Nursing student, and two deaths this week (very long, sorry...)

[LovingLearning]

Hi, all. This is my first post (and not my last...), and I came here for help and understanding. I am at the county's free hospital, and I'm in my first semester of RN school. I have changed my life around to do this, and as my name says, I'm quite literally loving this whole thing. I am not sure how it works in general, but we've been in medsurg (ortho for me) since the 5th week; bedbaths, ADLs, assessments, injections, meds (PO and PRN, no IV yet), and just general care stuff. We are assigned to one patient, and have an RN and our clinical instructor we report to. Our hospital has wards, so we get assigned a bed. Nothing too complicated, and while I've had some rough patients, I've always left the floor feeling good, no matter what happened.

Until Tuesday, that is. Tuesday, I was assigned to a tib plateau ORIF. No big issues there, normal meds, not even a secondary dx. Just the ORIF recovery and PT. We left pre-conference, and headed up to the floor. As I came off the elevator, my RN called for me to gown/glove/mask stat, and help. I handed off my books and got ready. Into the ward I trot, to be confronted by a patient with a pool of blood under his bed, dripping off the sides. Not my patient, but I'm ready to help. I help get him cleaned up, and realize he's bleeding from his rectum. Bright red, and a lot. Not sure even what his DX is, I'm helping clean and locate issues with this pt. We get a condom cath onto him (which I am not supposed to do, so I just watched), and finished cleaning up while the RN is calling for his dr. I take initial care of my pt, get him some pain meds and get him ready to take a bedbath, when I notice another pool of blood on the floor of the first patient. Condom cath is not working, and he's bleeding from his member now as well as his rectum still. I grab my RN, and she foley's him. And the blood coming into the bad is purple and clot-ish; thick and with bits of stuff in it. I can't rouse the patient. I take his pressure, and while it's in the normal range, he's tachycardic. He's compensating. The Dr comes in, and thinks maybe (???) the pt should be in ICU. Two hours later, another group of Drs come in, and they concur. It takes a third Dr to decide to actually call ICU and get the pt transferred...my RN and I get him ready to go, and we take him up to ICU. They start working on him as we get off the elevator... go back to our floor, and I get back to my assigned patient. I find out on Wednesday am in handoff that the transfer pt passed away.

So now it's wednesday morning, and I've been informed of my first death. I try to shake it off, and get to my pt. We have a readmit that was my pt last week, a lady with terminal cancer. I peek in on her (she's been put into iso because we didn't have a bed in the woman's ward), and she looks bad. My regular pt is complaining of pain, and I go to get him his meds and some water. He gets it all in, and he's feeling all right; good enough to eat breakfast. He asks for juice, so I head to the kitchen. Isolation is directly down a short hall from the kitchen, and as I come out of the kitchen, the cancer patient's sister starts screaming. I just sort of stand there, watching...my RN and another RN go flying into the room, and then one comes back out, mumbling something about code blue, and then gets mixed up and goes into the linen closet instead of the med room for the crash cart. Code Blue is called, and my RN gets the crash cart and is moving fast. I look down the hallway, and here comes a horde of scrubs, responding to the code.

I melt back into the basin in the lobby; I have to get out of the way, and so I get pinned in there by all the bodies. The sister of the cancer patient is sort of passed out into the lobby area, where I am, and since she recognized me, headed straight for me. She reaches me, grabs my arms, screams into my face, and her eyes roll back. I catch her (she's tiny) and am able to help her keep her feet; my isntructor has managed to make it through the crowd to me, and tells me to get her into the kitchen...so I do. In the kitchen, she's wailing and hitting the table and the wall, and screaming, asking me if her sister is dead. I don't have any answers, they haven't called the code yet...and then they do. She asks me again, and all I can do is nod. I'm fighting to keep my cool...she needs me cool. She asks me what happens now, and I tell her someone will come talk to her. I'm making that up, because we haven't covered this in class yet. Catch that? I have no idea what I'm supposed to do here...we haven't learned it.

My isntructor gets in there, and does start talking to her. Another student nurse comes in and helps. I am given time to get myself together...and so I do. Or sort of. While I'm out getting myself together, the patient's daughter comes. A brief backstory; she's been quite abusive to the Drs and RNs in the last few weeks. Everyone's been as patient as possible with her, as she's in denial and is fighting to keep her Mom alive. She has filed two complaints against RNs already. So because she hasn't filed a complaint against me, I was asked to watch for her arrival, and get the Dr when she gets there. So she gets there, and barges into the room where her mom is laying. She's screaming, and screaming, and wailing...and I go to her. She grabs me by the shoulders, and shakes me. 'I can't believe you let my mother die in that Godforsaken {blankity blank} room. YOU LET HER DIE!!!". I get my arms around her and just hold her for a few moments...she stops trying to hit me and just collapses into me...and I manage to get her into a chair in the hallway. The Dr comes, and he's talking to her, and tells me to go on and leave, he's got her now...so I do.

I get back to my patient, and he's being a good guy. Just pats my hand and says he doesn't want to know anything, except if I'm all right. Apparently, they didn't get the door shut to the ward, and he watched pretty much everything. I tell him I'm fine, and get to tending him. At my lunch break, I go out onto the patio, and am sitting there in the sun, feeling utterly overwhelmed and confused and shocked and exhausted to my very soul. I get the day complete, and head home. I try to study for exams on Thursday, and managed to get about 2 hours' sleep...go take the exams, blow them completely (until now, I've been a solid A student...), and come home and try to get some sleep. No dice.

I have a horse, and I went to go see him today; riding is my passion and my sanity...and I couldn't ride today. My head was too cloudy to get up on him and risk him losing it and spooking and me coming off and getting hurt...so I kept my feet on the ground.

