Death & Dying

[meadow85]

I recently started working on an Oncology Medicine unit and I have been there less than a month and I am feeling overwhelmed. I had 1 year experience on a Surgical Oncology unit, but it was a different. Very different. Patients stayed for a week or two post-operatively to recover and were sent home or we had one or two suffer from complications and passed away. Maybe one death every couple months. Even so, they affected me a great deal because I honestly thought they were going to get better with chemo but they didnt. I had a pt. one week and I thought he was doing great and the next week I came back to vsit him and he had died, just stopped breathing in the BR. Anyways, on this new unit we had 3 deaths in one week! I was later told this is expected on this unit, which I was not aware of at the time. I thought deaths happened on palliative units, no? I was wrong. I rec'd a pt. at 1930 one day and he was going into liver failure. He passed away the next day at 1700. He was diagnosed with Liver CA a week prior. I felt like I should have/could have done more. Maybe if I did a better job, he would have been OK. Another gentleman I cared for was doing OK (eating and drinking well, talking and up in the chair) and then the next week on nights, he was curled up in his bed semi-concious and pleading with me and begging me to leave him in this position when a collegue ad I tried to re-positio him d/t the wound on his side. Comfort measures only. He was such a pleasant man, so sweet. And he went downhill just like that. Yesterday I had a 28 y/o male pt. diagnosed with Brain mets and expected to pass within the next few months, the family was grieving and taking it out on the staff. C/O feeds being started late, meds not being given on time and carelessness of some nurses. It was not an isolated incident. But I couldn't help taking it personal because I was doing my best and they thanked me on several occasions on my good work, but at the back of my mind I always felt I could have done more. It would not be up to their standards. I am not good with words and I don't have much life experience let alone nursing experience to be able to console pts and provide the emotional support they needed considering the enormity of their diagnosis/prognosis and how can I possible talk to them about death and dying if i havn't really come to terms with it. I am still naive or hopeful in thinking pts will get better. Maybe because they look OK to me, but the go downhill fast. It always catches me by surprised even though it was expected. Its like I am the last to know in a way. My other pt. was also diagnosed with CA just yesterday and she said she expected it since her parents and 2/3 children died from Cancer. I was at a loss for words .... what can I possibly say after you have been given such a grim diagnosis? Most of the time I am busy completing task after task and I barely have time to sit down and eat. I am empathetic and very caring. I just wish I could do more for my pt. than doing things for them, but I dont know what I can say/do. I am weary of talking to my pts about their diagnoses because first off I dont know where to start and secondly I dont know what I could possiiby say to comfort them. Im also fearful I may cry, so I have been trying to avoid conversations re: diagnoses and just busy myself with tasks and small talk. I dont want to say the wrong thing and I know this comes with experience and listening always helps, but it just doesnt feel enough. Maybe Oncology isn't for me, it is too sad and out of my element. I can see why ppl say Oncology nurses are caring ... it is hard work emotionally. I dont mind the hard work because I can rest later. But the emotions stay with you. I want to see pts get better. Maybe rehab or L&D would suit me better. I don't know. I am confused. I see a few nurses on my unit in which I'd love to me like someday, the way they are with pts. I know it takes time, but I want to get there soon. I dont know if I should stay or go. Honestly I did now know what I was walking into with this position, I just got hired here basically. i chalked it up to being a good learning experience and it would open more doors for me, but it has been more of a life experience. Learning about life and how short it can be. I always missed the caring and one-on-one aspect of nursing that was lacking when I worked in surgery, but now given the opportunity I feel I am not ready for it. Sorry for such a long post. If had the time to read it through, any input would be appreciated.

[Straydandelion]

I feel for you and throughly understand. Some things may just take time but the ultimate authority on what you should and shouldn't do is you. Don't feel you are a "bad" person for not doing more, also don't feel "bad" if you ultimately decide the specialty isn't for you either. It might help to talk to the other nurses there, and the nurse manager but that is up to you. *gives a hug*

[TopazLover, BSN, RN]

You might want to review some of the previous posts about dealing with death. There is much wisdom there.

I think that if you can make yourself available to the families as much as the patients you will find what you need. They are hurting so much. Dying of cancer can be frightening to see. Make sure you are always ahead of the pain. Explain that you need to keep the patient comfortable. You probably don't have to say much about the upcoming death to the patient. Many times they know, they need permission to talk about it. Just be ready to listen and answer questions to the best of your ability.

