How to respond to "am I dying?"

[xmilkncookiesx]

During SIM usually if a patient is having cardiac/breathing problems, the "patient" will ask, "am I dying?" or "am I going to die?"

what is a good response to this?

not only for SIM, but for the real world! I don't want to say anything that I feel would be assuring but will be frightening or makes them feel worse.

Usually on tests, I see responses such as, "tell me your concerns" type of responses.

I was reading a few posts on reddit how EMS/nurses/other medical staff had patients that said, "I'm dying" or "I'm going to die" to them and they didn't believe it and the next day or hours later, the patient died. Something about them makes them feel calm when they know they're going to die-what the redditors said. It's like the patient KNOWS they are going to die, and that some people truly do believe patients when they say this.

Do you have any stories where you've come across patients like this, and you've believed them or not, how they felt?

[djh123]

It does all depend on context. As someone else said, hospice & some other types of patients usually know what's going on. But I have a Parkinson's patient, for example, who will tell me now and then that she thinks she's about to die, 'go', 'this is the end', etc. I make honest comments, that maybe her symptoms have advanced slightly, but that I don't think she's anywhere near 'going'.

[SeasonedOne, RN]

Be honest! Be kind! Ask why they are saying "I'm dying" and see what they say.

In trauma situations I've was asked by patient, "Am I going to die?" Nothing like putting you on the spot.

My response, "Right now you are stable and we are going to transport you." He survived after surgery and transfusions.

Trouble breathing or severe pain..... I reassure, use available medications, call the practitioner and reassess as time goes on. Are they improving or not? Sometimes getting a chaplain in to talk or family member is helpful.

Cancer or long term illness or old age.... I believe what they are saying and ask what we need to do for them.

Call family/friends? Are they worried about dying alone? Do they want something special to eat? Do they have a plan? Who do they need to say good-bye to? How can we make the experience better for them? Do they just want someone to listen? Do they need a priest for last rights? Or their lawyer? Do we need to get rid of everything but comfort measures?

Have seen them go out easy; or fighting every step of the way; or had to tell them it was ok for them to go; or be comatose and wake up to talk to someone special and then die in the next few hours; or code and come right back if witnessed; or code and not come back even when loved ones asked them to; or they linger for days or months and then boom their gone.

Dying is individual. Outside factors. It can be tricky...if all you are going on is what they tell you. Look for the clues. Put the pieces together. Still you might be wrong.

[blondy2061h, MSN, RN]

If you don't mind getting a response from the perspective of a patient. Keep in mind, I was NOT calm when I made the statement "I am going to die". However, it could have been a true statement. Due to severe asthma, I have made that comment at least 3 times. I have gotten both good and bad responses. First the bad:

"It's only anxiety talking", "you're fine, you O2 sats are good and your lungs are clear" (They weren't clear, there was no air movement and 5 minutes later my sats dropped to 72% on 2L) "don't be silly, you're too young to die"

The good: "we are going to do our best", "CG, I know your scared, the paramedics are on the way, and I'll stay with you until they take you out the ambulance" (this was said to me by my primary MD, who was apparently just as scared as I was) and "CG, we are going to take good care of you," and proceeded to tell me what they were going to do.

Please, even if the person is only appears anxious, don't tell them it's only anxiety. It actually can make things worse. If you stay calm, it can help a lot.

BTW: I worked on a palliative unit and I now work hospice and I have seen a couple of patients who were very calm before they died and they told us that they were going to die tomorrow or the next day or whatever. We acknowledged that they were terminal and assured them that we would maintain their dignity and treat any pain, anxiety and dyspnea. And that we would be there for them. Just knowing that they weren't going to be alone really helped them, I think.

I have severe asthma too. Thankfully it's been much better lately. Telling people it's only anxiety is THE WORST. You feel like you're dying and now you feel like the people who are there to help you aren't taking you seriously, as well. Further, I can't breathe. Aren't I allowed a little anxiety?

[Ruby Vee, BSN]

"Am I dying?"

"Not if I can help it."

