Witnessed a terrible death last night--pls help me...

Nurses General Nursing

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I think I just need to write. I am freaking out. As a new nurse, I expected to have to deal with death. And especially with the population I'm working with, who are mostly cancer patients in crisis. I chose this job because my grandmother, my angel, was once one of those patients--and on the very same unit where I decided to begin my nursing career.

I've been there 3 weeks and witnessed or heard about like 6 deaths already, which is to be expected. The first one I witnessed. She was my patient but I had just come on shift when she died. A caregiver was in the room with her. She had no family. I almost cried that night, but I didn't. I didn't linger on the subject too much after that either. Then I admitted a man with brain mets who was really anxious and in so much pain. I met his wife and daughter, who were grieving, and again I almost cried. I did cry when I left him that morning, and he had just died when I arrived the next night. I though a lot about him that night and the following day. I had trouble sleeping that day. I kept thinking about his family, and about the interactions between us after his family left the hospital the night he was admitted. I can remember word for word most of the things he said to me that night. I still feel sad for them, but I'm not thinking as much about it now. There have been other deaths that didn't really affect me so deeply.

But this morning I witnessed a terrible death. A really bad death. Woman dying of lung CA, unable to breathe, gurgling with each inhalation and exhalation for hours--anxious and trying to sob, but not really having the energy to do so. Her room was full of family, and they were all grieving. I was there when she died, and it was not a peaceful death. I was relieved when the end came, and then spooked to provide post-mortem care, but I did it. I didn't cry or anything like that, even after I left this morning, but I just keep thinking of her. I can see and hear and even smell the experience. I can't sleep. I just keep seeing her face in the horrific grimace and the anxiety just under the surface that she didn't have energy to properly display. The morphine we were giving her every 15 minutes didn't really work, but I think in the end she died more quickly because of it. It almost felt like euthanasia, to be honest, but we were following the orders. What could we have done differently? The sound was incredible, and I'll never forget it. It never seemed to phase the other nurses, but I guess to them it didn't seem to phase me either.

How in the world do nurses get over seeing such awful deaths? I'm freaking out. I've had a panic attack this morning. I just wish I could wash it out of my memory. Does anyone have any advice for me?

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

I think the euthanasia question was answered by Leslie well. Morphine did not kill this patient, it was used to relief the pains pain and suffering.

The "death rattle" that you heard is a dreadful sound and it can be haunting the first time you hear it.

So as long as there are objective signs/symptoms of distress, we keep giving narcs, even if the narcs are likely to end the person's life? I can live with that.

It is amazing how much better I feel just talking about this and hearing from you all.

I think I'm okay.

Specializes in ER.

The "death rattle" that you heard is a dreadful sound and it can be haunting the first time you hear it.

It is haunting any time you hear it, and it seems to go on and on.

I have already discussed end of life issues with my family and I have made my wishes clear. I hope that when the end is near, my family or a nurse has the courage to give me whatever is available to ease my suffering. I am not talking about euthanasia, just pain and anxiety control.

We all want to die peacefully in our sleep, but it doesn't always happen. It is our responsibility to do all we can to help those in misery. Meds are available to ease that suffering. Yes, morphine may depress the respirations, but there comes a time when those concerns should not overtake the obvious.

I think I'm getting it now. We help as nurses do. We don't LET ourselves imagine how the patient is feeling, or the family for that matter. It's like a protocol. Patient suffering=meds, family grieving=support.

I think my problem is that I'm still grieving my grandmother, and remembering exactly the events and her symptoms while actively dying. It gives me a wonderful perspective, BUT I need to put it aside and follow the protocols, without getting emotionally involved (as much as possible.)

Have I got it?

Okay, now I am crying, and I probably needed to.

No, I haven't come to grips with my own death, and I have no religious beliefs that help me to cope. Also, I'm a smoker, and so was the patient last night. Also, lung CA was what my grandmother died of. The difference in her case is that she was zonked out (I think on ativan and morphine) when she died, and there were never any secretions, just obvious air hunger.

The woman this morning did not just have secretions though. She had been coughing up blood, and she was drowning in it. It was a continuous coorifice gurgle, like a pot of boiling water. Her anxiety was obvious to me. I only wish that we could have made her comfortable. I think that's what bothers me the most.

I became a nurse (because of my grandmother's experience) to ease suffering. To ensure that folks died peacefully at least. This woman did not. That's what's getting to me. When we zipped up the body bag, she still had that horrible grimace on her face. I'm having such a hard time with this. Almost as bad for me is the way it didn't seem to bother anyone else. Am I going to become as seemingly cold?

Don't think that it didn't 'bother' the others or that they are being cold. After reading this post I am even more convinced that you should talk this over with the people I mentioned above.

I'm trying to figure out how to say this without sounding harsh; it is not my intention to do so, so please accept it as a true concern for you from someone who has been there. When you begin to identify with your patients as you describe (you smoke, your grandmother's death, comparing her death to the one you witnessed last night), it becomes harder for you to be effective and therapeutic, and sometimes you end up comforting yourself rather than your patients and families. Like I said, this happens to all of us at some point. The trick is to recognize it for what it is, and know when to step back and reset the boundaries. I am in no way saying you have to be "cold".

