I need to talk about my night

mattsmom81 · Apr 6, 2005

(((Gentle HUGS Alyssa)))

Stroke is a potential complication of cardiac surgery. Likely the clot was pre-existing. Nothin you could do could change that. Anticoagulants keep further clots from forming postop but do not promise to dissove pre-existing clots. I am reinforcing something you already know, because your sorrow is overwhelming your knowledge base right now.

It hurts to lose a patient and after 28 yrs in this game, I still remember how it felt...28 yrs ago, my first loss. BUT...we must continuously remind ourselves that just because there is a bad outcome, it does NOT mean we as nurses did anything wrong.

We are not ultimately in charge of who lives and dies, who strokes and who doesn't. We as nurses, as humans, only can do the best we can. Sometimes the public, our bosses, docs, seem to reinforce the implication when someone has a bad outcome it is someone's 'fault' but this is simply not true.

I'm sorry you had this experience your first 'solo'. Try to sit down with your preceptor and hash this out so you can feel better about this.

zambezi, BSN, RN · Apr 6, 2005

MattsMom- That was very nicely put.

Alyssa- I'm sorry for the bad ending to a good night. Unfortunately, as mattsmom mentioned, these things happen and there was nothing that you could do- you had him up with early ambulation, etc.

I too remember the first couple of times things went wrong on my shift when I was first on my own. I would (and still occassionally do) have dreams about it for a few days or so- my brain trying to process what went on. I found that writing it down in a journal or finding a co-worker to hash over it with was helpful for me. Sometimes, I just had to go for a run or have some me time to feel better. Unfortunately, this isn't the last time things like this will happen so finding a way to accept how you feel and process those feelings is important so you don't burn out. Even though we often can't put those feelings into words, those that work with you know how you are feeling because we have all been there too. That personal connection that we form with patients (especially in this case as he was your first "on your own" patient) hurts when things don't go the way we planned, even if everything was done right. It always makes me sad for the patient and their family when something like this happens but I think that everything happens for a reason. As long as I did my best and gave that person the best care and support that I could then I have done my job. I hope that you feel better soon- you won't forget that feeling, it is what makes us human- but it is important to find a way to process and accept what happened (and sometimes that can take time). I hope this week brings good things for you.

Super_RN, BSN, RN · Apr 6, 2005

Alyssa-

When something happens to a patient unexpectedly (and all night they have been doing superb!) I think it is harder. With some patients you expect the inevitable, but not with others. My first "solo" was with a great little old man. He was so friendly and cheerful, healed after his surgery and ready to go to the floor later in the morning. The nursing supervisor had just called me and asked who I could move to the floor, and I said Room1, he is the most stable. I went in to talk to him, got him up in the chair, and walked out of the room to get a clean gown for him. 20 seconds later I walk in to the room and see Asystole flash up on the screen...I thought, oh those darn leads are loose. But nope, he was unresponsive. He had thrown a clot and died right there. Of course, he was a full code but there was nothing we could do except go through the motions. I had a very hard time as well. Mattsmom put it well when she said that ultimately we are NOT in charge of who lives and dies. We may help and try to balance out the teeter totter, but God is the one who makes those decisions. I hope that you feel better! I know it is hard to deal with losses at times, but he is at a much better place now! :) Jaime

babynursewannab · Apr 6, 2005

Thanks for responding. It really helps to hear from you guys. I guess you're right. It is a loss. I also can't help but wonder if I did everything right (human nature). I know I did everything I was supposed to do, but there is that nagging thought...

Although I'm not devastated by this, I'm a bit shaken. Actually, I'm a lot better after my 6 hours of sleep. That chest sensation is gone. I think the reason it got to me more than the codes is that with codes, you know you've done everything you can and it either is or isn't their time. Here it is something that you wonder about and there isn't closure with it. There is a really good chance, based on reports, that he's not going to come back too well from this. It just saddens me for both him and his family. Although, I will say that in my short experience in the CVICU I have seen miracles. We did have one pt circling the drain after 4 weeks on vent and non responsive who suddenly woke up and started smiling and covering his mouth when he coughed. Even better, he's right-off-the-boat Russian and didn't understand English before he went to the fateful surgery. When he woke up, he was appropriately responding with nods when he was asked questions by his nurse! So.... there's always hope.

Thanks again. I can't tell you how much it helps to hear about other people's stories.

-Alyssa :redbeathe

my2sons · Apr 29, 2005

You have already received excellent advice. I have always kept a journal, it helps to get the stuff out of your head (and heart!) and on paper. I've been doing the ICU dance for almost 12 years and one thing I've learned is that sometimes there is no rhyme or reason to things that happen in ICU. I have seen people that are doing great just up and die. I have seen plenty who I never thought would make it come back to the unit to say thanks. You never know. My worst was a 23 year old trauma who threw a P.E. and died, right after joking with me that our hospital made the best jello ever. Hit me really hard, we were the same age--and this was 10 years ago. Hang in there.

Dinith88 · May 6, 2005

That sucks. Welcome to nursing/ICU. One of the more valuable traits you'll develope as you gain more experience is how to better deal with these unfortunate developements. If you don't, you'll be leaving the unit in a short while. Everyone deals with this stuff in different ways (some methods 'healthier' than others) and you'll surely find yours...but you wont ever get away from the stomach-aches, head-aches, and the occaisional bad dream. :)

These experiences, though difficult, are what make us grow as people/nurses in a way most other people do not. It's what makes us unique. WElcome to the club.

Or...you can just become a drunk like the rest of us... :)

MandyInMS · May 6, 2005

(((hugzzzzzz)))

Try not to be too hard on yourself...sometimes when we do everything right things still head south.

SthRNBelle · May 15, 2005

Think of all the other wonderful peoples life that you touched and helped to get better.....I'm sorry for your loss. :icon_hug: