My first death

Editorial Team / Moderator · May 30, 2016

Does your facility have any critical incident stress debriefing mechanisms in place? We use them to deal with difficult codes, traumas, etc., in the ER. Reach out to your management and see if they can help. Are there members of your team who are also struggling with this? I am sorry for your distress, it's never easy.

beckysue920 · May 30, 2016

Catebsn25, sorry you have to go through this, I know it isn't easy. and am sure you did all that you could do. Pixie has some good suggestions. It is important that you connect with others who were present and de-brief with them. No doubt they are having difficulty dealing with his death as well.

It may be helpful to contact the EAP your hospital has to get some 1:1 sessions to talk through this. Years ago a patient I had on in-patient psych committed suicide, in those days the importance of staff needing debriefing wasn't recognized, unfortunately. I encourage you to make use of the resources you have available.

~Take care~

catebsn25 · May 30, 2016

Unfortunately I work at a very small organization and we don't have an employee assistance program. I have been talking a lot with the staff who were with me at the time and other coworkers and it has been helpful. In case anyone is interested I will post the story... When I started the thread last night I just didn't have it in me.

Pt was admitted voluntarily for +SI w/ multiple plans, and reported ETOH and Opiate dependence. Pt has a long psych/substance abuse history with multiple past inpt admissions. I'm one of two RN's who work the overnight 12a-830a shift on the locked unit. Last Thursday into Friday was my last shift of 7 in a row. I knew the patient well as I had been with him every night/early morning throughout this admission.

Pt was initially put on a detox protocol for his reported substance abuse but throughout admission VSS and no physical s/sx of withdrawal. After every medication dose per the protocol the patient would become somnolent and appear to be "nodding out." All sedating meds were held after 3pm one day and after waking on the next day his VS were still perfect and no outward symptoms of withdrawal so one med was D/C'd and the other was held by the med nurses during the day. The patient remained somnolent but arousable by verbal stimuli despite the fact that all sedating meds had been held for almost 24hrs.

Since we are a small psychiatric facility we can only effectively handle so much in terms of acute medical problems and due to the continued somnolence we sent the pt out by ambulance to the nearby ER where he was hydrated with NS and sent back to us about 3 hours later. I came in for my shift that night with no reported issues. On the noc shift it is just me and two "techs" for support staff who do Q15min checks. The patient had a very loud snore throughout his admission. I had checked on him every night since he had been with us due to the snoring to find the patient in no acute distress, so he was considered just to be a person who snores loudly, probably has sleep apnea but that wouldn't be something for us to address during his acute psychiatric hospitalization.

I went in to visualize him at 5am with no issues at that time. When one of my techs was doing his 630am check and waking the patients up he came to the nurses station and told me I needed to check on said patient. I went into his room and up to him and he was nonresponsive, skin tone dusky/ashen, not breathing and I could not detect a heart rate. I hardly remember thinking, just acting immediately. Told one of the techs to call 911 and the other to go get me the O2 machine and AED. As they left the room I dragged him from his bed to the floor (gently yet quickly) and immediately began chest compressions. I noticed he had pink frothy sputum coming out of his mouth and nares, and when the O2 tank and AED were brought to me I sent them to get our portable suction machine and to plug it in. Chest compressions were maintained other than allowing the AED to analyze the pt. AED cycled X3 with no shockable rhythm found. As I was suctioning the patients mouth and nose EMS arrived and took over. One of the first responders asked me if he could've snuck in any opiates and I said I don't believe so but it's possible it has happened in the past no matter how diligent we try to be. They start setting up their nasal Narcan and I pointed out that his nares were completely full of frothy sputum and asked if they had Narcan IM, offering ours if they didn't. I was ignored and they still attempted to administer the narcan nasally. At this time more EMS personelle had arrived and I assisted them in switching the O2 and AED wires onto their equipment and helped transfer him onto the stretcher and off they went. Everything happened so fast.

Later as I was meeting with the Hospital Administrator/DON and explaining what had happened we got a call from the ER MD and he told me that the patient had "expired." I kept my composure and was calm until I hung up the phone with him and then started crying.

My coworkers (including the DON) were all supportive and I believe I did everything in my power in that moment to try to save him. But I'm still so sad for this man. I knew when I started compressions alone in the room with him that he was already gone. I still tried as hard as I could for him and was still hopeful that the ER might have better meds/resources and bring him back, but I guess it was his time.

I don't feel responsible for his death but I can't help but think I should've picked up on something being wrong when I checked on him at 5am...

Anyway, if you got through this whole thing thanks for reading. I know I'll be okay and move on at some point, but for now it's all I can think about. It was the first time a patient coded under my charge and the first time a patient died under my charge.

I hope he is at peace now. I'm not religious but I made sure to open the windows in his room. We are also leaving that bed open until all of the patients who were there and knew him have been D/C'd.

Thanks for listening, guys.

catebsn25 · May 30, 2016

One more thing I forgot to mention that also is bothering me... When I dragged him from his bed to the floor his shorts were inadvertently pulled down to his knees. The pt wasn't exposed as he was wearing boxers but as EMS had taken over and we're trying to administer the nasal Narcan I started to pull his shorts up gently (without jostling the patient around) and was sharply told "Don't bother." I wanted to protect his dignity and it bothered me that they didn't seem to care. Sorry for all the posts guys, I just can't stop replaying everything in my mind...

nutella, MSN, RN · May 30, 2016

I am very much in the end of life business and can tell you that a lot of nurses /staff need some time to process after a patient dies. I think especially the first code is something that is a very emotional event and some people even feel that death is the reflection of a personal failure (as a healthcare professional) or a sign of defeat. "Reviving" somebody is a violent act in itself and not like seen on TV, which can be hard to process for some people. When a patient is "younger" there is also sometimes the question why "those things happen" as the culture and religion often leads people to ask "why" did it happen and does not invite the "acceptance" of death as part of life.

So I think that for you it was the first event, it left an impression and confronted / challenged your own beliefs of dignity, life, and nursing practice. It is normal to feel unsettled for a while and talking to your coworkers/team helps to process as well. People with addiction live a dangerous life due to addiction itself, and violence, other healthcare problems. Sometimes people die anyways, despite all we do.

I do not know about your spiritual beliefs - my own is that "when your time has come your time has come" and nothing we do will change it.

You mention that your workplace does not offer employee assistance programs - if you have health insurance you might want to consider seeing a therapist if you continue to experience problems related to this event to help you process it further.

catebsn25 · May 30, 2016

I think you're right... thank you so much for the kind words and advice

nutella, MSN, RN · May 31, 2016

I think you're right... thank you so much for the kind words and advice

I found that for most coworkers just sharing what keeps you busy a couple of times (without violating confidentiality but that is self explanatory I think) with other people who understand, will help to process stuff and you can move on.