I have been a rn for almost 9 years, i have always worked cardiac and seen alot of codes and my share of dying patients. I know all people respond to death differently and i try not to judge people but last night experienced something so bizarre.
We had a patient that was infarcting since saturday, she refused intubation and made herself a dnr but will allow chemical code. Our cardiologist told her she needed a heart cath to determine the damage, totally refused everything. Family from everywhere came, even as far from tennesee was there yesterday, they were aware of her decision and how the doctors felt.
At one time i swear there were 20 people in the room and more filling up the waiting room. They left about 5pm and i told them one or two may stay with the patient if she liked them to, they left saying to call if she needed them. About 830pm patient was having hallucinations, confusion, o2 sat at 95% on 2liters. I told respiratory to give her a treatment that was due. She was crying for her family to come. I called her son, asked them to come in to stay perhaps for a few hours. They were reluctant, and said the son would come to stay for a hour or so...They lived 5 minutes away, he never showed.
At 1005 patient went into vent tachcardia and after all means to resucitate patient allowed per protocol patient went into v-fib and asystole. One of the nurses called the family and told them of a perhaps lethal arrythmia happening to the patient, they said fix the arrythmia and call them in the morning. When the family was made aware by the cardiologist she was gone, they all came in and was screaming, throwing thmselves on the bed
I cried all the way home, i know as a nurse we did everything we could legally allowed to us. Why do i feel so bad?
I cried all the way home, i know as a nurse we did everything we could legally allowed to us. Why do i feel so bad?
Seems the thread has wandered a bit. Went back to the original post to see if the OP was making any judgemental statements regarding her view of "proper" grieving. Other than a reference that the previous eve's event was "bizarre", I didn't see anything. What did strike me was the closing statement (quoted above).
I'm thinking that the thread is really suffering from having a bad title. Why? Look at some of the issues noted: pat. wouldn't let cardiologist do a proper assessment; a family response she'd not experiened before; and an apparent "missed" opportunity for family to be with loved one at the time of death. Most importantly, there's the telling "..did everything we could legally.." statement.
Not trying to be a monday morning psych major, but it struck me that maybe the OP was upset about a pat. who died that, perhaps, didn't need to. Magnifying the whole feeling was the overwhelming gathering of family and their show of loss at the death, i.e., they were going though unecessary heartache. Since she cried all the way home, was she thinking that there might have been something else she could have done?
Anyways... just struck me that there was more to the OP's "why do I feel so bad" question than what was implied in the thread's title.
Specializes in Infection Preventionist/ Occ Health.
No one can predict how they will react to the news that a loved one has died.
My first year in college, I went to visit my father a few hours away. I had been told that he was very ill, but I did not take it too seriously. He had been in an auto accident about nine years before, and he was quadriplegic. He had never been very healthy since. The day after I visited him, my mother called to tell me he had passed away. I totally freaked out, started screaming and crying. My roommate had to go and find my best friends to try and calm me down. The funny thing was, my father and I were not close at all because he had moved away when I was five. We only talked on the phone a few times a year, and I only went to see him a few times overall.
In contrast, when my mother called me the next year to tell me that my grandmother had passsed away, I just said "ok". I got my stuff together to come home and waited for my uncles to pick me up. I was totally calm and not crying at all. I grew up with my grandmother and spent a few days with her each week. We were very close, as is all of my mother's family.
The point I'm trying to make is that nobody can tell how they will act in the moment they find out about a loved one's death. I think that it is IMPERITIVE that the people around them cut them some slack and allow them to grieve in their own way. I understand that some posters think the family's reaction was disruptive and disrespectful. However, just because death makes some people uncomfortable (or most of us), that doesn't mean that people should have to bite their lip and hide their grief.
I almost think this hostile thread needs to be deleted. It seems most are trying to out do the others.
I am very pro-death and try very hard in my job to allow family members and the patients the decency of having death as conducive to their wishes as humanly possible.
