Things that nobody tells you - what was your first

[starsgirl78]

I am a fairly new hospice nurse (CC) and it has definitely been interesting. I am realizing that there are so many things that they never tell you in nursing school about death and dying and also that none of those things are covered in orientation! I find myself talking to my mentors after these situations and they say, "Oh yeah. That happens all the time."

My first OMGWTH moment was when I was sitting with a lady with E/S COPD. I had never seen anyone that shade of blue in my life. Literally, this blue -----------> ! Anyway, this lady sounded so wet. I was giving atropine and it just wasn't cutting it. She wasn't in any distress and appeared very comfortable, so I kept reminding myself of what I actually was told in orientation - a lot of times the sound of the secretions bothers the ones who are listening to it far more than the person in the bed.

So I am sitting with her and chatting with the family and everything is calm and peaceful and then she starts to really change. I gather the family at the bedside and we are holding her hands and encouraging her and praying. It's very calm and peaceful and beautiful.

Then came the secretions.

The daughter stops everything and says, "Uh....what is that?" I raise my formerly bowed head and see brownish foamy, mucusy liquid oozing out the side of her mouth. Ok. Not oozing. Pouring. It was running down her chin, onto her pillow, onto her gown. Everywhere. An aide happened to be right outside so I called her in and she gave me some towels and we did a quick change on her. On the inside, I am puking my guts up because I do not do mucus or any kind of respiratory related secretions. Give me blood, pee, even poop, but not that. It's my weakness. I had never in my life seen anything like it and I was completely grossed out. I am trying to clean her up while somehow maintaining my poker face and successfully reassuring the family that it's totally common and I have seen this sort of thing many times.

Minutes later, the patient passed. The family was doing very well and were not traumatized by the incident at all. Me on the other hand? After all was well and I stepped away from the bedside to call the office to let them know she had passed I noticed a huge smear of gunk on my forearm!

Nobody ever told me that was part of the process!!! Never once in nursing school did they ever say that sometimes patients discharge copious amounts of goo from their mouths at the time of death!

So what I want to know is, what was your first insanely eye-opening experience as a hospice nurse? Anything you encountered that they neglected to tell you about?

[jeannepaul, BSN]

oh how I relate to that one, but my pt actually came up off the bed like he was going to sit up. I had never had this happen either and I was also explaining to family how this was normal but on the inside I was totally freaking out. Never let them see you sweat! good times, good times!!!!

[ErinS, BSN, RN]

I have actually been mentoring lots of new nurses, and one of them just had the experience with the secretions. I honestly did forget to tell them, because it is not that common.

I think the first most eye opening experience I had in hospice was a pt who was on 300 mg of dilaudid an hour. I had no idea meds could go that high. I have learned quickly since then.

[AndiSN]

I am interested in hospice nursing myself. I first became interested during my first semester of nursing school. My father-in-law was under hospice care and I saw how much the nurses really loved what they did. I ended up caring for him during his last 48-72 hours and it was an eye opening experience. He did the whole sitting straight up thing. I yelled for my husband that his dad was almost out of the bed and I needed him to help me because I wasn't strong enough. He didn't believe me because dad had been incapacitated for 2 days at this point. It scared the living daylights out of both of us. Dad was almost on the floor before we could get him back up. The nurse explained to me that it can happen when his air hunger was getting really bad and that it meant we should probably start increasing his meds. I was in the room with him when he passed about 12 hours later. Although it was a scary experience in some ways it also showed me how much fulfillment you can get from helping someone through that final journey in their lives.

[Vtachy1]

I've been a Hospice nurse just for a few months and the whole dying process has always fascinated me. I worked ICU for 15 years and always have been drawn to these patients.

My husband is a police officer and I guess at a crime scene and the officer was waiting on the coroner the dead person was there with the officer and the dead person sat straight up! He said the officer nearly crapped his pants! But I guess this does happen sometimes even after the person is dead.

I have seen patients sit up BEFORE they die and reach up to heaven and things like that before. And in ICU I had a lady tell me to ask the room full of people at her bedside to leave so that the angels could come and after they left she peacefully passed.

One thing that shocked me was that how "anti-morphine" a lot of society is. Never mind the disease process or the fact that they patient hasn't eaten or drank anything for 10 days. Its always the morphine's fault Grr! And also how society doesn't accept death or think of it as a natural part of life. We are all dying.

