Nursing student, and two deaths this week (very long, sorry...)

[LovingLearning]

Hi, all. This is my first post (and not my last...), and I came here for help and understanding. I am at the county's free hospital, and I'm in my first semester of RN school. I have changed my life around to do this, and as my name says, I'm quite literally loving this whole thing. I am not sure how it works in general, but we've been in medsurg (ortho for me) since the 5th week; bedbaths, ADLs, assessments, injections, meds (PO and PRN, no IV yet), and just general care stuff. We are assigned to one patient, and have an RN and our clinical instructor we report to. Our hospital has wards, so we get assigned a bed. Nothing too complicated, and while I've had some rough patients, I've always left the floor feeling good, no matter what happened.

Until Tuesday, that is. Tuesday, I was assigned to a tib plateau ORIF. No big issues there, normal meds, not even a secondary dx. Just the ORIF recovery and PT. We left pre-conference, and headed up to the floor. As I came off the elevator, my RN called for me to gown/glove/mask stat, and help. I handed off my books and got ready. Into the ward I trot, to be confronted by a patient with a pool of blood under his bed, dripping off the sides. Not my patient, but I'm ready to help. I help get him cleaned up, and realize he's bleeding from his rectum. Bright red, and a lot. Not sure even what his DX is, I'm helping clean and locate issues with this pt. We get a condom cath onto him (which I am not supposed to do, so I just watched), and finished cleaning up while the RN is calling for his dr. I take initial care of my pt, get him some pain meds and get him ready to take a bedbath, when I notice another pool of blood on the floor of the first patient. Condom cath is not working, and he's bleeding from his member now as well as his rectum still. I grab my RN, and she foley's him. And the blood coming into the bad is purple and clot-ish; thick and with bits of stuff in it. I can't rouse the patient. I take his pressure, and while it's in the normal range, he's tachycardic. He's compensating. The Dr comes in, and thinks maybe (???) the pt should be in ICU. Two hours later, another group of Drs come in, and they concur. It takes a third Dr to decide to actually call ICU and get the pt transferred...my RN and I get him ready to go, and we take him up to ICU. They start working on him as we get off the elevator... go back to our floor, and I get back to my assigned patient. I find out on Wednesday am in handoff that the transfer pt passed away.

So now it's wednesday morning, and I've been informed of my first death. I try to shake it off, and get to my pt. We have a readmit that was my pt last week, a lady with terminal cancer. I peek in on her (she's been put into iso because we didn't have a bed in the woman's ward), and she looks bad. My regular pt is complaining of pain, and I go to get him his meds and some water. He gets it all in, and he's feeling all right; good enough to eat breakfast. He asks for juice, so I head to the kitchen. Isolation is directly down a short hall from the kitchen, and as I come out of the kitchen, the cancer patient's sister starts screaming. I just sort of stand there, watching...my RN and another RN go flying into the room, and then one comes back out, mumbling something about code blue, and then gets mixed up and goes into the linen closet instead of the med room for the crash cart. Code Blue is called, and my RN gets the crash cart and is moving fast. I look down the hallway, and here comes a horde of scrubs, responding to the code.

I melt back into the basin in the lobby; I have to get out of the way, and so I get pinned in there by all the bodies. The sister of the cancer patient is sort of passed out into the lobby area, where I am, and since she recognized me, headed straight for me. She reaches me, grabs my arms, screams into my face, and her eyes roll back. I catch her (she's tiny) and am able to help her keep her feet; my isntructor has managed to make it through the crowd to me, and tells me to get her into the kitchen...so I do. In the kitchen, she's wailing and hitting the table and the wall, and screaming, asking me if her sister is dead. I don't have any answers, they haven't called the code yet...and then they do. She asks me again, and all I can do is nod. I'm fighting to keep my cool...she needs me cool. She asks me what happens now, and I tell her someone will come talk to her. I'm making that up, because we haven't covered this in class yet. Catch that? I have no idea what I'm supposed to do here...we haven't learned it.

