I don't know how you nurses deal with death

[Poochiewoochie]

Today I sat and watched as my mother lay dying in her bed at the NH. Horrible-not like in the movies at all. I sort of knew what to expect but actually seeing someone die is a lot harder than most can imagine. Her lungs were so full of liquid and she rattled when she breathed. Then, at the exact moment she exhaled for the last time, all that fluid came up and out of her mouth and after a few seconds I knew she was gone. I am sad that will be my last image of her. Did she look peaceful when she was gone? No, she was just "gone". I've read so many stories about how peaceful they look at time of death and was a little shocked that it wasn't like that. It was a surreal experience and I will never forget it.

Yet in spite of it being so sad I am happy I was there at THAT moment. My Dad had gone out to have a smoke and the hospice nurse and chaplain were out of the room for a minute. I was the only one there when she died.

That being said I don't know how you guys can deal with this on a daily basis. I watched the hospice nurse and it was amazing how she helped my Mom so she didn't suffer. I have a new respect for the nursing profession-I know I couldn't to this every day.

[leslie :-D]

The hospice deaths are different for me than a family member and I have to say I haven't had one family try to fight EOL issues. Some need more education but no one has fought their loved one being in hospice. Maybe it has to do with our small town setting. I dunno .

We try to make end-of-life circumstances peaceful and painfree. Sometimes people do fill up with secretions and we have a portable suction machine to take if that happens or if they are an inpatient, suction is available in the rooms. Those are comfort measures.

as an aside...

1. i have to agree that it likely does have to do with nsg in a rural setting, vs an urban one.

where i am, lots of diversity and just lots more people...as one would expect in the city. :)

2. in our hospice, we don't 'do' suction...

as the med'l dir and DON strongly felt that suction in and of itself, was terribly invasive,

and that drying agents (scope, levsin, etc) were much more effective (if started at first sign of fluid shift) and less invasive.

i also know that hospices are as varied as the nurses who implement the care.

leslie

[nurseprnRN, BSN, RN]

In hospitals it's more common for the IVs to be running, which contributes greatly to discomfort at end of life. No hydration = no need to get on and off the bedpan, no gastric juices to vomit up, no pulmonary secretions to drown in. It's not the same as when you're forceably dehydrated. When the patient doesn't want anything po, that's the cue to stop the IVs; anyone on comfort care only shouldn't be tethered to an IV anyway. If s/he is thirsty, s/he will ask to drink. If not, it's a natural part of the dying process and not painful.

[leslie :-D]

In hospitals it's more common for the IVs to be running, which contributes greatly to discomfort at end of life. No hydration = no need to get on and off the bedpan, no gastric juices to vomit up, no pulmonary secretions to drown in. It's not the same as when you're forceably dehydrated. When the patient doesn't want anything po, that's the cue to stop the IVs; anyone on comfort care only shouldn't be tethered to an IV anyway. If s/he is thirsty, s/he will ask to drink. If not, it's a natural part of the dying process and not painful.

to clarify, i was talking about suctioning in eol care, grntea.

but reading your post, the bolded (by me) jumped out at me.

even when a pt is severely dehydrated, many pts still 'drown in their pulmonary secretions'.

this is a prime example of fluid shifts and more often than not, lots of fluid is shunted to the lungs.

also, vomiting happens, with or without iv hydration.

still, we have used iv/sc as a palliative measure...

not specifically to hydrate, but to restore lyte imbalances that can cause a type of delerium.

also, since i worked in a picu (palliative icu), there were always some sort of lines being placed and maintained.

if they were 'stable' enough to be dc'd from picu, then less invasive measures were implemented.

leslie

[LVN2RNMom, ASN, BSN, LVN]

I was with several of my loved one's when they passed yet I was present with a few patients when they too passed on. My humbling experience came with my families so when I have a patient passing, I am very much at peace. Since I have already been there with the family, I know how it feels. It's a terribly lonely place but having others around such as good nurses, it makes all the difference.

[Vishwamitr]

My dear friend,

First of all, please accept my sincere and heartfelt condolence.

Not to trivialize death, but as a nurse, I see life as a continuum where birth is the inception and death is termination. I also find that Kubler-Ross' stages of bereavement (denial, anger, bargaining, despair, and acceptance) are very pragmatic.

The reason that we can "deal with this" (as you have chosen to put it), we work with empathy and not sympathy (although, inadvertently and in a latent form, it is present to a certain extent). We call upon our belief system and then it is not so difficult.

[proud nurse, BSN, RN]

To the OP, I'm sorry for your loss.

[wannabecnl]

My sincere condolences on the loss of your mother. You are asking very good questions, but I wanted to address one thing you said, regarding the memory of her appearance at the time of her passing.

That image probably will never leave you, but over time it will not be the only image you can see when you think of her. I lost my mother suddenly about 14 months ago and was the one to find her body; it was the only way I could remember her for close to a year. As time has passed, though, and I have purposefully sought out pictures and other memories, it is not the first image that comes to mind. I am still grieving, but there is an element of fondness that was nearly impossible to conjure when all I could picture was her body in death, rather than my mother in life.

God's peace to you. I think we all have capacities to bear the burdens we are called to bear in our jobs and our private lives. I for one could never be a social worker, but nursing works for me.