For those of you that need an example, the first one that comes to mind is a man that I took care of for weeks in the ICU last year. He was septic, MSOF, ESRD on CVVHD and was on everything that would fit in the room short of a vent (at that time he died - he had been on one earlier that admission). There was no hope of his recovery and he was well aware of that. His family wanted him to be a full code but the pt disagreed. To make a long story short, I had to (over several days) get his team of doctors together, involve pastoral care, get his family in (some from out of town) and make plans to allow him the best possible death in the hospital setting.
His wishes were to die outside under the trees while he heard the birds singing. That had never before been done at our hospital and I met up with incredible resistance. I planned with him (as close to down to the moment as possible) for two days. The morning that he decided that he wanted to die, it took several hours to get his family in at that time, turn off the CVVHD and get cardiopulmonary and pastoral care that I would need their help. He would need several O2 tanks as he was on a NRB needing >10L flow.
Well, after two dry runs with two different stretchers (had to find one that would fit through the courtyard door), coordination with the OR (since we had to go down that hall) and L&D (they were the other side of the courtyard), he was ready to make his final journey.
We planned to leave the pressors on outside until he decided that it was time to turn them off (knowing that he'd last only a few minutes after that) so we had to take several triple pumps outside as well.
We got him out there, placed him under the large tree that he had selected from the ICU room, watched the birds, went through several O2 tanks, visited with his family, looked at family pictures, ate ice cream (that his son went to get at a local Baskin-Robbins which was closed but they opened the doors just for this occasion) and prayed. I stayed with him the entire time and was on phone contact with the unit, RT, etc so that he could have his needs met.
After nearly two hours in the blazing heat (Central Texas), he decided that he was ready and asked me to turn off the IV's. In less than 30 minutes, he took his last breath with his family all there praying over him. A remarkable event after they sat and told me repeatedly that they just don't understand why he wanted everything to end that way. I had lengthy discussions with them after which they thanked me endlessly for making their loved one's last wishes happen.
He was a 1:1 pt because of the CVVHD but it should be noted that my manager ran up to me as soon as I returned the blood and turned off the CVVHD stating that "Good he's not a 1:1 anymore." All she was concerned with was staffing issues. Nevermind what was best for him. I told her that he'd continue being a 1:1 until he died which could be in 1 hr, 5, or 10....
I am VERY sensitive to the dying issues and the fighting that appears to be going on here on this thread is getting old.
Before I close, yes, I have personally experienced death far too many times as have my children. I held the hands of two grandparents and a best friend as they died. My kids father committed suicide when they were 8 & 7. My oldest daughter lost her 2nd grade science teacher to an accidental drowning as well as a close friend from suicide when she was in the 7th grade. My daughter's beloved kindergarten teacher that we had remained friends with, died of breast cancer that had mets to the brain less than one week before she graduated from high school. Her former teacher wanted to live to see her graduate. My brother's best friend lost his 5 year old sister when they were in high school - she drowned in their backyard swimming pool. I can go on here - there are several others but you get the idea.
Try not to judge and to take comments so personally. Everyone has a different level of experience and exposure. I'm not proud to say that I have experienced way more than my share of death nor am I condemning of those that haven't. The death rate on Earth is 100% - always has been, always will be. Those that have not experience death as yet, will eventually.
Lets move on to something else, shall we?
I don't think I've ever heard anyone call themselves "pro-death" before, but I think your story illustrates what you mean. As you point out, we're all going to die. If we're lucky, we get to die well.
Although I've found some of the comments on this thread disturbing, I think it's worth exploring. I do see a value in providing privacy for grieving family and friends, and in shielding those who may be confronting life and death issues from disturbing displays of grief, but I also recognize that there are moments of extreme emotion when decorum is the last thing on someone's mind.
I initially found the comparison to a child's tantrum condescending, but after further thought, it may be apt. A child throwing a tantrum isn't a bad or spoiled child, he's a child so overcome by a feeling that he can't control his behavior. It's hard to witness a tantrum without feeling judgemental, but really, it's kind of a temporary insanity.
On the other hand, there are boundaries. If a person were so distraught with grief that he needed to punch the nurse in the nose, I don't think many of us would say that was okay.
Anyway, that was indeed a touching story. Your patient was lucky to have you.
