How Did You Handle Your First Experience with a Patient Dying? - page 2
As a pre-nursing student, I am wondering how I will handle my first experience with a patient whom I am caring for passes away (not because of negligence) but because of the illness. I know how I... Read More
Nov 20, '07Occupation: LPN Specialty: LTC, MSP, ICU ; Joined: Jan '07; Posts: 50; Likes: 9Quote from nurse2b20101st ? I have mostly worked LTC--death every day-- 2nd? what is wrong with showing emotion--while it is okay to show emotion it is not professional to cry because the family that needs your support may end up supporting you. It isnt always possible though. Just try your hardest to be strong.Thank you for sharing your story. Two questions: what is MCP (your specialty) and also, what would be the harm in allowing the family to see your emotions . . . that you are caring and compassionate as well. As I said, I am a pre-nursing student, I have a lot to learn, but it doesn't seem to be that it would be that horrible to cry in front of the family.Last edit by nitewarrior on Nov 20, '07
Nov 20, '07Occupation: Registered Nurse Specialty: 7 year(s) of experience in Home Health, Case Management, OR ; From: US ; Joined: Jan '06; Posts: 462; Likes: 238Quote from nurz2beWow that made me tear up a little! Very well said and I hope to remember that when I have to face a death again, or a birth, which I have yet to witness.I think it all depends on how you view life and how you view death. For instance, I felt it was such a privilege for me to not only be able to have children but to actually be there and see my kids first breath was amazing. It was an honor for me to experience that with my children. Likewise, I view death in much the same way. Yes, it is sad when a young child, infant, young person, young mother, passes. But, to actually be able to be present with someone, like a previous poster said, to hold someone's hand as they pass, is a honor. It is sad, but it is a fact of life. We are born, we live the best we can doing what we can to make a difference, and then we pass. Hopefully we have left behind a mark on this world. So, when you have your first patient pass try to look at it as a mark on the world. You will NEVER forget your first death, the first birth. That person, if they made no other mark on society, they made a mark on you. They made you rethink your day, your care, and the way you will be with your patients in the future. Try to grasp SOME positive from that experience.
Nov 20, '07Occupation: Registered Nurse Specialty: 7 year(s) of experience in Home Health, Case Management, OR ; From: US ; Joined: Jan '06; Posts: 462; Likes: 238I witnessed my first death last December. She was a long time resident of our facility and it was a extremely emotional situation. We knew she was going to pass, it was not a surprise, but it was very strange to actually visually note the changes that took place as she was dying. Her whole family was there, and we were all crying together. I tried to hold my composure, but I couldn't do it. Nor could our nurse or the other CNA's. She was the first dead body that I touched, which just felt so strange, so empty. The one thing that I will never in my life forget is the sound her husband made when she passed (we were not in the room at that time, were giving the family their time with her). I knew from that sound alone, as my heart hit the floor, that she was gone. I could go without ever hearing that sound of anguish every again, though I know in nursing I will encounter it many more times.
Nov 21, '07Occupation: Medical Specialty: Med/Surg <1; Epic Certified <1 ; Joined: Nov '05; Posts: 2,257; Likes: 366I was new to the world of the hospital and nursing (other than having had kids myself)...it was our first clinical day and thank heavens we were partnered with another student....my partner was a tech at another hospital...our pt was expected to pass that day...the family had been called and were on their way...we went in and gave her a bath and changed her...she was coherent enough to nod her head in answer to our responses, but never opened her eyes. She was in her 80's and had extensive cancer.
We went out to the hall to do some charting and saw her daughter enter her room. She was waiting for additional family to show up. The daughter came out of the room and said she didn't think her mom was breathing. The RN was nowhere to be found, so we entered the room and I checked for a pulse as we had found a pretty strong one earlier; nothing. I told her we were students and let me go find her nurse. The nurse listened for a heartbeat and checked the pulse again and told her daughter she was sorry. We left the room.
Wow....quite the intro to the world of a nurse! Toward the end of our shift, the family left and we participated in the postmortem work. THAT was tough....my mom had just passed very unexpectedly 5 months prior, so I was dealing with the emotions of watching the daughter having just lost her mom and also the recentness of having just lost my mom. So much empathy...I teared up, but managed to hold on.
I had another pt this semester (my 3rd) who went on in-hospital hospice on my first clinical day. They d/c'd a lot of her equipment and put her on comfort measures. By my second day she had gone from a pretty coherent, though uncomfortable pt, to a comatose state. The following day I was working as a tech in the hospital and went to see how she was doing. She had passed that morning. That also touched me deeply while I was caring for her and also knowing she had passed as I again felt such empathy for her daughters who were with her constantly.
I was also present this summer when I was doing an internship in an ER and an ambulance brought us a pt who was most probably gone when he came in, but they did run a code on him for several minutes before he was pronounced.
That's 3 in 3 semesters. I think being an older student and having lost very dear grandparents along with my mom's passing gave me a perspective about this being another aspect of life, sad as it is. It's not easy, but it must be dealt with. I don't know that one ever gets used to it, but I think it's definately something you should expect to deal with.
