I gave the last dose...

[pedsrnjc]

It was a rough night last night. The resident was one I had worked with for years and I loved that resident. I had never seen that much mottling. Family was at bedside. Resipirations 60. Unresponsive. Eyes looked pained, not normal dying. No Morphine order, just oxycodone and tylenol rectally. Gave tylenol and 10mg oxycodone per prn orders. 50 minutes later resident dead.

I know I didn't kill him, the disease did, but my heart hurts. I feel responsible. An elevation in vital signs can indicate pain in an unresponsive person, right? Right? He was also twitching his eye brows and occasionally clenching his fists. After working with him for years, I loved this one. He suffered as many years as I worked with him, he needed to go, so why am I grieving?

Just needed to debrief. Thanks.

[NightOwl0624]

You did nothing wrong. Greiving is normal, especially when you care about someone.

Now, take extra care of you. :)

[leslie :-D]

every time i read about elevated vitals (60 resps???), moaning, clenching, etc...

i want to wring someone's neck...esp when they're dying.

ltc rn, thank God you gave him the little that was ordered, and enabled him to die w/less pain.

it's a blessing, for sure.

as you heal, you too will realize that you treated him with the love and compassion he so deserved.

bless you.

leslie

[GHGoonette, BSN, RN]

All of us will eventually face death, and nothing you can do can prevent that, but we can help ease another's passing, especially if they are so clearly in great pain. You did the only thing you could for this patient, as the road had come to an end. Grieving is good, but focusing on happier times, when you and your patient shared stories, jokes and laughed together, is better. Guilt, however, is self-destructive and the most useless of emotions, especially when there is no reason for it.

I hope that when I need someone to ease my passing, that I have a caring nurse like you near me.

[Hospice Nurse LPN, BSN, RN]

every time i read about elevated vitals (60 resps???), moaning, clenching, etc...

i want to wring someone's neck...esp when they're dying.

ltc rn, thank God you gave him the little that was ordered, and enabled him to die w/less pain.

it's a blessing, for sure.

as you heal, you too will realize that you treated him with the love and compassion he so deserved.

bless you.

leslie

I agree! You DID NOT do anything wrong, OP. You showed compassion and caring till the end. We greive because we are human beings. I wish there were more nurses like you!

I lost a nsg home pt this morning. Scheduled visit yesterday a.m. and the pt had respirs @ 46-50, HR >120. Got order for Roxanol ASAP (my DON delievered). Roxanol was administered and you could see the pt start to relax. She held on for almost 24 hours, but she was comfortable and able to die w/o pain.

[pedsrnjc]

I had tried to get morphine for this guy, because I really believe that having every single organ shut down has to be painful, regardless of the disease.

When they're unresponsive, I think that they can still have pain, and the hospice nurse angered me because, she said, other than elevated vitals how do you know this guys in pain? Then she said I really didn't know he was in pain, I know he was. She told me to continue using the oxycodone.

I hung up the phone absolutely angry. The oxy helped, but I think we could have done better for him. My grief has mellowed, but I think I still feel bad because we could have done better by him.

When I go, I expect very liberal morphine, ativan and atropine gtts. I expect my nurse to give it to me liberally. I know it's not all about me, as someone previously eluded to, but every time someone dies, I ponder my own mortality.

Thanks everyone for all the kind comments.:heartbeat

[cmonkey]

I sincerely hope I have the honor of giving someone their last dose. It's one of the reasons I'm planning on going into hospice, because of stories like these, where people are in needless pain because families have too much baggage and can't let it go in order to do the better thing. *sigh* Things are changing for the better, if slowly.

[Katie5]

When I was in clinicals many moons ago I had 3 peeps i gave MS too die in that one week.

My instructor who was usually a total dog assured me I had not knocked them off. One of them i gave the MS and went to lunch and came abck and she was gone...

You gave excellent care. Be happy the patient had a nurse like you and know that he can now rest without any pain or discomfort.

Huh?!! You totally misused that smiley face.

[CrunchRN, ADN, RN]

Yeah, I do that sometimes.