Unfortunately hospice and palliative care are not always available when our patients need it. Yes, it is a heavy burden for you to shoulder. You do not need to be the person with all the answers. Talk to a nurse you trust about your concerns. Ask how she/he handles the questions and the unasked questions. Many times the family knows what the outcome will be, they just need the reassurance that you are keeping their loved one comfortable. If you can connect with the family while the patient still needs a lot of care it will make your job easier. When the time comes that minimal care is given make sure the family has the option of staying with the person and also the option of not being there. make sure they know that you will be with that person. Sometimes the pain of watching death approach is too much for some family members. They need space to do anticipatory grief.

No one knows when death will come. Even the best of the palliative physicians will only say "hours to days, or days to weeks, or weeks to months. Don't feel bad that you can't feel comfortable anticipating when it will happen.

If you really believe this is not the kind of nursing for you, talk to some one. This could be an EAP, clergy, family member, another nurse or someone else you trust. You do not have to stay there if you do not want to do this kind of nursing. If you decide to leave be clear in your own head why. Is it fear of death, fear of getting close to your patients and losing them, or is it unease with something else. Only you will know if/when it is time to leave. Nursing is filled with many kinds of fields. Don't stay in this one if you find it is not right for you.

Finally take good care of yourself. We used to say that you needed to leave the patients in your cap when you left work or they would be in your head. Now without a cap to put them in, find someplace to keep them so they don't "rent space in your head".

This is just as long as your request for help, sorry. Bottom line may be to be caring, but not to care too much.

Best wishes, keep in touch.

[meadow85]

I find it surreal when doctors give pts timelines. My pts karex said, "death expected within the next few days" and RN to pronounce death. I have never been to a funeral. I have never seen a dead person. I have never had a close loved one pass. I have never had a pt pass away on my watch nor do I ever want to, although it is inevitable. It saddens me to hear of a pt passing ... I cant imagine how I would be able to deal to care for pt and get to know them and be the one to pronouce them. And how can you just put a date on someones last days. You always hear stories of people who end up living longer right? I am attentive to my pts needs and ensure they are comfortable. Checking on them as often as possible, giving them privacy when they have visitors and asking them if they need anything. I suppose next time I could simply ask if they would like to talk and just listen. I will give it more time and speak to co-workers. Its just difficult to find the time to debrief on such a busy ward. But I know people mean well and support is there if I need it. Just gotta search for it. I will read some of the older forums as well. Thanks.

[leslie :-D]

aw meadow, i am vascillating betw responding and ignoring your post.

so much to say, yet at a loss for words.

i've been working inpatient hospice for many yrs and i still can't rubberstamp the magical response that everyone wants to hear.

this is an excellent time for you to peruse your beliefs on life and death.

get in touch with your spiritual side...

talk and listen to your God or other energies.

you need to get comfortable and sensitive to the sounds of silence, for your answers lie within the stillness.

as for your pts, their dxs are new, so remember the stages of grief.

they don't have to go in any order, but know there will be anger, denial, bargaining, hope and sometimes, acceptance.

the newness of one's terminality brings out families core fears and many will act irrationally.

do NOT take this personally.

you will learn to be neutral, sympathetic and supportive, with time.

death is with us, whether we want to acknowledge it or not.

we are all vulnerable and fragile.

and, we really are all connected in the grand scheme of life.

seek out your mentors, go to eap, pound a pillow at home, have a good cry.

love and hug your family, friends, neighbors and strangers as if today is our last.

regardless of how we handle aversity, life does go on...as does death.

so we may as well leave our handprints in the event that another needs to hold it.

'understand' your pts/families grief, anger, numbness, depression.

regardless of what you say or don't say, let your eyes do the talking...

one soul to another.

that is where we are connected.

and they will feel your love.

be gentle and true.

and yes honey, life experience does help.

you may be too young to handle the enormity of these life events.

this is the time for you to truly review where you are in nsg and where you would like to be.

wishing you much peace and all things wondrous.

leslie

[mama_d, BSN, RN]

When we reorganized our tele units and the one I ended up on was the oncology one, I was not sure how I'd be able to handle the deaths. I have since come to take a great deal of pride in the fact that I am a part of a phenomenal care team which has come to understand end of life care and delivers it in a compassionate manner. I have gotten very close to many of our patients who have gone on to pass, it's hard not to when they seem to spend more of their last weeks with us than at home.

