Death

My first patient in the ICU died. I went into ICU right after I graduated and thought I was going to change the world. I won't go into the patient's story too much, but he was young and had a tragic accident. Watching him slowly die changed my professional and personal life. I was devastated when he died. I went back to my first preceptor I had had in nursing school and talked about the case. She said to me, and I will never forget it and actually quote it to my students now often... "It could have been you in the bed, make a difference with your practice". Words I live by. Good luck, make a difference everyday, and know how privledged you are to be there for your patient and their family at their most sacred and tragic time.

The ones that get me aren't the "end of a long life" people, or even the "had'm a long time as a patient" people. It's the ones that for some reason hit a cord. "Paratrooper," who was at Ft. Benning at the same time my dad was stationed there. I always wondered, was I the little girl riding in the shopping cart as he walked by to get get groceries at the commissary, neither of us knowing we'd meet in the last days of his life? Or Doll, who called everyone "Doll" and was the spitting image of my 3rd grade teacher. "Christmas" who came in just before Christmas with endstage COPD and the only thing she worried about before she was terminally extubated was who was going to look after her cat.

You see sad stuff, stuff that will make you wonder what's going to happen when it's you or someone you love in the bed. There's no easy answer. But I suggest you also reach out to a local hospice -- they have excellent resources on handing death, dealing with family at that point, and also dealing with your own emotions.

those words could have come straight from me. i am 31, and i have lost a great aunt, a great grandma, and my grandfather. that's it. all of them were old, and sick, and it was very far from a shock when they died. so i had no experience dealing with death either.

about three weeks ago, i experienced my first patient death. she was middle-aged, had a completely routine (for my floor) surgery, and was recovering well. no complications, nothing. i took care of her for three days. first two days, completely fine. on the last day, during the afternoon, she wasn't her normal self. she kept complaining that she just didn't "feel right". she couldn't give any concrete reason, but it worried me. i called the doctors to let them know...her vitals were normal, labs were normal (including troponin), assessment was normal, but something just wasn't right. the doctors came in to see her. at 7pm, they decided to put her back on a heart monitor and ordered some labs. i drew the labs, hooked her up to the heart monitor, talked with her, and went out to give updates to the next nurse. the next nurse took my updates and went in to see the patient. i had had an absolutely horrible day, and hadn't been able to sit and chart at all, so at 7:30 i sat down to chart. at 7:45, her monitor alarm started going off. v-tach. everyone ran into her room. she was unresponsive. they started cpr and called a code. i have only been a nurse for 8 months, so the more seasoned nurses immediately took over...i just ran and got whatever supplies they were shouting for. (also, this was only the second code i had ever been in. the first one was for low blood pressure and the guy was fine and talking the whole time.) they worked on her for an hour. brought her back twice, got an icu bed for her, and she crashed again in front of the elevators on the way to the icu and died.

it was the most horrible thing ever. i felt like it was my fault. completely my fault. we both knew she wasn't her usual self, and i kept feeling like there was something else i should have done. i had another very needy patient that day, and i felt like if i had paid more attention to this woman, i could have caught whatever was wrong with her. i helped to do post-mortem care, because i felt like it was the least i could do. then i talked to the doctor who had just been in the room. he said that they thought it was a pulmonary embolism and that i did everything right and that we did a really good job calling the code as quickly as we did, which should have made me feel better, but it didn't. there was another nurse there who did an amazing job during the code, and he sat and talked to me afterwards about how sometimes there's just nothing you can do, but i still felt like it was my fault.

i slept for two hours that night and then my brain woke me up replaying everything that happened. the next night, i couldn't fall asleep, and i started to get scared, because 2 hours of sleep in 48 hours is not ok. i called my fiance and he read to me till i fell asleep. i had a rough time sleeping for about a week. i still cry when i talk about it. i don't know how to get past the feeling that it was my fault.

i think that i would have an easier time with a patient's death if it was an expected one. i have taken care of my share of cmo patients, where death would have been a release from suffering. i think that the reason that my first death was so hard to deal with was the unexpectedness of it, and the fact that i feel like i could have done something to prevent it. i don't really have advice for you on how to deal with it, i just hope that your first experience is far less traumatic than mine was.