I know this is really long, and if you're still here, believe me I appreciate it. I am struggling really hard with this week's events...two deaths, neither one a peaceful transition...we haven't learned how to deal with this in class yet, and I'm feeling ever so overwhelmed and lost and scared and ineffective. I'm not coping well, you know?

I guess this post has two goals. First is to be heard and to get some comfort from those who've seen what I saw this week. And second, to find some effective coping strategies because I don't seem to have any. My NANDA would be ineffective coping d/t sudden deaths of patients.

Thanks in advance, and please, help if you can. I'm having a really hard time of it. I keep seeing the sister screaming into my face, and hearing the daughter accuse me of letting her mother die. This is a lot to deal with as a first semester student, you know?

Best-

Lovin' Learning

[LovingLearning]

I wanted to update this thread...

I had the opportunity to speak to the first semester proctor this week. She did not know what had happened, but listened carefully. When I asked in which semester we would be learning about death and dying, she said '3rd.'

I took the opportunity to explain to her that, as students, we need to learn earlier. We need to know what might happen, how to deal with it per school/hospital protocol, and to whom we could go to talk afterwards should we need it.

She repeated we don't learn about it until 3rd semester...and I took a breath, and said 'well, then something needs to change. That's too late.'

She looked at me, and asked me what I'd suggest. I said 'how about even just a half-hour discussion about it sometime before we go to the hospital for clinicals?'. Again she looked at me, and said 'which half hour do you think would be good to miss?'

I said, a little more vehemently this time, 'everything is important to learn. But this is more important to learn about early than late. I don't know where you can fit it in, but it has to be done.'

She basically dismissed me at that point, saying she'd consider it. I didn't think she would...after all, we do follow a proscribed syllabus, and there really isn't room to squeeze out a half hour (according to her....).

She left a note in my mailbox yesterday. On it, she said "I've found a place to do the 1/2 hour...during orientation. I can justify it by orienting new students to where the counseling/chaplain's office is, and that way we can talk a bit about what to expect when one is dealing with a family in grief. And I've sent an email to each semester's instructors asking that they take time during post conference to help a student who faces death on the day it occurs."

I have to say I'm pretty pleased. This is a definite change...and I made the change happen. If I hadn't said anything, she'd've never done that...and other students would've been as lost as I was when this went on. I recognize that there isn't a lot of room for things to be switched around, but at least new students will know to whom they can reach out for help, and where these folks are located.

Just thought I'd update the thread, and let you all know what happened. I really appreciate your support...and your encouragement. It makes a difference.

Best-

Lovin Learning

[Hal O'Peridol]

Loving Learning,

I want to let you know you did an outstanding job in very difficult situations with very little to no training. I commend you for that!

A few comments about the incidents follow, these are no reflection on you, and will I hope help you sort out your feelings. Glad you are riding the horse. Very therapuetic, keep it up.

Regarding the situation with the patient with the rectal/urinary tract bleed. I am a House Manager at my hospital with 10 years of medsurg/ 5 years of oncology, chemo and renal nursing experience. If you as a nurse find yourself in a similar situation, you must, as all nurses should, advocate for your patient.

A three hour delay in transfer to ICU with an active bleed like that should have been a stat transfer. If in the future when you are an RN and you run up against a dragging of feet like that, get the nurse team leader involved, or even the House Manager. Safe, appropriate and timely care of the patient take first priority, yes there may not have been an ICU bed available at that time, but many other interventions could have been done rather than letting the poor guy "bleed out". I can't say for sure what should have happened, since I have no history or knowledge of the patient, but the interventions should be started ASAP when appropriate. Does the facility have a "Stat Nurse"?

Regarding the second case, I sense some question regarding the initiation of a "code" on a terminal patient. I have run into this same issue before, especially with oncology and renal patients. As a clarification, just because a person is considered "terminal" does not mean they are ready to die yet, or even medically going to die in the near term, and as such, CPR, intubation and cardiac meds would be appropriate for such cases. I once had a patient who was terminally ill from lung CA who was leading a nice full life when she keeled over from a massive MI.

As you gain more experience in nursing and dealing with day to day situations and other nursing challenges you will find yourself able to make quick, appropriate and correct decisions regarding your patients. You are already off to a great start, don't get discouraged early.

Kudos also to the clinical instructor, who was able to listen to you and make a real effort to include your suggestion about discussing death and dying with the other students.

[MrsMommaRN]

:icon_hug::icon_hug::icon_hug::icon_hug:

great job keeping your cool. you did great. what a crazy two days. you did everything you knew how to do. keep your chin up.

[LovingLearning]

Thanks, WickedRN...I'm doing my best, that's for sure.

Hal, you're completely correct; there should've been earlier action. Being brand new, I wasn't sure what I could do, or how to do it...but I won't let that stop me again. I was, and still am, unaware of protocol, or to whom to turn, if something is going south...but I was following the RN's lead, which I now understand I should've been more vocal in advocating for the patient.

As for the second patient, the code was initiated...and then stopped because she was a DNR. It was the whole reaction from her daughter which shook me. Now that I've had a chance to process everything a little more fully, I understand what her reaction was...and can accept it.

I will be better prepared in the future...and I am a better nurse because of these deaths. And happily, other new student nurses will have at least a rudimentary understanding of what to do when something like this happens to them...

Thanks again, everyone, for all the support and the encouragement. It made a difference when this happened, and it makes a difference now.

And yes, I have been making a point to ride at least 4 times a week...we did some bridleless work today, and he was soooo good for me. Makes things easier to deal with, you know? The escape and physical activity riding provides me is of incalculable value.

Best-

Lovin' Learning