My first patient death

  1. Tonight I had a patient who I admitted last week for change in mental status. Unfortunately, this patient had been declining steadily since admitted. The family was unsure of what to do, so Full code remained. Today I have this patient again (4th time I have personally cared for this woman). The woman is making the horrible gurgling sound (everyone knows what I mean). I call respiratory therapy and we implement the order for deep suction. I call the doctor on call to "please just take a look it would make me feel better". The pt vital signs were stable, slight fever corrected with tylenol, and bp was normal in range. 02 is within normal limits but I just didn't like how she looked and sounded. The poor daughter has been at her mother's bedside for this whole week, watching her mother decline. She didn't want to make the wrong decision by placing the pt on a DNR. So tonight I get the doctor on call involved we continue the original plan (suction, HOB up, Lasix which she received 160 of and not putting out nearly enough fluid). I give the pm medications. The daughter (thankfully) was in the room came out and said "I think she's gone".

    Enter in flustered and frantic here. While initiating the code blue, the daughter decides to make this pt a DNR. Some parts of me feel responsible for this woman. I know I called the doctor, respiratory, and did my best to not let her drown in her own secretions. I know she was elderly with multiple organ failure. I know she wasn't going to get any better. Everyday I would think how this poor woman should just be left alone. It's easy to judge the family and their decisions, but I am not the one who will have to live with that decision the rest of my life. The daughter had very little support from other family members. She was receiving conflicting information from different doctors. She was lost, and for that I feel sad for her that we as her mother's caregivers couldn't help her make the decision.

    This was my first patient who died. I am relieved the woman was able to pass on peacefully, and that her daughter was with her, and saw that she was at peace. I am thankful the daughter told us to stop before starting the compressions and making this poor little frail lady suffer further. I am thankful she passed with dignity. I have been a nurse for over a year and just experienced my first ever patient death, and it really sucks Thanks for listening!
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    About katielam616

    Joined: Sep '11; Posts: 30; Likes: 57


  3. by   ozoian
    My heart goes out to you. As a new nurse, I think this is one of my biggest fears. I hope I am able to provide amazing care like you did in her final times.

    Keep your head up!
  4. by   mikeicurn
    You did good.
  5. by   chordringer
    I remember my first patient death and I know what you mean with feeling bad and constantly wondering and thinking if there was something that could have been done to bring a better worldly transition. But in the end, I think it is important to realize that medicine --while doing some miraculous things for people -- is ultimately limited in what it can do to prevent human demise. Our jobs, at least when the time comes, is just to help the patient and the family prepare for the inevitable and let God handle the when and the why.

    Working in the ICU, I see death much more frequently and the kinds of death I see are often worse than what is seen on a typical medical floor. It requires a little bit of resolve because with each death, I think we see in ourselves our own vulnerability and our own finiteness. We will all be there ourselves one day. I hope that when its my time that my family will be there to wish me a fond bon voyage.
  6. by   Biffbradford
    Yes, you did fine. It's all part of reality. Learn, store that experience, and move on. Next!
  7. by   CIRQL8
    Sometimes it just feels good to hear your peers tell you that you did the right thing. Well, you did. A first death is one of the many milestones in a nurses career. It doesn't get much easier, but I think we develop our own methods of dealing as time goes by and these things happen again. Best of luck to you. If I or one of my loved ones are ever hospitalized, I hope we have a nurse as caring and conscientious as you.

    Sent from my iPad (so excuse any typos and autocorrects!!) using
  8. by   ncat
    this is soo tough and it is imp for u to have support and vent also. i have been a nurse for many years and this exp will never leave you. think u did great--always remember-death with dignity, give care with skill,but,with empathy and gentleness. then cry in the bathroom.
  9. by   Double-Helix
    It sounds like you did a wonderful job keeping the patient as comfortable as possible in her last moments. The patient passed peacefully, with dignity and with family at her side. That sounds like a success, and a job that you can be proud of.

    The first patient death is always difficult. Do you have a mentor at work that you can share this experience with as well? Sometimes talking to someone in person can help you process what happened. You did a good job.

    (Just as a clinical thing, Robinul- generic glycopyrolate- can be very effective in controlling secretions and that 'gurgling' sound you were hearing.)
  10. by   Been there,done that
    Oh, yeah.. death is ugly, death sucks, and death is my enemy.

    You did well, and I hope you can put this out of your mind even as you prepare for the next death.

    Please consider utilizing your ancillary services. It would have been useful to consult spiritual services, hospice, any areas that are available.. to talk to the daughter ... before it got to the end. The patient, family.. and you ,would have received some support.

    P.S. Scopolamine patches! Very useful at the end of our fight with the enemy!
  11. by   sherdk
    Hi__ I think that you did very well and did all that you could. I have been a nurse for 47 years and death is still difficult-- usually because of pain or family that are left behind to grieve. At this stage of my own life -- death is just part of a life-- it comes to all of us-- so I dont consider death an enemy in any way ( certainly showing my age). iT really makes a difference in what kind of a facility you are employed -- like emergency always had some very tragic expericenes but in LTC or hospice death frequently is a relief for the resident and the family-- because they are frequently prepared for their final voyage. Keep up the good work-- I love to hear from all of the new nurses.
    PS --I still work and love every minute of it!!!
  12. by   P_RN
    My not so favorite experience in the above scenario-was the daughter who said don't give "Mama" anything I want her to hear me talk to her.....Mother had been aphasic, non responsive for over a year. Rattles, rales, contractures., 50 lb wt loss, g tube...the DIL said we need to speak to the doctor. As all hovered in the consult room. DIL asked him "Is there a reason she couldn't have some MS IV?"
    Daughter was very pleased "Mama" wasn't making so much noise so she could hear her better...................and,yes, peacefully within a day.
  13. by   bsyrn
    Sounds like you did everything right . The first death is the hardest...
  14. by   TopazLover
    I agree, death is not my enemy. Not my friend either. Sometimes it is right to fight it. Other times it is a kindness to allow the body to stop being badgered. We do not control the outcome. We play an important part. The OP did a fantastic job of nursing the ill and caring for the family. Both are unique challenges.

    To the OP. Death is not easy to accept when we work with the same patients and hope for a better outcome. You did well. Learn from this how to make the next death, and there will be more, one you can handle as well or better.