How do you handle emotional codes/deaths?

Da_Milk_of_Amnesia, MSN · Nov 7, 2014

I wish I had a good answer for you. Some people are better at handling death and dying than other. I come from a long history of EMS and firefighting where I've seen the worst of the worst. I wish I could tell you how i deal with it but truthfully, I don't deal with it; I just let it go. Watching someone young or even children die is perhaps the hardest to deal with, I carried a dead 2 year old of a house and i took almost 6 months off from EMS because I was just burnt out and needed a break. It's the hardest thing to deal with but you just learn to deal. You can be empathic, its not a bad thing, but you need to keep it in check. You really do need to keep your emotions out of whatever you are doing. I'm not saying be cold-hearted but keep an arms distance. I think the best way I deal with things is that I compartmentalize things and learn to let it go, live by the saying 'It is what it is.' I suppose you'll learn to deal with or you will burn yourself out. There's no easy answer to your question.

Nalon1 RN/EMT-P, BSN, RN · Nov 7, 2014

Yup, everyone deals with it differently. Some better than others, and some never can and have to leave.

I too come from an EMS background.

From day 1 work is work. I do everything I can for those I care for, but when I clock out, I am done. When I was on the ambulance, I did not follow up with people I dropped off. As a nurse, I don't follow patients if they are not mine. I don't talk to my wife about my day aside from "it was good" (it is always good, no need to bring her down with all the crap that goes on at work).

I truthfully don't have to decompress from high stress situations because I don't allow them to stress me out. You can be empathetic without getting emotionally involved, but some have a hard time finding that division.

Unfortunately there is no easy answer for you. I can't tell you to "suck it up and deal with it". I can't say to deal with it the way I do. You will need to find a way though to be able to keep that separation of work and personal while remaining empathetic.

Codeblue1982 · Nov 8, 2014

Thanks for the input, my husband is a police officer and has no trouble leaving work at work, where as I find it follows me home, I think I just need to find a way to redirect that type of energy and change my thought process to prevent burn out. Unfortunately it is not always that easy but I'm sure I will find something that works for me.

calivianya, BSN, RN · Nov 8, 2014

I think sometimes we can be blind to how sick our patients actually are because we see so many recover, or at least get stabilized enough to go to the floor/hospice/whatever. Even a fairly independent A&O who just needs Levophed and some antibiotics but otherwise is managing herself just fine in her room, might be dead if she wasn't admitted. Our patients are all (mostly) at risk of death. That is why they are with us. I know that sounds a little simplistic but that is how I think about deaths. I do my best to prevent them but some people are just going to die anyway, and if I did my best, that patient's death is out of my hands. Death is a natural part of living and it sucks, especially if it seems like that patient is too young, but unless you made an error, it is not your fault when your patient dies.

Farawyn · Nov 8, 2014

Talk to other nurses. Cry. Eat. Then get up and do it again.

Sometimes it's the deaths that you don't expect to affect you, that affect you the most. Think about "what was different about this one that got to me?" We bring our own stuff to the table, too.

Take solace that as The Nurse, you did more for this patient that most can do. You may have helped prolong his or her life, brought comfort to the patient, and to the family, and that you did not cause death. Death just happens.

EmergencyNurse2012 · Nov 12, 2014

Codeblue1982,

One thing an instructor told us the first week of nursing school has served me incredibly well. She sat all 52 of us down in a room and while going over expectations for clinicals, she stated, "I don't want to ever see you crying in a patient's room and absolutely NEVER in a code situation!" At the time, I thought she was the most cold-hearted person on earth and I totally disagreed with her. To me, in my mind, crying with the family or for the family showed I was human and not detached from what was going on in their lives. I didn't understand her stance at all until I was in my final semester of school-my next to last week of preceptorship clinicals. A pediatric code came in and we were working very hard to get this little one back. Multiple rounds of epi, bicarb, fluids were pushed, to no avail. Half way through the code, the respiratory therapist, who was bagging the intubated child, started crying. Up until that point, everyone was working like a well oiled machine and things were going as well as could be expected. When the RT started crying, it went around the room like an ocean wave. Everyone became ineffective in their own jobs from the RT to the person doing compressions, to the nurse pushing the meds, to the pharmacists preparing the meds. It made me very, very angry and I was screaming inside "pull it together! this child needs us, we don't have time to do this now! get it together!" My preceptor who was next to me whispered in my ear, "I have to leave, I can't stay in here." She was crying. While I totally understand the human emotions we all were feeling, it was not an appropriate time/place to vent them. This child unfortunately did not have a chance at survival-the down time was just too long.

I digress, your original question was how do I deal with code situations? I look at the person on the bed as a loved one and I do everything in my power (within my scope of practice and the family's wishes) to get them back. While I'm doing compressions, I'm saying internally "come on, come on, they need you here." While I'm getting a line, I'm saying, help is coming, help is coming. I detach from the person emotionally but always keep in my mind that they are loved and valued by someone. They are someone's son, daughter, father, mother, grandpa, grandma, lover, friend, spouse...and I give it all to get them back. I do not allow myself to process the emotions until I clock out and I'm in my car. My poor car has "heard" me say words that no human ever will. I've driven home banging on my steering wheel, crying my eyes out and screaming why??!! But I won't do it in front of the family or co-workers while we are on the clock. Why? because we see over 80,000 people/year. We can not save every one and when we can't, there are 10 more people waiting for help that we can and must save. We move on and help where we can.

Oh, and by the way, the second half of my instructor's statement following "I don't want to ever see you crying in a patient's room..." was: when you cry and get emotional during the code, you are making it about yourself and not about the family or patient. When you make it about yourself, you can't possibly give your best to the patient or family because now they have to take care of you too.

While everyone reading this may not agree with it, it has served me very well over the past few years. I also decompress with one of my co-workers (after the shift, off the clock, away from patients/families). This particular co-worker (paramedic) recently shared that he is suffering from PTSD from not being able to process and decompress after responding to a particularly horrific crash the same night he lost his mother-in-law. He's also a member of the clergy, and had not sought professional help due to the expectation he feels is placed on him by society to be able to deal with tragedy-as a member of the clergy. We spoke at length and he is now getting professional help to process what happened that night. I am a talker-when I talk things out, I can release them and heal from them. Some people can release by journaling and then burning the journal. Please find what works for you. Ask around, seek out alternatives such as those mentioned and yoga, meditation, running, biking, working out, etc. For your health and the health of your patients, you must find that happy medium where you can empathize without being paralyzed. For me, focusing on the end goal works. Find what works for you. Best wishes to you.