How to respond to "am I dying?"

[xmilkncookiesx, RN]

During SIM usually if a patient is having cardiac/breathing problems, the "patient" will ask, "am I dying?" or "am I going to die?"

what is a good response to this?

not only for SIM, but for the real world! I don't want to say anything that I feel would be assuring but will be frightening or makes them feel worse.

Usually on tests, I see responses such as, "tell me your concerns" type of responses.

I was reading a few posts on reddit how EMS/nurses/other medical staff had patients that said, "I'm dying" or "I'm going to die" to them and they didn't believe it and the next day or hours later, the patient died. Something about them makes them feel calm when they know they're going to die-what the redditors said. It's like the patient KNOWS they are going to die, and that some people truly do believe patients when they say this.

Do you have any stories where you've come across patients like this, and you've believed them or not, how they felt?

[MPKH, BSN, RN]

Well it depends on context. If my patient is making a joke and being non serious, then I'll fire back with a cheeky response. If they are being serious, I'll try to suss out the reason and providing reassurance/education as dictated by the situation. Maybe even ask the doctor to speak with the patient as needed.

Palliative and end of life patients and families are usually aware of impending death, so their questions deal with more of symptom control and what to expect during and after death.

[That Guy, BSN, RN, EMT-B]

"am I dying?"

-"Everyday"

[Lunah, MSN, RN]

One piece of advice: never make a promise you cannot keep. One of my coworkers was devastated because she told a patient that he wouldn't die, but then he did. I tell patients we are doing all we can.

[CoffeeYogaNurse]

Your questions have a few answers depending on the situation. It sounds like the simulations you're describing are sort of "pre-code" or "not actively arresting yet but probably about to" sims where your instructors are prepping you for responding to a patient telling you something is wrong. If a patient says they feel like they are going to die ALWAYS do a thorough reassessment as some events give a pt a "sense of impending doom" (STEMI's, AFib with RVR, some strokes, etc). By reassesment I'm talking EKG, troponin or lactate if possible, thorough head to toe, vitals. Call the MD with results or call sooner if you get abnormal findings. In these scenarios where the pt isn't in acute distress you can say "what makes you feel that way", "are you feeling bad", etc as part of the assessment.

Now, if you're actively treating and working up a patient who might actually be about to die and they frantically look at you and ask you that question, I usually tell a soft version of the truth. Everyone will have a different answer on this one, some people will lie, some will try to be thereapeutic and ask "what makes you think that?" or "tell me your concerns". I think in an emergency scenario these are not great responses because the pts answer will be "I think I'm going to die because y'all are doing stuff really fast and using words I don't know and bringing strange machines in here and I have 2 more iv's and 6 more people in my room than 15 minutes ago". I usually say something like "you're very sick right now because your heart is in a dangerous rhythm" (or you're not getting enough O2 or whatever the reason is), "a lot of things are going to be happening very quickly, tell me if you feel strange in any way, I'll be right here" and then I make sure I AM right there. You don't want your pt to panic, but if it were me I wouldn't want to be lied to or have someone ask me my "concerns" when it's obvious something emergent is happening. Just try to stay calm and keep talking and being with to your pt.

As far as the question about people who are stable at the time saying they're going to die and then actually dying days later I will just say there are definitely a larger number of people who say they're going to die and DON'T die. Go to an ER and everyone there is dying from their ailment, at least that's what they say. Most don't die from said ailment. Still do a thorough reassessment, always.

I'm not aware of a proven physiological response where people feel calm days or hours before they die, unless it's a hospice situation or they're on anxiolytics something. However, there is a theory that a chemical called dimethyltryptamine is released at the time of death (as in heart stops or lungs stop) that some say can give a sense of calm. I'm not sure on the validity of that but a lot of personal accounts tell a similar story.

TLDR: it depends on the situation, reassess the patient always, there is no "right" answer.

[xmilkncookiesx, RN]

"am I dying?"

-"Everyday"

although thats not appropriate to say, it was funny lol

[xmilkncookiesx, RN]

One piece of advice: never make a promise you cannot keep. One of my coworkers was devastated because she told a patient that he wouldn't die, but then he did. I tell patients we are doing all we can.

thats a good response. I'll definitely will use that. simple, yet reassuring in a way

[xmilkncookiesx, RN]

Your questions have a few answers depending on the situation. It sounds like the simulations you're describing are sort of "pre-code" or "not actively arresting yet but probably about to" sims where your instructors are prepping you for responding to a patient telling you something is wrong. If a patient says they feel like they are going to die ALWAYS do a thorough reassessment as some events give a pt a "sense of impending doom" (STEMI's, AFib with RVR, some strokes, etc). By reassesment I'm talking EKG, troponin or lactate if possible, thorough head to toe, vitals. Call the MD with results or call sooner if you get abnormal findings. In these scenarios where the pt isn't in acute distress you can say "what makes you feel that way", "are you feeling bad", etc as part of the assessment.