Specializes in Case Mgmt; Mat/Child, Critical Care.
Dear "you just don't get"...you see, I think you are the one who just doesn't get it:
How can you forget or ignore there are other patients on the floor with family members & loved ones who themselves may be confronting the issues of death and dying as well?
Are their boundaries to be run roughshod & trampled over so someone else may display thier grief loudly & even flamboyantly?
Must they be tortured & tormented by someone else's verbal tirades when they may be trying to confront their own loss of life?
Do they not have the right to peace?
Do they not have the right to come to terms wth their own situation without distress being piled upon them by a stranger?
Evidently not. For the life of me, I cannot comprehend why it is inconsiderate to have the door closed?
How you elect to grieve is your own personal affair...I would not presume to tell you how you feel about your grief.
However, that does not give you the right to impose your situation on someone else, particularly other patients on the floor.
All I am saying is, there are boundaries. Boundaries are about respect & consideration, without which no civilized society can exist, all becomes chaos.
Wow, jansailsea, the more I read your posts the more i just think... "wow"! I have not read your profile, I guess you are a nurse, but for the life of me, I just am not feeling any compassion from you towards humanity at all....
Let me explain,
First of all, what about the rights of the dying patient and their family? Sometimes just "closing the door" isn't gonna help. Especially during codes, etc. Your display of concern for the other pt.'s, at first, seems understandable...to a point. I think perhaps you may not realize the different grief processes others may go through.
I can tell you, if I lost my child, or husband, God forbid, I wouldn't give a damn who in the entire state heard me. That wouldn't even cross my mind. Perhaps if you realize the extent of the pain and emotion a person may be sufferring, you would "get it". And certainly, if I were the nurse, I wouldn't really care, either. I would be more concerned trying to get the looki-lous out of the way and allow the family some privacy! Does it really matter who hears what?
Do you really think being in the ER or the ICU is perceived to be a picnic, a day at the lake, for other pt's? Sure there is a lot of suffering and sorrow in our line of work. We as nurses have to somehow become accustomed to that and learn how to deal w/it....it seems you deal w/grief at an almost angry level...irritation, more concerned for others than the one who is truly at that moment undergoing perhaps the worst pain/grief in their lives? Yeah, it scares others, that is really not to be helped. Pain and death do exist in the world, I'm not getting the concept of the "other person's rights" and "boundaries"....
Just like in L&D, there are gals moaning, screaming and yelling all the time....and guess what, the other laboring moms (as well as visitors) hear 'em. Does it scare them? Yeah, most of the time; we nurses offer reassurance and assistance. Am I gonna tell my gal who is writhing in pain to "pipe down, so you don't scare the others...", uh, no, not gonna happen.
Working in our line, seeing what we do, we witness the rawest of emotions....giving birth and dying....the two are closely related, one the pain brings joy (usually), the other sadness, grief.
I have seen the kinds of nurses who, over time, have become bitter, stoic "walls", incapable of experienceing any emotion, b/c of their inability to deal w/the pain. I will never be that nurse, the day that comes, I'm outta nursing. To this day, when one of my moms loses a baby or we lose a little one in NICU, I sit w/them and cry w/them....as do most of us.
Dealing w/grief is never easy, but to be so harsh about it, so judgemental, really....geez, I hope you work in a clinic or do phone triage or something....
Peace to you, jansailsea, I'm sorry to sound critical.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
why would anybody be offended by someone's loud expression of grief?? i have been fortunate not to have been in that situation myself, but i can tell you now that i won't give a rat's a** about how anybody else feels about my grief. it's inappropriate to compare grief (of any kind) with a child's tantrum.
others would be offended by someone's loud expression of grief because it's loud. allowing for cultural differences, some cultures believe that it is unseemly to put on a display of any kind, and such a display makes them uncomfortable. moreover, many patients in an icu are sick, and such a display scares them, disturbs them, reminds them of their own mortality.
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[color=#4b0082]i think we need to be just as respectful of those whose culture prohibits loud, attention-seeking displays as those whose cultures demands it and shut the gall-durned door on loud displays of any type.
