Do you ever get over it?

tencat · Dec 27, 2008

You didn't send the patient to the great beyond. You helped ease the patient's suffering. When it's their time, they go.

I have felt that way on occasion, wondering if I'd done something the hasten the process. For example, I gave a flu shot to a patient who was pretty ill but didn't seem imminent, and two days later he died. Part of me feels that I killed him by giving him the shot (did debate fervently about it with another nurse and the family before giving it, so I had thought about it. He wasn't acting like he was THAT close when I gave the shot). Maybe I did push him over the edge with the shot, but I have to remember he WAS dying......

No, you don't 'get used' to it all. You just learn how to deal with it all. If you feel overwhelmed, take time off. I have taken unpaid days off just to keep myself sane. Hospice companies don't give near enough time and support to staff to help them deal with the realities of the job. Talk with your coworkers. They understand how you feel and can offer a lot of good ideas and a shoulder to cry on if needed. It is not for everyone. It is the hardest job I've ever done, but it is also the most rewarding.

leslie :-D · Dec 27, 2008

honestly no, i never feel guilty.

i look at it as containing their symptoms to a desired outcome of homeostatic calm.

once that is attained, their disease processes can and do take over, ultimately causing their death.

even those times that it has hastened death, i would much rather see them die a peaceful death than live their last hours in intolerable anguish.

leslie

marachne · Dec 27, 2008

I have just started a new job as a hospice nurse. I have experienced a lot of deaths, as we all would. But tonight for instance, I was the one that helped someone on their way, per se. I spoke to one of the other staff nurses and she disagrees stating that the patient was already dying, but because she had terminal restlessness, I eased her pain and anxiety and made her calm. I do agree and feel that way too, but there is a part of me that feels that "I" was the one that ended her life. If you asked me to do it, I would do it again. I don't want people to suffer and this poor woman was doing just that. Do you ever get over that feeling of guilt? Or feelings like I'm having?I don't feel bad really, just different. Not sure what it is.Also, another thing...when do you learn WHAT to say to the family members. I only know the textbook answers. Or the physiology of something. It's hard to speak what I don't know what to say.Any suggestions?

I know at times, early on, I felt a little uncomfortable w/the amount of comfort medications I gave someone...until I had my first palliative sedation patient and I saw how much his anguish was diminished...until I saw someone who went through thousands of mg of morphine in a shift and still tootling around on his scooter....until I saw that really and truly, I do not have control over when someone dies.

I have had to console families who worried about if they had "killed" their loved one with how we were treating their symptoms. I remind them (and me that they are in the process of dying - nothing we do is going to change that course, all we can do is may the journey easier/more in keeping with their wishes.

As to learning what to say to families, in general, less is more. Listening, offering a gentle touch, a hug, a shoulder, empathy (without presuming you know how they feel) goes a long way. You'll find what is comfortable for you, as well as develop an instinct about what the person needs. Some people wil want all the technical information. Others just want to know that they "did good." Others may want to be able to talk to a neutral person about feelings that are not w/i what society thinks is "normal" or "appropriate."

I think of a lot of hospice work is providing witness and presence to the patient and their family. Don't worry about the words -- they may be the least of it (and you will have the opportunity to say the exact thing someone wants to hear at that moment, and you will feel so blessed).

leslie :-D · Dec 27, 2008

oops, sorry...

i forgot to address your question of what to say.

but actually, marachne answered it for me.

less is always more.

families/friends need to feel understood w/their loss...

however that presents itself.

and, not just in dying, but i find that overall, words are relatively meaningless when interacting.

granted, we cannot communicate w/o words, but i find that more words have less meaning.

so where less is more, in this case, more is less.

sorry for my mini tangent.:chuckle

leslie

rngolfer53 · Dec 27, 2008

I'm pretty new to hospice, and I have worried about how much morphine I was giving, for instance. I do believe, and am comfortable with the fact that the disease process is irrevocable and will kill the Pt, no matter what I do. In some cases, what I do may hasten that process by a few minutes, or hours. That isn't my intent, and I don't give more meds than my assessment indicates. Nor can I know in advance--or after the fact for that matter--if hastening death will actually occur.

As to what to say to families, less is more, just as the previous posters say. One thing I do find is getting the family to talk about their loved one is helpful. Most start hesitantly, but often end up telling stories, etc. which certainly seems to give comfort.

Others never say much of anything, and it can be a looong wait for the funeral home to come.

There's some good information on this and other topics at a web site called pallimed.org.

Berkshire1995 · Jan 1, 2009

Your intuitive perception will tell you what to say. You gave that patient comfort! Kudos to you!!