Shell Shocked

[Spiderella]

My patient died a few nights ago. It was the most bizarre experience ever. I had just been in his room, taking his blood pressure (which was fine), drawing his AM labs and talking to him. I walked him to the bathroom and back, then tucked him in his bed, got him a warm blanket and said goodnight.

I went into my next patient's room to hook up his antibiotics. The Monitor tech calls me and tells me my other patient has a junctional rhythm. I rush in there and he's pale and unresponsive, his head crooked over to the side, his dentures halfway out of his mouth. I instantly freaked and started shaking him, then hit the code button (even though he was DNR). I told the other nurses that he was DNR with chemical intervention but his heart had stopped beating and he wasn't even breathing. The doctor pronounced him at a few minutes after 3am.

I'm still upset beyond belief. How can someone be talking to you and then dead the next minute? He was old, ...beyond that, he should have been fine. The family is not going to do an autopsy, so I'll never know what happened but always have questions.

This isn't the first time that my patient died, it's just the first time that it was so unexpected and random. I was the last person that he saw before he passed. I was the last person he spoke to. I was the last touch he had, the last voice he heard, the last smile he saw. I'm still shell shocked. The nurses on the unit accepted it cynically, just another day on the job; and almost without empathy. I'm dealing with hella emotions at this point, feeling that if I had stayed in the room for just a few more minutes I could have helped him live.

The next night I had a patient in the SAME ROOM. Unfortunately he didn't get much sleep that night because I kept going in to make sure he was still alive. I checked on him almost religiously, freakishly paranoid that this old guy would die on me too.

How do nurses deal with all these emotions? I don't know what to do.

[Blee O'Myacin, BSN, RN]

My patient died a few nights ago. It was the most bizarre experience ever. I had just been in his room, taking his blood pressure (which was fine), drawing his AM labs and talking to him. I walked him to the bathroom and back, then tucked him in his bed, got him a warm blanket and said goodnight.

I went into my next patient's room to hook up his antibiotics. The Monitor tech calls me and tells me my other patient has a junctional rhythm. I rush in there and he's pale and unresponsive, his head crooked over to the side, his dentures halfway out of his mouth. I instantly freaked and started shaking him, then hit the code button (even though he was DNR). I told the other nurses that he was DNR with chemical intervention but his heart had stopped beating and he wasn't even breathing. The doctor pronounced him at a few minutes after 3am.

I'm still upset beyond belief. How can someone be talking to you and then dead the next minute? He was old, ...beyond that, he should have been fine. The family is not going to do an autopsy, so I'll never know what happened but always have questions.

This isn't the first time that my patient died, it's just the first time that it was so unexpected and random. I was the last person that he saw before he passed. I was the last person he spoke to. I was the last touch he had, the last voice he heard, the last smile he saw. I'm still shell shocked. The nurses on the unit accepted it cynically, just another day on the job; and almost without empathy. I'm dealing with hella emotions at this point, feeling that if I had stayed in the room for just a few more minutes I could have helped him live.

The next night I had a patient in the SAME ROOM. Unfortunately he didn't get much sleep that night because I kept going in to make sure he was still alive. I checked on him almost religiously, freakishly paranoid that this old guy would die on me too.

How do nurses deal with all these emotions? I don't know what to do.

Hi Spiderella - I am assuming that you are a relatively new nurse, and just because the other nurses that you work with weren't freaked out and upset about this patient's death, doesn't mean that they aren't caring, professional practioners. Having a patient die is never easy, but when the patient is old and didn't suffer, it is far better than to have agonizingly declined and had a painful death with a nasty, messy code at the end.

I'm not trying to be callous here, and I do not mean to belittle your feelings. Quite the contrary, I will never forget the first patient that died under my watch. 99.99% of the time, there is nothing that can be done to prevent the inevitable. You gave this patient competent and compassionate care during the last hours of his life, be proud of that.

((Hugs))

Blee

PS - I had a patient die in the ER two days ago and it was rather traumatic. And I had to get the bed and room cleaned and start all over again with the next patient. If I mourned them all like my own family, I'd go crazy. But I give my 100% when I am there.

[pagandeva2000, LPN]

My heart goes out to you. It will take time, but you will get past this and take it as a learning experience. Hugs for now, though...

[Annebug]

Similar situation happened on my floor the other day. Pt with family who left room 10 min earlier, very pleasant man, telemetry monitoring, A and Ox3 all day without complaints. Walking past our monitors I saw a sudden flash: Vtach/Vfib. He was a full code and we tried our best for 45 minutes, but he died. His EF was 10%.

The one that haunted me was a man with some kind of CA with newly dx brain mets. He was so anxious and in so much pain all night. He died the next morning a few minutes after I left. I saw his wife on the way to my car, and we talked about what a bad night he'd had. Little did I know he would die minutes later.

Hard--really hard--to deal with the emotions after my first few patient deaths. I'm not cold now, but I think I'm learning some acceptance about death. I try really hard to make folks comfortable--and their families. Of course we can save the day here and there, but most often it seems to be a matter of comfort.

[Midwest4me]

Here are some hugs from me too, Spiderella. I feel for you and know full well how hard it can be suddenly losing a patient. You WILL find a way to work through the intense feelings that these deaths bring; it just takes time.

[Calgon-take.me.away]

Many large hugs to you. At least you gave him a warm blanket, tucked him in before you left the room. In my years as an LPN and an EMT, I have one memory, that at times, still makes me shudder. This goes back to my days running volly ambulance.

We were called to a 45 year old's home that we had taken many times before. He had serious cardiac problems and had 3 prior MI at his young age. When we walked into the livingroom, he was sitting on the couch, first thing he said, "Don't let me die this time." We loaded him up and proceded to the hospital. I had the jump seat iin the back of the ambulance, which is at the head, and the entire way to the hospital, he kept saying not to let him die. One thing about him, he had the most amazing green eyes. We reassured him he was fine and that we were gonna take real good care of him.

We got to the hospital, and he coded as we went thru the ER doors

We worked him for 2 hours, every time they would shock him, he would grab his chest and sit bolt upright and scream. His wife was ini the room, and even while his was flat line on the monitor, he was talking to her, telling her were important things were at home, telling her that he loved his kids.

The doc and nurses and us EMS, we were in such a state for days after this. We lost Ray that day, and all say that his was the most bizarre code and death that we have ever witnesses.

Still today, I see those green eyes, pleading to me, reassuring him that all was going to be fine.