Death- your experiences

[Darkfield]

I'm taking an informal survey here. I work in critical care and I see quite a lot of death. My attitude towards death has become quite callous - when someone is sick, they should be a DNR, and when someone is really sick, they should be comfort care. I'm more relieved than upset when people die and death in general does not bother me.

My question for all of you who have had experience with dying patients is this; does touching and handling death on the job change your perspective when one of your own family members is dying? Are you more likely to make Grandma a DNR or be at peace with someone's passing?

I'm also interested in this; do you think it is normal and healthy that nurses are comfortable with death or is there something wrong with people who can joke on the way to the morgue and cry during lifetime movies?

[Been there,done that, ASN, RN]

Handling death on the job has not made me callous towards death. It has made me more sensitive to it.

Death is a personal event for the patient and their family.

I will NEVER be comfortable with death.. death is an ugly thing to see or be involved with.

I" pulled the plug " when my father died.Was I comfortable with that decision? Can ANYONE be satisfied with that decision?

[artsmom, BSN, LPN]

I'm taking an informal survey here. I work in critical care and I see quite a lot of death. My attitude towards death has become quite callous - when someone is sick, they should be a DNR, and when someone is really sick, they should be comfort care. I'm more relieved than upset when people die and death in general does not bother me.

My question for all of you who have had experience with dying patients is this; does touching and handling death on the job change your perspective when one of your own family members is dying? Are you more likely to make Grandma a DNR or be at peace with someone's passing?

I'm also interested in this; do you think it is normal and healthy that nurses are comfortable with death or is there something wrong with people who can joke on the way to the morgue and cry during lifetime movies?

Knowing what I know about prolonging death- Grandma is a DNR. I couldn't stand to have my 90 yr old grandma getting CPR and having all her ribs crushed. Make her comfy, make her happy,and let her go.

I think nurses have to be comfortable with death. My perspective is that we can't let other people's death affect us in a negative way- they need their families for that. If we get too emotionally involved it will cloud our decision making abilities. I am not sad when my patient's die, in fact, I am normally thankful that they are no longer suffering.

[Aeterna, BSN, RN]

I believe that once you've reached a certain age and/or stage in a chronic/terminal illness, then you should be a DNR. However, that is my personal belief. It was actually how I was raised. I remember being just a little kid and my paternal grandmother told me, "Granny's going to die soon." She said it in such a matter-of-fact way and, me just being a little kid, I thought she meant she was going to die the next day! It took me a bit of time to realize she just meant, being in her late 70's (my estimate), statistically she wasn't going to be around for much longer (actually, she lived to the age of 94, lol).

But, that memory has stuck with me ever since. I spent the majority of my life knowing my grandparents could die any day. They were never in denial of their mortality - in fact, they were completely ready for their own deaths. My dad even explained to me that my grandparents had bought their gravestones and their space in the cemetery years and years ago and pre-paid for their cremation so far in advance that they received a partial refund for it (because the price difference from when they paid for it to when they died had changed so much!). This idea that death was inevitable was reinforced by the death of my maternal grandfather when I was about 10-years-old (I never knew him, but still, I knew what death was). I also had a classmate accidentally drown and another of brain cancer when I was 12.

When I was in nursing school, my uncle was diagnosed with stage 4 colon cancer at the age of 70. The prognosis was very poor. He refused all treatment and just wanted comfort measures. His idea was that there was no point going through the difficult treatments only to extend his life a little longer, and for what? He was retired, his children were all grown and self-supportive, and he really did not want to live long enough to be admitted into a nursing home, anyway. He made all the necessary arrangements in preparation for his death, and died 3 months later. The last time I saw him, he was perfectly content with how things were going (besides the pain, of course) and was still joking around with everyone.

Now I work in medical/oncology with a small palliative section. I see all sorts - people who are ready for death, and others who want to hold on for as long as possible. That goes for both patients and their families. I also see some miraculous recoveries of people we never thought would make it. On the other hand, we see people go through so much suffering just because they were given false hope. For the most part, I've gotten accustomed to seeing dying people and don't get too affected by it. Occasionally, though, there is a patient that comes along and I get close to, and when the time inevitably comes when they must pass on, I do get emotional (not in front of the families, though) I'm lucky that I work with some good doctors that know how to control symptoms, and if not, I can offer up a few suggestions of my own because I've seen so much.

