Patient's death hard to deal with

rn/writer, RN · Feb 21, 2006

Hi all !! I guess I just felt the need to post this so that I could vent. I am working in a long term care facility and just had, yet another, patient die tonight. I have only worked there for 4 months and this was the 5th one. This one...I was very close to. Not that I dont become attached to them all...if you have a heart, you cant seem to help it. But I was especially close to this lady and her death was very unexpected....we believe she threw a clot. She went downhill very fast, to the point that I had to send her out to the hospital. Her son came by a few hours later to tell us that she had passed. I tried so hard to keep my composure......but failed miserabely.....and lost it right there. I felt like it wasnt proffesional of me to cry and was kinda' mad at myself for doing so.....some of the other "seasoned" long term care nurses always say that you get to the point where you're just "numb" and you dont cry. Well, even though I wish I could have kept my s*** together and not cried.....I sure dont want to lose my compassion enough to become "numb" either. Anyway...now that I have rambled on and on......thanks for the opportunity to vent.

If I returned to the LTC facility where my relative had been a patient to let them know she had died, I'd surely prefer to see someone burst into tears than to see that same person take the news with a ho-hum attitude.

Obviously, you don't want your reaction to overshadow that of the family, but there's a lot of room on the spectrum between "falling to pieces" and "another one bites the dust."

It's time for us to ditch the idea that professionalism has to be cold and impersonal. This is especially true in LTC where the people you care for aren't patients, but rather residents. You relate to them and provide for them in what is their home, so developing a more personal aspect to your care is not only NOT inappropriate, it's essential to being able to humanize what could be a sterile and depressing environment.

I'm sorry you lost this resident so unexpectedly. That's never easy. But I'll tell you what I told my daughter (who has been a CNA for five years and who will soon be in nursing school): caring sometimes hurts, but not caring hurts so much more. Yes, it's sad when one of your residents dies, but you can take comfort in knowing that YOU helped give their last days meaning and joy and a bit of kindness.

You won't always cry a bucket when someone passes, but the day you find yourself numb, it's time to move on.

Be the kind of nurse you want taking care of you. You can't go wrong with that.

Trauma Columnist · Feb 21, 2006

I'm so sorry for your loss. I've had my mother, father and mother-in-law all die in NH and was so impressed with the staff there. When my MIL died, my husband and I went the next day to get her stuff and the staff came by one by one to give him a hug and tell him how much his mother meant to him. My husband was so touched.

Like the above poster said - caring is what its all about. There's nothing wrong with expressing grief. Thanks for taking such good care of your patients.

beepeadoo · Feb 21, 2006

Be the kind of nurse you want taking care of you. You can't go wrong with that.

Truly words to live by! Amen!

I'd ask "What is the ultimate focus of my practice?" Well, the patient(s), of course. "And in 'losing it' as I did, did I in any way impair my care of that patient, or any other patient, for that matter?"

Jo Dirt · Feb 21, 2006

It isn't that some people become "numb". Just because you may not cry and lose your composure doesn't mean you have no compassion. I've worked in long term care ten years and have had many patients die. The last patient who died on my shift I liked very much and was holding her hand as she drew her last breath.

We lost one a few days ago to a massive heart attack. Total shock to us, because there are people in much worse shape than she was who keep hanging on. She was crocheting and laughing and talking as usual that day and died that night.

That is the way I want to go.

I'll never forget the demented little woman who was always laughing and happy. She died one day unexpectedly and she had a smile on her face! I didn't feel sad, I was happy for her! I always wonder if she saw something as she died that made her really happy!

And that is the way I want to go, too.

Not every death was met with peace. One that makes me sad is the old farmer who would never accept that he needed to be in the nursing home. He was very strong willed and kept saying "I'm getting out of her and I'm going to rent a house...etc." He wasn't demented and that made it all the worse. It seems like as soon as he realized he would never be out of the nursing home he lost his will to live and died very soon after.

But I have found it refreshing to be around people (generally the elderly) who realize they are about to finish their journey on this earth and are totally at peace with it. We're all going to die. The nursing home is generally the last address and most old folks realize it and they are ready to go whenever the Big Man is ready for them.

carolinapooh, BSN, RN · Feb 21, 2006

My father's nurse, who was with us when he died in the hospital, cried with us when it was over. And I thought it so odd because she was always so businesslike and efficient as hell (not in an UNCARING way, mind you; I think she was an outstanding nurse).

I gained a whole lot of respect and admiration for her that day. She cared.

Even his doctor was upset - the man had literally tried EVERYTHING he could think of. I mean, no one freaked out or anything, but it was nice to have a team that CARED.

I would trust any of those folks with anyone.

I wouldn't worry about your reaction. And if others that you work with don't like it, I would consider it their problem. We as families appreciate that there are still so many providers who care that much.

And let's face it - it's hard when someone dies, even if we KNOW it's coming, or that for them it's the best thing. That's OK. Especially in LTC, where as someone else said, that's their HOME. You were a part of her daily life. No wonder you were upset.

Hang in there. You're fine - trust us. :nurse:

QuigRN · Feb 21, 2006

As someone just said - you ARE fine. I've been in nursing for a long time and will leave the day that my life isn't affected by someone. I also thank my God that I might have some effect on someone whose well-being can be ensured by my touch or hug. Crying is good.

carolinapooh, BSN, RN · Feb 21, 2006

And might I add that it was that nurse that I thought about when I wrote my admissions essays...she was the one I always pictured when I would work on it. She's unaware of how she influenced me and I wish I could remember her name so I could tell her.

She's practically the one who talked me into nursing school without ever saying a word to me.

valpn · Feb 21, 2006

I want to thank you all for your kind, encouraging responses. You have all reminded me to look at the bright side of what I did for my patient in her last days. And that it is ok to cry.....'guess I should have worried if I didnt. The day that I become "numb" to the grief of losing a patient is the day that I would find another line of work......that will never happen because I believe caring is what it's all about. That's why we're all nurses in the first place. I knew that venting on here would end up making me feel better :) I'm so glad I found this site....Thanks again to everyone