feeling bad... pt died

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Specializes in Telemetry.

So I last worked the other night. Had a pt who was having severe chest pain. 93 yr old DNR. At the beginning of the shift, his vitals were ok, EKG was ok, lungs clear etc. Pt was totally freaking out, full of anxiety. Nothing we did relieved his pain. He had a hx of angina (and about a million other health problems) and so while I thought he probably really was having chest pain, I also thought the anxiety was exacerbating the whole issue. This guy was on the light literally every 3 minutes. You could barely walk out of the room and he'd hit the light again. My preceptor and I (I'm a new grad, going to be off orientation in 2 weeks) were literally running like crazy trying to take care of this guy (never mind the other patients I had) and every time he got on the light, you'd walk in the room and he'd say "You gotta do something". So both of us were getting fairly annoyed with it- him being on the light every 3 minutes and the whole "you gotta do something statement" like we weren't doing anything when in reality we had spent between the 2 of us 4 hours straight trying to help him. Preceptor was on the phone with drs while I'm running back and forth to room with meds. Finally the cardio dr orders fentanyl and follows that with versed. So the guy calms down but still says his chest pain is no better when asked. About 3 hours into the shift I'm in the room and his breathing was audibly wet. So listen to lung sounds, they were wet too. He went from clear to wet in about a half hour. ABGs were ordered, they were crap, he goes on bipap. Family finally gets there, and the guy is still feeling the effects of the fentanyl and versed. Still complaining of pain, but his primary wasn't ordering more morphine for him. He was on scheduled vicodin, and morphine q 3 prn. (At that point neither dr expected him to make it thru the night, and neither did we. I thought they should have put him on a morphine PCA) As day shift came on thursday morning his family had left and I think the sedatives started wearing off because he was back on the light every 3 minutes. I had been thoroughly annoyed by the guy, but still gave him the best care I could, but there were a couple times earlier on in the shift where I might have been a little short with him. I did one time explain to him that we had given him everything we had orders for and had to call the dr for new orders and that I couldn't be in the room with him and on the phone with the dr at the same time and to give me a few minutes and I'd be back. (he hit the light again as soon as I left anyway, and when I walked back in he once again said "you gotta do something")

So I saw in the obits that he died that day. (after I left) Now I'm feeling bad because I was annoyed with him. :( I do know though, that as annoyed as I was there were several times I took his hands and tried to comfort him and help him calm down. I've had patients die before, but I just feel bad because I was annoyed with this guy even though I knew he was dying. Everything was just really frustrating.

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Specializes in Future - Midwife.

I am so sorry that you had to go through that, but I think when it is extremely busy and you are trying to be in so many places and doing so many things at one time those feelings can occur. I'm more than sure your heart was in the right place.

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Specializes in Med/Surg.

I think you took good care of him and didn't let on to him that you were annoyed, busy maybe but not annoyed and you handled it politely and respectfully.

A 93 year old patient with a history of CP and a multitude of other health problems, could not possibly have had an unexpected death, forgive yourself, he's out of pain now and at peace. You did everything you possibly could have to help ease his CP. There was nothing else you could have done.

I think his family members who left him should probably be feeling the guilt, not you.

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Specializes in Neuro ICU and Med Surg.
I think you took good care of him and didn't let on to him that you were annoyed, busy maybe but not annoyed and you handled it politely and respectfully.

A 93 year old patient with a history of CP and a multitude of other health problems, could not possibly have had an unexpected death, forgive yourself, he's out of pain now and at peace. You did everything you possibly could have to help ease his CP. There was nothing else you could have done.

I think his family members who left him should probably be feeling the guilt, not you.

Very nicely said.

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personally i think the docs dropped the ball big time,,,,they acknowledged that they did expect hime to live much longer but no morphine drip, or at min. iv push q15 till comfortable......shame on them.....what a terrible way to die......

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Specializes in CNA.

This seems like some bad judgment on the doctor's part. Please correct me, if I'm wrong. I think you did everything in your power to help keep him comfortable. Please don't be hard on yourself. :redpinkhe

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Nurses are so hard on themselves. I'm not a nurse yet and already know this. You can't be all things to all people.

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Specializes in Telemetry.

I'm hoping day shift was able to get him something more to keep him comfortable. Next time I see the nurse who had him I'm going to find out.

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Specializes in LTC, Disease Management, smoking Cessati.
I

I think his family members who left him should probably be feeling the guilt, not you.

:yeahthat:

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personally i think the docs dropped the ball big time,,,,they acknowledged that they did expect hime to live much longer but no morphine drip, or at min. iv push q15 till comfortable......shame on them.....what a terrible way to die......

I agree. It's despicable they didn't give him more morphine and keep this poor man comfortable. He was hitting the light constantly because he was in pain and desperate. You're right..awful way to die. What a disgrace the doctor allowed this to happen.

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Specializes in psych,maternity, ltc, clinic.

Totally agree....guy should have been on a morphine drip and allowed to die in peace. It's unfortunate he spent his last few hours terrified, but sounds like you did what you could.

RIP, old man.:redpinkhe

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I'm feeling the same way about a patient I have, except the patient isn't dead yet. About 2 weeks ago I cared for this patient. She was fully alert and was making crafts, but was very sarcastic and made borderline rude comments to me. Well, fast forward two weeks, and she's now on palliative care for cancer. She's lethargic, hard to arouse, and just wants to sleep. I feel bad because I was annoyed with her and now she's on her death bed.

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