1st patient that died

Vito Andolini · Sep 29, 2009

First, do NOT EVER say anything negative about doctors. You will very quickly find yourself out of work, blacklisted, dead in the water.

If asked why doctors did this or that, did not do something, answer honestly by saying "I don't know. You should speak with the doctor about that." And that's the truth. You really don't know. And voicing your opinion could be very dangerous to your own wellbeing.

If you really do think the doctor is making mistakes, you need to go through the proper channels to report him. You can go to the doctor first and try to delicately discuss things. Just say something like, "I took care of your patient, John Doe. He was a very interesting case." And go from there. Or talk to his boss. Or report him to the licensing Board. I suggest you really have your ducks in a row before doing ANYTHING along these lines. Have another source of income lined up and don't care if you lose your job and your ability to get another one in Nursing in your current locale.

Reign in those emotions. Life happens. Not to be harsh or less than sympathetic but people do die, doctors do make mistakes (or seem to, in some cases), and accept that you cannot control anything but your own life and even that is tough to do sometimes. So just keep your nose to the grindstone and share your feelings with your pillow. It is hard to do sometimes - be less emotional, I mean, but you can learn.

Sorry you are dealing with this tough lesson and rite of passage in Nursing. I expect we've all been there, though, and understand how you are feeling. Let it go and keep going.

Sorry about the apathetic preceptor, too. Why do you say she's apathetic? Do you mean about this patient or is there other stuff?

talaxandra · Sep 29, 2009

It sounds like you're having a rocky start anyway, and the first time your patient dies is rough. Brace yourself for the first time one dies when you're looking after them, and the first time one codes, because they're also hard events to go through.

Obviously I know nothing about this individual patient or his care. His surgeon may well be incompetent. However, Vito's dead on the money - you don't criticise members of the team to family or patients. Ever.

Even if litigation and your career weren't potentially in play, you don't have enough knowlege or experience yet to know why the team ordered (or didn't order) what they did. As well as being expensive, TPN isn't benign - it not only requires a central line and close biochemical monitoring, it can cause liver dysfunction and endocrinological disturbance. That it was ordered later doesn't mean holding off in it earlier was wrong.

Patients die and sometimes that's really hard, particularly when they and/or their families are lovely. Sometime's it's someone's fault, but often it's not. We feel more comfortable when we can allocate blame, but that doesn't mean blame is deserved or right.

If you have concerns about handling tricky cases, and you can't approach your preceptor, find someone reliable and experienced who can help - your manager or a clincal support person perhaps. Just bear in mind that patients and families tend - as we all do - to filter and interpret what they hear and see, so the message you intend may not be the message they receive. Once an idea's been incorporated into their view of a situation, changing it can be almsot impossible - for example, on another thread a member talked about her aunt being convinced the anginine her husband was given "blew up his heart" despite multiple attempts by the member to correct her.

A stressed out and anxious family don't need more stress in the form of doubts about the treating team. Be careful, and good luck with the rest of your grad year.

valsquek · Oct 1, 2009

I'm definitely not liking the above two comments. I do know that criticizing doctors and getting emotionally attached to patients are a big no-no. Although I did neither, knowing someone died still affects me greatly. Thankfully I talked w/one of my friends (whom is also working as a new grad on the same floor), and she eased my mind; sometimes comforting positive comments are needed instead of hardened ones. I appreciate the above two comments for being honest, but a stern lecture is not what I needed at that time.

WalkieTalkie, RN · Oct 1, 2009

I'm definitely not liking the above two comments.

Like them or not, the above comments are something you should take as good advice, as they are all true. I understand that you are upset. You asked for advice and these people gave you some. Not all advice is warm and fuzzy. I am truly sorry that you lost a patient, but please do listen to the advice, because you will be thankful for it in the future.

I can't tell you how many times I've wanted to say "your doctor is a **** idiot"... but that opens everyone to litigation. You need to go through the proper chain of command with something you think is causing a patient harm. Talk to your lead, your manager, the fellow/attending (if an academic facility), or take it up with the ethics committee.

nerdtonurse?, BSN, RN · Oct 1, 2009

Welcome to the dark side of nursing. I had a friend tell me once, after I'd lost a patient that was one of our COPD/CHF frequent flyers, "everyone in that room gets to cry and mourn. Except us." And it's true. You'll see people who die from stupidity (their own, a doctor's or a nurse's). You'll see people die because it's their time. And sometimes you won't feel anything but relief for the suffering patient, and some times it will flat out tear you up.

I had to put an 8 year old into a body bag, and I had no idea how I was going to go back to work the next day. But I did. And I will hear the soft clicking the beads in her hair as I zipped that bag up as long as I live. I've also put people in body bags that I didn't like, people I was scared of, and people where it was a relief that they had finally stopped suffering, people I was angry at because their decisions to not look after themselves ended with me running a futile code and torturing them their last day on earth.

That's the kind of thing they never tell you how to handle in school, because we each have to find our own way thru the "valley of the shadow." Nobody can really help you, you've got to find out how you walk it. I wish, oh god how I wish there was some quick and easy way to process what we see, but there's not. You just learn to deal with it, or you quit. I've seen two people who quit because they were sheltered from death during school, and the first time they saw it, they flipped and quit. The only suggestions I have is talk to your pastor, spiritual advisor, or whatever; also, if you can chat with a hospice nurse, they have a deep calmness which might help.

Sorry. No miracles here. Just life. And sometimes, death.

talaxandra · Oct 1, 2009

I'm sorry you didn't like our advice, though I have to tell you that if you think that they were stern lectures you've been fortunate thus far. I clearly can't speak for Vito, but my post was intended to be supportive of your distress while also responding to your questions about what to do when you have concerns about the care your patients receive.

rn-jane · Oct 1, 2009

Unfortunately in our profession, not all patients get better and some will die. You don't know what happened with that patient last week. There are many things that could have gone wrong that you frankly just aren't aware of, heresay from family or hospital gossip most times is not fact.

You are a new nurse and you can't say the surgery was botched. Don't ever talk against a doctor or be negative about care with a family unless you are preparing to lose your job, be dragged into court and possibly lose your license. The nursing art is not glamorous regardless how it is portrayed on tv and instructors don't teach this in the classroom. I have seen many patients over the years that appears in good health and they code and die and you feel horrible like somebody missed something.

I'm sorry you don't like the advice given above I thought both posters were very supportive.

valsquek · Oct 2, 2009

Just to clear the air, I was venting. In my head I was thinking botched surgery, nothing was said to the family along those lines. I can see how that could have been misinterpreted. ~ I am an emotional person, but above all professional.

Thank you *nerdtonurse* for your story, it was heartbreaking, but insightful.

Columnist · Oct 2, 2009

That first death is a difficult one. It can evoke so many emotions especially if there are complicating issues. It is fine to come here and vent.

You might find some helpful comments in the staff blog entitled Nurses Coping with Personal Grief. Feel free to go there and share your story.

rawrn · Oct 2, 2009

pray for them and their families and regardless of the circumstances and/or outcome...I'm always thankful that I could be a part of their care.