Death

CompleteUnknown · Jun 24, 2012

My first patient death was an elderly woman who had breast cancer. The cancer had eaten a hole through her breast and it was rather ugly.
I did not cry because it was a relief for this woman.
I also reminded myself that this was going to be part of my job, so I needed to learn to deal with death in a detached way. I couldn't be sobbing over every death. I needed to do my job.
If I did cry (and I recall doing this only twice), it was the pain of the surviving family members that broke me down and I had to retreat to the utility room to suck it all up, take a deep breath and carry on.
Most of the time, I felt a sense of awe with the fact that I was there when the patient died and that I was responsible to make sure I handled the deceased with respect (whether I liked that patient or not).
There is something undescribable in the awareness that I was a part of the patient's last moments and I was doing whatever I could to make those last moments as comfortable as possible.
To me, that is huge.
This was when I was a CNA in a nursing home and working for myself as a private-duty aide.
Overall, it is no good to fall over in a heaping sobbing mess.
The patient needs you to keep it together to provide good solid comfort care and the family needs you to keep it together to give them some much needed support.
You need to be able to do your job.
I did have one younger woman who died unexpectedly (in psych) and it hurt us all.
Her problem was medical and it still bothers me today as I wonder about the preventability of it.
She had a young son (who was the same age as my boy) and I remember him visiting the day before she died.
It was bad enough this poor boy's mother was so mentally sick, but for her to die (unexpectedly) when he was so young and still needs his mother...
This tears me up and I need to remind myself to "separate" and move on... or else I would have no heart to continue to do what I do.
I do not see anything near as extreme as some who work in the ED or ICU (for example) but death is everywhere--
On one hand, it can be a blessing and relief... a privilege to be a part of that patient's care.
On the other hand, it can be a WTH happened??... leaving you feeling very disheartened and maybe a wee bit angry.

This is a great post and I think that most nurses feel the same, that 'it is huge' to be present when someone dies. It's easier when it's an expected death (no matter what the age of the patient) because things are usually relatively calm. Codes and unexpected deaths are harder because there isn't that sense that something profound is happening, it's too 'busy', if that is the right word. It sounds ridiculous to say you will get used to it but there's not really another way to describe it.

There will always be deaths that upset you far more than others and often it's hard to even know why this death in particular affected you so much more than that one. Back in the dark ages when I first became a nurse, most of us were very young and had little or no experience with death. We all learned to cope in our own way and in our own time and it's okay, I think you will too.

BrnEyedGirl, BSN, MSN, RN, APRN · Jun 24, 2012

ixchel, I've been a nurse for almost 15 years and have worked in healthcare longer than that. I currently work in ER and yes I often cry when people die. I cry every time a baby is born, and I often cry when I have a patient who is alone, with no one to hold their hand or care that they are hurting. Now,..I say I cry,...I don't become a blubbering fool who has to go home and can't finish my shift. You asked about becoming jaded,...and yes I have, about some things,...but the moment it stops affecting me that something horrible has happened to a fellow human being,..I need to find a new job and re group! I have many times left the ER thanking the good Lord for keeping my family safe and healthy. I often pray for those left behind and have gone home to cry with my kids. I don't know that it gets easier,..maybe just easier to recover from. Best of luck to you!

VioletKaliLPN, LPN · Jun 24, 2012

Here is my 2 cents :)

I do not view death as a sad event, rather as a natural and expected outcome/part of this life. The manner in which some people die is sad, angering, and sometimes criminal in nature, but I do not view death as specifically bad or sad.

Bklyn_RN · Jun 24, 2012

There was a sickle cell pt who was a regular. Very pretty sweet nice young lady. She was brought in to the ER with lower abdominal pain. Then was transferred to the OR for emergency surgery. Tubal pregnancy. Surgery did not go well, she lost massive amounts of blood. Coded several times while in ICU following surgery. I went to see her in the ICU, she was unconscious and was getting back to back transfusions. She was grey when I saw her. The nurse caring for her knew me and was trying to make small talk. I was angry at him for doing so. I was also angry at another coworker who had seen her before I did and had told me, "she was already gone." I was angry at the hospital for not diagnosing the tubal pregnancy until it was to late. I was angry at the doctor who thought the abdominal pain was related to a sickle cell crisis and kept prescribing copious amounts of morphine. I was also angry that the only person at her bedside while she lay dying was her boyfriend. He was besides himself. Seemed like a really nice decent guy. I was thinking how sad and unfair that this young girl who had endured a lifetime of suffering with sickle cell disease, would succumb to a tubal pregnancy not diagnosed in time.