If they're seriously terrified as opposed to making a bad joke, we talk about what they need to complete -- talk to the child they've been estranged from, sign that will, see a priest for confession, see their dog one last time. Don't make promises you cannot keep, but reassure them that you will do everything possible to keep them safe and/or comfortable.

[CelticGoddess, BSN, RN]

I have severe asthma too. Thankfully it's been much better lately. Telling people it's only anxiety is THE WORST. You feel like you're dying and now you feel like the people who are there to help you aren't taking you seriously, as well. Further, I can't breathe. Aren't I allowed a little anxiety?

I had a paramedic tell me that it was anxiety and I ended up "accidentally" kicking her. She was very dismissive. She was gone by the time I tanked so she probably still thinks I was just a raging hypochondriac.

[JBMmom, MSN, NP]

In my long term care facility, we've had many people make statements about dying, and some really did. One gentleman we had was a real prankster who was always joking around. He had no acute anything going on. Out and walking in the hall just before midnight he told my coworker, his assigned nurse, that he wouldn't need his medicine that night because he was headed to his room to die. They both laughed, and he went to bed. She got to his room about 12:15am and sure enough he was gone. Not the first time he had threatened it, but we were all shocked he followed through. That's how it want to go someday, walking around one minute, gone the next.

[djh123]

In my long term care facility, we've had many people make statements about dying, and some really did. One gentleman we had was a real prankster who was always joking around. He had no acute anything going on. Out and walking in the hall just before midnight he told my coworker, his assigned nurse, that he wouldn't need his medicine that night because he was headed to his room to die. They both laughed, and he went to bed. She got to his room about 12:15am and sure enough he was gone. Not the first time he had threatened it, but we were all shocked he followed through. That's how it want to go someday, walking around one minute, gone the next.

Wow. Haven't had that at my LTC facility! But the 'best death' I've ever heard of - although even there, it was too young (60-something) was an uncle of my ex, who literally died in the saddle, riding along, checking a fence on a ranch. Not a bad way to go.

[djh123]

OK, this is a whole different thing - a bit more on the dark comedy side - but I've had at least two patients in my LTC facility tell me they were dead. But obviously...

[elfself25]

I like Bernie Segel's (an M.D. who wrote book Love and Medicine) answer to this: Take an old car that is running poorly just as your body is now. Is the car's engine going to blow up today or much later. No one knows. We can spout statistics in situations like this, but who's to say what patient will be what statistic--then one who dies and the one who lives. If the prognosis is grim, I let the patient know. I also let the patient know that we will continue to support your body until you or your DPOA or legal next of kin, when you cannot speak for yourself, asks us to stop. After the emergency is handled , you can discuss living will, DPOA, thoughts and feelings on death and dying as you are able and you may get social work involvement and/or chaplan services. I also let the patient know if I think they are going to eventually walk out of there. i had a multi-trauma patient who had coded on the nursing floor the day prior. A parade of consultants came in and spoke about the systems that they were consulting on. When they left, I had an intuition that the patient needed to hear the big picture. I said, "All of us think you are going to walk out of here." The patient burst into tears and told me that he thought he was dying. He was 24 years old and had a son.

[Flatline, BSN, RN]

"Every man dies, not every man really lives." - Mel Gibson playing William Wallace

Have to say it in the Scottish accent otherwise it doesn't really work.

[Lunah, MSN, RN]

"Every man dies, not every man really lives." - Mel Gibson playing William Wallace

Have to say it in the Scottish accent otherwise it doesn't really work.

FREEEEEEEDOM!

He had a good point, though!

[Ellie G]

I would turn the conversation around. Talk with them about what is going on factually and honestly. I wouldn't answer with a yes or no. More something along the lines of here is what is going on right now, this is what we are doing to change the bad things and keep calm. Focus on what you are going while validating the patient's concerns. I had a patient once tell me she was going To die. She said she saw an angel at her bed that morning. She was scheduled to go home that morning. When her family arrived I went in to remove her IV. As she was about to leave the room she complained of being acutely ShOB and was becoming cyanotic

She ended up coding having a large saddle embolus and died later that day. That was many years ago and I have never forgotten it