[katiescow]

Sadly last week my experience with the losing someone happened and it was unexpected. My grandmother of 84 suffered a stroke and had hemorrhaging in the brain. It took a few days but there was nothing left we could do but to make her comfortable and wait for things to start shutting down. Nurses are humans to we're also going to grieve just like anyone else but it's a part of our job to accept death eventually happens and as medical professionals we have responsibilities to our patients and their families to provide them the care they're entitled to and deserve regardless of what stage of life someone is in.

[BrandonLPN, LPN]

Having seen so many NH residents die as the OP described, I'm a firm believer that what we see physically in these cases in no way represents what the actual process is like for the dying loved one. I'm not a religious person, but I believe that when the dying process reaches that stage, the dying person already is more...... wherever they're going than they are here on earth.

[Mommy&RN, BSN, RN]

Condolences on the loss of you mother, hugs to you.

I work in an area that usually does not have many deaths. Although we are making changes to what areas receive what type of pt. so we have had 3 deaths over the last 2 weeks. Of the 3, none had any quality of life. My belief is there are worse things than death.

[lolaviex]

You know, a student reading this thread might think that most nurses deal with a death every day. Not true. Even in ICU and ER, people don't die every day, or even every week.

I'm a student and I must have a little black cloud that follows me around. It seems like every week I'm at the hospital one or more patients die

Before going into nursing I worked in the veterinary field. Death was such a frequent thing that I really did get used to it. The patients were indeed animals, but over a decade I'd known some of them their entire lives and saw them frequently. It's still sad and I recognized the loss, but the emotion was very fleeting. I moved on quickly and got back to work on the next patient. It's tough when I'd try to explain that to people I always felt like it made me sound insensitive.

Strangely enough, over the years I've had hundreds of people tell me they grieved more for their pets passing than their own family members.

[SaoirseRN]

My condolences on the loss of your mother-in-law. I don't know if anyone has told you this, but often I see that people seem to "plan" their moment of death -- often when families have stepped out for just a moment, or other times after that last grandchild finally makes it to say goodbye. I've seen it too many times to discount it. I would like to think your mother-in-law picked her moment, too, knowing how you would feel about being the one with her. Perhaps because the others would have felt differently.

Now, to the topic at hand. I'm sure others have said much of what I'm going to say, but I thought I would share anyway.

I think in North America we are one of the few cultures in the world that doesn't easily accept death. I'm not saying that *you* don't, but as a society it is something we have come to fear, where other cultures accept it for what it is and though the death of a loved one is always a sad time, it's also accepted as part of life. Over here I think we grow up feeling that death is scary. It's unknown and we are afraid of it.

Nursing is it's own sort of culture, too. When I began my career, I didn't know how I would handle death and dying. I remember during our hospital orientation prior to our first acute clinical experience, one of my classmates burst into tears when we were shown the morgue. I actually don't remember the first death I was involved in, oddly enough now that I am writing this, though I know it must have happened when I was a student. I do remember the first death of my own patient after I graduated. The man died and minutes later, down the hall, a baby boy was born. I thought that was kind of fitting.

After almost seven years of practice, I've seen lots of death. It's always sad, though some cases are harder than others. No matter what, a life has ended, and people mourn. Death is a part of life, and at the end of life, like in the beginning, people are at their most vulnerable. For me, and I think for many nurses, we feel honoured to have been a part of that ending -- not because we enjoy seeing people die, but because helping somebody die with dignity, in peace and comfort, is one of the greatest things we can do for another human being.

The easiest way to say it is you "get used to" death, though that isn't exactly it, either. I think somewhere along the way, I started seeing death in a different way. I'm sure it would be different if I was holding vigil around the bed of my own family member, but I can't say for sure. When my grandmother was dying, I had a couple of years of RN experience already, but my parents decided not to call me until she was already gone (they felt I couldn't *handle* it, which saddens me more than I can express). As I said, it's always sad. It's harder when it is a young person with children at home than for an elderly person who has lived a long life, but regardless, that person meant everything to somebody.

I said above (and I'm writing this on the fly, so I apologize for any repetetiveness), that loved (or lonely) person deserves nothing short of peace. I see death not as an end to a life, but as an end to pain, to sickness, to all things which wear on us in life. Sometimes dying is peaceful without our help. People go to sleep and just don't wake up. And sometimes it isn't, and that is where I, through my training and experience as a nurse, can help. More than that, I am honoured to help. When my patient passes in comfort, because my coworkers and I have done everything we can to make it so, I am not sad. Not in the way I would be if that were my loved one.

I am relieved, gladdened that their death, which would have happened with or without my care, happened in relative peace. Honoured, as I've said, to have been a part of this moment. Some nurses welcome people into the world, and some wish them goodbye.

I always open a window, did you know, after they have died.

It isn't always peaceful, and those deaths are difficult. Sometimes even with all that is available to us, we just can't take away all the pain. Even in those deaths, though, there is that relief at the end because, no matter what, you know for certain there is no more pain. I do regret, in those cases, that I couldn't do more. The families, too, the ones that have such a tough time accepting that their loved one is dying -- I wish I could help them see it differently. Some are relieved, in the end, and some are broken. In those moments, caring for them is just as important as caring for the patient.

I don't know if I have made any sense or not, but there you go.