Well it was just a matter of time before I experienced it, but it officially happened this week: my first death.
It wasn't my patient, but I'm an employed student nurse on a medical floor, so I was asked if I'd like to see the process following a death. Of course I said yes, and felt quite prepared going into it. But oh man. No matter how prepared you think you are, how can you really be? I helped with bagging the patient and transferring them to the morgue. When we got to the morgue, there was not enough room, so I had to help with moving several bodies around.
Even though it was educational and a necessary part of nursing for me to learn, I've been having a bit of a hard time with it and on the verge of tears a few times. It was the rigamortis and the modelling of the skin that really gave me a good shock, but I think what has been the hardest for me was moving the bodies around in the morgue. That is something I never thought I would have to do (the hospital I work at is very small and the morgue is tiny, so they have shelves that bodies need to go on to make room...of course, no one wants to do that, so the job falls on the unlucky person who gets there last...). It also doesn't help that it was a very unexpected death. This patient was set to be discharged the next day.
My one saving grace was that I had an incredible care aide who was showing me the process. She really helped debrief me and role modelled a very respectful way of dealing with death. I am so so thankful that she was the one to teach me.
I guess my expectation of this post is to get my feelings out to those who understand (I tried to explain a little to my husband, but it's difficult for him to relate). Is there anything you do to help deal with the death of a patient? Have you found it gets easier over time? Or just bear it because it's "part of the job". I'm in my 3rd year and have a palliative rotation coming up next, so I'm sure I'm about to experience a lot more in the coming months and want to work on some good coping skills.
OP, you are at an advantage in that you seem to be a very thoughtful person. The fact that you are asking for advice says a lot about you and I think you will do just fine as you progress. As with most things, I think getting "used to" death is a matter of time and exposure. Not that it becomes meaningless or that you don't care anymore, just that it doesn't elicit the same response. There are always exceptions, of course. It sounds like your patient was one of them...someone who was expected to walk out the next day but instead died. That's a tough one even for the seasoned nurse.
I am glad the person you were working with was such a good role model. I have seen some people act atrociously when doing post mortem care and have had to remind them to be respectful. I am sure it is probably discomfort that causes them to act that way but it is inappropriate nonetheless.
I like what SoldierNurse22 said about appreciating death for the relief that it represents. Your patient had not suffered with a prolonged illness but when you do your palliative rotation you will see patients that are suffering terribly and have been fighting illness for a prolonged period of time. You will begin to see death as these patients do...a welcomed release. As nurses, one of our greatest honors is being able to be present during the final hours of a patients life. For me, there is nothing more rewarding than being instrumental in providing comfort and (hopefully) peace to the dying patient.
It is very true what other posters have said about our society being fearful of death. It was not too long ago that people kept their dead loved ones in their home for extended periods of time and family and friends came to the home to say their goodbyes. They even photographed the dead (dressed in their Sumday best) and sent out little cards with the photograph. Much like today's baby announcements. Do a Google search for Momento Mori. It is fascinating. It may also get you used to seeing dead people although in a lot of the pictures you cannot even tell they are dead. The photographer used special stands to pose the person in very life like positions. If you read about the history of these photographs they will not seem as strange as they do to modern day people.
I wish I could figure out how to quote pieces of your email to put in here to explain better, but cant figure out how.
FYI I've been a nurse for 20 years in many areas, mostly surrounding birth and death. (NICU, all things OB, hospice). When I read your email I thought, "Wow." That's a lot to handle! .....and you're still in school! That's a real in-your-face dose of reality. I was fine until you said that they had you 'move bodies around.' Felt really bad for you in that scenario - morgues can be shocking, and 'moving bodies' would be really hard for even seasoned nurses. I'm so glad you had that caring worker with you so you werent more "traumatized!" What you did was not particularly "common." Many nurses never end up even seeing the morgue, so dont think that this experience was "routine." It wasnt, depending on what area of nursing you go into.
With dealing with death in babies, there's a lot of really wonderful & respectful things that are done - like in the above post by "NICUnurseEliz." I find working with death really healing and really hard at the same time. When I worked in hospice, I dealt with death a lot - only with adults, though. At first it was hard because I couldnt figure it out in my head. Couldnt figure out my role - esp. after having been a former adult ICU nurse that was always trying to "save" everybody.
