How to deal with guilt after pt's death

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Hi, I am a grad nurse working in ICU.

Today I have got a patient with complex medical background (liver/cardiac/kidney/lung issues), but he looked fine from the start of my shift. Low dose Norad support, some sedation to keep him calm, some dextrose, that's all. With my limited experience, I truly believe he is going to stay here for a few more nights and get discharged.

In the middle of my shift, he started to require 1L-2L oxygen (he was on high flow yesterday). When doctors did their ward around, his sats dropped a bit so we switched back to high flow. While I was a bit overwhelmed by my tasks (4 IV meds needed to be started and I have got no access yet, all lumens of CVC were being used, waiting for IVC insertion), his sats and BP dropped. I increased oxygen and flow and Norad, issues not fixed. I managed to give all his important meds, not helping. I felt a bit helpless, I was thinking, OMG something was not right, my pt is deteriorating. So I grabbed a senior nurse, informed the medical team. Eventually, he was on 3 inotropes, fentanyl, fluids, and the doctor decided to contact family as he may not go through the next few hours. The family came over, they were crying. 

I didn't see the pt die, but he will. I started questioning myself, even though I felt I have done the right thing, there is a voice saying, maybe I have done something wrong I just don't know it, after all he looked OK at the start. So I asked our doctor, he said well the patient has multiorgan failure plus type 1 DM and sepsis, there is a high chance that he may not survive.

I don't have a lot of experience, is it possible for a patient to deteriorate so rapidly? (within a few hours) How do I deal with this feeling of shock and guilt?

Thank you all.

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Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.
3 hours ago, AlexisZ said:

I don't have a lot of experience, is it possible for a patient to deteriorate so rapidly? (within a few hours) How to I deal with this feeling of shock and guit?

It can be really stunning how fast some people can deteriorate and die with no real way to pull them back. The first few times you’ll see this you will be incredulous and wonder how you or anybody failed somehow. It will make you sleepless and upset. This way lies madness.

With time and experience you will learn this. You’ll learn to recognize and report early symptoms of sepsis, and multi system organ failure due to sepsis, and to your point about guilt, learn how even when recognized and reported quickly they can sometimes be signposts on the road to death no matter what you or anybody can do. In a longer term, you’ll develop that sneaking feeling of “everything is normal but something just doesn’t feel right,” or learn it from some more experienced nurses, and have the confidence to act proactively, but you’re a long way from that.

Go in peace. It will get better. 

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Specializes in NICU, ICU, PICU, Academia.

This was on my Twitter feed the other day:

"CPR is great if the heart is trying to kill the body. It is not helpful when the dying body is taking the heart with it..."

Your patient had a dying body and the heart went with it. 

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Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.

Brilliant. 

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Specializes in retired LTC.

to meanmaryjean - so insightful.

to AlexisZ - Sometimes they go fast - even as you're standing right there. But then there are also the pts that survive and do well. They surprise you and make you feel good that you were able to make that difference.

 Just no telling ... You will heal.

 

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