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Discussion

First patient death

Acute rehab nurse here. Last night we were short staffed with just 2 nurses and one CNA. I had 6 patients. One was recovering from a stroke , completely aox4 left sided weakness vastly improving. I checked on my patients every hour. Her BP had run high all day which day shift said "they weren't worried about it until it reached 160s 170s" and patient was completely asymptomatic . I checked on her at 5am, she denied any dizziness, confusion, weakness, headache, said she felt fine, I noticed no changes, I took a set of vitals her BP was then Normal at 120/82 

At 6am one hour later the CNA came and told me she helped her to the bathroom got her back in bed and suddenly she's "breathing hard". I immediately went in to check on her she was unresponsive , agonal breathing, I called code blue but we couldn't resuscitate her. The doctor running the code thought with her history of stroke this looked like a textbook brain bleed/hemorrhagic stroke.

I cannot get this out of my head I feel like I missed something I feel so so terrible I cried I even cried in front of the family which im not sure was unprofessional or not. I feel like I failed her, I just keep combing over the night wondering what I could've done different, I'm already thinking of ways this will change how I practice trying to learn from this but I'm questioning if I should even be a nurse. ?

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    • Featured Replies

    Sometimes patients just die. Their time has come.

    From your description it sounds like you were surveying your patient correctly. Really nothing more you could have done.

    First death is always traumatic. Don't beat yourself up. Sounds like you did OK. You're a nurse, not a magician. 

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    • Author
    DavidFR said:

    Sometimes patients just die. Their time has come.

    From your description it sounds like you were surveying your patient correctly. Really nothing more you could have done.

    First death is always traumatic. Don't beat yourself up. Sounds like you did OK. You're a nurse, not a magician. 

    My team and charge nurse relayed the same message to me so I am trying to believe it. Sometimes it just takes hearing it multiple times from multiple sources. Thank you so much for your reply! It helps to talk this out with other healthcare workers who get it

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    It was the patient's time to die, a time each one of us will eventually come to. I don't think it was unprofessional of you to cry in front of the family. If my person's nurse cried, I would feel validated and comforted by her compassion. 

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    • Experts

    My first LPN nursing instructor said, in 1983, "If you can do nothing more for your patient, be there for them" and this advice buoyed me on through my nursing career.

    You, Celestialbeing, were not only there for your patient, monitoring and intervening, but you also reviewed, critiqued, and requested feedback from your peers regarding the situation. There really isn't anymore that a prudent nurse could do.

    In 1979, having worked as an EMT in the Volunteer Emergency Corps on Search & Recovery, I was exposed to dealing with death early on. The totality of our job was to recover and respect the victim, and I found some satisfaction in that.

    As a new LPN student, I called a code on a patient, which went well, but the patient expired. Being actively involved in that code, I did everything possible, and was able to deal with it reasonably well.

    Later working in ER and OR, I experienced a fair share of patient deaths, up to my final position in Geriatric Psych. One truth I learned was that when it is their time, they go.

    An elderly lady who had a minor procedure in OR, with the nurses telling her how good she looked, passed away the next day. A coworker who I later told, "I saw your guts all over the table", recovered well and went on to get her RN while working as as Unit Secretary.

    I reiterate: When it's your time, you go.

    The very best to you, Celestialbeing

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    Try to get past this. It really is part of life and the profession we chose. I still recall the first patient I "lost" and it was long before I became an RN. If it didn't matter at all to you, I would be concerned, but otoh, remember that these patients are sick, and people do die. That is life. Strokes don't happen suddenly, there are chains of events set in motion long before they came to the hospital. Things you had no control over.

    Be well.

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    OP, I agree with the posters above: death comes for all of us. It's a normal part of life and at the end of the day we don't get to control it. You are not God. It makes no sense to flog yourself for something for which you are not responsible and which you can't control.Neither the death of your patient nor your response to it make you a bad nurse. The best you can do is all you can do. You did good.

    (PS: from your description, it sounds more like she threw a PE than a brain bleed.)

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    Wow, I'm so sorry this happened to you.  I know it sucks because you are remembering her last known well and envisioning and picturing it with all the senses and it's okay.
    It will hurt for a while but eventually you will be okay and be able to come to terms  with, it really was her time.  
    and I agree with Heron it sounds like she threw a PE when she got up to stand. Know this once she became and agonal and unresponsive she was gone and not suffering.  Also you're a Great Nurse!

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