Sometimes I talked about it to my husband, who really didnt understand, but once he had insightful advice after I expressed to him my distress over taking care of patients who were proud to be atheists. Now, I would never ever push my views on anyone, but internally, I wondered things like "Where are they now?" He gently chastised me and said "You know you cant "save" anybody, you know that's not your job. It's their journey, not yours. Remember why you are there and why you are not there." He really helped me. From then on whenever I entered the building's front doors I'd think about what my job was, and what it wasnt. I hope I'm making sense. (I worked in hospice while the Terry Shiavo case was going on, although not where I worked).
It's just a weird job, working with death. One day/hour/minute you're talking to your patient, the next day/hour/minute they arent here anymore. They become very much only a physical "body." The part of them that makes them who they are - their "soul" or their "spirit" - is very much gone, and when you work with the dying - and see the whole process - you'll know what I mean by this. It's a sacred space you are in. I loved my job, and would still be in it, but found it too difficult to do with motherhood/small children.
Here are some random thoughts that may help you during your palliative care rotation:
-Figure out what your goals are when working with the dying. It is much different than the goals you have for someone you are trying to "make better." What can you do and what can you not do? Is your job to "rehab" them? No. Is your job to try to take away physical pain with meds? Emotional pain by having the loved ones they want present, or by calling their pastor? Alleviating their fears - well, what are their fears? Are they able to speak and tell you?
-Death is viewed much different in the U.S. than in many other places in the world. I'm not a world traveler, wish I was, but in my experience it's us Americans that have so much fear of death, and too much belief and trust in Science. Just because you have the technology does NOT mean you should use it.
-It can be very messy moving a body from the bed to the stretcher, and not at all something you want family members to see....but you cant say exactly why because they dont need to hear about the details. The patient may have stuff come out of their mouth or peri area. We were really respectful and tried to "kick people out" for that part if possible for their own good. That's a terrible memory to have of their loved one. Not to mention they are really heavy and it's not always graceful.
-You probably dont have time to read it, but I love the book "Final Gifts" written by two hospice nurses & highly recommend it
-One side effect of working with the dying? It really helps to prioritize your life. When you see the whole process and work closely with a family, you dont spend a lot of wasted time worrying about your hair or what the Kardiashians are doing.
Good luck with your career. I'm sorry that you had to deal with that....but glad that you wrote in. You sound like a very caring person and the world needs more people like that :-)
annie.rn
546 Posts
OP, you are at an advantage in that you seem to be a very thoughtful person. The fact that you are asking for advice says a lot about you and I think you will do just fine as you progress. As with most things, I think getting "used to" death is a matter of time and exposure. Not that it becomes meaningless or that you don't care anymore, just that it doesn't elicit the same response. There are always exceptions, of course. It sounds like your patient was one of them...someone who was expected to walk out the next day but instead died. That's a tough one even for the seasoned nurse.
I am glad the person you were working with was such a good role model. I have seen some people act atrociously when doing post mortem care and have had to remind them to be respectful. I am sure it is probably discomfort that causes them to act that way but it is inappropriate nonetheless.
I like what SoldierNurse22 said about appreciating death for the relief that it represents. Your patient had not suffered with a prolonged illness but when you do your palliative rotation you will see patients that are suffering terribly and have been fighting illness for a prolonged period of time. You will begin to see death as these patients do...a welcomed release. As nurses, one of our greatest honors is being able to be present during the final hours of a patients life. For me, there is nothing more rewarding than being instrumental in providing comfort and (hopefully) peace to the dying patient.
It is very true what other posters have said about our society being fearful of death. It was not too long ago that people kept their dead loved ones in their home for extended periods of time and family and friends came to the home to say their goodbyes. They even photographed the dead (dressed in their Sumday best) and sent out little cards with the photograph. Much like today's baby announcements. Do a Google search for Momento Mori. It is fascinating. It may also get you used to seeing dead people although in a lot of the pictures you cannot even tell they are dead. The photographer used special stands to pose the person in very life like positions. If you read about the history of these photographs they will not seem as strange as they do to modern day people.
Good luck to you. You will do fine :-)