Last clinical in ER

EMTandNurse2B · Apr 20, 2006

My first patient death was as an EMT student, before I got into nursing school. We responded to a call in the bad section of town for a "unknown", turns out a one-night stand had passed out on her boyfriend. It was a massive, massive GI bleed that had being going on for a long time. CPR was in progress by the first responsders when we arrived. She did regain a pulse and spontaneous respirations, but in the end didn't make it. We couldn't pour enough fluids, blood, etc into her to replace it fast enough to get her to surgery. She had a hemoglobin of 2.2 when we arrived at the hospital! I stayed in the ER and observed until she died. Her death didn't bother me that much, partly due to her choices in life (major alcoholic, cirrhosis, ascities, jaundice, reaked of ETOH, etc), and partly due to lack of family response (boyfriend didn't care, all family members that were phoned were either very drunk or mentally impaired and NOT ONE of them could come to the hospital!!!!). Also, I was comfortable with the thought of death, and settled in my own convictions about death/dying.

My third patient death did get to me, though. I was still an EMT student. It was a unexpected event, the wife woke up and found her husband unresponsive and seizing in bed next to her. His pacemaker had failed, and he had a pulse of 30 and was actually conscious when we got there (Conscious with an ejection fraction of 10% on a good day, and a pulse of 30!). He did this really weird flipping in and out of fine v-fib/asystole while being externally paced. He would be lying there talking to us, and then go unresponsive, we would do CPR for 1-2 minutes and then he would convert out of it by himself, and start talking to us again. About 5 minutes later, it would repeat. At first, it really freaked the one nurse out. She was doing compressions automatically, and happened to look down and the guy is looking at her and talking! She gasped, and then said "Hi!, your heart stopped and we were trying to save your life!", the pt replied "yeah, I know"! We were unable to save him, despite pacing, drugs, CPR, etc, he went into aystole and nothing we did brought him back. This one hit me hard. I went home just thinking about how this lovely man and his lovely wife had come to our area just to visit for the weekend, and here he died up here. He wasn't very old, but had been on the heart transplant list for 2 years (the reason why the death wasn't totally unexpected, just very sudden). He was so polite!! While he was bouncing down the road in the back of an ambulance with four people standing over him, shocking him, poking him, talking to him, etc. he was saying "please" and "thank you"!!! His wife broke down in my arms shortly before he died, and I nearly lost it with her. His children were unable to make it before he died. This one just got me, unlike the first two. This was the first time I had to deal with family at the death, and I think that was a part of it. It also didn't seem fair. Here was this lovely, polite man dying; while the beligerant drunk next door was still alive. Each patient just hits you differently, they are different people and they touch you in different ways.

CEN35 · Apr 22, 2006

Not sure? Seen quite a few. The only thing I can say, is it seems like as time goes on and you see more, it isn't as bothersome. Although, every now and then there are certain situations that can tear you up.

The only thing that gets me every time is when its a kid.

Zachary2011 · Apr 22, 2006

I agree w/ CEN35, many times its actually a blessing I would think that some of the pts. that code do not make it.. Its all about quality of life........ The children on the other hand is horrible....... we just had a 10 day old die about 2 weeks ago and those are the ones that get to you......... also when a code comes in by the medics and you know them.......... as many of you know your friends and family just dont look like themselves when they come in intubated, coding , or critically ill. When that happens it tears your heart out. But you keep going ....... I strongly believe ER care sets the tone for the pts. future recovery and the fact is no one can do it better then we can (ER Team) given the situation and circumstances that we work in, so with that said most deaths I believe is God calling for them and no matter what we do we cant change that calling.

Katnip, RN · Apr 22, 2006

One of the things about ER:

Most people who are in full arrest when they're brought in from the field aren't going to make it.

There's often no telling how long they were down before they were found. Some people might have died hours before being found. Even if found right away, it can be 10 minutes or more before EMS arrives. That's doesn't help the odds.

When the do arrive at the hospital, by all means do your very best, but keep those things in mind.

