3 Weeks Old RN - My Patient Died Today.

  1. Don't want to share too many details... confidentiality and such...

    My patient was a few hours from discharge. Cardiac surgery previous, was being walked in the hallway... collapsed, tele monitor showed SR, but really PEA. Long code, everything possible was done, no one saw it coming. He died.

    This wasn't some distant ER code I repsond to... this was MY patient. I had him the previous night... we talked about his retirement, his family... his life. He was a great guy... fun to talk to. And all of the sudden.... he's gone. Assesment looked fine... vitals normal... labs decent...

    I have a case of the "what ifs", but its really not that bad. I don't see where things could have been done differently... MIs happen. But it still doesn't feel that great...

    I guess part of me just wants to vent... But I don't feel the same anymore. My post-op CABGx4 had boarderline HTN and I felt reluctant to walk him. My AICD was doing perfect, lab-test ordered for escort without tele, but I still wanted a nurse escort. In the end, I acted the same... but my mind told me different.

    My question is... does it change your thinking? Are you more cautious after this kind of ordeal... or do you get use to it? Does that increased awareness make your a stonger nurse... more thorough in your questioning/assessment?

    Is there a silver lining to this ugly cloud?
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    About Slobgob

    Joined: Mar '05; Posts: 192; Likes: 89

    6 Comments

  3. by   RGN1
    Sorry about your experience - especially so early on in your career. You're right about this sort of thing happening though and you can't beat yourself up about it!

    I think that it may make you more cautious for a while, that's only natural but if, as you say, there really was nothing that you would or could have done differently check it off as an experience & move on! If there was something you might have done differently then add that to your "nursing list" and again move on!

    Do they have any sort of counselling/de-brief in your area for nurses who may need it? If so then take advantage of that, even if it's just to clear up in your own mind that you couldn't have foreseen this or done anything (which is usually the case).
  4. by   Tweety
    With unexpected deaths, codes and crashes it's natural to process it such as you're doing. In fact it's a learning experience.

    I think as time goes by I don't obsess over it like I used you. I think we get so attached, and expect such a good outcome that when something bad happens, we beat ourselves up thinking "what could I have done, what could I have seen, what could I have done differently, it's my fault". I don't do that nearly as often as I do now. Now I process it quickly and let it go.

    Regardless of what we do people are going to crash and burn. People are going to have complications, eviscerations, pulmonary embolisms, bleedouts, death. That's why we're trained to do assessments and know what to look for.

    All that aside, it's not easy when an patient crashes and dies unexpectedly, expecially for the first time.
  5. by   Altra
    Quote from Slobgob
    But I don't feel the same anymore. My post-op CABGx4 had boarderline HTN and I felt reluctant to walk him. My AICD was doing perfect, lab-test ordered for escort without tele, but I still wanted a nurse escort. In the end, I acted the same... but my mind told me different.

    My question is... does it change your thinking? Are you more cautious after this kind of ordeal... or do you get use to it? Does that increased awareness make your a stonger nurse... more thorough in your questioning/assessment?

    Is there a silver lining to this ugly cloud?
    I totally understand what you're saying. About 1/2 way through my orientation I experienced my first unexpected patient death. He was an ER patient presenting w/chest pain - EKG was OK, no elevation in cardiac enzymes, slightly hypertensive ... was going to be admitted & have a stress test in the morning. Suddenly, his heart rate dropped to the 40s, rhythm totally changed, and then the next minute he was arresting. I had been joking w/him & his family as I awaited his admission orders ... and then there we were in a code. Despite "ideal" circumstances for attempting resuscitation (crash cart 3 feet away, IV access already established, etc.) we did not get him back. Yes, it scared the crap out of me, and I will not forget him or his family.

    I think that experience was part of the process of my fully understanding & accepting the responsibility I had chosen to take on. It was also a demonstration, IMO, of the limits of medicine to affect the outcome of life/death.

    Your increased caution is not unreasonable. My "comfort level" has become more fluid as I've gotten more experience.

    Here's wishing you a better day today.
  6. by   youngatheart
    slobgob, I had been in orientation for 10 weeks on days and now was to go 2 weeks of my orientation at night 7p-7a. The first night I had a patient who just went into hospice care. the first check she was very diaphorectic but my preceptor said it was ok, about an hour later another recheck on her and she had already expired I could tell just when I walked in the room. Even though she was hospice I felt horrible, expecially when my preceptor told me I had to notify the family, UGH it was difficult. NOw that i am working nights the nurse said get use to this as most of the patents die at night. thanks for telling me!
  7. by   traumahawk99
    death is part of the job. the choices are to develop a thicker skin or quit. you simply can't go through an emotional roller coaster every time a patient dies. if you do, are you going to be as effective when dealing with the next crisis that pops up? you might have a chance to make a difference with another patient 20 minutes after one of your patients dies. you've got to be ever vigilant to find the places where you can make a difference.

    death is a fact. it's the design of life. there is nothing that can be done about it.

    the silver lining is every good outcome you see. without the bad outcomes, there wouldn't be good ones.

    so buck up. you'll get used to it. .
  8. by   Cardiac-RN
    Quote from Slobgob
    My question is... does it change your thinking? Are you more cautious after this kind of ordeal... or do you get use to it? Does that increased awareness make your a stonger nurse... more thorough in your questioning/assessment? Is there a silver lining to this ugly cloud?

    Having been on my floor for a couple years and worked as part of the code team, I have never really gotten used to it. I can keep a clear head to do what needs to be done, but when its all over, I find that at the end of the night I am on the road in my car going home and bawling my eyes out. I let myself grieve over it and then I try to put it away, and think about what had been done, what might be done differently next time, or did we do all we could and it was just out of our hands etc. Death is a very real and scary part of our job, and it gets easier to handle as far as what to do in response, but it will always pull at the heart strings. Just try to address it, it is ok to be sad, but don't let it fester and get you depressed. Talking to other nurses helps alot, because we have all been through it.

    I think it does make you a stronger nurse, because you learn to be wary, cautious, and trust your gut instinct more despite decieving appearances or presentation by a new patient.

    There is a silver lining- your kindness and tender care might be the last thing encountered by this patient, and their family will be very grateful for that. Remembering that we tried our best and did all we could can help bring some peace as well- in the end, it is not for us to decide who makes it, we can only do as good as we can with what we are given. I have to think that there is a bigger plan for all of us.

    ::hugs::

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