Coping With A Difficult Death

This article explores ways to cope when our hospice work doesn't go well. It invites the reader to share their own ways of working through difficult times. Nurses Announcements Archive Article

Coping With A Difficult Death

My phone rang as I sat in my car charting, wrapping up the visits for the afternoon. I recognized the number from the hospice house and reached over to answer before the second ring. In a gentle voice, my supervisor asked about how things were going and where I was. I filled her in, and she asked if I had time to make one more visit to a patient who was on the verge of death.

After getting directions, I asked a few questions and headed toward the home. When I pulled up there were several cars in the driveway, indicating the family had already gathered to say their good-byes. The patient lay on a hospital bed just inside the compact home, wheezing loudly and experiencing spells of apnea. I could tell from a quick glance from the door that death was near. As I stepped in, one of the family members stopped me. "Take off your shoes!" she insisted. While this is a custom in many places, in our part of the country it is an unusual request. I self-consciously stepped back and gladly complied, embarrassed to not have noticed the shoes at the door before heading in.

It seemed that from that moment forward, things just did not go smoothly. It's hard to say exactly why: maybe the family was simply annoyed that I wasn't the primary nurse and they had never met me; maybe they were angry at being in a situation where they even needed hospice; maybe everyone was tired, hungry and emotionally spent. The reasons simply don't matter. I did my best, and I know they did their best especially given that their loved one was dying. The tragedy was compounded by the fact that the patient was not very old, that he was dying a physically messy death, and that the process had lingered on for days.

The priest arrived to give the Last Rites shortly before the patient died. The family gathered around, disconsolate. I waited in an out of the way place and began making the necessary phone calls to the funeral home, the equipment company, the hospice house, the pharmacy company and the doctor's office. I disposed of leftover drugs with another family member and then, at an appropriate time, did my best to clean the body and make him presentable to the family.

As I followed the heorifice out of the driveway and made my way toward home, I couldn't help but feel a bit dejected and defeated. I wondered guiltily if I could have done something to make it better for him, for them? Even as I went over the situation in my mind, my rational self knew that the answer was probably "no." Sometimes things just don't work out at the time of death. We all know that. We want to help make every passing as easy as we can, but we are not always successful in achieving this goal. We are not always the one the family wishes for; we are not always able to anticipate every need; we don't always come up with the right thing to do or say. It's just the way it goes. As a hospice nurse, I understand that. But it doesn't make it any easier to cope with a difficult death.

In his book, When Breath Becomes Air, neurosurgeon-in-training, Dr. Paul Kalanithi, details some of the emotions that accompany the sense of guilt when everything doesn't turn out as we would hope. He says, "I still had a lot of practical medicine to learn, but would knowledge alone be enough, with life and death hanging in the balance? Surely intelligence wasn't enough; moral clarity was needed as well. Somehow, I had to believe, I would gain not only knowledge but wisdom, too."

Sometimes hard visits happen. They may be because of mistakes or they can be the result of many other factors outside of our control. But they all leave us with the question: how do I get beyond this? How do I process this? How can I do better next time? How do I cope?

That night I found sleep elusive. I tossed and turned, read my Bible, prayed, and tried again. I finally drifted off but woke up the next morning still feeling a burden. I thought it over then put in a call to the hospice house and asked for one of the medical social workers. When Laura got on the line, I said, "Laura, I don't need you to fix anything. I just need to tell you the story of this death yesterday and see if that will help me get through it." So I proceeded to tell her, over the phone, in as much detail as I could, all that had happened. She asked a few helpful questions, but mostly she just listened. When I was done, I felt a burden lift. I wasn't "all better" but I was definitely "better."

"Thanks, Laura! I appreciate your willingness to listen."

"Anytime. Call me anytime," she responded with a genuineness that warmed my heart.

