My patient coded, and it's giving me nightmares!

xoemmylouox, ASN, RN · Feb 7, 2012

I myself am haunted by one that I witnessed/assisted. She wasn't my patient, but seeing someone die the way she did took a toll for a long time. I am better now, but still think of her. I think it is worse when we know there was something that should have been done, but wasn't (intubation, medication, etc). This will get better. It just takes time.

TammyFNP2b · Feb 7, 2012

I've worked in critical care for years and I think the majority who have will all tell you that there are "those patients" that you will never forget...some with positive outcomes--some negative. Sending you a hug-- All you can do it your best. Sometimes it can be extremely frustrating when your gut is telling you one thing and the doctors are saying another.

In those cases I was paid extra detail to my documentation---who I notified...what was communicated and the response etc... Also, with experience comes a greater boldness as well.

Trust your gut...and if you are not satisfied with a response go to the next level. xox

sweetgeorgia · Feb 7, 2012

I am a nursing student and I remember the first patient who coded while I was there at the bedside. While it wasn't bloody it was repeating throughout the two days that I was on the floor. The first time was intense though, in fact every time was pretty intense. I'll always remember the patient but with that much burned in my brain, it can only be channeled into more attention to detail and the willpower to do as much as I can for every patient that I meet in the future. Try to take it as a life experience and remind yourself that you are still worthy and good on the inside. I send you all my love and prayers to help you through.

Nienna Celebrindal · Feb 7, 2012

I also had something similar happen. We were short staffed, I was a slammed new nurse working in ICU stepdown and I went to check on a patient he was SOB, VS were fine. Called Doc, called respiratory therapy. Went back to check on him he was almost done with his breathing tx and said he felt better and I was like great on to the next patient. In the back of my head I still didn't feel comfortable with how the patient was doing but I was so busy I felt I had to keep moving. The next thing I know the RT is screaming for nursing and the crash cart. Turned out it was a PE and there was nothing that could have been done differently but I felt like such crap for so long and honestly its been 10 years but that night is still very clear in my memory. Probably because I think of it regularly.

I learned a lot of valuable lessons from that experience and I think it really helped shape me into the nurse I am now. I think the only thing you can do now is forgive yourself (and not because you ARE guilty of wrong doing or not doing enough, but because you feel that. You did the best you could in the moment and that's all we can do. Don't let yourself own something that isn't you burden to carry, does that make sense?), and take the lessons you've learned and use them from now on.

Esme12, ASN, BSN, RN · Feb 7, 2012

:hug: Like Tammy said there will always be those patients that will "stick" with you. Some will "stick" with you for a positive reason others for a negative reason. She did have a significant heart history. Personally, it sounds to me like a blown pulmonary artery. We used to see some pretty horrific codes in the old days when ventricular aneurysms blew.....those were blood baths. If the patient had right heart failure there could have been some undiagnosed portal hypertension and liver congestion that would have caused unknown varices. I remember a varicies patient that bleed out like that and when the code was over the blood on the floor was congealed around my shoes on the floor.

There have been times where there would be a difficult MD and no matter what I said to them they knew better.....they eventually learned that if I said the patient was going to code.....they were going to code.That "feeling" is difficult to explain, but it's an instinct......something you just "know". But it does mean you are a good nurse. Talk it over with pastoral care or EAP........talk with your manager or others that were there.

I had a patient once was admitted with new onset diabeties and fever.......he continues to elevate his sugars until has was in DKA and was transfered to ICU. He looked funny.....I can't explain it but something wasn't right.....he became more and more acidotic more and more confused, his glucose went higher and higher inspite of increasing insulin gtt. I had a bad feeling. I wnet to his room to increase his drip again, he grabbed my arm and said...."Please don't let me die" one pupil constricted and the other blew and promtly coded.....he was on FIRE!!!!!

We paged and paged his attending this guy was a jerk.....when he finally showed up I told the MD......"I told you he was going to code.....go sign the death certificate. Oh that's right he's a coroners case, he'll find out what went wrong"......I was so angry. It turned out the guy swallowed a balloon filled with drugs....that ruptured. I don't know why he didn't say anything I guess we will never know......that was over 20 years ago and I can still hear his.....please don't let me die.

