tremendous pain. This was when the medical community was still hinky about giving narcotics at a sufficient dose to conquer pain, in case the patient got addicted.

Yuh.

I remember that patient screaming, "Kill me! Somebody please kill me. PLEASE!" The floor nurses closed the door to her room so the other patients wouldn't be "disturbed". It made me so mad that they were letting her live out her last days in excrutiating pain.

But I was 'just a student' and my 'opinion' went against the medication standards of the day, and I was powerless.

The cruelty of that 'caregiving' was breath-taking. I became a big proponent of Hospice from the very first moment I ever heard about it.

[DeeAngel]

The woman who was dying of cancer whose 80 some year old mother never left her side. The patient kept crying and apologizing to her her mother for being so sick and dying, saying she was sorry that she would soon leave the mother all alone because it wasn't supposed to be that way. This daughter was the mother's last surviving child. It was truly heartbreaking and I have never forgotten those two women.

[JaxJax5423]

God I keep coming back to this thread and reading all these incredible, heart breaking moments us nurses endure/experience . This thread makes me proud to be a nurse. We do so much for our wonderful patients. Kudos to all of you.

[annie.rn]

I was a new nurse working Oncology and taking care of a young guy in his early 30's who had colon CA. It had metastasized and he had horrible, draining fistulas tunneled throughout his abdomen. I remember it taking hours to change all of the dressings and drainage bags. He was on triple antibiotics, multiple daily transfusions, and a narcotic gtt for pain relief.

He was understandably angry about his condition. As a result he was not always the easiest guy to take care of. He could be very short tempered and sullen but I never held that against him as his situation was really awful. He had a wife and 3 young children and he did not want to die. The day came for the oncologist to have "the talk" w/ the patient and family. None were willing to accept that nothing more could be done. I remember the pt.'s father asking the oncologist, in all seriousness, if they couldn't just give his son an organ transplant. His idea was they could take out his son's cancer riddled GI organs and replace them w/ a donor's cancer free parts. It was so sad to see how desperately he wanted to fix his son.

A few days later, the family had finally settled on the idea that there would be no cure short of a miracle. So, we went about trying to get the pt. home to spend one more day w/ his wife and children. (We would regularly send pt.s out on pass) It was not easy but we had some very committed Oncologists, nurses, social workers, pharmacists and medical technicians. It took the better part of my shift that day to help organize his day at home. We had to locate a small morphine pump so he would not be w/o pain control for the day. We also had to gather several doses of all his medications and I had to write out administration instructions for the family. Additionally, there were dressing supplies and instructions on dressing changes. As I saw him out of the hospital and into the car, I was so happy to have been part of the team that made this happen.

I had a stretch if days off and was eager to see the patient when I came back to work. I wanted to hear about his time spent w/ his family. Unfortunately he passed away before I came back to work. I asked my co-worker about the pt.'s death. I was hoping it would have been a peaceful one w/ little suffering. It was not. He had a massive GI bleed. I won't go into graphic detail b/c I'm sure you can all imagine what that looked like. It was the opposite of a "good" death. That was heartbreaking to me but I took some comfort in knowing he got to spend one if his last days at home w/ his kids.

[Purple_roses]

Mine is my first code as a nurse. I'd had a couple of codes while I was a student, but I knew we had done everything we could for those, so I'd been fine with them. This one was different.

We'll call him Jim. Jim had end stage heart failure and end stage COPD with histories of multiple MIs. He was a pretty sick guy. He had developed the habit of telling his family goodbye before any hospitalization, just in case, because he knew how sick he was and there was a chance one of his diagnoses would do him in at any time.

I never got to meet him, really. That day, as I was walking through the door, night shift was coding a patient. I asked the charge nurse whose patient that was going to be and she said, "Yours!" Oh cool, I thought, second week on the job and I was going to get to see how this hospital ran its hypothermia protocols, etc., assuming the patient lived. It was going to be a good day! I was obviously going to have a great orientation because I was getting some really sick patients!

My preceptor and I immediately jumped in to the code and got some compressions in, gave some drugs, etc. and we got Jim back - sort of. We got a heart beat, at least. Jim's pupils were blown and he had no spontaneous respiratory effort. Since Jim was temporarily stable, we started getting report. We got report from a different nurse than the one who'd had him. It turns out that Jim had been having arm pain all night. Jim had told the night shift nurse that he'd had arm pain like that the last two times he'd had a MI. She'd labeled him as a complainer, gave him Tylenol, and told him to go back to sleep. Multiple times. A few hours later, his pulse ox wasn't picking up well. "You know those COPDers," she'd apparently said, "Sometimes it's hard to get a good pulse ox on them."

Somebody else finally walked into the room at 0620 or so, and Jim was gray and unresponsive. He had a rhythm on the monitor but they couldn't palpate a pulse, couldn't get a BP to cycle either, so they started coding him.

I started to get a really sick feeling about all of this. Jim might have an extensive history, but it was immediately clear to me that we killed him, and he might have been alive this morning - really alive - still if he'd gone somewhere else for care that night. The thought of it just about took my breath away.

