I can’t stop crying over a bad death

[rmacns]

I work on a very busy neurosurgical floor. I haven’t dealt with death a lot - only a girl with cerebral palsy but this was expected, she had comfort care, and she was surrounded by her whole family. This is what I considered a “good death”.

Another patient I had was an off-service medical patient who came in for hyponatremia, CHF, and failure to thrive. She was an elderly woman in her late 80s with no close family and was living by herself up until now. She was found by her landlord covered in feces on the floor after a fall, she was there for a couple of days and covered in pressure sores. On the the floor she would constantly ring every 15-20 minutes in the 12 hour shift for non-emergent things and she became quite well known as the call bell happy person. After 2 weeks, people were getting short with her (including myself) trying to get her to do things as best she could herself, but this didn’t really work out.

Fast forward to my night shift last night, one of my colleagues had her as a patient. She was audibly wet and had terrible SOB and her sats went down to the 80s. The doc came and started her on nebs, antibiotics and lasix. Respiratory came and got her 02 back up at 94 on 2LNP.

I went to help and insert and IV and she was shaking. I asked why and she said that she was scared and nervous. I reassured her that she is going to be okay and just for a moment to try and keep her hand still. After a couple of minutes her arms were still shaking and I said in the really direct tone please stay still and she did. At that point I felt rushed to get onto the next task and I could actively feel the compassion in my voice slowly go away. I needed to be better.

I got the IV in and she held into a rosary the entire time and and I said you have nothing to be afraid of we are going to take really great care of you, don’t be scared. God is with you. I was leaving the room and a CTA was with me. Her nurse was coming back for meds in a little bit. I said I was leaving but we would check in her.

The look in her eyes was pure fright. She said she did not want to be alone, she begged us to stay. We explained we have a whole floor to attend to also but we will check in routinely. We didn’t have the resources to stay 1:1 and her vitals were back to normal. Well her nurse went in for her meds not 10 minutes later and she was found dead. Nobody expected this at all.

She died alone, scared, and frightened. She had her rosary in her sweet hands and she held onto it until her final minutes. Wouldn’t even let go to wash her hands.

I feel an unbelievable amount of guilt. I let her die alone, I had no idea she was so scared because she probably knew she was going to die. She probably had an impending sense of doom and we left her. She had a PE. And if I was more compassionate and stayed with her and wasn’t short with her, her final moments would have been better.

I can’t do nursing anymore. I honestly don’t deserve to be one.

[ruby_jane, BSN, RN]

You did not have the resources to stay 1:1 and her vitals were back. You had to attend to your actual patients.

You are taking this hard and personally but I want you to re-read that first sentence again.

Sometimes people in respiratory distress or with PE have a "feeling of impending doom." Sometimes ladies who sit on their call bells don't actually need you. You cannot have any way of knowing other than to do an assessment - and your assessment was that she sounded terrible but was given meds and recovered somewhat. (Reread the first sentence.)

If you'd stayed with her, what would have been different? If she was going downhill fast, there *might* have been some interventions which prolonged the inevitable. (Reread the first sentence.)

The only other thing I can think of is perhaps a charge nurse could have helped...but if it was busy, I am sure your charge would have briskly told you no...

Analyze what makes you sad about her death. But realize - this is a job, and you cannot be everywhere and do everything. I am actually triggered when someone says "nursing is a calling" - it may be for some of us but a lot of us burn out trying to be everywhere at once and everything to everyone.

Take some time to gather your feelings. Be easy on yourself. Hugs from North Texas.

[rmacns]

Thank you Ruby. I really appreciate your response. ❤️

[LibraSunCNM, BSN, MSN, CNM]

37 minutes ago, ruby_jane said:

You did not have the resources to stay 1:1 and her vitals were back. You had to attend to your actual patients.

You are taking this hard and personally but I want you to re-read that first sentence again.

Sometimes people in respiratory distress or with PE have a "feeling of impending doom." Sometimes ladies who sit on their call bells don't actually need you. You cannot have any way of knowing other than to do an assessment - and your assessment was that she sounded terrible but was given meds and recovered somewhat. (Reread the first sentence.)

If you'd stayed with her, what would have been different? If she was going downhill fast, there *might* have been some interventions which prolonged the inevitable. (Reread the first sentence.)

The only other thing I can think of is perhaps a charge nurse could have helped...but if it was busy, I am sure your charge would have briskly told you no...

