First patient lost

Long Term Care Columnist / Guide · Oct 18, 2018

The first death is always the hardest. You will be present at many of them, and some will hit you harder than others, but you never forget that first one.

It takes time to process such an event, especially when you've participated in CPR, and even more especially when it happens while you're still a student. There should be a debriefing session for all involved, and your instructor should have done some one-on-one counseling for you. Yes, you will get past this, and you'll respond appropriately to the next incident, and the next, and the next after that. You are doing well under the circumstances; allow yourself to grieve this first patient loss and then move on. One day you will be the one to initiate a code, and more often than not it will not go well. It's the nature of the beast. But you'll be a professional and do the things that need to be done because of your training and experience.

I wish you peace. Viva

cleback · Oct 18, 2018

I was a nursing student for a man brought in by private car... he had arrested in route. We did cpr for a while before the doc called it. The patient was moving slightly during compressions... and the doc attributed that to perfusing his brain with cpr. It was just odd stopping cpr when it seemed there was a sign of life. But never got a pulse back.

The wife was distraught but seemed to know there was nothing to be done.

Agree that you never forget the first. I've had others since that have been more peaceful, and others very heartbreaking. Makes you appreciate the life you have a little more.

gamecaco4, BSN · Oct 18, 2018

My first was a neighbor. I was on my way to clinical and saw his wife trying to help him down the front steps to the car. Knowing this didn't look "right", I asked if I could help. He collapsed into me and I lost his heartbeat just as the ambulance was pulling up. They got him back, loaded him up and they were off. I found out that right after they pulled away, he coded again. Then again in the ER. I will always wonder if I could have done something else.

My first clinical experience was a young adult pt who was found down for unknown time outside in March...in the Northwest. A year to the date of the neighbor. Core temp of 82. We had the thumper going for compressions after we got extra batteries from local fire stations and pleural lavage, bladder irrigation, and warm IV fluids for the better part of 8 hours until the temp was within limits to pronounce death. That was the first and only trauma in clinical. I'll never forget the differences in how the compressions felt between those two patients.

llg, PhD, RN · Oct 23, 2018

I don't remember my first death. Whether that makes me unusual or not, I don't know. Maybe that's because it was so long ago ...

I remember that in school, another member of my clinical group had a patient die and she got all upset about it. I thought that was a bit curious because the death was expected and managed well. There was nothing mis-handled or anything about it.

Perhaps it's because I grew up in a small town where my dad was the only doctor. I was aware of people getting born, getting sick, getting injured, recovering, and dying all my life -- and knew that the normal role of health care professionals was to be a part of those life events.

But all that doesn't mean I haven't felt some deaths deeply, and cried for some of my patients and grieved over their losses. I was a NICU nurse for many years and for a while, I was somewhat of a specialist in the care of neonatal patients at the time of death. And of course, I have experienced deaths among my own family that have effected me deeply.

But I don't remember my first.

JKL33 · Oct 23, 2018

I am still not sure how I feel and just seem bothered by everything that happened that morning. Any suggestions of how to get through the death of your first patient? Does it get easier to deal with your emotions the second or third time it happens to you?

These are normal feelings, Codybball. My advice is to not worry whether your processing of them is the same as others' - unless you feel that you are having life-altering difficulties coming to terms with the experience. The way people process things like this is quite individual.

A lot of things (including deaths, whether expected or unexpected) that we deal with as nurses can be life changing for us, especially if we haven't witnessed or experienced anything quite like them before. We get a view of the world/life/death/humanity that is unique and we are exposed to different things than some of the others around us are. Personally I think it gets easier after a chance to process an experience for the first time.

Facilities often have protocols for what we call "debriefing" - this is kind of a review of technical aspects of a case and care given, but also a chance for those involved to express themselves. As a student you don't have great opportunities to be involved in debriefings, so please talk to your clinical instructor to see if they can give you a few minutes of their time to talk this through. You (all nurses/student nurses) deserve that.

OldDude · Oct 23, 2018

Death is only a concept or perception of our imagination until you experience its occurrence with all of your senses and emotional self. Yes, the first one will likely have the greatest impact on you but it's effect on you is a sign you will be a caring and compassionate nurse and respect life, and death, for the patient and family for your entire nursing career. This will be easier as each day passes.

Editorial Team / Moderator · Oct 23, 2018

I remember my first deceased patient as an EMT student. It was probably 20 years ago now (geez), but I remember what one of the guys from the engine company said: "Man, he died watching the travel channel." Our patient was obviously dead and had been for some time, so there were no measures to be taken. I realized that the responders joking about the travel channel was their way of dealing with death.

It does get easier, OP. But there are those that will always stay with you, particularly children, or those people who were talking and joking with you one minute and then coding the next. Or those that beg you to not let them die, when they sense it is coming. Those are hard to forget.

Make sure you take advantage of any critical incident stress debriefing opportunities. It's okay to feel things, it's just not always healthy to hold them in. Sometimes after pediatric codes we all have a good cry together, no shame.