My isntructor gets in there, and does start talking to her. Another student nurse comes in and helps. I am given time to get myself together...and so I do. Or sort of. While I'm out getting myself together, the patient's daughter comes. A brief backstory; she's been quite abusive to the Drs and RNs in the last few weeks. Everyone's been as patient as possible with her, as she's in denial and is fighting to keep her Mom alive. She has filed two complaints against RNs already. So because she hasn't filed a complaint against me, I was asked to watch for her arrival, and get the Dr when she gets there. So she gets there, and barges into the room where her mom is laying. She's screaming, and screaming, and wailing...and I go to her. She grabs me by the shoulders, and shakes me. 'I can't believe you let my mother die in that Godforsaken {blankity blank} room. YOU LET HER DIE!!!". I get my arms around her and just hold her for a few moments...she stops trying to hit me and just collapses into me...and I manage to get her into a chair in the hallway. The Dr comes, and he's talking to her, and tells me to go on and leave, he's got her now...so I do.

I get back to my patient, and he's being a good guy. Just pats my hand and says he doesn't want to know anything, except if I'm all right. Apparently, they didn't get the door shut to the ward, and he watched pretty much everything. I tell him I'm fine, and get to tending him. At my lunch break, I go out onto the patio, and am sitting there in the sun, feeling utterly overwhelmed and confused and shocked and exhausted to my very soul. I get the day complete, and head home. I try to study for exams on Thursday, and managed to get about 2 hours' sleep...go take the exams, blow them completely (until now, I've been a solid A student...), and come home and try to get some sleep. No dice.

I have a horse, and I went to go see him today; riding is my passion and my sanity...and I couldn't ride today. My head was too cloudy to get up on him and risk him losing it and spooking and me coming off and getting hurt...so I kept my feet on the ground.

I know this is really long, and if you're still here, believe me I appreciate it. I am struggling really hard with this week's events...two deaths, neither one a peaceful transition...we haven't learned how to deal with this in class yet, and I'm feeling ever so overwhelmed and lost and scared and ineffective. I'm not coping well, you know?

I guess this post has two goals. First is to be heard and to get some comfort from those who've seen what I saw this week. And second, to find some effective coping strategies because I don't seem to have any. My NANDA would be ineffective coping d/t sudden deaths of patients.

Thanks in advance, and please, help if you can. I'm having a really hard time of it. I keep seeing the sister screaming into my face, and hearing the daughter accuse me of letting her mother die. This is a lot to deal with as a first semester student, you know?

Best-

Lovin' Learning

[casi, ASN, RN]

Dealing with death isn't really something you can learn about in class.

You did any amazing job this week and you'll make a great nurse.

[JustaGypsy]

Sometimes the best you can do is give great care to your patient.

One thing I have learned; you can't make their bills get paid, their roof not leak, or make their family not be "dynamic." Sometimes the best you can do is be a good nurse and PERSON to that patient having what may be the hardest time of their life. And usually, to that patient, it is enough.

(((HUGS)))

[vashtee, RN]

Wow, what a tough week. I think you handled yourself perfectly. Did your nursing instructor counsel you after everyone calmed down? or perhaps refer you to someone who could? I hope so.

[LovingLearning]

Wow, what a tough week. I think you handled yourself perfectly. Did your nursing instructor counsel you after everyone calmed down? or perhaps refer you to someone who could? I hope so.

No, it was sort of discussed in post conference, but not in detail or privately. And no referral was given. I'm thinking about heading to the chaplains office and talking to someone there, but I don't know if that's appropriate.

Casi, I'm sorry I wasn't clear. We have had no instruction as to how to behave in a code blue, or what information we can give the families, or what transpires after a death (like how to handle the body, what to get prepared for the family, stuff like that). We are not supposed to talk to the Drs yet, but that's not strictly enforced if they're asking us direct stuff. And BTW, the attending Dr went out of his way to tell my instructor I was wonderful for the family and to him, and that he appreciated my help. She kinda quizzed me on what 'help' I gave him, and when I told her it was getting tissues and bringing chairs and water to him and the family, she was all right...I think she was worried I was 'helping' in the code or something. I was plastered to the wall...and when I reminded her she was right there and helping me with the patient's sister, she realized her thoughts were unfounded.

It was just so overwhelming and sudden and two in two days is a lot for a newbie to handle...and I'm not sure I'm handling it well.

Thanks so much for replying...and Gypsy, thanks for the hugs. I needed that. I'm feeling lost right about now...