Just know you can't save everyone. You can only do the very best you can for you patients.

My first code was a gunshot victim. He was young and didn't have a chance. We did try for over an hour but it was futile. I was elected to go through his pockets for ID. There wasn't any, but I sitll remember the coins that fell out of his pocket.

About an hour after we were finished with him, a 40-year old man came in. Was having lunch and dropped dead at the table. We couldn't save him, either.

It's not an easy job, but you have to learn to not take them home with you. At least not often. That way lies madness.

pikevillenursing21 · Apr 29, 2006

You know what..I'm like you. I finished my last preceptorship in early March this year. Alright...I live in a small town with not alot of shootings, etc. and it's a Level 3 ER. We had a bunch of chest pains, abd pains, pneumonia, hip fractures...stuff like that and my last day I came in and a older teen was coding. Well...I'm just 21, so it really bothered me. He didn't make it. The patient was out partying the night before and decided to drink and drive home at 5am that morning. It was horrible, I had never seen anything like it and to beat it all I can still remember everything that patient....it was bad.

JR816, BSN, RN · Apr 29, 2006

I graduate nest year and I think I want to join the ED team. I originally thought about L&D, but it's a little slow paced for me. I know I still have a lot to learn but I think my personality will fit in well with the fast paced ED team. I still have a year to go, I don't think I'll change my mind, but who knows!!!

onarie · Apr 29, 2006

My first patient's death happened during my last semester of nursing school. I was doing my clinicals in the Medical ICU at the hospital I now work at. A patient was on a ventilator and there was no hope of recovery. The family decided that it would be better to let their wife/mom go. My preceptor tells me to go in the room. I will never forget it. I had only talked with a few of the family members before this but the 2-3 minutes it took before this lady died seemed like an eternity. She was extubated and we all stood there. I felt so unprofessional, I had tears in my eyes. I thought my preceptor would say something, but then I looked around and the other nurse and the respiratory therapist both had tears in their eyes also.

clee1 · Apr 29, 2006

The only thing that gets me every time is when its a kid.

Uh huh.....

Especially the tough little ones that lose a LONG battle with CA. :bluecry1:

I once heard a beautiful 4 y/o girl tell someone (in perfectly pronounced language, mind you) her Dx: Acute Lymphoblastic Leukemia. She added, matter-of-factly, that "my prognosis is poor".

I had to, quickly, find a quiet place to bawl my eyes out.....

I will never, EVER work peds oncology!

JessicRN · Apr 29, 2006

Been an ER nurse since 1990 told you burn out fast. Although I have changed hospitals going from trauma 1 ER's with life flights to level 111 ERs. I still love the organized chaos. I tried to go to another quieter unit L&D, DON in Rehab but hated it. I am where I want to be. pedi deaths are hard, baby deaths are harder but dealing with family in tragedy is the hardest part or ER nursing in my opinion. I have been puked and peed on, spit at, hit, choked ,screamed at and shot at and those are just the visitors (the one who shot the patient with an automatic weapon while in our trauma unit in texas said he was the patients brother;) can't tell you what the patients have done. I would not trade it for anything. I work the 7pm to 7am shift and won't change that either. People think I am crazy. I AM crazy and I love it :monkeydance: :monkeydance: :monkeydance:

sanctuary, BSN, MSN, RN · Apr 29, 2006

I am so glad that there are nurses like you around when the tough stuff happens. Blessings on you.

ERNurse06 · May 7, 2006

I am graduating this year... in just a few days actually!! I have accepted a job in the ER. I had an instructor once tell me that "if you ever become cold to death and stop crying on the inside, then it is time to get out of nursing." It is true, I have seen many deaths... I have worked in the ER as a tech for a few years.... I've seen old ones, young ones, new ones, tragic ones... you name it... Somehow the death itself gets easier to deal with personally, but when there are family members involved, it makes it much worse. There have been many times that I have cried with the family, and no matter what anyone tells you, it's okay to cry with them!!