Published Jun 5, 2006
kwagner_51
592 Posts
I had to post this. I lost my first patient today. He was admitted to the NH on June 2. I worked all weekend, 7P-7A. Yesterday he was able to sit up and was talking to me. He wanted to know what meds he was taking and why. I answered his questions and explained everything to him. His skin was yellow from liver failure.
I went in last night and in report, I was told that he was stable and that she had given him 15 mg MS at 1030 d/t pain. I went in to do my assessment at 7:30pm and he was basically unresponsive. He would respond to pain and open his eyes when I called his name. His vitals were good. BP 128/70, P 78, R 24, O2 Sat 93%. He just didn't 'look right'.
I went ahead with accu cks and med pass. At 9 pm, I checked him again. BP 79/39, P55, R28, T99.2 ax O2 91% I did my 5 tube feedings and in between feedings, I kept checking on him. His vitals kept fluctuation. BP would 90/60 P between 101-44 temp 96-100.2 ax o2 90-85%. He didn't have an order for tylenol and he was on PO ATB. I called the dr. and got an order for suppository and was told to hold the ATB. I also put him on 10L non rebreather because his sats were in the mid 80"s.
I gave him the supp. and continued to monitor. I also had 23 other pts to care for. We have a wandered and a lady who thinks her children are in danger, so we have to spend time oreinting her and reassuring her that her children were ok. Another pt was in a-fib but the hospital sent her back with a dx of UTI. :angryfire :angryfire :angryfire Her IV infiltrated.
Long story short, I got all the AM meds passed and was in the break room thinking I had to get the insulin drawn up when something told me to check him again. I walked into his room and his head was turned toword the left. I thought cool, he finally moved. I put the O2 monitor on him and he was satting 95% pulse was 65. I used a digital BP cuff and it read 0. I watched his chest and saw no movement. All night I had had problems getting an accurate BP with a manual cuff. Another nurse, with an amplified stethoscope head couldn't hear anything either. Finally, he took out his penlight and used it to determine that the pt's eyes were fixed and dilated.
I called time of death at 0620. However, I am sure it was closer to 0545. I feel so bad because he died alone. I didn't know him but still cried. [Not alot, and I feel silly for crying over him.] I guess I handled it ok but I don't really unerstand why I cried. I KNEW he was dying.
He was admitted with multiorgan failure and was there to die. He was 59. He went to the dr, because he thought he had the flu. On May 30 he was in a coma at the hospital. He was a DNR, comfort measures only. I hope that I gave him that at least. I tried to preserve his dignity and he became a bed check at 11PM last night. The day before he was using a urinal!!
I only knew him for 24 hrs. Am I wrong to cry?
Thanks for letting me discuss my night.
Also, for future reference, what exactly does 'comfort measures' mean?
Thanks!!
_______________________________
In His Grace,
Karen
Failure is NOT an option!!
Jolie, BSN
6,375 Posts
Please don't ever feel silly for crying over the loss of a fellow human being.
You did well by him, Karen. Take care of yourself.
Gromit
821 Posts
Comfort Measures means exactly that. Keep 'em comfortable -generally do what you can (within orders of course) to keep them from feeling pain, but not gorked out -it does totally depend on the situation.
Don't feel bad for crying. But by the same token, keep it all in perspective. Everybody dies. You have a LOT of patients (23 to one ? ugh!) -I work in a hospital critical setting, our load is only 3 to 1, but they are very "busy" patients, and while they don't die nightly on my floor, its often enough that it doesn't take too long before you 'have one under your belt' as it were. I also do my best to never let one die alone -if we are blessed with having a tech, and I can't be there when they're about to die, I try to get the tech to at least be there. But in the setting YOU work in, lets face it, nursinghomes are chock-full of patients waiting to die. It is truly a fact of the jobs we've chosen. Comfort yourself with knowing that you DID check up on the guy, and did what you could. He knew you were there -you took the time to answer his questions which would (presumably) put him at ease -nobody likes having unanswered questions).
Hey, I even talk to the ones that are so far gone that the odds are they can't hear me, or even understand -but thats my way.
Don't spend a lot of time on it, though. You did right by the patient.
chadash
1,429 Posts
I cry when a patient dies, but then sometimes I don't. Some times it is later. I think it is important to not question your responses too much, allow yourself to feel, and allow yourself not to sometimes. Make it a judgement free zone.