Analyze what makes you sad about her death. But realize - this is a job, and you cannot be everywhere and do everything. I am actually triggered when someone says "nursing is a calling" - it may be for some of us but a lot of us burn out trying to be everywhere at once and everything to everyone.

Take some time to gather your feelings. Be easy on yourself. Hugs from North Texas.

So beautifully stated. So many things in the situation you described were out of your control. I do understand being sad about it, but try not to blame yourself.

[TriciaJ, RN]

It's always hard when all was not as it could have or should have been. Sometimes people are anxious and needy even when they're perfectly fine. This lady might have been the stoic one that never asks for a thing, and still been frightened at the end of her life. If you had stayed with her and someone else had had a poor outcome because you weren't there soon enough, you would be torturing yourself over that.

You had absolutely no control over the way she lived her life, and pretty much no control over the way she died. Why was she all alone in her 80s? There was probably a whole series of decisions she made in life that got her to that end point. You were there for her at the end, just not as much as you would have liked. You weren't in charge of how your unit was staffed.

If you've been spending time crying over her less-than-ideal death, you might be the only person in the world who has cried for her at all. You gave her that. Many people go out unmourned by a single soul.

Going forward, you will find ways to curb your impatience when you're stretched to the max, and you will get more skilled at reassuring anxious people. And this lady will always be remembered by at least one person. That's really the best any of us can hope for when we get to the end.

[rmacns]

Thank you Tricia for your response. It means a lot, you are so right. It makes me rethink a lot.

[JKL33]

First, let me say that I wholeheartedly agree with the above; those are the main take-aways. Here is another thought, offered with a spirit of encouragement:

On 1/30/2020 at 2:11 PM, rmacns said:

The look in her eyes was pure fright.

There's garden-variety anxious and then there's impending-doom anxious. We can't always tell which is which, but when we have an experience like yours it adds to our knowledge, understanding, gestalt, and wisdom that we use in the future. I trust that many of us have had an experience like yours; I have. I think it would be difficult to care for the sick and dying for very long without considering some pretty big concepts about humanity, life/death, caring, ourselves, and all of our interactions and what it all means for patients and for us.

Just accept this as life, nature, complicated things. We don't control everything (or anything) and we can't make everything right. All we can do is reflect thoughtfully and go on.

You are okay. ?

[ruby_jane, BSN, RN]

On 1/30/2020 at 3:26 PM, TriciaJ said:

If you've been spending time crying over her less-than-ideal death, you might be the only person in the world who has cried for her at all. You gave her that. Many people go out unmourned by a single soul.

I'm weeping a little. My little cold heart just grew three sizes. Thank you!!!

[LibraSunCNM, BSN, MSN, CNM]

Just now, ruby_jane said:

I'm weeping a little. My little cold heart just grew three sizes. Thank you!!!

Seriously! What a beautiful and true statement.

[ClaraRedheart, BSN, RN]

She knew death was coming. That could sound terrible, or it could be a beautiful grace that would allow for the necessary reflection and prayer imperative for her to feel at ease. You didn't know. Perhaps a hand gripping hers would have helped, but perhaps she needed the alone time and clarity to make amends in her final hours. You'll never know. You did the best you could though. She was safe and other patients had needs that you couldn't ignore.

[jobellestarr]

On 1/30/2020 at 1:26 PM, TriciaJ said:

It's always hard when all was not as it could have or should have been. Sometimes people are anxious and needy even when they're perfectly fine. This lady might have been the stoic one that never asks for a thing, and still been frightened at the end of her life. If you had stayed with her and someone else had had a poor outcome because you weren't there soon enough, you would be torturing yourself over that.

You had absolutely no control over the way she lived her life, and pretty much no control over the way she died. Why was she all alone in her 80s? There was probably a whole series of decisions she made in life that got her to that end point. You were there for her at the end, just not as much as you would have liked. You weren't in charge of how your unit was staffed.

If you've been spending time crying over her less-than-ideal death, you might be the only person in the world who has cried for her at all. You gave her that. Many people go out unmourned by a single soul.

Going forward, you will find ways to curb your impatience when you're stretched to the max, and you will get more skilled at reassuring anxious people. And this lady will always be remembered by at least one person. That's really the best any of us can hope for when we get to the end.

How beautifully stated ❤️

[CharleeFoxtrot, BSN, RN]

((hugs)) What you are saying are very normal thoughts and feelings. I'm sure your hospital has an employee assistance program, just keep that in mind for the future if need be.