Nov 21, '07Joined: Jun '05; Posts: 6,742; Likes: 1,030Quote from nurse2b2010Thank you - there are times when death can be a good experience.....when the patient and the family are ready and accepting - these times are few and far in between. My first code was hard on me and took me a long time to get over those hurtful comments, but there are times when things are not so hard on me.OH GOSH, this is what I am so afraid of . . . the doctors jumping all other you instead of taking responsibility for their own actions. I am so glad the charge nurse backed you up! It must be hard enough dealing with the fact that your patient just died, but then having to deal with misplaced blame! So glad you are hanging in there. You sound like a great caring nurse!:spin:
Nov 21, '07Occupation: Full-time Student Joined: Oct '07; Posts: 190; Likes: 58I too am new to the hospital and nursing world. I have two grown children, but I didn't see them being born. I know the first birth and death will have a great impact on me. I witnessed my father passing away and it was hard. I want to be the best nurse I can be; give the best care I can and have a feel that I made a difference in that person's life.
Nov 21, '07Occupation: Full-time Student Joined: Oct '07; Posts: 190; Likes: 58Quote from nurz2beThank you, very wonderful advice!I think it all depends on how you view life and how you view death. For instance, I felt it was such a privilege for me to not only be able to have children but to actually be there and see my kids first breath was amazing. It was an honor for me to experience that with my children. Likewise, I view death in much the same way. Yes, it is sad when a young child, infant, young person, young mother, passes. But, to actually be able to be present with someone, like a previous poster said, to hold someone's hand as they pass, is a honor. It is sad, but it is a fact of life. We are born, we live the best we can doing what we can to make a difference, and then we pass. Hopefully we have left behind a mark on this world. So, when you have your first patient pass try to look at it as a mark on the world. You will NEVER forget your first death, the first birth. That person, if they made no other mark on society, they made a mark on you. They made you rethink your day, your care, and the way you will be with your patients in the future. Try to grasp SOME positive from that experience.
Nov 22, '07Joined: Nov '06; Posts: 266; Likes: 79I was very upset by the first patient I had that died. He died after I had left for the day, but it was very upsetting. I haven't seen a patient die in front of me yet, though. I hope I never do, but odds are we all will see a death at some point.
Nov 22, '07Occupation: Full-time Student Joined: Oct '07; Posts: 190; Likes: 58Quote from future L&DnurseI was very upset by the first patient I had that died. He died after I had left for the day, but it was very upsetting. I haven't seen a patient die in front of me yet, though. I hope I never do, but odds are we all will see a death at some point.
I am sure it was upsetting; being able to feel emotions is what makes a great nurse I think. I see that your name says "future L & D Nurse"! That's what I want to do also! I can't wait to see a baby being born. How long have you been a nurse or in nursing school?
Nov 22, '07Specialty: 9 year(s) of experience ; From: NZ ; Joined: Aug '05; Posts: 268; Likes: 254I actually have no issues with death or dying, and I'm not sure if that's a good thing. I'm about the only person who doesn't break down when patients where I work die, and the place I work is pretty much an elder care hospice. On clinical I witnessed a woman die of something horrid, she was only 48 and started convusling and puking blood in large amounts, the other students, and even some of the RNs freaked. It actually didn't bother me all a heck of a lot.
Primarily, I think my lack of outward mourning is based on the fact I beleive there's an afterlife and that most of the people who have past that I have cared for would end up in the good side of post death.
As for peopel who might end up in a rather hot place post death, I feel sorry for them and I simply remember them in my prayers that they'll be shown mercy.
We're all going to die, everyone of us, it may be in a resthome at the end of a long life, or from SIDs, or you could slip on the soap in the shower and smash your head open. At the end of the day, I don't really get too worked up over something that's so inevitable. Of course, its kinda unfair when people are murdered or die young from cancer, but again, we're all going to die, and a beleif in an afterlife enables me to quite stoically care for patients facing it.
Nov 22, '07Occupation: working and going to school Specialty: Med/Surg, Tele, IM, OB/GYN, neuro, GI ; From: US ; Joined: Aug '07; Posts: 724; Likes: 225I don't think death or dying bother me either. I use to work at a hospital and a handful of patients would die after my shift ended find out the next day never got upset. Sad that they passed but not upset. Both my grandmothers died within a year of each other didn't cry because I felt that it was better than living with what problems they had. Last month one of the patients on the floor coded and everyone in my group helped with the code in what ways we could. Afterwards everyone was flipping out about it got even worse for them when they found out she died and three times worse when the funeral home came to get the body because it was the first time some of them had ever seen a body bag.
A lot of people that are in the hospital have things wrong that affect them not only health wise but their way of life and in some cases it is better than suffering. I'm there to help them pass as peaceful as possible.
