First Patient Death

maire, ASN, RN · Apr 17, 2008

I'm curious to hear stories about your first experience with a patient passing on. It's one of those things you never forget, I think.
I recently had my first patient pass after a year and a half of nursing and it was calming and reassuring but at the same time frightening to come face to face with what a lot of people consider their biggest fear.

I had a patient about 2 years ago, whose diagnosis I've since forgotten, that was admitted to my floor for strength training and rehab before going to live with her daughter. She was a dear, sweet lady, always smiling, but rather frail. She was part of my patient assignment every night that I worked for almost 3 weeks, and I got to know her rather well in that short (?) period of time. I would often bring her out of her room and 'park' her by the nurses' station so she would have people to talk with and something to see other than the inside of her room (family wasn't local so couldn't come to visit all that often). She got to know all of us by name, and always seemed happy to see me when I came on shift. "Oh there's my favorite nurse!" she would say with a smile. It got to the point where I was looking forward to my shift just so I could see her. :)

As time went on, she started to deteriorate, and was (finally) made a DNR. The family liked the care we gave her so much they wanted her to stay with us until the end. The last few days she was alive, I came in on my days off and sat with her for a few hours. She was completely unresponsive, but it made me feel good to be there and hold her hand. Her daughter was in as well for those few short days, and wasn't sure what to do with her. She was afraid to touch her, afraid to talk to her, just was at a complete loss.

"I'm going to lose my mother, and I don't know what to do."

I lost my sister in '05 to cancer, so I had all the empathy in the world for the daughter. I told her, "Talk to her. She can still hear you. Touch her, kiss her, hold her hand. She may not respond, but she knows you're here." So she did. I left her alone with her mom, went home, and got a call from a co-worker that night letting me know that the patient had passed.

I was very saddened by the loss, but I know we gave her excellent care and her passing was peaceful.

Several weeks later, one of my co-workers came into a room where I was doing an assessment and said "There is someone at the desk who wants to see you." When I went out, there was the daughter. She gave me a huge hug and said, "Thank you. I will never forget what you did for Mom, and how you helped me to be there for her as her time came to an end." She handed me a card and a small, tissue-paper-wrapped package. "This was Mom's. I know she would want you to have them, and my brother and I want you to have them, too."

Inside the box was a beautiful set of opal earrings. I was absolutely overwhelmed, and the two of us sat and hugged and sobbed and smiled at each other.

I will never forget Mrs. R. This is why I became a nurse.

Queen216 · Apr 17, 2008

That was so sweet! Bless you!

nyapa, RN · Apr 17, 2008

The first death I dealt with was of a man I had never looked after. From the little I had seen, he was in a lot of pain. I was still a student at the time, and forced myself to go in the room. Far from seeing what I thought I would fear, I saw somebody at peace. The sad thing was, he had no family, no body to say goodbye or sit with him.

I don't know why, but I always feel like the person is somewhere close when I care for them after death. So I always speak to them, telling them what I'm going to do. I have found a lot of nurses do that; but you do get the odd strange look from some. Maybe its because I develop a relationship with that person, and it may be part of the process for me to say goodbye?

trmr · Apr 17, 2008

The first patient I took care of that died was several years ago. He was a kind old man. I don't remember what was wrong with him, but he died so very peacefully. He was still smiling even after death. His passing was the most peaceful one I have ever seen. His wife was at his side holding his hand and smiling the whole time too.

DaMale Nurse · Apr 17, 2008

The first pt I had die on me was a 14yr old kid diagnosed with ALL. He was one of the most intelligent articulate funny personable person I had ever ran into. He was a Johva (sp) witness and refused blood transfusions. After some fairly nasty legal battles he was allowed to refuse and passed several weeks later. Very sad that he died, since he had a great chance of being ok, but I'm glad he got the right to say no.

TazziRN, RN · Apr 17, 2008

I was a new CNA in an LTC, had never seen a dead body before, had never been around death at all. The CNAs delivered the breakfast trays and then I was making rounds to see if anyone needed help eating. After checking on one elderly woman who had been awake and alert just a short time before, I went up to another CNA and told her that Mrs. So-and-so was acting funny.......holding her OJ glass weird and just staring off and breathing funny. The CNA took off running. That's how I learned what it looks like when one is in the process of dying.

I'll never forget my first pedi death: a 10-yr-old girl who had run out from between two parked cars and been hit by a van. She came in with eggshell fractures of her skull, traumatic arrest. Everytime we pushed on her chest, blood came out of her ears. The parents had been out shopping and came to the hospital not knowing what had happened to her daughter. She was placed in an empty room and the doc went in to talk with her. I will never ever ever forget her scream through the closed door when she was told her daughter was dead.

buzkil · Apr 17, 2008

I actually forget. That's weird. I remember doing post mortem care for the first time, but I don't remember the patient. Well, It was a long time ago.

nrsang97, BSN, RN · Apr 17, 2008

I was in orientation to the night shift as a nurse. I was with my preceptor. My pt was struggling to breathe. We suctioned her to help, got orders for Morphine and scopalamine. We kept getting PRN orders for lasix, and morphine all night. We did all we could to make her comfortable. I called a friend she had since she had no family. She came in and sat with her. We gave her some more morphine to make her comfortable. She ended up passing away later that night. She had pulmonary edema. And I will never forget it.

nerdtonurse?, BSN, RN · Apr 17, 2008

Mine was just this week. I've seen dead people before, and I'd done postmortem care. However, this guy was special to me. None of the other nurses could seem to stand him, but he and I hit it off for some reason. At first admission (the ever helpful "back pain" diagnosis) he was irritable, short tempered, and had an abdomen that was harder than my driveway. A more comprehensive look at his chart revealed a long cancer history, prostate, thyroid, lung, and the "presumptive diagnosis" that it had mets'd all over the abdomen. I was trying to care for him as professionally and quickly as possible, since he was ripping the head off everyone who came into his room, when he reached up and grabbed my hand. "What the hell's wrong with me? None of these bozos will tell me."