Best-

Lovin' Learning

[jennt9]

Wow

sounds like this week has been a tough one for you. I would suggest to do some reflective practice (journal). I'm sure you are required for nursing school but it is definately helpful to put things down on paper,and to learn for next time.

I'm sure you may not see it at this time, but be glad that you were able to witness a code as a student for the first time and not be considered an active staff member. I found it helpful to watch the other staff to see how they interacted with other staff and the family members.

My best advice is that you get a job in the code and stick to it- codes are incredibly busy and crowded so being a recorder (when you're full-fledged staff member) or being a "runner" (just like you did:)) can be a good way to stay out of the way but still be part of the team.

I think you did a great job! But it seems like you still need to debrief- speaking with pastoral care is a great idea but I would also approach your teacher if you feel comfortable. That is part of their responsibilities to you as a student and quite often students are so focused on the expectations set on them that the clinical instructors "coast" without questioning from the students (not always but may happen).

This past week may have been incredibly difficult but I think it will definately make you a better nurse:)

Jennt9

[sunnie16]

Hey Lovinglearning. What a tough way to experience your first death of a patient/pts. I remember my first pt dying, it was tough without all the extras you had to deal with!

The emotions you are having are normal for what you experienced, but like Jennt9 said, you really need a good debrief with one of you teachers or pastoral care. Its good to think about the experience, write it down-what happened, your feelings, what you did good, what you could have done better, what you need to learn for next time...

You are already a great nurse, your story tells me that. This experience will make you even better and stronger. It will equip you for next time.

Keep on at it

Hugs and prayers

[*LadyJane*]

Hi

You might check out some information about transcultural nursing. Some cultures get very vocal and demonstrative when given bad news, and really get quite quite vocal and dramatic at the news of a loved one's death. It is traditional to act this way, and shows their love and devotion to their loved one after death. I don't know the cultural background of the family of your second death this week, but this might shed some light on this drama for you.

BTW, are you in England?

Jane:nurse:

[debi49]

WOW! What a week. Sounds like you did great! WOnder why they ran a code on a terminal patient? You were thrust into a stressful , unknown situation with emotions running high and proved yourself worthy. (remember this incident when you apply for jobs after you graduate. you'll surely get a question on the lines of "Tell me about a time you handled a particularly stressful situation")

[morte, LPN, LVN]

it seems to me, you could teach the class in "doing the best you can with what ya got".....your instints appear to be excellent......and yes you need to "talk" it out....do a little "off loading" on someone else who can help you process it......and the instructor should have seen to that....maybe she is waiting on you to ask?.....please be kind to yourself, and be at peace with your self....

[anurseuk]

Maybe not the most comforting thing I can say but... It happens!

It sounds like you coped very well at the time, and keeping a professional manner is very important. It sounds like you had already built up a good relationship with the family with 'interesting' family dynamics, which you should be commended for. And if you haven't learnt things yet then you do as you did, be there should you be asked to do something, and learn as you go along.

My first night shift as a qualified nurse was absolutly awful, we had 3 deaths on my ward!!!! 2 DNRs and another terminal pt on care of elderly floor... even though I kind of thought WHY ME!?!?

I still have 'why me' moments, which I think never go completely but now with continued learning, more knowledge and more expereince I understand why a lot more, and I can (most of the time) walk away thinking, that pt recieved the best possible care and we could not have done anything else :)

[Tait, MSN, RN]

First off your story made me literally cry at my desk this morning. What an amazing and I will agree "one hell of a week" you had.

A few questions:

Why did the RN call you back to take care of a patient that wasn't yours when you were finished with your day? (Story #1)

How stupid are your physicians to leave a man bleeding for three hours one the floor and not move him to the unit?

Where are you that your hospital has a "women's ward". (Generally speaking, not specifics of course) What other kinds of distinctions do they have there?

Now kudos to you and handling the family member, I feel you did exactly what I would have done. It broke my heart when you said she finally collapsed into your arms while you tried to calm her. Despite not learning about families/grief/death and dying in classes yet you went with your gut which is a huge portion of nursing. They can teach you all the stages, but you still have to be a human for these people.

Many :icon_hug: my dear,

Tait