Rough day

  1. I'm losing a patient. She is dying and I can't do anything to stop it. She's 97 years old. Refuses hospital/doctor.
    I think the hardest part about being a nurse is not being able to fix something. I'm rambling but I'll be brief.
    I went in tonight because I know she's going downhill - no I wasn't scheduled, I was just concerned. I had called the family because she hadn't eaten and was talking to the air (spirits?) and reaching for something that wasn't there. Her son thinks she will pull through this, however I am certain she won't. I see the pain of the family. I can't fix that.
    My patient is dying (old age/refusal to see the doctor) I can't fix that.
    These are the things I hate about being a nurse. When I can't FIX it.

    I said I would keep it short - there's alot more to the story - but I need to go to bed as I am expecting a call during the night. Just having a hard time dealing with this aspect of nursing. At the same time. I'm glad I'm like this - it's sad but true. I'd rather be hurting for my patients then have them feel the pain. But in either case - it just can't be fixed.

    Sorry if this made so little sense, I'm tired and it's been a long day and will be a long night.

    ~Jen
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    About JentheRN05

    Joined: Aug '05; Posts: 965; Likes: 49
    RN
    Specialty: OB, ortho/neuro, home care, office

    11 Comments

  3. by   UM Review RN
    :icon_hug: :icon_hug:

    So sorry this is happening. Yes, it is hard to be a nurse when someone dies, when we ourselves have such a difficult time accepting it. I pray that you will be comforted by remembering that you did your best for your patient.
    Last edit by UM Review RN on Oct 23, '06
  4. by   banditrn
    Bless you for caring. As hard as it is to go thru, try not to lose that part of yourself.
  5. by   nursingisworkRN
    So sorry that you are going through this right now. Please realize that by taking the time and initiative to care for this pt you are helping. You may not be able to fix the situation, but I can guarantee your love and support do not go unnoticed.

    I am somehow reminded of one of my nursing instructors Janie saying "Nursing is a caring profession. Never lose the caring. There is always a person underneath the sickness. When you lose sight of the person, you lose everything." My thoughts are with you.
  6. by   PedsRN1991
    He Jen,
    (((HUGS))) to you! It is very hard to lose a patient that you have become attached to. Bless you for being a caring nurse.
    Perhaps the patient earlier refused anything else because they were ready to go. A family (and us nurses) are never ready to let go. Try to hang in there and be comforted by the fact that you played such an important role in this patients (and family's life).
  7. by   thsnursluvsgeriatric
    Hi Jen, I feel for you. It's hard to access the right feelings to convey to you.
    You did sound very tired in your post and I can only hope that you have
    been able to rest both your mind and body. I'm sure you know that dying is as much a part of life as being born, but why? I never understood this until I searched for an answer. This might only be an explaination for my own heart but it soothes me. I think that it is when we have to dig deep that we can grow, this often happens in our lowest times. I used to wonder why
    the elderly had to endure or why did the bed patient have to endure. Then I realized (and this may only be true for myself) that even in death our elders can teach us something about ourselves. The patience and love, the gentle touch and acceptance of grief what greater gift, then for our frail elderly to bestow us at their weakest. But when you see the vulnerability and need, well it has taught me that live is fragile, and to love those who are living and in my life more patiently.
    I do hope that all is well and have been praying for you.
  8. by   adrienurse
    This is a really hard lesson to learn. Remember that part of geriatric nursing is to go beyond treatment of illnesses. We have to make it okay for patients to die comfortable and peaceful deaths when their natural time comes. We have to allow out patients to make the decision when it's time to go and continue our care to support this.

