Nursing Fear

[MN-MN]

I am just starting to think about what it will be like when my first peds patient dies. That could come any day now, or it might happen years from now, but it will happen.

Just thinking about it for a while today brought me to tears. I'm thinking this is significant.

I am a nursing student. I've worked in a business environment my entire career, and making a switch; I have now been working in healthcare for about three years at a Minneapolis hospital as a para-professional.

I've known and worked closely with patients who have died. I feel good about how I worked with those people and help them die a dignified death in my own small way.

I have yet to see a patient I knew well in any state other than alive. I also have not experienced a child die in front of me.

I am afraid of my response to the latter. I know I'll handle it, and it will be difficult. I've been denying that fact. But, it will also drive me to become a great nurse. I'll move on with passion and sense of purpose, but that gift must come at some emotional cost.

[NotReady4PrimeTime, RN]

Your fear is about as common as grains of sand in the desert. I don't think there's a nurse alive who wasn't terrified of the day of their first patient death. There really is no way to plan for it or prepare for it. My first pediatric death wasn't unexpected, but it WAS sudden. I know that sounds nonsensical but when you hear the whole story it will make total sense. The child had drowned in waste water and had chemical pneumonitis as well as overwhelming sepsis and was in disseminated intravascular coagulation. My first day with him was busy with trying to keep him alive; we tried all day to get him on continuous renal replacement therapy but because of his small size and DIC the filter kept clotting. I was almost surprised to see him still on the unit when I returned for day #2. By lunchtime we had abandoned the notion of CRRT and had sent off a schwack of unusual labs on him, including some special hematology tests. The hematologist came by at noonish to tell us that the baby's (clotting) Factor V level was incompatible with survival. So we had incontrovertible information that this child was going to die. The family wasn't available at the time for our intensivist to share this information with, so at suppertime when the child suddenly blew a tension pneumothorax and went into cardiac arrest, we were required to resuscitate him. After only about 1 minute of compressions his heart began beating again. We got the family to the bedside and explained things to them. About 10 minutes before my shift ended, he died in his mother's arms. I knew he was going to die, but I didn't think it would happen on my shift, so although I had time to process the fact that he was going to die, it didn't make any difference to my response. I still felt like I'd been hit by a truck. Now, more than 12 years and several deaths later, I'm still not prepared for my patient to die on my shift. But my head knows that all of us are here for a finite amount of time and sometimes there's no way to control or decide when death will come. Having seen the many ways that surviving some situation that shouldn't have been survivable can be a true fate worse than death, my heart is able to be present but not be wounded by death when it comes. Anything truly worthwhile comes with a price... and there really isn't anything more worthwhile than caring for sick children.

[NurseRies, BSN, RN]

I am just starting to think about what it will be like when my first peds patient dies. That could come any day now or it might happen years from now, but it will happen. Just thinking about it for a while today brought me to tears. I’m thinking this is significant. I am a nursing student. I’ve worked in a business environment my entire career, and making a switch; I have now been working in healthcare for about three years at a Minneapolis hospital as a para-professional. I’ve known and worked closely with patients who have died. I feel good about how I worked with those people and help them die a dignified death in my own small way. I have yet to see a patient I knew well in any state other than alive. I also have not experienced a child die in front of me. I am afraid of my response to the latter. I know I’ll handle it, and it will be difficult. I’ve been denying that fact. But, it will also drive me to become a great nurse. I’ll move on with passion and sense of purpose, but that gift must come at some emotional cost.[/quote']

My first death came while I was still in training at my first job. It was an outpatient dialysis clinic, where we did about 30 treatments per day. The man was in his 60s, had been on dialysis for a number of years, diabetic, wheelchair bound, and a heavy smoker, among some of his problems. He was always so nice to us, joking around, asking us if we were staying safe. He was always bothering me to get a guard dog bc my husband worked late and he didn't want anything to happen to me or any of us nurses. He usually took a cab there, but this day his son took him, and he was especially happy. He got on the machine as usual, vital signs weren't too abnormal, he felt fine, and I went to lunch with my preceptor. A tech ran back to the break room and seemed very distressed. There's something wrong with Mr. X, she said. We both ran our and by the time we got there, we saw the other nurse bringing over the crash cart. I took one look at him, and it looked like he was already dead. His face was gray, no breathing, and yet he was still spinning his blood on the machine. Someone ended the treatment, someone called 911. And we got him under the backboard. The rest is a blur. I know I did the ambu bag but that's all i remember. We have no means for coding patients other then AED. He was shocked 3 times. When EMS arrived, they knew he was already gone. It's hard in an outpatient clinic because you know these people well. Apparently it was a massive MI the MD later told us.

