death and dying

McIndia · Sep 30, 2000

I am a CCURN of 4 years and it seems like I have seen alot of people die. I work in a hospital that is located in a popular retirement area . I am not saying that we don't get our share of teenagers that put their little heads through the windshield on Saturday nite, but we do deal alot with an aging population. The stress and anxiety level of dealing with dying people sometimes depends on the situation...I mean are they a young person dying in a code, are they an elderly person that has made their own decision to have life-support withdrawn with their loved ones around them...there are days that I still cry all the way home and ask myself "what were you thinking in college"...then I will get a thank you note from a family that lost a loved one for one reason or another and they will say you made it easier for my wife,mother,dad...etc and we as a family appreciate all that you do. I sometimes feel relived for the patient when they do die because I know they are suffering and there is only so much we as profession can do...I try to keep them as physically comfortable as possible and if they need their spiritual person(we deal with several religions) I do my best to get the specific person at the bedside. I take care of the dying patient (with as much, if not more of "myself") just like I take care of the 36yo MI that just rolled thru the door. I guess that is why I feel like I lose a small part of myself when I lose a patient...but a very smart friend of mine told me that God replenishes the part of your soul that hurts so bad when you see people suffer...that keeps me going...Knowing that the patient needs me to be there to help, comfort and sometimes cry with them(which I still do sometimes). If I get to the point that human suffering of any sort does not affect me in some way--then I am out of this profession...I guess what I am trying to tell you is my faith keeps going thru all that I see and do...that is how I handle the horrible stress and anxiety that comes with watching another human die...I don't know if answered your question adequately or not...I don't know if there is a tool to use or not...I think the format comes from within you, about how to care for a dying patient...some people can do it and do it well and some people just aren't comfortable with it, for whatever reason. I hope I helped you in some way. Good Luck.

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fireandice · Oct 1, 2000

Macky:

The truth is most of us don't deal well with death, particularly the idea of our own death. You and I know of many patients with whom we've tried to discuss the seriousness of their disease, only to be dismissed with the wave of a hand or tightly closed eyes. 5 years ago when I was still in the Philippines, my reaction to death and dying is "too much to handle" and until now, my reactions are still the same. Lets just say...some people are not good at it. One time, one of my collegues spouse died suddenly. Instead of going up to her and console her, she ended up consoling me instead since I couldn't stop crying! How can I comfort my client and his family if I myself can't?

macky · Oct 1, 2000

McIndia:

Sometimes nurses deal with death as if it is nothing for them. But, it is quite normal for you to be of feelings with those you deal with. In some studies they pointed out that nursing need to focus on one's preparation in dealing with death. It will take sometime to be emotionally mature. It is good to know that the essence of caring is still within you.

macky · Oct 1, 2000

Fireandice:

It is true that dealing with death is too much to handle. The advancement of science and technology brought a dramatic changes all over the world. Health and nursing is not exempeted from that. As I observed, nurses are now dealing with death as if it is just simple care. I thought to myself were is nursing now specially caring for the dying? We cannot just say that it is lost just in a snap. It is good to Know that the essence of care is within you. Your still exploring on how to deal with the dying. Well, I just looking for the why nursing care or the Humanistic care is slowly diminishing specially with the dying.

KellRN · Oct 4, 2000

Hello, I am an oncology nurse, and I see death just about everyday. I take care of a lot of people who know they are dying and already consider themselves dead. That is very discouraging and it is difficult to deal with. I never know what to say to them. Then, there are the people who tell me how much they have enjoyed their life and that they would not have done anything differently. They don't have any regrets. This gives me a totally different perspective on dying, and I can almost see it as a celebration of someone's life. These are the deaths that are easier for me to deal with. I just wish I knew the right words for those who are not ready to die. I would love any good advice.

rosemarie · Nov 10, 2000

Originally posted by KellRN:
Hello, I am an oncology nurse, and I see death just about everyday. I take care of a lot of people who know they are dying and already consider themselves dead. That is very discouraging and it is difficult to deal with. I never know what to say to them. Then, there are the people who tell me how much they have enjoyed their life and that they would not have done anything differently. They don't have any regrets. This gives me a totally different perspective on dying, and I can almost see it as a celebration of someone's life. These are the deaths that are easier for me to deal with. I just wish I knew the right words for those who are not ready to die. I would love any good advice.