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[color=#4b0082]ruby (who, after 6 years of marriage into a latin family has learned a bit about loud displays.)
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
dear "you just don't get"...you see, i think you are the one who just doesn't get it:
how can you forget or ignore there are other patients on the floor with family members & loved ones who themselves may be confronting the issues of death and dying as well?
are their boundaries to be run roughshod & trampled over so someone else may display thier grief loudly & even flamboyantly?
must they be tortured & tormented by someone else's verbal tirades when they may be trying to confront their own los of life?
do they not have the right to peace?
do they not have the right to come to terms wth their own situation without distress being piled upon them by a stranger?
evidently not. for the life of me, i cannot comprehend why it is inconsiderate to have the door closed?
how you elect to grieve is your own personal affair...i would not presume to tell you how you feel about your grief.
however, that does not give you the right to impose your situation on someone else, particularly other patients on the floor.
all i am saying is, there are boundaries. boundaries are about respect & consideration, without which no civilized society can exist, all becomes chaos.
amen! and i don't understand why it is only the culture of those bent upon inflicting their emotions on everyone around them that must be respected. what about respect for the boundaries and culture of those who find such displays offenseive and who may be experiencing their own grief/fear/pain/sorrow/whatever?
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
wow, jansailsea, the more i read your posts the more i just think... "wow"! i have not read your profile, i guess you are a nurse, but for the life of me, i just am not feeling any compassion from you towards humanity at all....
let me explain,
first of all, what about the rights of the dying patient and their family? sometimes just "closing the door" isn't gonna help. especially during codes, etc. your display of concern for the other pt.'s, at first, seems understandable...to a point. i think perhaps you may not realize the different grief processes others may go through.
i can tell you, if i lost my child, or husband, god forbid, i wouldn't give a damn who in the entire state heard me. that wouldn't even cross my mind. perhaps if you realize the extent of the pain and emotion a person may be sufferring, you would "get it". and certainly, if i were the nurse, i wouldn't really care, either. i would be more concerned trying to get the looki-lous out of the way and allow the family some privacy! does it really matter who hears what? .
i'm guessing that your culture allows for loud displays and perhaps jansailsee's does not. as i read it, jansailsee is in favor of recognizing cultural differences and allowing folks to experience and express their grief as they need to. she also seems to understand that some other cultures do not allow these types of public displays and that some equally sick and sorrowing patients and their families are deeply disturbed by such displays.
i think some of us need to keep in mind that it isn't only the culture of the display-putter-onner that needs to be respected. quieter cultures deserve respect as well, and perhaps you don't get that.
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i'm not getting the concept of the "other person's rights" and "boundaries".....
that was my point, and perhaps jansailsee's as well. you aren't getting it.
i'm guessing that your culture allows for loud displays and perhaps jansailsee's does not. as i read it, jansailsee is in favor of recognizing cultural differences and allowing folks to experience and express their grief as they need to. she also seems to understand that some other cultures do not allow these types of public displays and that some equally sick and sorrowing patients and their families are deeply disturbed by such displays.
i think some of us need to keep in mind that it isn't only the culture of the display-putter-onner that needs to be respected. quieter cultures deserve respect as well, and perhaps you don't get that.
.
i'm not getting the concept of the "other person's rights" and "boundaries".....
that was my point, and perhaps jansailsee's as well. you aren't getting it.
thank you ruby vee!
at last someone else believes the other patients have rights too!
Specializes in Telemetry, ICU, Resource Pool, Dialysis.
I don't think anybody disagrees that loud displays may disturb other patients or families. I don't see anything wrong with quietly containing the greiving family in the room or a quiet room. I also don't see anything wrong with closing other patient's doors temporarily. Respect is a 2-way street that often involves give and take, or compromise. It think some of us may be thinking of extremes: 20 family members all screaming loudly, spilling out into the hall. That is certainly not the norm. I've never seen it. I'm sure it happens, but rarely. To describe someone's grieving behavior as 'bizarre', 'over-the-top', 'overdramatic', is judgemental and wrong.
