What's the saddest thing you've seen in your career??

zuzi · Jan 27, 2009

The sadest think in my nursing life is discovering that between " We need to talk, clarify with physician about patient condition" and "let's call the physician" is a matter of MONEY and EGOs, and this you not learn in school, looool and is not used to be.

meadow85 · Jan 27, 2009

When a patient dies, which is very often on my unit. I can still remember most of those who have.

NeoPediRN · Jan 27, 2009

My pedi rotation was in an LTC facility for congitively-impaired children. All had a mental age of less than 12 months; the median mental age was 3 months. Some were born that way, but the saddest ones were the ones who ended up that way because of accidents, near-drowning, or abuse. One was the product of rape; her mother was comatose in LTC, and died during delivery.

Was this NE Pediatric Care by any chance?

Pediatric Critical Care Columnist · Jan 27, 2009

I've seen a lot of sad situations and it's hard to decide which was the saddest. Some have been senseless and some have been tragic but all have touched my heart in some way. As I think about them though, my mind keeps coming back to one family...

I had a really cushy assignment that first day, and should have known it couldn't last. Around lunchtime the charge nurse came to tell me that she was changing my assignment because we were getting an admission from an outlying hospital with a reputation for reaching far beyond its grasp... and the child had already arrested twice. (Great, there went my nice day.) The latest information we had was that she was on max epi, norepi and dopamine and was expected to arrive at 1500 hours. I got the bed ready and started infusing my pressors into a blue pad on the bed so that when she arrived there would be no interruption in her infusions. I was incredibly releived when I looked down the hall to see that my good friend Rick was the flight nurse on this run; with him there I knew she'd be as stable as she could be. (Great, my day just got a bit better.)

She was 11 years old and had been involved in a head-on collision at highway speeds. She folded in half over her seatbelt, shredding the contents of her abdomen into ribbons while leaving the skin intact. The surgeon at the sending hospital had done an end-to-end anastamosis of her small bowel after resecting about 3 feet of it and the same to her large bowel after removing about 9 inches. She had to return to the OR to decompress her abdomen when she developed compartment syndrome, and that was when she had her first arrest. She then arrested again when her dopamine tubing was pinched in the side rail of her bed. That's when they finally called us.

My first two days with her were relatively quiet. She was stable for the moment and as long as we didn't change anything we were fine. I had the weekend off and came back to find that she had been started on CRRT; that lasted a week after which she had recovered enough renal function that she could come off. We let her wake up, and she figured out how to communicate despite being intubated. Her mother had been hurt in the crash so for the first week and a half it was just her dad at the bedside. He was a lovely man who never asked for anything other than the best care for his daughter. Later, when Mom arrived, Dad acted as interpreter for us because Mom spoke little English. Over the next few weeks, her stability was maintained with copious amounts of fluids and dopamine; she went to the OR every few days to have the necrotic areas of her bowels cleaned up. Her abdomen was left open, packed with lap sponges; each surgery increased the number of drains she sprouted. The surgeon herself did the dressing change everyday, not because she didn't trust the nursing staff to do it but because it was very complex and it was easier for her to do it than to teach all of us. The times I assisted her with it made me very glad I wasn't responsible for it.

By the beginning of her fifth week with us, we were seeing the writing on the wall. She was still needing significant volumes of fluid and we hadn't been able to wean the dopamine. She had systemic candida and her viscera continued to leak fecal matter whenever we attempted feeds. She had 4 sump drains and every so often we'd notice bleeding. The surgeon began preparing the family for the inevitable. On Day 41 the family agreed to a withdrawal of life-sustaining treatments and the fluids and dopamine were stopped. She was alert and understood what was happening. She indicated that she was ready. The doctor opted to leave her intubated so that she wouldn't gasp and upset the parents. I came on for the night shift knowing that the end was near. We turned the monitor off in the room and I sat outside watching the remote monitor, waiting. Waiting. Each time I thought we were getting close, all of a sudden there would be a spike in her heart rate and a bump in her BP. Finally I went to watch from the window, to learn that somehow the parents sensed the end and would stimulate her in some way, by touching her hand, rubbing her foot, talking to her or weeping quietly. She was still breathing when I had to leave. The doctor came in and extubated her; she told her parents how much she loved them and they prayed together. Then she smiled and died.

RN1982 · Jan 27, 2009

All the posts in this thread are sad but Jan's post had me in tears..

Pediatric Critical Care Columnist · Jan 27, 2009

You know, I have never felt the urge to cry about this young lady. When her death finally came, it was such a blessing. She and her family had suffered so much that they were ready for it. What has stayed with me though is how lucid she was, right until her last breath. Those who were there said that the smile on her face was like nothing they'd ever seen before. It still raises the hair on my neck when I think of it.

Cindy_A · Jan 27, 2009

That's so horribly sad! The place where I did my clinicals had a resident who told me about his nephew and how he took advantage of him, took all his money, etc., but since it was family he didn't know the right thing to do. The next day the guy was gone. He'd gone out to lunch with said nephew and never came back.

I realize you were doing your clinicals, but did you ever find out what happened to the uncle? Didn't anyone investigate?

What was the nephew's excuse, or did they just not come back?

*ac* · Jan 27, 2009

I didn't read this whole thread because this is something I really try not to dwell on. I work with kids and I don't feel I can really be there for them and their families if I focus on the sadness of kids being sick.

I've only come home and cried once, and that was with a new diagnosis of leukemia. The problem for me was knowing what the child and the family was in for. No details, as again, I don't want to dwell on it.

learning08 · Jan 27, 2009

I'm just a new nurse, mostly working with elderly pts. nowadays...the saddest thing I've seen so far was in a NS clinical...a woman is her early 20s dying of brain CA, about to leave her toddler behind.

Imafloat, BSN, RN · Jan 27, 2009

I didn't read this whole thread because this is something I really try not to dwell on. I work with kids and I don't feel I can really be there for them and their families if I focus on the sadness of kids being sick.
I've only come home and cried once, and that was with a new diagnosis of leukemia. The problem for me was knowing what the child and the family was in for. No details, as again, I don't want to dwell on it.

I don't feel that anyone is dwelling on anything. I have read this thread with tears of sadness, and joy, I am proud to share my profession with people like these. The love and humanity coming through these postings is almost touchable. I admire everyone for posting what's in their heart.

newohiorn, BSN, RN, EMT-P · Jan 28, 2009

I work in neuro critical care and it is very hard to watch the "young" patients with massive strokes. It's awful to watch their spouses and children as most of these patients do not die right away and it takes the family a while to realize they are not going to get better. It is also very difficult to watch a patient being told they have a malignant brain tumor.

zuzi · Jan 28, 2009

Janfr ....I am so soory for little gurl. You are a awesome strong nurse, take care!