One tech had to be sent home early that day she was such a mess. She had put him on the machine and wondered if it was her fault. It was just his time. Everything was done correctly. That night I felt sick to my stomach and numb, I cried and wondered why I was a nurse. I told my husband but he sorta had the whole, "well what did you think you were getting into when you became a nurse"? So anyways, since then, I've built up a lot thicker skin. Although it's hard not to be empathetic and take things hard, we cannot let this job destroy our mental health. I see people in ICU all the time now, with no hope and distressed family. It sounds cold, but I really try not to get overly involved. It is the only way I think this job can be done long term. We have to toughen up, know when to cry, but not let every sad moment get us down, otherwise we would all be a depressed mess!

[RH_Fan]

I just started school at the beginning of the year and I'm still waiting to get accepted into the program. But I know my heart is working with kids. I also know it'll be the hardest thing I do. Reading these stories are always heartbreaking but I know where my heart is and I know it'll be worthwhile.

[umcRN, BSN, RN]

My first patient death was a newborn. We knew she was going to die. She was an HIE baby (apgars 0, 0, 0, 1) we cooled her but she herniated. Support was withdrawn but she continued with spontaneous breathing for around 36 hours. Over the course of time she would stop breathing longer and longer, heart rate would drop, we would think "this is it" and then a gasping agnoal breath would get her going again. Torture for us and her parents. I was able to hold myself together when she finally died and throughout bereavement care with her family but after they left I Just lost it. I shut myself in the room with her (we have private room NICU), scooped her up and just sat rocking her in the rocking chair sobbing over her for about 20 minutes. One of my coworkers finally realized I was in there alone, came in and took her from me. We shrouded her together and carried her to the morgue together.

I am now the co-chair of my cardiac ICU bereavement team. It hasn't gotten any easier dealing with a patient death but I enjoy being there for those families in there time of need and I always shed a few tears for my little patients, it's just who I am.

[meanmaryjean, DNP, RN]

I have to say that in my 30+ years of practice, I have encountered pediatric death about as often outside the hospital as inside. I don't think that being a nurse makes it any harder- or any easier. It is what it is. That heart-breaking awfulness, and our response to it in serving our fellow man, is what makes us human.

I always tell my PICU parents, "There is no script in this life."

[KelRN215, BSN, RN]

I've been a pediatric nurse for over 6 years and I've never actually had a child die in front of me. I've taken care of many dying children, I've been working shifts when patients died but have never actually been in the room when a child took his last breath. Rarely have the pediatric deaths I've experienced been unexpected and nearly all of them have been oncology patients. Usually when these kids finally let go, there is peace. Their little bodies have been tortured for so long and, while I am sad for their families, I am also very happy for the kids that they are free of their disease.

[xoemmylouox, ASN, RN]

So far I have lost 2 Peds patients. Both were unexpected and unfair (not that death is fair). I cried for both. It's hard, but it happens.

[morningland]

I don't know... call me cold or crazy... but I feel worse when an adult dies rather than a child.

I am haunted when an adult dies... but I'm a peace when a kid dies. I believe in heaven and hell (almost wish I didn't believe in hell but I do) and when an adult dies, I am never sure where they are in the after life. That is scary. When a little child dies, I know they are in a place of such unimaginable beauty, peace, love and joy that I realize it would be silly for me to grieve. I feel horrable for the family but I know the child is in a place that is beyond what the human mind can comprehend. Adults are a different story; the bible says few get into heaven and it's "easier for a camel to go through the eye of a needle" so I am pretty haunted by that.

Basically, I view it as a great mercy when God calls a child home

[RN*mommy]

I've lost a few babies working in the NICU but peds is a scary new ball game. A dear friend of mine works in ped palliative care at our local children's hospital as an APN. At first I thought she was crazy. Now I think she's one of the strongest women I know. I'm actually beginning work on my thesis for my MSN and she's my inspiration. I've decided to focus on nursing perspectives of pediatric palliative and end-of-life care. My plan, when I reach this point, is to post a survey here on allnurses and get peds nurses thoughts, feelings and such. I hope you'll all help me out! I'm really excited about this project because I was always scared of death and dying in any capacity and peds....well that scared me the most, especially as a mother myself. However my perception is changing and though it still tugs at my heart, I slowly starting to see where hospice and palliative care can really benefit the child and the family.