Feelings after first loss

[dharmalove]

Hello Nurses,

I'm asking for help and possible similar situations.

I am a first year nurse in Med Surg and just had my first patient pass. The patient was fine according to my assessment. The patient also did not have an underlying history As they were admitted for something minor though they had mental instability. Out of nowhere, the patient stopped breathing and a code was called in which they could not be saved. The doctor said it may have been a PE..

Im wondering, is this something you have ever seen happen? Just sudden and unexpected?

i worry will this come back to me in any way if I missed something? I honestly don't know what I could have done, what I could have missed, as there were no signs of respiratory distress or history..

some insight would really help as I am losing sleep over this

[evastone, BSN, RN]

What really happened?

I don't understand what you are asking. OP stated what happened in the first post. Also, with your previous post, how come you wrote nurses with quotation marks? If they passed their boards they are nurses. If not, then who are these people you are talking about?

[BadAszFannyPak]

I had my first patient death in 2002. I remember her name, the room she was in, what she looked like and her family. Now, I can remember a few fading details of the really tragic or super weird deaths but mostly can't recall people that passed last week. I haven't hardened to it or become unfeeling, it is just part of the job.

I remember two surprise ones. One was a PE and one was a missed AAA. It happens. Think about things you could have done different but don't beat yourself up over it. It happens. They are all learning experiences but don't try to blame yourself. We all work in a dangerous job where stuff happens s.

[luvspnk31]

It's always hard when a patient passes, and I think it's completely natural for us to ask ourselves if there's more we could have done or something we missed. Its frightening to think we could be responsible for someones death, even unintentionally. If you did everything you were supposed to ( meds, assessments, dr's orders, etc) then I don't think there's anything to be concerned about on that end. I think if you're worried enough to lose sleep then maybe speaking with your floor nurse or supervisor may help? Or maybe one of the social workers or a private therapist. As nurses, these type of situations will undoubtably cross our paths and learning good coping behaviors are needed.

[JAL85]

I remember my first patient who died even though it was 31 years ago. He was all excited about being d/c in the morning so he could be at home with family and friends to watch the OSU vs Michigan game. He slept peacefully through the night as I made rounds. The nurse aide talked to him around 5:50 am when he asked for some water. I was on my way to give him an early morning med and took the water pitcher with me. He was laying kind of oddly in the bed. He was unresponsive as I lowered the head of the bed. I came to the hall and yelled for the other nurse who came running. Everything happened so fast....but I remembered what to do. We coded him for about 30 minutes but there was nothing. The resident who ran the code talked to me about what happened just before I found the patient. He assured me that I did everything right. So what I learned throughout my career is these three absolutes: rule #1 is that people die even when you do your best; rule #2 there is nothing you can do to change rule #1; rule #3 you have to make peace in your heart, mind, and soul about #1 and #2. Peace be with you, my friend!

[patticakes59]

When you have your first death experience, it is normal to feel vulnerable and as though it were your fault. I would hope your place of work offers some sort of stress incident management process to allow you to voice your feelings and get some support. If you did a thorough assessment and all was normal, you have nothing to worry about. It could very well have been a PE. I have had a patient throw a PE before my eyes and we were unable to save her. I hope you find some resolution to your worries. Death is something we are not taught well about in our education and is something that is so normal.

[Jmf76]

I am a CNA, so I don't assess pts like RNs do, but I do pay attention to signs, symptoms and vitals. Anyhow, I was caring for a pt the day before Thanksgiving. This was about 10 years ago, and I had cared for him several days before. He was a cancer pt and was there for pneumonia, however he was doing very well. He told me he didn't feel well again one day. He felt nauseous and felt like he was having trouble getting air. His vitals were WNL, so we called respiratory and they gave him a breathing treatment. His family was visiting with him a little bit later, and he coded...right in front of his family. I felt so horrible, as did the RN. They worked on him about an hour and a half, but he was gone. It turned out that he did have a PE. That is something so hard to catch..and there's not much to be done for it if it happens so sudden anyway. The vitals are WNL usually when this happens, right up until...as I have found from my experience. I've also had a pt fall off the toilet and die right there..from a PE...after being fine just minutes before. It is scary and it is shocking. I'm sorry for the loss you had. It is always hard the first time and every other time. I have done this for 13 years and it never gets easier when it happens. I also feel bad like I should have caught something else.

[wondern, ASN]

Dharmalove, don't play the blame game on yourself.

I bet you were very helpful to the family just with your compassion.

Do something nice for yourself. Take it easy on yourself. Soak, grieve, and then try to meditate on happy thoughts. Do whatever you do to help yourself feel better.

It does hurt so don't beat yourself up more. Sorry for your first loss pain. It is a growing pain as well so that is a positive outcome. He helped you grow.

God has a plan for us all.

Who knows what kind of worse death could have happened? Oops, nevermind, don't go there too long it's not a happy thought. Funny movies are good to get your mind off of it too.

[sunny time]

I hope you have malpractice insurance. that doesn't mean you will need it. your hospital will investigate and let you know if you were responsible. if the family is mad or feels there was a hospital glitch they will sue the hospital. more money. but to make you feel better if the Dr is correct and it was a PE there was nothing you could have done but calling a code which you did. was an autopsy done? That could satisfy everyone. do not let this color your practice going forward. continue to do your job and chart sufficiently. you will get over this but you will remember the incident.

Calm down and check in with your mental health practitioner. Continue to be diligent.

[matthias_h]

After my first loss, I was internally very upset while remaining composed externally and had a feeling of possible guilt. I was a new EMT and performed CPR on a patient already unresponsive when I arrived. His wife was helplessly witnessing. I worked very hard until an emergency physician arrived, intubated the patient, placed a central line and infused a dose of epinephrine on the scene. The physician remarked that my CPR had been quite effective as the patient's blood had been kept in perfectly fluid, circulating condition. But we could not revive him. It certainly helped to hear this assessment of my work from a trained emergency physician but I still felt very bad.

It helps me to rationalize these situations, realistically evaluating my performance and responsibility in the situation against the chances of success or failure. That seems to help with managing feelings of guilt but it does not shield me from my natural empathetic feelings. I have now accepted that it is natural and psychologically even desirable if I process such events by going through an abbreviated, controlled version of mourning for a lost patient. It is professional and a part of being an empathetic and effective nurse.