It's ok to be bugged, and it's ok to be disturbed. Grieve, talk about it, get it out of your system. What you are feeling is normal. But you sound like a good nurse to me:hug:. Peace

nurseprnRN, BSN, RN · Feb 7, 2012

my earliest code memory was a cachectic old woman with so many positive nodes they were actually visible through her translucent skin, and there were more every day. she failed, she got dyspneic, she arrested, and the code began. i will never, ever forget the horrible feeling of this poor old woman's rigid old ribs snapping off her sternum and spine as i tried not to compress her too hard. i got one glimpse of her eyes looking at me before they rolled back. she "lived" for another 12 hours or so.

that was when i vowed to advocate for no-codes whenever it was reasonable. and i will never, ever do compressions on someone with terminal metastatic disease no matter what the code status.

**NickiLaughs, ADN, BSN, RN** · Feb 7, 2012

I appreciate all the comments. I'm actually making a switch to case management, I think I was borderline ICU burnt out anyway, and then this happened.

If the respiratory rate is 40 -50, I don't care WHAT your ABG's look like ... you bought yourself a tube!
Look at what you have learned from this and move on. Counseling is an excellent idea.
You will never let pharmacy drag their heels on a stat med again .. will you?
And.. most important of all.. sometimes it is just their time to leave us , despite our puny efforts.

I assure you I didn't let pharmacy drag, I had called them 3x already between constantly holding pressure on my patients nose, my patient coded during my 3rd phone call to them. Nurse Sup was aware and had called earlier for me as well. They had put the order in as SC which is in our pyxis, I needed it IV. The new guy made the mistake. I let pharmacy know when they finally arrived for the code. And they were going to explain to him that stat means sooner than 45 minutes.

apocatastasis · Feb 7, 2012

I'm sorry you're going through this. I second the professional services... it can be hard working in critical care and losing patients. I left ICU for that reason, among others.

It seems like there was a bad mix of lack of physician action and pharmacy issues. The physician should definitely have acted on the 40-50 resp rate... at least attempted to see how she'd manage with bipap or something. There's no way a patient can maintain 30s/40s/50s for extended periods of time... not intervening quickly and appropriately is just begging for a code. I'd have gotten the charge, house sup, and chief medical officer in the loop as soon as I'd hung up on that doc.

All that said, what's done is done. Patients die despite our efforts. You have the right and the duty to take some time for yourself. Take care.

Gregmercer601 · Feb 8, 2012

That's tough - its quite understandable that you find it a challenge to get past it. I'm an experienced Psych Nurse, and I wouldn't begin to get diagnostic on you with so little information, but I wouldn't assume you have any diagnosis. Just as not every headache means a brain mass, not every distress of nightmare or worry, etc means a Psych illness. Find supports, seek professional assessment if it seems to you or someone you trust. Learning and practicing simple meditation can be helpful in times of stress - check on the web, perhaps DR Herbert Benson's Relaxation Response, he's a leader in the field and trains Harvard Medical Students in meditation for their own self-care. Also, keep in mind that you have a tough job, and if you've been managing, you're tough and resilient. Everyone hits their limits here and there, or they're not challenging themselves.

I'll never forget my first death - it was years before I was a Nurse, fresh out of college. Guy was an obese heavy-duty chain smoker, beloved by all in the Group Home, one of the nicest, kindest, gentlest people I've ever met, but also rather impaired with Schizophrenia. He'd smoke most of his waking hours, sucking on each butt hard enough you could see it dwindling, tamping it with each exhale without breaking rhythm, starting a new one without having to slow down - very impressive in its way, a true expert in this form of slow self-destruction. I met him, then soon had my first team meeting, advocating like only a novice can for a full-court press to help this guy stop "before he dies," I said. Folks had tried without success for years, and had given up. Groups homes generally have their hands full or more most of the time, and the issue was considered an untenable waste of resources.

So a few days later, Guy hadn't come downstairs by noon, so we went to check on him. He was face down on the floor, dead for hours, his shirt half-pulled over his head, nose smashed. It seemed clear he was undressing, fell like a tree. Now I've had CPR but no other health care training, I don't know how long he's been down. I sent my peer to call 911, rolled the guy over with much effort (400 lbs or so). Had no barrier device, so I'm struggling with whether to give mouth-to-mouth, but it was moot - tongue was too stiff and sticking out, and after a few minutes of not realizing this wasn't a matter of my inadequate skills but a hopeless situation (it seemed to last for hours, alone with a corpse), an EMT came in, looked down all casual, and said - "Forget it - he's done."

I've had lots of codes, deaths, emergencies, terrible violence, a fire that destroyed that same group home, lots of scary days and low times, but that was the worst - I didn't even know enough to know no knowledge could affect outcome.