What's most frustrating to me is when families make a person "palliative" but then want certain invasive things done. For example, the family is concerned if a patient isn't eating or drinking enough so then they want an IV put in. They don't understand that, once a person is dying and at a certain point in that process, they don't require the same amount of food/water as usual. Or, in the event of a Code Blue, they want us to do chest compressions but not to intubate.

[tewdles, RN]

I work hospice...nuff said about working with and seeing death on a regular basis.

The American culture has become a death denying culture. We as a people seek to prolong youth, and life in an almost religious manner. In some areas of health care, the medical and nursing professionals are so uncomfortable with death that they cannot even recognize the most obvious signs of decline toward death. Therefore they never speak of it with their patients. Therefore the patients and their families are never provided the opportunity to process through that reality before it becomes their daily routine...and even then they have often become so entrenched in the notion that the "hospital" can fix everything that they cannot accept that allowing a peaceful and dignified death in their home is in anyway appropriate.

Our death denial as professionals does nothing to serve the needs of our chronically ill patients. Rather, it perpetuates the cycle of admission, readmission, and death in the ICU with extraordinary measures (expensive, emotionally destabilizing, futile care)

[ellen 12]

I work in aged care with a hospice attached. I enjoy this type of work- maybe I am a bit desensitised.

I like to ensure the patient is kept comfortable physically and emotionally throughout the dying process.

I become upset when people die with distress - in my experience this shouldn't happen if people receive the right level of care.

My dad died at 92 after a long history of CHF, He died peacefully, just the way he wanted.

I don't think he would have appreciated the people who then took the measure of thumping on his chest and forcing air into his lungs in their effort to bring him back.

[ellen 12]

I work hospice...nuff said about working with and seeing death on a regular basis.

The American culture has become a death denying culture. We as a people seek to prolong youth, and life in an almost religious manner. In some areas of health care, the medical and nursing professionals are so uncomfortable with death that they cannot even recognize the most obvious signs of decline toward death. Therefore they never speak of it with their patients. Therefore the patients and their families are never provided the opportunity to process through that reality before it becomes their daily routine...and even then they have often become so entrenched in the notion that the "hospital" can fix everything that they cannot accept that allowing a peaceful and dignified death in their home is in anyway appropriate.

Our death denial as professionals does nothing to serve the needs of our chronically ill patients. Rather, it perpetuates the cycle of admission, readmission, and death in the ICU with extraordinary measures (expensive, emotionally destabilizing, futile care)

Sad...

[annlewis]

I work in LTC, 3 years now, I am not calloused, I see myself as enlightened, death comes to us all, when a person is sick or old, comfort and pain meds help relieve any suffering so one can die more peacefully. I think religion can help people come to terms with death, I for one believe our souls live on and the pain goes away. If children are raised with religion and nonjudgmental attitudes then it could help them later in life to see death as a passage to something better.

[marmar1231]

Being a home hospice nurse I deal with death all day. I think if your not comfortable with death...nursing as a profession is going to hard for you. I do think people should think about their code status...I'm fighting Leukemia and am a DNR. If I die it is my time...for God's sake don't bring me back just so my family can turn me off again. I think people think a code blue is like on tv and the patient wakes up and eats jello. Only 5% of codes end in a pt returning the same....I think medical staff needs to be more honest with patients and families. I can't tell you how many times I've been in a home for a hospice appt and the pt has no idea their dying....the doctor left that part out!!

[amoLucia]

To respond to OP's thread - I believe my attitude toward death & dying to be more of a pragmatic, practical, realistic approach rather than insensitive or 'callous' as Darkfield calls it, but I think s/he is probably more along the same lines as I am. I work LTC, so death is not unexpected for many - just part of 'the circle of life', as iti is for critical care/hospice/oncology. etc.