I believe in respecting others. Other cultures, other customs, beliefs, needs, etc... But just because another patient doesn't "believe" in loud grieving, doesn't mean that the other family should give up their custom to accomodate the "quiet" family. It's a temorary thing, lasting a few minutes. We all choose to live together here in this great country - one of the responsibilities of that is to respect the huge variety of cultural and religious freedoms that we have.
We have had many grieving families in our unit. Many times other families hear or witness the crying or sobbing family members. I have NEVER, EVER encountered a patient complaining about it. Non-health-care people seem to have much more respect for the process than we do. To them it's a big deal, to us it's another death. I have seen other family members and patients come out of their rooms and comfort the grieving family.
This is a very important subject because, as you can see from other poster's stories, people are not always treated compassionately by US during their grieving process.
I don't think anybody disagrees that loud displays may disturb other patients or families. I don't see anything wrong with quietly containing the greiving family in the room or a quiet room. I also don't see anything wrong with closing other patient's doors temporarily. Respect is a 2-way street that often involves give and take, or compromise. It think some of us may be thinking of extremes: 20 family members all screaming loudly, spilling out into the hall. That is certainly not the norm. I've never seen it. I'm sure it happens, but rarely. To describe someone's grieving behavior as 'bizarre', 'over-the-top', 'overdramatic', is judgemental and wrong.
wonderful response prickly.
i'm just not getting what the posters expect us to do about respecting other people's rights to peace & quiet. your interventions are what i would do. but to become annoyed and disgruntled over the 'dramatics' of a mourning family is beyond my comprehension. their reaction was gutteral and knee-jerk. do the posters think they were attn-seeking? should we start hanging signs on our units that excess noise will be prohibited (so in the event you lose a loved one, keep the noise down)? should we inject them with ativan 3 mg?
i can't help but be sarcastic but i am seeing some complaints w/o any answers.
all i can say is God forbid you should lose someone ferociously close to you and try to keep your emotions in check. granted this type of mourning isn't the norm, but it happens quite frequently. and we can only do our best to comfort them, talking in low voices, gently guiding them to a family room (if able) or even removing the body as quickly as possible....but during this gut-wrenchingly painful time for the family, why work in this profession lest we lose our compassion for those who have lost their loved ones? this is one area where there's no room for judgement.
I greatly decreased my judgementality about wild and crazy families after witnessing MY OWN after my grandfather's death! We were awful--hogged the miniscule waiting room, drama @ the final moments, etc. Because of my grandmother's melodramatic personality, anyone living in town had better be there: roll was taken, believe me. When I walked in on the last day, my sister announced, in an innocent but sort of happy way that "he's got an arrythmia!" I told her to get my father (they had 2 sons, but he was the only one alive @ the time). She told me he had just left to go home for dinner (and, no doubt, to take a break from his mother). I said, just get him, and went into the ICU. Sure enough, a terminal pattern! It took about 3-4 minutes before everyone else figured it out, then they all swarmed in the room.
But at least we were there, and we didn't wail or carry on, just cried like normal. The worst was that there was such a small waiting room and we planted ourselves in it. What's that? Your mother is sick, too? Too bad, we don't want to deal w/Grammy if we're not here!
Works2xs
193 Posts
Seems the thread has wandered a bit. Went back to the original post to see if the OP was making any judgemental statements regarding her view of "proper" grieving. Other than a reference that the previous eve's event was "bizarre", I didn't see anything. What did strike me was the closing statement (quoted above).
I'm thinking that the thread is really suffering from having a bad title. Why? Look at some of the issues noted: pat. wouldn't let cardiologist do a proper assessment; a family response she'd not experiened before; and an apparent "missed" opportunity for family to be with loved one at the time of death. Most importantly, there's the telling "..did everything we could legally.." statement.
Not trying to be a monday morning psych major, but it struck me that maybe the OP was upset about a pat. who died that, perhaps, didn't need to. Magnifying the whole feeling was the overwhelming gathering of family and their show of loss at the death, i.e., they were going though unecessary heartache. Since she cried all the way home, was she thinking that there might have been something else she could have done?
Anyways... just struck me that there was more to the OP's "why do I feel so bad" question than what was implied in the thread's title.