Feelings after first loss

Nurses General Nursing

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Hello Nurses,

I'm asking for help and possible similar situations.

I am a first year nurse in Med Surg and just had my first patient pass. The patient was fine according to my assessment. The patient also did not have an underlying history As they were admitted for something minor though they had mental instability. Out of nowhere, the patient stopped breathing and a code was called in which they could not be saved. The doctor said it may have been a PE..

Im wondering, is this something you have ever seen happen? Just sudden and unexpected?

i worry will this come back to me in any way if I missed something? I honestly don't know what I could have done, what I could have missed, as there were no signs of respiratory distress or history..

some insight would really help as I am losing sleep over this

I had an alert, oriented elder (70s), independent living who fell in her apartment.

I assessed her, helped her up to walk to her bed, she was laughing and joking, not a mark on her, I tucked her in, real nice conversation, then she gasped, her eyes rolled up and she was gone.

I had a pt. in the ER who came in complaining about butt pain. She was from a SNF and had scabies, so it was thought she probably had bites on her butt that were infected. After talking with her/putting her on the monitor, and assessing with the MD, we find she had nothing on her butt. Went of her room for two minutes to get pain medication for pt. and went back and and she had gone non-verbal, non-responsive to verbal or painful stimuli, with a HR that was bradying down. She was a DNR/DNI. No response to atropine *at all*. Started dopamine to hopefully keep her HR elevated enough for her family to get in to say bye to her.

Called her family to urge them to come down ASAP, and ten minutes later she was gone. Family didn't get there in time. *sigh*

Specializes in LTC, Rehab.

I really feel for you, as I've been in somewhat similar situations in my LTC/rehab facility. It sounds like you did what you needed to do. I had a surprising incident recently myself, and have been doing a lot of second-guessing.

dharmalove: I feel your pain. Death is painful to witness, no matter who you are.

The first death I saw as a student was a man in end-stage liver disease. He was positively orange. His belly was 9-months' pregnant swollen. He wasn't lucid. I was horrified to see nurses pounding on his chest, shocking him, and pumping drugs into him in a vain attempt to save a life clearly filled with misery. I understand the role of hope in our decision-making, but sometimes there really is no hope. Death is a natural part of life--everyone dies. Sometimes it's too soon, it seems unfair. I worked in PICU for many years and witnessed premature, and sometimes horrible, deaths of little kids who never hurt anyone and didn't deserve to be thrown into a wall, shaken, shot, or in the car with a drunk parent; to say nothing of leukemia, cancer, sepsis, asthma, or idiopathic thrombocytopenia that caused a girl to die from a nosebleed. I've seen so much stuff I wish I could forget. But I'm a nurse. I chose this fight. I do what I must. So must you.

We all cope in different ways. Me, I love music. So, when something happens that is just irretrievably sad, I put on sad music and cry for a while. When a death seems particularly unjust, I put on hard rock or old-school punk and get in touch with my anger. Find some way to vent or give yourself some catharsis when you have bad experiences at work. If you have trouble finding something that works, do some research on the subject to explore your options or see a therapist. Nursing is hard work. In caring for others we sometimes forget to care for ourselves. Please give yourself the same love and care you give your patients. Peace.

Specializes in Mental Health, Gerontology, Palliative.

It is somewhat a shock to the system when someone died unexpectedly and especially when it happens for the first time.

its not something that you need to answer here. For me I find in those situations i ask myself "did I do everything I could possibly do for this patient"and "this is hard however I need to find a way to let this go, because if I carry the weight of every deceased patient with me, I'll drown". I've been a nurse for five years, and done alot of work in palliative and gerontology and seen alot of people die.

It does get easier with time. Be kind and gentle on yourself ok, find something out of work that energises and refreshes you. For me its my crafting, for you it make be something completely different.

All the best

Losses are hard no matter how experienced you are, some of us just hide our grief better. It is very normal to question yourself and even feel guilty even though you did nothing wrong.

I unexpectedly lost a patient on my unit, and even though I knew he was heading to hospice it still made me feel awful and question myself on everything I did or didn't do for him that shift. One of the new grad nurses on my shift said "if that happens I don't know if I can do this?"