My preceptor and I went back to get his family. There were at least ten people in that waiting room. We let all of them come back to speak with the physician about Jim. This was in the deep South, so we had a lot of young strapping farmer-type grandsons and sons in there, what you typically think of as very strong men's men. When the physician told them Jim had a massive heart attack and there was no chance of him recovering, some of these men's men fell out in the floor, so overwhelmed with grief they couldn't even stand up. The women weren't much better - they had those glazed-over looks like someone had hit them over the head with something while tears were running down their faces. They decided to withdraw support.

Withdrawing support on Jim was the worst experience I have ever had. It took him at least 20 minutes to die after we pulled the ETT. The group tried to start out strong, singing hymns and his favorite songs, but most of them had petered out into just pure sobs about ten minutes in. Finally, the only one with any strength at all to talk to him was his daughter. She just started talking to him, stroking his forehead as he was agonal breathing. She said, "Daddy, I know you can see momma now. I know how much you missed her. I'm so glad you get to be together again. Dance with her for me and tell her I love her and that I can't wait to see her again one day."

I was already having trouble keeping it together but I looked at my preceptor and saw tears running down her face, and I just lost it. I had to step out and cry in the bathroom for a few minutes before I could come back out. The family didn't stay for long after he finally went into asystole and stopped gasping, but I will never forget the daughter talking so lovingly to her father as he was dying. It was clear to me that we destroyed that family's lives, and they just accepted it because they knew Jim was so sick that they didn't question anything. He was so bad off that he'd even said goodbye, after all, what was there to question?

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.

I honestly don't think it would have been better for the family to know. He'd said goodbye, and to them, it was his illness and his time to die; there's more peace in that than in knowing that it may not have been his time. But I understand your wanting to be honest too. That's just so sad.

[Soida]

I was doing my PED's and L&D rotation in school and the class had already had a bad week for parents. Our orientation day partly consisted of what parents do after a loss. They showed us photos, molds of babies' hands, feet, etc.. Many of my classmates were crying. Being one of the few men in the class, I just kept quiet to let them grieve.

We had a turn in NICU where we would switch out half way through the shift, and I had the first shift. I talked to the nurse I was following that day, and as we walked in I saw a preemie who was in bad shape. She was born with genetic abnormalities, roller rocker feet, one lung, cognitive deficits. The worst part was that they were young parents and were completely unaware of any problems until the birth. I don't know what pre-natal care they were receiving but that didn't matter now.

The baby was barely over a pound and was gray from the neck down. She was on an oscillating vent so when I assessed her it sounded like a jackhammer in her chest. It was a 4 bed NICU and all the other parents were aware that something bad was happening. It was near silent. She slowly declined during the day as family came in to grieve with the young couple. She had turned from gray to a purplish red by this time. They were in a daze. The young mom was crying, and could not be consoled. The young dad just stood there holding her, giving her the only support he could.

The shift was over and my instructor came in to say that the next student would be relieving me. I told her that this baby was not going to make it much longer and that it wasn't a good idea for the next student ( a mom) to be in here, since she was having such a hard time during the orientation. She said ok, and the student later thanked me, it was a hard day for almost everyone that day.

We were working on connecting her to a standard vent so the mom could hold her while she passed. Her heart rate continued to slow, pulse-ox slowly declined. Then finally asystole. Just the young mom, dad, me, and the RN there with them. They held her for a while then left the room.

Respiratory came in and I helped remove the vent tubes. Another RN came in to perform post care. I asked if I could help and she said yes. We gave her a bath. I lifted this tiny little baby so we could put new bedding under her. She was by far the most delicate thing I have ever held in my life. A life that weighs so little...

I put on a tiny diaper, and put on the smallest little pink footies on this little girl, hoping to give her all the love I could even though I never knew her, or loved her. We styled her curly hair and put on a pink matching cap. All tubes were gone, all lines removed, and there she lay.

The RN left the room and I was all alone with her. I am not a very sentimental person in public ,but when I was alone with her, I simply told her that her mom and dad love her very much, and I'm sorry that you'll never get to know them. I wish there was more we could have done for you, and that wherever you are, I hope you feel the love that we are sending you. Goodbye.

I don't have kids, but when I told my wife about that day, all I could do was imagine was her holding this baby and just being there to hold her up like this young dad was doing.

[Awesomocity0]

Into the ER rolled this guy (relatively young, 40-something), gasping for air, looking as frail as could be. There was enough of a crowd, so I moved on and thought nothing of it. Until I heard someone mumble about getting RT involved. I poked my head in. I never saw someone conscious with such agonal respirations before, with a non-rebreather on that may as well have been for decoration. His sats kept dropping.

It was such a frightening sight to me. There was no collapsed lung or sudden trauma. There was just the lung cancer. And him, barely audible, gasping, pleading, crying, "... tube... me."

In my head, I could not comprehend the sort of misery someone must be in, the sort of desperation to ask for an ET tube to be put in, just so he could breathe.

Then I looked around, and there was his wife and two young children, crying. And in my head, I suddenly pictured my Dad, who is in his fifties, who had smoked his whole life, whose lungs sounded horrible even without a stethoscope, and I saw his possible future in that patient. The ET tube was barely in before my tears came.

I stepped out of the room and slumped against that wall by the glass doors, crying. And then I saw the patient's wife crying. And I hugged her, and we cried. We sobbed into each other's arms for a long, long time, crying for her, and crying for anyone else who would ever have to see a sight like that in their lifetime.

He wound up dying in the ICU that night.