I heard the final code called right before I left my unit that morning after I had seen her. And I just knew. She was gone. As I walked to my car, the anger eating me up inside turned to tears. That morning was the start of my long anticipated vacation. But in that moment of overwhelming grief. Vacation plans seemed so meaningless and hollow.

bsplyr1063 · Jun 24, 2012

Been a nurse for over 18 years and still remember my first patient death very clear. It was numbing and scary at the same time, but you learn how you will deal with it. I unfortunately have had several. including my own 2 year old grandson. You dont get thick skin, you just lean how to deal or you dont

BlueDevil,DNP, DNP, RN · Jun 24, 2012

I've seen a lot of death. I am pretty calloused about it by now. I didn't even feel anything strongly when my parents died. I think because I don't believe in an afterlie, it actually eases the conflict for me. Dead is dead, it's over, the end. I remember the last infant we coded before I left my acute care position. Everyone was very broken up by it, and they had grief counseling for the employees. I just couldn't help but think how lucky the kid was. The parents were real losers and she was spared a lifetime of misery. Death was much kinder to her than life would have been. I'd have been pretty upset had she lived and gone back home with those parents, however. I don't think I am normal, lol.

BlueDevil,DNP, DNP, RN · Jun 24, 2012

OK, the afterlie was supposed to be afterlife. It was either a typo or a Freudian slip, lol, not sure.

minnymi · Jun 24, 2012

I just feel the need to point out one great thing about nursing and all the different personalities that are drawn to the profession...there is a place for practically every type of person out there.

I'm not a spring chicken, but I'm a pretty new nurse (career changer). I always had an interest in nursing, but one thing that kept me away was knowing that I wouldn't deal well with trauma. I had obviously watched too much TV and didn't know enough about the world of nursing. Now I realize that there are SO many different areas of nursing, and it's typically ER nurses who have to deal with patients who were in a car wreck or have a stab wound. All that time I thought I couldn't function as a nurse. Come to find out, I just couldn't function as a "trauma nurse."

Maybe the OP won't ever deal well with death. Yes, she might have to face death no matter what area of nursing she is in, but some more than others. I knew I wouldn't deal well with trauma patients so I'm not an ER nurse. I know that I become way too attached to LTC residents so I don't work in LTC.

OP - death is a part of the job, but it's a bigger part of the job in some areas than others. If death is something that REALLY bothers you then maybe the ER or ICU or obviously hospice isn't the right area of nursing for you. That doesn't mean you wouldn't be a great L&D nurse (although there is death there at times too) or med/surg (where there is also death, but you don't come quite as attached). I dunno...I'm just throwing that out there. I've known people who are totally freaked out by death and don't want to be in the room of an expired patient. If it is an issue for you on that level then just take that into consideration when choosing where to work.

PITA members don't work in meat factories. People who hate trauma don't work in the ER. People who hate death don't work in Hospice. Knowing your strengths and weaknesses is half the battle.

minnymi · Jun 24, 2012

I've seen a lot of death. I am pretty calloused about it by now. I didn't even feel anything strongly when my parents died. I think because I don't believe in an afterlie, it actually eases the conflict for me. Dead is dead, it's over, the end. I remember the last infant we coded before I left my acute care position. Everyone was very broken up by it, and they had grief counseling for the employees. I just couldn't help but think how lucky the kid was. The parents were real losers and she was spared a lifetime of misery. Death was much kinder to her than life would have been. I'd have been pretty upset had she lived and gone back home with those parents, however. I don't think I am normal, lol.

I don't know if it's because you don't believe in the afterlife. I don't believe in 'heaven or hell,' but I'm still touched by death.

In my experience, people who DO believe in the "afterlife" are often able to find MORE comfort because they believe their loved one has gone to 'a better place.'

For me, the emotions are more for the family members than the person who dies. I don't know if you're a parent, but there's nothing more heart-wrenching (in my opinion) than watching a mother lose a child. I always feel some empathy when there's a grandchild or a spouse who has lost their loved one, but I can hardly contain a few tears when a mother has lost her child. It's heartbreaking.