KellRN,

I worked in oncology for over 10 years. People I worked with and patient and their families would tell me that I was very good at dealing with death and dying. The way I see it, I was just being myself. I empathized with the patient and their families. I made it known to them that it was okay to be angry, upset, hurt. I told families many times to go home and shout to the walls that it was not fair. I told them it was okay to cry, and to let the patient see that, so they can talk about what's going on. I found that it helped me also in dealing with their impending death. Some deaths really effected me, some not so much. I always made it known to the patient and their families that I was there to listen, cry or even laugh with them. I like to hold the patients hands to, that comforts them and me. We all became nurses to help people with their illnesses, and diseases. With all the inroads in medicine, we are able to keep people alive for longer periods of time. But are they living, or surviving? Nurses help people, whether it it to get better and move on with their lives, or if they are at the end of their life. I tell patients there are two kinds of fight. One is to fight for the cure and the other is to say "nothing else is going to help, so lets make my life, whats left of it as comfortable, and productive as can be, even if it's only a day, week, month, year or 20 years left. That is very hard because we are taught that we must treat and cure everything even at the expense of a patient or family saying "No more. Sometimes healing is having to die. We help patients over that hill. It helps to have your faith. Faith can help patients and you over the rough spots, as far as knowing what to say, it's not what you say sometimes it's your actions mostly that help patients and families deal with dying. Even just saying to them "I don't know what to say" or "I can only imagine what your are going through" I found that those two lines helped my patients more than anything else. It sometimes opened up the flood gates to an understanding between the family or patient and me.

Jay-Jay, RN · Nov 12, 2000

I am struggling with this topic, too, and will be following with interest what other nurses say.

I have had a lot of people die in my family recently. I just lost my favorite cousin to cancer - she was only 47, same age as me, and left behind a wonderful husband and two teenage sons. Now, this is causing me to have trouble coping with patients who are dying, because I keep thinking of her.

Does it get easier? Sometimes I wonder. I picked up a book in the bookstore about dying. A well-known Oncology doctor talked about this one particular death. It was a young child with a brain tumor. He was called to the child's bedside during his final hours. The child had started to bleed from nose, mouth, I think even eyes, and he was agitated and splashing blood all over the room. The nurse, who should have been helping the child was sobbing in the corner of the room. The doc managed to get the child quieted down with sedation/

painkillers, and he eventually died peacefully. Still, the doctor says it is a case he will never forget. The parents of the boy are still deeply scarred, too, and the father says he has lost whatever faith he had in God.

How do you deal with it day in, day out? I still have my faith, and it helps, but it seems to get harder as time goes by, not easier. Maybe it's because my parents are getting on in age (Mom's 87, Dad's 86) and that may be the next one I have to face.

Jenny P · Nov 13, 2000

I once was told by an elderly Frenchman who was dying of cancer that "we are born to die; it's just another part of life." He was anxious to move on, as he had a strong faith in God and felt that this life was "just practice,"and that he would be with his Maker after death. I think that we Americans forget that death is part of life; no one escapes it. I've worked with doctors who take the death of a patient as a personal insult; I've seen CPR done on a patient when rigor mortis has set in. These are tough to deal with. When a patient is dying, there are times that I cry, and there are times when I just listen to the family. I've encouraged patients and families to let go when it is time. I never want a patient to be alone at the time of death, and I encourage families to stay at the bedside at that time if they possibly can. The hard deaths to me are when we do CPR and all sorts of extraordinary measures on the 98 year old whos' ribs break on the first compression and the code lasts for over an hour. I've actually apologized to that soul afterwards; that was inhumane and cruel treatment. I could go on, but the main thing is that life is precious and we should treat it with respect. And part of living is dying. I've lost severalvery close family members, and it doesn't get easier, but faith can make a difference.