Sadly, the truth of nursing is we lose patients, I've always said if "losing a patient ever gets to where it doesn't bother me, I'll hang up my stethoscope"

For me, each loss makes me contemplate what I did that shift, and I try to learn from each, what I did well, what I didn't do well.

Do you have EAP at your facility? It might be worth your while to talk to them for a debriefing. We did them alot in the fire service and I wish hospitals would do them on units. They help quite a bit. I do urge you to talk to someone whom you open up to.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Hello Nurses,

I'm asking for help and possible similar situations.

I am a first year nurse in Med Surg and just had my first patient pass. The patient was fine according to my assessment. The patient also did not have an underlying history As they were admitted for something minor though they had mental instability. Out of nowhere, the patient stopped breathing and a code was called in which they could not be saved. The doctor said it may have been a PE..

Im wondering, is this something you have ever seen happen? Just sudden and unexpected?

i worry will this come back to me in any way if I missed something? I honestly don't know what I could have done, what I could have missed, as there were no signs of respiratory distress or history..

some insight would really help as I am losing sleep over this

My first code (in 1977) was a visitor. He was fine -- visiting his wife in the hospital. Went down just like THAT -- no warning. Couldn't save him. My second code was a brand new patient, fresh from the farm. So fresh that there was a "bathe before seen by house staff" order. She arrested in the bathtub. Couldn't save her, either. She was admitted for "work up of "feeling funny"". Nothing in the admitting physician's orders, notes or my assessment indicated that she was in any way unstable.

It happens. It's not your fault. Stuff happens, and you cannot prevent it. Please stop losing sleep over it. It won't help the patient, and it doesn't help you.

Specializes in ICU; Telephone Triage Nurse.

Yes, this happened to my PCP. He was older (late 70's) but healthy, then his office chair dumped him on the floor injuring his back. Bad. Like really bad. The pain was indescribable, and nothing squelched it. He ended up inpatient not long after after flying out of state to a conference (he and his wife, also still working as a psychiatrist, were going to a concert while away too).

He was discharged and flew home, only to be readmitted locally that very night. He threw a massive PE and died suddenly. It was shocking how quickly it all happened to an active seemingly health guy.

PE's are sneaky. I knew a nurse in her late 30's also healthy, a marathon runner. She also threw a massive PE a week after a marathon. She likely had a DVT and didn't realize it, just thought her leg was sore. Saddest thing I ever heard. She was a gifted nurse, and a mom of 3. She was one of those people who just had an extra helping of life force, very vibrant and full of life.

I understand your feelings of loss. PE's are like thief's in the night - stealing lives that should in no way have ended. I'm sorry you are hurting my friend.

Specializes in Med-Surg/Neuro/Oncology floor nursing..

Oh man I remember when my first patient passed. It still haunts me years later and I tore myself up and went on with the what ifs in my head. If its someone's time its their time.

Just like Flatline my patient was on my floor for a while..6 weeks. She was a young girl that was in a pretty bad MVA..she had multiple surgeries on her back, both legs, arm etc. Finally she was ready for discharge with home health on board, she was obviously up and moving(with assistance) talking and alert. As I went to her room literally with her discharge RXs and instructions in my hand she wasn't moving and her eyes were fixed. No bringing her back. I'm pretty sure she threw a clot if I remember correctly.

She was a young girl too so her age with the fact that it was so unexpected haunted my dreams...many sleepless nights were had after that.

Unfortunately, you get use to it. Sometime random things like this happen, you cant blame yourself, its just part of life. As long as you assessed the patient and charted it you should have no issues, you did it to best of your ability. I had a patient choke on breakfast and die... like others said... stuff happens. I just ensure that the process of them passing *bagging and tagging* is as calm as possible with some classical music in the background.

The LTC facility I work at, we are not allowed to show any emotion, make any comments like "how close we grew to the resident" or anything......or we got written up and possibly fired! I am CNA, and I know for a fact the Admin. came down hard on a few of the "nurses" and CNA's for showing emotions ie crying and verbally expressing. crazy

What really happened?

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