Nov 23, '07Joined: Nov '06; Posts: 266; Likes: 79**off topic**
Quote from nurse2b2010My name isn't entirely accurate, I want to work a few years in L&D and then go back to school (I"m a glutton for punishment) and get my masters in midwifery. So it really should say "future midwife"! I have already done a L&D rotation and LOVED it. I saw 10 births and just think there is no better way to spend the day than helping mothers have their babies. I'm in a BSN program and graduate in May.I am sure it was upsetting; being able to feel emotions is what makes a great nurse I think. I see that your name says "future L & D Nurse"! That's what I want to do also! I can't wait to see a baby being born. How long have you been a nurse or in nursing school?
Nov 23, '07Specialty: med/surg, telemetry, IV therapy, mgmt ; Joined: May '05; Posts: 15,027; Likes: 8,983You are asking some very soul searching questions and I think I have an idea of what you may be struggling with yourself. Before I answer you I just want to assure you that as a nurse you will be compelled to examine your feelings and beliefs about death and the death experience. It is inevitable. I went through it and thousands of other nurses who work with patients who die go through this. I have now reached a point where I feel comfortable in my feelings and beliefs about death.
My very first patient who died
I was working as a nursing assistant in a nursing home while in nursing school. One of the patient's was not very responsive and I was told by the charge nurse that she would probably pass away. I found it hard to believe because the lady was talking with me and although she seemed weak she sure didn't seem like she would be dead any time soon on my shift. Well, I was wrong. About 4am I went in to the room and found her lying quietly in the bed. However, when I talked to her she didn't respond. Intellectually, I think I understood that she had died, but I just couldn't believe it. I tried to think of all the things I had been taught in school to verify that someone was not alive. I used my stethoscope to try to hear a heartbeat and couldn't find one. I couldn't palpate a pulse. I couldn't see any evidence that she was breathing. BUT, her coloring looked absolutely normal and she was still warm when I touched her. She had just died, no doubt. I called the charge nurse into the room and she took a few steps in and I'll never forget her saying, "Oh, honey, she's gone." How did she know by just looking? Now, years later I understand. There is a paleness of death that is much different from the paleness of a live person that is unmistakable. I felt very sad at the time and as we got the body ready for the funeral home I remember treating it as gently and respectfully as any other patient.My mother's death
My mother was living with me and had breast cancer that had metastasized (spread) to her lungs. She had a lot of trouble breathing. She wanted to be at home and so she had decided on hospice services. The night that she died was kind of a strange thing. She was very irritable and actually kind of nasty to me. She accused me of not giving her enough medication to help her with her shortness of breath and I felt bad. I had given her a whole bunch of Roxanol (morphine) and Ativan (an antianxiety drug) to help her relax and sleep. I worried that I might have given her too much, but I had given her way more in one dose in the past so I am sure that I did not overdose her. We both went to sleep. Around 4am something woke me up. I can't tell you what it was. I got up went to check on mom. I knew immediately that she was taking her final breaths. Her coloring was pasty pale and she was having agonal breathing. She was, however, looking very peaceful and not at all struggling and irritable like she had been earlier. I sat at her side and held her hand which was quite cold, another sign that her body was shutting down and waited as the inevitable death happened and cried. It was so quiet and peaceful. When I called my brothers and sister something very interesting came to light. One brother and my sister were also suddenly awakened around 3am and couldn't get back to sleep to the point that they finally had gotten up and started pacing around.My death
I decided a long time ago that I wasn't worried about my own death. I've seen enough people die that I am convinced that it is a very peaceful process. It is as easy as going to sleep. What I am scared of is the way we get to the end of our lives. I had a classmate who died in a very traumatic traffic accident where her car was forced off a mountain road and went over the side of a cliff. For some time I used to think about the terror that must have gone through her mind in the final moments before her death. Now, that I don't want to happen to me. I have had cancer three times now. I've beat it twice, but this third time is kind of iffy. The chemotherapy treatments are kicking my arse and I often wonder if it's worth all the trouble. We are all going to die--that's a fact. If we have a choice in how it is going to happen, I'll take dying in my own bed any day. But, I would prefer not to be in agonizing pain. I'd just like to close my eyes and go to sleep.When I worked on a stepdown unit, we had many frequent flyers, mostly COPDers. As they came in and we saw their medical conditions getting worse and worse many of us wanted these patients to be on our unit when they became terminal even though they might be intubated or had tracheotomies and were on ventilators. Why? Because we felt that we knew them. What a privilege it is to care for someone when they can't tell you what they need, but you know because you've attended to them so much in the past. You know just how they like to be positioned or that they can't turn to one particular side because it's too uncomfortable for them. You knew what they wanted every time they had turned on their call light before you even answered it. We wanted to be the nurses who took care of them as they took their last breaths. Partly, I think, it was because it gave us closure as well. It's funny how all the complaining and griping we had done about them when they were patients with us before (some were real pains in the arse) was replaced with a solemn reverence to seriously attend to them when they were dying. I wonder if nurses working on the oncology units feel the same. I was sad with the passing of every patient even if they had been a royal pain in the arse at some time. These are people. In their heyday they were productive members of our society just as we are and I feel very strongly that they deserve our respect and kindness in the days of their illness and passing. After all, we are all doing something very common--living and learning.