anotherone, BSN, RN · Jun 24, 2012

I sitting here reading allnurses and I've realized something that I didn't quite put into context like this before..... I have no experience with death. None. I am 31 years old, and in my life, no one close to me has died. I'm reading threads in the peds section and some of them are talking about kids dying and I'm thinking to myself.... death is inherent in every field of nursing, and I'm sure I could handle it as long as I get a few minutes to have a good cry.
But then I thought about the critical patients that might be there for a long time, and how things will feel different going to work and not seeing them there anymore because they've passed. This is what made me realize I've never experienced death before. I DON'T know that I can handle it. I DON'T know how that next day at work will feel. I DON'T know that it wont destroy me inside.
Don't get me wrong-- I'm not bailing on my program and plans over this. But.... well..... crap. Shouldn't this be a prerequisite or something-- knowing what it feels like to lose someone? *sigh* I'm a little scared now. I guess the critically ill patients will be "expected", and so there will be time to emotionally prepare for that. I understand that in some cases there could be a feeling of relief at knowing they will no longer be suffering.
Is it normal, or even acceptable, for a nurse to become a giant sobbing mess if she/he loses a patient she/he was close to? Does the skin thicken after time? Is it okay if it doesn't thicken? I don't know how I feel about the idea of not feeling sadness at the loss of life.
Can you tell I'm all over the place about this? When you were a noob, what were your experiences with death? Had you experienced it in your personal life before professional? How do you cope with it now?

Younger than you and a working nurse for about 2 years. Had some experiences with death before nursing school but not very close family or friends. When I was an extern I saw people die in the er that came in coding, strokes, heart attacks etc. As a student I saw deaths in med surg, icu and picu. As a nurse the patients I have seen die were mostly elderly comfort care pts . honeslty, there has been so much it is hard to remember, so there is some desensitization towards that. some were not pleasent at all and despite many interventions :respiratory, pain meds, drs ordering anything off label that s/he thought might help with the secretions etc. As for giant sobbing mess it depends on the cirucmstance and co workers. Where I work everyone expects you to get over it and quick as that bed will be assigned with a PACU/ER pt soon and most deaths like i said are expected pts on comfort measures only. If say your pt coded and died, co workers would be more understanding if you were a mess for a bit afterwards. but honestly, tthey have their own patients and can probably not help much with yours at all, you will still be responsible for your other patients. did talk to a former icu nurse the other day who told me he left icu because all the death was overwhelming. gets a lot of young 20-30 year old trauma patients. i think for most people that would be different than the expected 95 year old on comfort measures. It is NEVER easy.

GitanoRN, BSN, MSN, RN · Jun 24, 2012

needless to say, i never found death to be easy to deal with even when my feelings weren't involved i always feel a knot in my throat when i witness a mother balling her eyes out for her child. unquestionably, even more when is the death of a young child. having said that, after so many years i have learned to cope with it by hitting the gym, and taking care of those who need me :cool:

TopazLover, BSN, RN · Jun 24, 2012

The OP and some others have expressed some of the major problems we face nowadays. We are a culture that does not talk about death, we have few rituals about death, and corporate America decries 3-5 days is all a family member needs to have off to recover from a death. Return to work is expected to be a full capacity.

At the same time we are not connected as a society. In more interconnected societies one could not get to be an adult without participating in death rituals. It could be making food to give to the family, going to a wake, attending visitation hours for neighbors who passed away or any number of other taks that allowed us to see death as part of the life cycle.

Death for a nurse is different. Different specialties have differing rituals. Nursing Homes, Assisted Living Facilities, and other long term care usually havee DNR orders so they see usually death as a slow progression of aging, and debilitation. Chronic illness leads to easy attack by acute infections, etc. Staff are connected in a similar way to a small community. There may be feelings similar to close family friends passing.

For the acute care nurse death is more likely to be the foe. The demon that is to be prevented from winning a battle. So the death may be felt as more of a failure to succeed. In ER, trauma, and critical care is it a fast paced end run, more to prevent if possible. There is more likely to be an acceptance of death as "too much damage to be compatible with life". It tends to be more impersonal; do the best you can and move on.

Every nurse needs to work in an area compatible with their own acceptance of how they see death. For many young nurses this may be unknown territory because of our societal norms. Other nurses and other members of any health care team can assist the new nurse. In my case a kind pediatrician helped me to develop my own acceptance with the death of a 3 yr old child with Spina Bifida. The parents had refused surgery. He walked with me as we took this beautiful blue eyed boy to the morgue together, both of us crying for the child who no longer had to try to hold up a head that was so enlarged from a hydrocephalus that could have been prevented.

OP. If you are very worried about how you will deal with death, take time to talk with others. Religious leaders are always willing to share their views. Interview health care professionals, do a nursing project that will allow you to connect with people who know death. All of us have walked the path that you are choosing to walk now. Know that you do not have to walk it alone and everything you learn will help you in some way.