[Hospice Nurse LPN, BSN, RN]

My "oh my moment" happened when I'd been in orientation for about 4 days. I got a call one evening from the hospice nurse on call. She asked if I would mind doing a "death visit". I live out in the country and this pt only lived a couple of miles from me. I asked what I needed to do. She told me to basically make sure the pt WAS dead, call the coronor and funeral home, clean the body, and comfort the family. Sounds easy enough to me.

Everything went fine. Family was o.k. Then they hand me a WalMart sack full of meds. What was I supposed to do w/ that? Hmmm in school (and in LTC) is was stressed that you NEVER waste a med w/o another nurse to co-sign. I'm the only nurse there. Soooo I put the sack in my trunk and head home. The next day I walk into the office and hand the sack to my DON. She says, "OMG! You didn't" That's when I learned to distroy meds in the home w/ a family member to witness.

Now, I only see pts in LTC and they distroy their own meds w/ the DON of the facility.

[leslie :-D]

i've been a hospice nurse just for a few months and the whole dying process has always fascinated me. i worked icu for 15 years and always have been drawn to these patients.

my husband is a police officer and i guess at a crime scene and the officer was waiting on the coroner the dead person was there with the officer and the dead person sat straight up! he said the officer nearly crapped his pants! but i guess this does happen sometimes even after the person is dead.

i have seen patients sit up before they die and reach up to heaven and things like that before. and in icu i had a lady tell me to ask the room full of people at her bedside to leave so that the angels could come and after they left she peacefully passed.

one thing that shocked me was that how "anti-morphine" a lot of society is. never mind the disease process or the fact that they patient hasn't eaten or drank anything for 10 days. its always the morphine's fault grr! and also how society doesn't accept death or think of it as a natural part of life. we are all dying.

oh yeah, that's one of the scariest events, for sure.

i've never gotten used to it, because there's no warning that it's coming.

everything went fine. family was o.k. then they hand me a walmart sack full of meds. what was i supposed to do w/ that? hmmm in school (and in ltc) is was stressed that you never waste a med w/o another nurse to co-sign. i'm the only nurse there. soooo i put the sack in my trunk and head home. the next day i walk into the office and hand the sack to my don. she says, "omg! you didn't" that's when i learned to distroy meds in the home w/ a family member to witness.

now, i only see pts in ltc and they distroy their own meds w/ the don of the facility.

that's a policy about wasting, but i can assure you, many nurses waste alone....many.

were you switched to ltc, because of this event?

leslie

[Hospice Nurse LPN, BSN, RN]

that's a policy about wasting, but i can assure you, many nurses waste alone....many.

were you switched to ltc, because of this event?

leslie

no. that happened about 12 years ago. i actually enjoy seeing the hospice pts in ltc. just one stop and 6-10 pts. it works great for me because i'm also in school and i can get to the facility early in the morning or evenings.

[leslie :-D]

i'll share a miraculous event i witnessed.

we had an elderly lady who presented as actively dying.

she had been unconscious for days, blue/gray, stoking, and mottled.

before she lost consciousness, she hadn't drank/eaten anything for couple wks, and was a challenge to get anything into her before that.

and finally, she had these stage 4 gangrenous ulcers that just wouldn't heal.

well.

i walked in one morning to assess her.

not only was she bright-eyed and bushy tailed, she devoured her entire breakfast (i had ordered her one.).

AND, her ulcers had completely healed... i am talking, there wasn't even a stage 1.

after breakfast, she made her own bed (had been bed-bound for wks), laid down to take a nap, and died.

my jaw automatically hangs open, when i recall h. and her final exit from earth.

she was one of the sweetest and Godliest people i've ever met...i mean, a true saint.

intervention by an angel?

leslie

[Ginapixi, BSN, RN]

i think my strangest experience was a pt who no matter what we tried for weeks would not move his bowels; at that time he was still semi ambulatory, ate little to nothing, but his bowels never moved; a few days before he passed, was mostly unresponsive, he began to let loose: the foulest liquid just kept pouring out of him, almost non stop, as soon as we got him cleaned up there came more; that was a once in a life time experience so far!

[czyja, MSN, RN]

AND, her ulcers had completely healed... i am talking, there wasn't even a stage 1.

after breakfast, she made her own bed (had been bed-bound for wks), laid down to take a nap, and died.

Wow. I guess she did want to meet her maker with gangrenous pressure uclers. And heaven forbid she should exit this life with an unmade bed...

Thanks for sharing this!