These are real live people, and you will experience real live emotion. I think I wondered about myself the first time I did not cry: was I getting jaded? Nah, just sometimes you don't.
.
msn2008, MSN, RN
53 Posts
It's OK to cry; he impacted your life and many others and deserves to be grieved for. Something I learned years ago from my hospice nurse sister: some people wait to be alone to die. I know it sounds like the opposite of what we think we would want, and it sounds really sad to say "he died alone", but that's what happens on a daily basis, especially seen by hospice. You gave him excellent care and he knew you were there for him when he needed you; it's possible he didn't need you to be there when he breathed his last. Allow yourself the freedom to express your emotions over this loss; they are valid and real. You will have other patients die and you will cry over them too, again, it's OK!
Melissa
They do sometimes wait for you to leave the room.
Tweety, BSN, RN
35,411 Posts
You did a good job. It's o.k. to cry, you're human and you're a good nurse.
LouleeRN
13 Posts
I agree with the previous writers. Sometimes patients DO seem to wait to be alone to die. I always wonder if it is their way of "sparing" others the emotional pain of being there at the moment of death. I've seen families sit for days with a loved one who is barely hanging on to life, but the moment that they go for a bite to eat, or run home for 10 mins to shower, is the time the patient dies. Like you, families, too, feel guilt about not being there, but I usually tell them that maybe that was what the patient wanted. I think it's always nice if someone can be there so that they don't die alone, but the reality is that it's not always possible. It sounds like you did everything to make his last hours comfortable and dignified and peaceful--that's EXACTLY what comfort care means! Don't ever feel ashamed of crying over a pt's death--nurses are human too, and even though you may not have known the patient long, he still impacted your life and grieving is a natural process. We all do it in one way or another.
indigo girl
5,173 Posts
I know you must have heard that hearing is the last sense to go when someone is dying, and that is why we tell families to go ahead and speak to their loved ones even when they appear comatose. You hear stories of how patients remember what was said to them, particularly by their nurses when they were considered to be unconscious. And, many of us, on at least some level, believe in the Near Death Experience. I have had three people share their experience with me including one who was volunteering at the World Trade Center Disaster as a result of her NDE. I believe that human consciousness, our lifeforce energy is ALWAYS aware of the presence of others around us. As other posters have said, sometimes people will choose to die when a particular family member who has been keeping a vigil, leaves the room for a break. And, I think it is a choice. The point is, your patient was AWARE of your concern for him, and that you were checking on him. You had already established a caring bond with him when you took the time to answer his questions, and were doing things for him. That is a form of love.
Your emotions are real, and I say, acknowledging that you cared means you are a compassionate human being. And, it is a way of HONORING a fellow human being's passage from this world.
I know some won't believe this, but I believe the choice of leaving the body during an illness, is real. I was taught in one of my energy based healing classes, that the reason so many people die during the weeks before and after December 21st is because of the Winter Solstice. During that time period (not the exact date), a window opens up into the next world, and if it is appropriate for that person to go, it is easier for them to leave then due to a stepping down in the difference of the energy between this world and the next during that timeframe.
You are a wonderful, caring nurse. Thank you for sharing your experience with us.
suebird3
4,007 Posts
You did the best you could, and I do not fault you for crying. I actually applaud you for that. You made the patient comfortable enough.....
Suebird
leslie :-D
11,191 Posts
our pts do appreciate the human side of us, no matter what they teach us in nsg school.
i've shed many a tear; and ea and every time, it was evident the family was touched by the display of human frailty.
you sound like a gem. nsg is lucky to have you.
leslie
NicInNC, CNA
241 Posts
Don't ever feel bad for crying. I had my first loss 2 weeks ago. I've been there since October.
Her family called me in just as she was taking her last breaths. I literally stood there and watched her take her last breath. It was so sad. But, at the same time, I think it was a bit easier for me because this lady had been telling me for months to pray that she would die because she was ready. She died on a Sunday. On the Friday before that, she said that the angels were there to take her and she was excited about meeting Jesus. I still wonder if angels really were there. Her daughter asked her if she was scared and she said no. The daughter finally told her it was ok to go with the angels. My resident just seemed so at peace, then she went into a light coma. Her last day was awful to watch her though because she was having such a hard time breathing. I can only hope that she was in enough of a coma to be out of any pain.
As for only knowing your patient only 24 hours, I've learned that times doesn't mean anything. I have one resident that I got attached to the first day he arrived. If he had died that same day, I would have cried also.