Now, if you're actively treating and working up a patient who might actually be about to die and they frantically look at you and ask you that question, I usually tell a soft version of the truth. Everyone will have a different answer on this one, some people will lie, some will try to be thereapeutic and ask "what makes you think that?" or "tell me your concerns". I think in an emergency scenario these are not great responses because the pts answer will be "I think I'm going to die because y'all are doing stuff really fast and using words I don't know and bringing strange machines in here and I have 2 more iv's and 6 more people in my room than 15 minutes ago". I usually say something like "you're very sick right now because your heart is in a dangerous rhythm" (or you're not getting enough O2 or whatever the reason is), "a lot of things are going to be happening very quickly, tell me if you feel strange in any way, I'll be right here" and then I make sure I AM right there. You don't want your pt to panic, but if it were me I wouldn't want to be lied to or have someone ask me my "concerns" when it's obvious something emergent is happening. Just try to stay calm and keep talking and being with to your pt.

As far as the question about people who are stable at the time saying they're going to die and then actually dying days later I will just say there are definitely a larger number of people who say they're going to die and DON'T die. Go to an ER and everyone there is dying from their ailment, at least that's what they say. Most don't die from said ailment. Still do a thorough reassessment, always.

I'm not aware of a proven physiological response where people feel calm days or hours before they die, unless it's a hospice situation or they're on anxiolytics something. However, there is a theory that a chemical called dimethyltryptamine is released at the time of death (as in heart stops or lungs stop) that some say can give a sense of calm. I'm not sure on the validity of that but a lot of personal accounts tell a similar story.

TLDR: it depends on the situation, reassess the patient always, there is no "right" answer.

I REALLY enjoyed this. thank you SO much!!!

[Castiela]

For a patient who is really sick, I tend to respond by saying factual things such as your heart rate is really high, I'm worried about your o2 but we are trying to treat it by doing xyz and reassure them that way. My approach will cry depending on the patient, but I like giving them factual information that validate their fears while reassuring them we are taking actions to help solve them

[CelticGoddess, BSN, RN]

If you don't mind getting a response from the perspective of a patient. Keep in mind, I was NOT calm when I made the statement "I am going to die". However, it could have been a true statement. Due to severe asthma, I have made that comment at least 3 times. I have gotten both good and bad responses. First the bad:

"It's only anxiety talking", "you're fine, you O2 sats are good and your lungs are clear" (They weren't clear, there was no air movement and 5 minutes later my sats dropped to 72% on 2L) "don't be silly, you're too young to die"

The good: "we are going to do our best", "CG, I know your scared, the paramedics are on the way, and I'll stay with you until they take you out the ambulance" (this was said to me by my primary MD, who was apparently just as scared as I was) and "CG, we are going to take good care of you," and proceeded to tell me what they were going to do.

Please, even if the person is only appears anxious, don't tell them it's only anxiety. It actually can make things worse. If you stay calm, it can help a lot.

BTW: I worked on a palliative unit and I now work hospice and I have seen a couple of patients who were very calm before they died and they told us that they were going to die tomorrow or the next day or whatever. We acknowledged that they were terminal and assured them that we would maintain their dignity and treat any pain, anxiety and dyspnea. And that we would be there for them. Just knowing that they weren't going to be alone really helped them, I think.

[oceanblue52]

I had a hard time with this scenario too in Sim. Its awesome though that your program is presenting you with this, because you will encounter this conversation if you work in acute care. I love the responses on this thread, and agree that using a combination of factual statements with some therapeutic communication is generally a good response. If the patient is calm enough to describe their concerns, that can also be an excellent source of data to hone your assessment.

This might not apply in a Sim setting so much, but remember too that your words are only a TINY part of communication. Tone, cadence, body language etc. are also key. Developing a confident, calm demeanor does wonders for keeping a patient calm when things turn south.

[amzyRN]

we are all dying. Everyone dies at some point, but at this time your vitals are stable and I don't forsee you dying today.