When I receive shift report that a resident is actively declining, or when I newly assess someone as such, my first question is to code status and then to family awareness. I dislike having to notify family of an imminent event such as sudden deterioration or actual death, esp on 11-7 shft at some unholy hour. I do manage as gently and reassuringly as possible. When there is no Adv Dir/DNR, I most esp dislike having to question them about how aggressive do they want us to be as hospitalization is still an option if chosen. This SHOULD HAVE BEEN DONE already.

I have no problem broaching the subject of DNR/DNH as I explain 'comfort care' very honestly to assay any fearful concerns. I find that within 24 hrs, family has been in, MD notified, and paperwork initiated. This situation actually did occur as I did a vigorous sternal rub/painful stimuli revival to a minimally responsive pt. Had she been found 5 mins later, she would have been coded or on her way to hosp, or being pronounced by the 911 squad. Dtr came in within a few hours.

And yes, I have applied this approach to my own parents. In 1993 during the Waco, Texas confrontation, my mom was in the ER in severe cardioresp failure. ER kept assuring me "her O2 sat is 92%". Had to play the RN card to tell them, "I'm a long time nurse from the old school; do ABGs and humor me. If they're OK, I'll shut up and not bother you again". Well, they got gases; then I hear xray being paged, then I hear RT being paged, then pulmonary. ER MD shows me xray and ABG results (I didn't know life was compatible with the ABG results I was shown!) She was critically sick.

Being a nurse and a LTC nurse, I knew what the course of therapy had to be immed and long range. She needed intubation. I knew it was time for the family and to have The Talk. I could see The Big Picture because I knew my mom. There'd be long term intubation, poor weaning effort, extubation?, trach? LTC/LTAC? SNF? spend-down, Medicaid. etc The decision was made for DNR/DNI but to treat her medically.

Amazingly, she recovered and was discharged home. About a month later, she and I had our talk about the DNR/DNI. She said we did right for her, and then she and my dad had an attorney make a house call to draw up their dual Wills, POAs and AdvDirs. She died a few years later.

Six years or so ago, my dad went the same route. PMR, valve replacement, on/off intubations, J tube, trach, code, blood, cardiac ICU, ICU, LTAC, SNF. But he wanted to fight on when he was asked along the way. He did finally pass away in his sleep at a skilled rehab.

I didn't see myself being terriby distraught by their deaths. I cried then and I'm getting a little mushy as I type this. But I like to remember life goes on. I had my legal paperwork done just after my folks had theirs done. It was just the right thing to do. I've read here on AN that there's another document needed that I have to followup on.

[logachelle]

Morbid humor is a coping mechanism that is very common in those on the front lines and see a lot of death. I have worked acute care and I have worked hospice. I feel blessed to be able to provide comfort and symptom management to the dying and is a rush to save those who still have a chance at life. The old are easy for me, the young are hard and I am certainly not above a little dose of morbid humor on occasion

[TopazLover, BSN, RN]

I believe our roles as nurses is to treat patients. We fight dis-ease rather than death. If death is a natural outcome of the disease we need to recognize our limitations to treat. We fight discomfort. This may be in pain relief, prevention of secondary complications, and in some cases discussions with those who do not understand aggressive measures by physicians who fight death.

Every death I have attended is with a bit of sorrow, mostly for others who lost a family member. I rejoice in the fact that the person no longer has dis-ease. As many codes and as many natural deaths as I have been part of I do not think I have become hardened. Perhaps I have a callous where it used to hurt more but it still is very personal to me. When the spirit leaves the body things change. Until that time I fight for what will deal with the dis-ease. It may be aggressive interventions or hand holding and music playing. Either way the loss of a person does impact me. I do not recall each death I have attended. I do recall the feelings of loss, peace, and at times anger for a life snuffed out too soon.

We use humor to cover our pain. Things are only funny if they are true. Sometimes it comes out in unusual ways. It may be black humor or it may be wisecracks. Usually when I do this I feel stupid later.

[SoldierNurse22, BSN, RN]

I have seen MANY MANY MANY of these patients die sometimes once a week, once a month, other times 3 a shift!

I'd hate to be the patient that dies three times a shift!

Sorry, anotherone. I couldn't help it. :)