Since we're not strictly oncology, we get a mix of other tele patients as well. Nothing against our other patients, but most of us try to spend extra time with our oncology patients, especially when we know it's near the end. The hardest is when you know that you're leaving to go home and you'll never see Mrs. Smith again, when you've been there through six months of chemo hell with her and her daughter hasn't even made it there yet and the doc just told her she's going to die today b/c she refuses intubation. Sorry...I just really miss one of our old spitfires we used to take care of! We also are very close on our floor, so when someone passes, we have an internal support system for venting, reminiscing, and hugs whenever needed.

It is also important to include the patient's family in your care. We're always sure to offer coffee, tea, etc. for the family when we round on our patients, try to get them extra beds if a family member is staying 24/7, etc. We also send sympathy cards, bought and signed by the staff, to the family when someone we are particularly close to passes. And we usually have one every couple of months or so who we've taken care of so many times and bonded with so much that management opens up their budget to send floral arrangements in our name to the funeral home.

I guess what my rambling is trying to say is that I understand where you're coming from, take pride in the fact that you help these patients have as good of a death as is possible, and figure out what support system you need to help you grieve for them. What you're feeling is natural, and I think helps you to deliver more compassionate care to these folks.

[flightnurse2b, LPN]

wishing you much peace and all things wondrous.

leslie

leslie, i can only hope that if i ever have to use hospice services, that i have a nurse like you. your posts are truly inspiring.

[*LadyJane*]

Oh I think oncology would be rather difficult to become acclimatized to. Having said that, you might be interested in reading this thread where nurses have told about deaths that were uplifting and hopeful. This might give you another way of seeing these deaths.

Just try to see past the first post, which seems to be trolling for wierd, bizarre stories. There are alot of really good, encouraging stories there.

https://allnurses.com/forums/f25/death-stories-101481.html

Of course, there are plenty of informative threads in the Hospice section.

Jane:nurse:

[bamagt]

This is such a great post!

It just comes to show you to live every day like it's your last. Life is so amazing! I'm only 21 now and 2 years ago in July I was almost killed in a car wreck. I had multiple injuries including multiple broken bones, CHI, spleen laceration... Every night for as long as I can remember before I go to bed I thank god for having me on this earth and I always pray for health and safety. God was definetly looking after me that day!

I'm sorry to bore you with my story but I felt compelled to share a little bit of it.

As far as death/dying go... I work in an ER and most of the deaths we see are older patients who are basically dying of old age. We do get the occasional young patient and normally I don't find it hard to deal with mainly because I ignore it.

It's so sad sometimes but it's a part of life.

I know that many patients may die while in your car but maybe you should try and focus on the patients that you can help and do everything you can for all your patients. Just the fact that you may be one of the last people on earth to truly care for a pt would be kinda touching to me!

Good luck!

[meadow85]

You know I have been on the unit less than a month and 3 patients that I cared for at one point ended up dying. The 28 y/o pt. that I cared for last week, who was expected to live until Christmas, died unexpectedly this Thanksgiving weekend during his first chemo treatment .... I am so distraught right now.

[mama_d, BSN, RN]

Meadow, I'm so sorry for what you're going through. I do think that if you can manage to figure out a great support system to help take care of your emotional needs when one of your patients passes that you'll do awesome at taking care of this population; too many nurses seem to avoid attachment b/c of the imminent death issue, and it shows in their care.

When the "Mrs. Smith" I referenced above passed, it coincided with one of the nights that many people from our shift were getting together to go out for a night on the town. We spent a good deal of time reminiscing about the great moments we had with her and (I'm whispering furtively here...drinking rounds in her memory...she would have loved that). It really helped me to cope with the loss. Not that I'm recommending that you go out and get plastered every time a patient dies, just that being surrounded in a non-work setting by people who understood exactly what I was going through helped me shift my focus to the care we gave her and the fact that she was no longer in pain and suffering instead of focusing on the sadness of her death.

Maybe you could take the initiative here and try to implement a "support group" of some kind for the caregivers on your unit, or even wider (like at your hospital or your church, if you attend). I'm sure that you're not the only one who has this kind of turmoil when one your patients passes. It would give you a positive way to channel all the emotions that you're feeling.

Best wishes to you, try to focus on the positives and all the wonderful care you've given to these patients as they stare death in the face, and try to feel the pride you should in being one of the people there to face it with them.