mustangsheba · Nov 13, 2000

[Macky: There are certainly some very good posts here. I too have been privileged to have accompanied many patients in their journey to the other side. Some went easily and some had problems. The hardest ones for me are the ones who can't breath. The first thing I try to do is find out what their own personal beliefs are so I can support them using their own vocabulary. My own personal belief is that they are going to a place of beauty and love, so even though I don't say this, it helps me to be calm and supportive during the process, which admittedly can be extremely traumatic. I encourage familys to to talk about whatever the patient wants to talk about. Some people refuse to let their love dones talk about dying, which leaves the patient in the position of trying to protect them from the pain of dealing with the truth, and so essentially they die alone. Some families are concerned about pain relievers and will under medicate so the patient will stay alert long after this is appropriate. The bottom line is the desire of the person who is doing the dying. When the desires of the terminally ill and someone else who is in control are not in sync, as a nurse, I consider it my job to advocate for the patient. Gently and with sensitivity, of course. I too have a problem with coding just because we know how. It's one of the reasons I no longer work in the ER. Untimely deaths are always hard and the death of a child is something I will never get used to. I will be there to hold them and clean them and support the family, but the pain is unbearable. If I were unable to function, I would find a replacement. As nurses, I consider it unprofessional to put ourselves in a position where someone needs to take care of us. That may sound hard, but that is what our profession is about, so we need to recognize when we are fragile and make provisions. I talk like that is always possible, right? What I'm saying is that caring for the dying and their families requires being centered. Center yourself before you enter a room, before speaking, before calling the doctor, before doing a procedure. It brings a sense of security and comfort to the patient and family. Does that make sense? I hope so. Best wishes.

Jay-Jay, RN · Nov 13, 2000

I agree, mustangsheba, that if WE are so distraught that we need care, we should not be there. It's okay to cry with the family, but you should still be able to remain professional, and do what is needed. (Eg, help family contact the necessary people, call MD if pt. died at home and needs the death certificate signed.)

That nurse who was huddled in the corner weeping while the child was bleeding and dying was not doing her job, not functioning as a professional. (Okay, I'm sure we can all empathize with her, what a tough situation she was in, but still, she was not able to put emotions aside enough to do what was best for the pt. re. pain control/sedation.)

That's why I'm going to take a little more time off work to center myself emotionally re. my cousin's death and a whole bunch of other stuff (just had a major operation) so I'll be better able to cope when I go back.

Spellbound · Jan 6, 2001

I just came across this posting and even though it has been a while since anyone posted to it, I had to respond. I worked as a CNA in LTC and rehab facility with units for every kind of care in between and as a home health aide and in adult foster care and dealt with death alot. In fact, the first patient I was given during the clinical part of my CNA course died after 3 days.

I agree with mustangsheba when she says that if you cannot do you job because you are too emotionally distraught, you need to find a replacement. My problem is that others always thought I was too emotionally distraught, even though I continued to do my job exceptionally well, no matter how upset I was. A case in point was one DNR patient I had who was suffering continuous heart attacks one night. I sat by her bedside, (my other patients were asleep and I had just completed rounds when I found her convulsing in her bed) She was in immense pain, and our pharmacy was out of the pain killer that the Dr. had ordered so we had to wait for almost an hour to have it delivered. I sat there holding her hand and talking to her with tears streaming down my face. She had no family with her and she kept telling me not to let her go and that it hurt so much that all I could do was cry and keep talking and taking her vitals every 5 mins. Although it is true that my exterior probably looked to others like I was out of control, I was actally very clear headed and in control. I have this problem being unable to keep the tears away sometimes but it never affects how I do my job, I just wish I could convince others of that. They see the tears and think I have lost it. I tell them I am ok, just my heart showing its feelings in the only way it can sometimes.

I see my job with a dying patient as making that transition as easy on them and their loved ones as I can, in whatever way I am able. I think that is half of the reason we are nurses. One half is saving those we can and who want it, the other is helping those whose time it is to move on to do so with dignity, caring, respect, and above all, compassion.

Sorry to be so long winded, but it was dealing with my own grandmother's death years ago that made me decide to become a nurse, so I have a lot of thoughts on the matter.

Chris