Oh, kaka. The doctors were not telling this guy what the problem was, nor were they doing any further tests other than q12 h/h, cbcs, d-dimers and cmps. (Read: the family wants him to die in the hospital, not at home). I sat own on the edge of his bed, a big no-no, and tried to figure out what to say. I mean, yeah, everyone thought it was mets, I thought it was mets, but even if I had proof, I couldn't tell the man. Sometimes being a nurse sucks lemons.

Finally, after a couple of false starts in the brain department, I took his hand and said, "Mr. Smith/Jones/whatever, I'm not a doctor. I couldn't tell you that you've got a cold, even if we both knew you did. What I can do is tell you this. I will do everything I can to control your pain. If you need me, I'll be in here as fast as I can. If you just want someone to talk to, I'll come in after my shift is over and you can talk my ear off. I may not be able to tell you what you've got medically, but what I can tell you is this: you've got a nurse who cares."

He teared up, and looked at the window for a minute. "Ain't had nobody give a **** about me since Alice died." He patted my hand, and smiled. "I'm okay. You go look after your other patients. I'll be alright."

And, for the next two weeks, as he slowly went down hill, I would always stop in and say goodnight or good morning before my shift was over, whether I'd had him as a patient or not. I'd always ask him before I left if he needed anything, and sometimes he'd talk about how worried he was about his grandkids growing up in this world, or share a story from his long life as a farmer -- what was good equipment, and what "wasn't worth stealing." He'd always end it with, "I'm alright, don't you worry about me." (His usual response to the other nurses was "get the **** outta here, I'm not dead yet.") The last time I saw him when he know I was there, all he could do was squeeze my hand. He finally passed, night before last, and it was a blessing. My mom couldn't understand it, and maybe I'm just crazy, but I told her that it was an honor to know that man. And I'd like to think at the end of my life, when I close my eyes on this world and open them on the next, he'll introduce me to Alice, and we'll talk about the merits of a International Harvester versus a John Deere again as we walk up to the House.

SillyStudent, ASN, RN · Apr 17, 2008

My first patient death was in 1990. I was a Navy Hospital Corpsman, working on an Internal med/oncology floor. My patient was 57 years old and was suffering from small cell lung CA.

He had been with us for months. He was terminal when he was diagnosed two years earlier. The docs told him pretty early on that there was almost no chance he would survive it. He tried chemo, but it was hard on him and he declined further treatment.

He took his wife on a trip. He had been in the Navy for 30 years, and his wife was good at saving money. The home she made for him had always been in enlisted base housing. He was usually at sea and spent quite a bit of time on ships that entitled him to hazardous duty pay. They went to Greece, and Spain, and Italy....as tourists for a change. They loved to show us the pictures. When he became confused, I taped some of those pictures to his bedrails and talked to him about Rome. He was Catholic, and seeing the Vatican was a precious memory.

Finally, the symptoms and pain he suffered at home became too much for his wife to handle. It nearly killed her to put him in the hospital for the last time. They both knew he wasn't coming home again. His wife and grown daughter arrived at 1030 each morning and stayed until 2100. It was an open-bay ward, just a line of beds 13 deep down each wall. She brought food and magazines, as well as genuine smiles to the patients in neighboring beds. When I think of them, I thank God that hospice has come so far. It must be hard to mourn your husband's passing in a room with twenty-five other patients.

He told me when he was admitted that he would never die in front of his wife if he could help it. He gave me a half-smile and told me that she was gentle, and shouldn't have to see anything as ugly as death.

They left at 2100 the night he died. He was already in bad shape, and breathing about 5 times a minute; he must have quietly given himself permission to die around the time his wife and daughter drove off the base. I noticed it when I went to take his vitals about an hour later. I notified one of the two RN's on duty. We pulled his curtain closed and sat with him for a few moments. He died in about thirty minutes. We called his wife at home, and she was just arriving. They lived quite far from the hospital and there were not too many cellphones in 1990. She declined to come back to the hospital that night. I can't say I blame her.

semiller36545 · Apr 17, 2008

The 1st day of clinicals, I was assigned a 56 yo man 10 days post exploratory lap ( this has been a while, clearly). I went in and met him, and helped get his bfast tray situated. While he was eating , his MD came in and told him he could go home the next day. He and his wife were very happy to hear this. After finishing his meal, he wanted to go to the restroom , so I assisted him and his IV pole there. While sitting on the toilet he apparently threw an embolus that went to his lung, and that was that. The code was unsuccessful.

I understand that they still tell this story to students beginning clinicals at that school as a "worst case" example.It's a pretty small town and I saw his wife many more times visiting other pts. She never failed to come and speak and thank me for caring for her husband,even though I didn't really get a chance to do much for him.

I've lost many pts since then and while it's always painful, you know, I haven't thought about this experience in a long time. I'm amazed how traumatic it still feels after all this time.