With confidentiality concerns being what they are, we must choose carefully who we talk with and what details we reveal, but it can be very helpful to simply tell someone else the story, setting the stage first by helping them understand that you simply need a listening ear. I also discussed the event with the patient's primary nurse, telling her some of the details of the death; she was able to fill me in on some of the difficult family dynamics, which helped me to understand parts of what took place.

That same day, I worked to schedule in a long walk with my dog. Exercise can be another way to work through a sense of frustration and loss when things don't go so well. I knew that physical fatigue was one of the reasons that I had experienced such a struggle during that patient's death. For me, exercise and being outside can help to restore perspective and balance.

I also tried to pray about it and journal, releasing my concerns to God. Spiritual processing of griefs and troubles in not something that everyone believes in or practices. But for me, it is a source of great comfort and a help in my practice of nursing.

In this particular story, nothing goes terribly wrong. It is not a case of a true medical error. It is more basic than that and something that can happen with fair frequency: we are not at the top of our game as nurses some days, and we don't "click" with every patient and their family. Having said that, as professionals, we continue to strive for excellence in each interaction, and we work hard to be the best we can be. I wonder if some of you would like to share some ideas for how to pick up and carry on after a bad experience? What helps you?

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jeastridge

About jeastridge, BSN, RN

(Columnist)

Joy has been a nurse for 35 years, practicing in a variety of settings. Currently, she is a Faith Community Nurse. She enjoys her grandchildren, cooking for crowds and taking long walks.

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Keep your loving spirit and caring ways. Most hospice patients and families are very grateful as you are aware. We do what we do because we care. I am sad to read so many are burnt out fast because of how they are received and treated. Keep you head held high and Bless You for helping.

Specializes in Registered Nurse.

So true! "We cannot be everything to everybody," is a line that comes to mind. But no, we cannot click with every patient or every family, especially a grieving one...because they all grieve in different ways. And, in this case, you were a stranger to them.

I recently had a difficult death of a patient that was new to me. The family was already angry when I took the patient. After the death, the patient's family focused on complaints about the nurses before me and other things...there was no making it easier for them.

Specializes in Faith Community Nurse (FCN).
So true! "We cannot be everything to everybody," is a line that comes to mind. But no, we cannot click with every patient or every family, especially a grieving one...because they all grieve in different ways. And, in this case, you were a stranger to them.

I recently had a difficult death of a patient that was new to me. The family was already angry when I took the patient. After the death, the patient's family focused on complaints about the nurses before me and other things...there was no making it easier for them.

As you point out, there are often circumstances that are well beyond our control. I find that I have to work through these hard times by talking it through and then finding ways to release any residual negative feelings.

Specializes in Faith Community Nurse (FCN).
Keep your loving spirit and caring ways. Most hospice patients and families are very grateful as you are aware. We do what we do because we care. I am sad to read so many are burnt out fast because of how they are received and treated. Keep you head held high and Bless You for helping.

Thank you for your kind words. It is so helpful when we can offer professional and personal encouragement to one another. Bless you.

1 Votes

It seems unfair to ask a nurse to visit a patient who they have never seen before (seems to be the case from you description) at the very end of his or her life. As a Hospice volunteer for a number of years, in my opinion, nothing can substitute for being with the family and patient over a period of weeks or months. It can often create a deep bond and sense of appreciation between the caregiver and the family. Entering a situation where the patient been in extended pain at the very end of life seems like you are being set up to fail in relating to the family.

Unfortunately, the patient needs professional care (with shortness of breath and other issues) and someone needs to do it. It seems kind of like being a policeman where you have to go outside your comfort zone and face unpleasant, no-win situations for the greater good of the society (or the patient). It is sacrificing one's own well-being for the sake of another. In the short term it feels bad but in the larger scheme of things, I believe it is a noble and praiseworthy act.

Specializes in Faith Community Nurse (FCN).

What an insightful comment you shared! Thank you for your perspective. You are so right, sometimes we are called to respond to situations that are not ideal. But we do it with all of the best that is within us.