    ((((Jen)))) Thankyou for caring for her so much.
  9. by   marjoriemac
    So glad you acknowledged the 'touching the air' phenomenon. I have seen this so many times in the dying as well as staring and smiling at someone unseen to us! It is a very comforting thing to observe!
  10. by   JentheRN05
    Well - I did received a call at 12:15 last night. But instead of the patient that is dying, it was my grandma. She had a heart attack and died at 74.
    My patient is still holding on. I got orders for Ativan and Scopamine (sp). I don't want her to be frightened when shes suffocating = she is rapidly filling up with fluid. I can't hear any breath sounds in lower lobes, and upper lobes is a terrible rattle/rhonchi. I can't feel a pulse, not even a carotid, and hearing her heart (which is so weak) through the stethoscope is almost impossible with her lungs sounding the way they do - but outwardly they aren't bad yet.
    I haven't slept but 3 hours last night, I'm so tired. But I'll explain my patient further.
    She has had a few brushes with death. 3 years ago her family was told she would never leave the hospital. She has severe CHF, and is on massive amounts of lasix and spirolactone. Well when she made it through the last time at the hospital, her son is now convinced that she will pull through this. I think she's holding on waiting for the words from him, that it's okay to go. He won't accept it. She's lingering and he won't say it. He still thinks she'll pull through. I can't convince him otherwise even though he has seen and heard her talking to people who are not there and grasping at the air. Talking to her husband (died 30 years ago) and her sister (died 5 years ago). She is barely waking. Her legs are purplish, have been though for a couple of weeks. Her eyes are glossy and almost opaque. She said last night in one of her ramblings, that 'I can't see anything' Which tells me she's lost blood supply to her eyes. She's only urinating about 100 - 200cc/day. Not eating anymore, but I suggested they hold food, only because she has had problems swallowing for some time now, and lately she has no appetite. I am suggesting they offer her boost (nutritional drinks) and water, but not too often because shes so overloaded with fluid that she has +3 pitting edema in her ankles and her belly looks like she's 9 months pregnant. I have implemented a turn schedule every hour if possible. She doesn't awaken when turned. Hasn't had a BM in 2 days, last one was uncontrolled.
    It's just hard not being there. But the family is there. I just can't be there all the time.
    If you remember correctly I'm the only RN on staff, in fact I'm the ONLY medical person on staff. I had to give the family instructions on when the staff can give the ativan and scopamine. Because I don't feel comfortable leaving the choice up to the staff. I have written 2 page instructions on the meds and that they are recording them (yet they haven't been started as of yet).
    I'm going to go check on her tonight. I just wish her son would let her go, so she can go in peace. I plan to talk to him tonight when I go in.
    I am doing everything I can to comfort her, to keep her comfortable. As well as give the family plenty of time with her. This is a private run facility. So this is just the way things are done. I have made alot of changes but in no way is this place in perfect running order, I've only been there a month and have changed so many things that haven't been changed in 40 or more years. So change takes time.
    Anyway - I plan to go in before I go to bed. Just to check on her. I just don't know what else I can do. It's too late for hospice and it was veto'd by the board but now they are seeing the need, it's too late to help my resident much at this point.
    Will she linger until he says it is okay for her to go? Seriously? It may be weeks of her suffering if so.
    Anyway - just adding to my rant. I'm so tired, but can't sleep, my head is pounding because of the stress (grandma included of course). I just am a little overwhelmed.
    Sorry to ramble a book this time. I guess I really should just be journaling this instead of sharing it with the world, but your kind words do help.
    Thank you :kiss
  11. by   adrienurse
    (((((((Jen))))))))
    Sorry to hear about your grandmother

    It seems like your taking good care of your patient's symptoms. This is great, it's sometimes hard to find doctors who will prescribe scopolamine. Versed is also really good for terminal distress (off label use so some MDs are apprehensive about using it). Works very very well at helping them on their way in peace.
  12. by   adrienurse
    Sorry to hear about her son. I hope that he is able to make peace with her dying and that it's time to let go (her being in her late 90's and all). I pray for him to ease his pain.
  13. by   JentheRN05
    Well - my resident passed away, she went peacefully in her sleep. With no pain. Her daughter was at her bedside. I had just gotten home from my grandmothers funeral and gotten to sleep about 2am on Thursday. Got a phone call at 6am that my resident had passed and I was needed to come pronounce her. So I went in and did that. Was there until 7am. Came back home to try and get more sleep, finally drifted off sometime after 7:30am and my mom called at 8:30am. I was going to go to my residents funeral today, but I have come down ill and am not able to. Which I promised the family I would be there. But have no way to contact them to let them know otherwise. Which I doubt matters whether I'm there or not. I emailed the funeral home a poem I wrote in May for my mom when my grandma passed. It was entitled 'Mother'. It seemed to fit the situation quite well.
    Anyway - as far as getting hospice into the residential home. It was shot down by the local judge (he has the final say on things like that). I am going to do my best to dispute it, but it seems he has his mind set, that when the ladies are going to die, they must be moved out of the residential home elsewhere to die. I don't agree with that, but with everything that has happened lately I just don't have the energy to do anything about it right now.
    Thanks all for your support
    ~Jen

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