I'm tired of seeing death...it takes something out of you..the smell, the sight. BUT I don't ever mind taking care of the person. It's kind of a quandry...

I'm tired of seeing death...it takes something out of you..the smell, the sight. BUT I don't ever mind taking care of the person. It's kind of a quandry...

i know EXACTLY how you feel, roshea.

i think it's a type of burnout, where you feel that you've had all your life forces sucked out of you...

yet you feel pulled into assisting those who desperately need it.

there have been times that at home, i continued in smelling death...

even in stores, anyplace other than where i worked.

that is precisely why it is strongly encouraged for hospice workers (and others that work around death frequently) to take care of themselves.

some don't understand that it is so much more than holding someone's hands.

when i was working inpt hospice, it was a picu (pall icu)...

so even though these folks were terminal, they were in pathological crisis and we were aggressive in containing s/s.

op, i understand your reservations but no one can truly prepare you for it, until you've experienced it.

still, it will not be anything remotely close to having a loved one die.

if anything, when you're around death a lot, it changes you as a person.

the stuff i have seen, has resulted in permanent and positive change.

embrace the opportunity, as there is potential for lots of growth.

leslie

I say, don't allow yourself to get to that place where it will affect you. Learn to detach yourself or it will get to you.

I guess we all arrive as nurses with vastly different experiences.

I have known lots of death. Murdered 5th grade teacher (stabbed to death by husband's mistress), murdered girlfriend (also stabbed to death, by stalker/ intruder), two classmates killed in auto/motorcycle accidents in high school, father dead from Ca at 46. And of course death of g-parents.

One day, while at work in Shock Trauma unit, we were intensely coding an MVA victim. Rapid infuser, etc. When I picked his arm up to move it, I felt all the bones crunch and move. He was a young man. While we were coding him, the social worker kept coming up giving updates. Like " His name is so and so", " He is getting married next week". "Fiance and parents on the way" I wanted to say to her "Please stop. This code will be much easier without you telling me he is (er, was) getting married next week".

I need to code this person, not cry right now!

It is easier if you can detach.

Funny aside: after a painful divorce, I had a therapist question if I should return to critical care. I laughed, b/c I have dealt with death SO MUCH during my six yrs in critical care (plus another six on floor...I'll never forget my hip replacement pt. who DROPPED DEAD right in front of me from PE) and did a fine job of it, thank you. She apparently thought me far more fragile than I actually was.

I find I deal with codes and death better than divorce! I guess my therapist had no way of knowing that! ;-)

Life is tough, and beautiful. Death is tough. I only hope there is something beautiful about death, too. I have often wondered what it feels like to BE BORN. Is it scary? Is it painful? Whatever birth is, it is SOMETHING DIFFERENT. What is death? Something different? Something BETTER? Just another CHANGE? None of us know til we get there...

Thank you so very much for all of these touching stories. Very insightful and I'm so glad to have someplace to turn with these thoughts.

Have ever had a pet that died? Then you've experienced loss and grief, people go through the same feelings regardless of the species of who died.

Nope, not even a pet.

Nope, not even a pet.

I've thought about this a lot since I decided to pursue nursing. I have a very fragmented family, so I've always been very untouched by death. My close relatives are all either still living or died when I was quite young, so I wondered if I could handle it. The only childhood pet I ever had was given to the Humane Society when my mother married someone who was allergic to dogs.

Then last year a close friend of mine and her three children were in a car wreck. She passed away on the scene and her 5 year old daughter passed on in the ICU the next day. She was only 25, survived by her 3 and 6 year olds and husband.

It hit me really hard. Obviously the tragedy of the situation was a huge factor, but I also had to grapple with the idea of death for real for the first time. It was extremely tough....honestly, it still can be.

Earlier this month, our family dog got out of the house and was hit by a car. I cried for three days and I'm still not over it. What a PP said is definitely true - we grieve for all family members, regardless of species.

I don't think I'll ever be cavalier about death. I don't believe I'll ever want to work in an area that deals with it directly at a high rate. I'm extremely empathetic and I internalize a lot. Even if I accept death, I still carry the pain of those close to the pt with me. I'm sure it gets easier, but I don't think I'll grow an entirely new personality.

So, anyway, I'm in the same boat, wondering how I'll cope. Time will tell.