You sound like a warm, caring, compassionate person. Please don't let this drive you away from this field. We need oncology nurses like you. Please discuss this with those I mentioned, and allow them to help you work through this. You're going to be a wonderful oncology nurse.

Specializes in Med-Surg/Tele, ER.
I think I'm getting it now. We help as nurses do. We don't LET ourselves imagine how the patient is feeling, or the family for that matter. It's like a protocol. Patient suffering=meds, family grieving=support.

I think my problem is that I'm still grieving my grandmother, and remembering exactly the events and her symptoms while actively dying. It gives me a wonderful perspective, BUT I need to put it aside and follow the protocols, without getting emotionally involved (as much as possible.)

Have I got it?

Yeah, wow. I can imagine if you are still grieving your grandmother, this patient's death comes pretty close to home. I think it's good you are recognizing this as a contributing factor in how you are feeling now.

So as long as there are objective signs/symptoms of distress, we keep giving narcs, even if the narcs are likely to end the person's life? I can live with that.

It is amazing how much better I feel just talking about this and hearing from you all.

I think I'm okay.

yes, even when it's likely to hasten death.

when i first started hospice, i remember calling up my nurse's association,(spoke w/the legal dept) to confirm that what i was doing was indeed legal.

but please keep in mind, it's not just narcs as the mainstay in a pt's regimen.

again, anxiolytics are a must.

agents to dry secretions, to stop/prevent bleeds, stop/prevent seizing and twitches, stop/prevent vomiting...

you really need to look at the big picture.

feeling nauseous can be just as unsettling as feeling pain.

it's just as important to treat the body image disturbance.

watching someone's face fall at the sight of a bald head, puffy face, skeletal appearance, dang, even hair on the chin, contribute greatly to a sense of despair.

it's imperative we treat the total patient.

giving morphine to only address the pain, is not sufficient.

there's so much more that we can do.

*exhale* :)

leslie

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
I think I'm getting it now. We help as nurses do. We don't LET ourselves imagine how the patient is feeling, or the family for that matter. It's like a protocol. Patient suffering=meds, family grieving=support.

I think my problem is that I'm still grieving my grandmother, and remembering exactly the events and her symptoms while actively dying. It gives me a wonderful perspective, BUT I need to put it aside and follow the protocols, without getting emotionally involved (as much as possible.)

Have I got it?

Yes and no. Yes patient sufferering - meds, family grieving - support. Your assesment skills are still very important at this stage. Don't become a robot that isn't aware of others feelings or your intuition. If you feel your patient is having pain and anxiety that isn't controlled, call the doctor. If a family member is stoic and says they don't want to talk, wait a few seconds to see if they are really wanting to talk or cry before you walk out of the room. But also know that your really don't know exactly what is going on inside their personal experience and that you sometimes can't fix everything (such as the death rattle, the coughing up of blood, or a loved one's grief etc.)

You're a human being with real emotions and feelings that need to be processed. But the experience needs to be about the patient and the family, not about us and our issues.

Specializes in ER.
I think I'm getting it now. We help as nurses do. We don't LET ourselves imagine how the patient is feeling, or the family for that matter. It's like a protocol. Patient suffering=meds, family grieving=support.

I think my problem is that I'm still grieving my grandmother, and remembering exactly the events and her symptoms while actively dying. It gives me a wonderful perspective, BUT I need to put it aside and follow the protocols, without getting emotionally involved (as much as possible.)

Have I got it?

You are definately getting it. It does help to talk about it and get some perspective and coping skills. When you are in there alone with the patient and family it is not as easy as it is here, but you have things to reference.

Yes, it is very much a protocol, but certainly not like changing a dressing or starting an IV. The stakes are a bit higher, but it does help to have protocols. It gives us "something to do" rather than wring our hands and focus on things we have no control over.

From time to time you will have a patient that will trigger something you remember or feel from your grandmother's death. Those will be the harder ones to deal with, but you get through it.....you have no other choice, really.

It sounds like you are getting hold of what you need to cope. Hang in there, you will never get immune to the feelings you have, and that is OK.

Specializes in Education, Medical/Surgical.

Oh bless you ; first for choosing Nursing. Then for choosinc oncology-that is a hard place to start. That's where I started and I admit I could not hack it there. I was 34 had no peer family or friends that had died and didn't realize what oncology was back in the 70s.

It is OK to cry. I'm 62 years old now and have been an rn since 1974. I guess I have been with dozens and dozens of people who were dying. I cried with each and every one. I also chose to offer postmortem care to other's patients when their nurse was having a hard time dealing.

Death isn't easy for some like your dear lady. Some though just smile, close their eyes and have gone before you realize it.

Morphine as Leslie said is comforting to people in respiratory distress. My dear mother in law passed away 2 years ago with sepsis not cancer but the sx were the same. Can you believe her daughter did not want her sedated because then she couldn't talk with her? MIL hadn't spoken for at least a year. I can be a biddy when I want to and I dragged the whole family to the nurses station to see the doctor. *I* insisted on MS. The doctor said "but you know what that will do?"

Of course I did, it gave her peace, comfort, eased her agony and allowed her to join her family who had gone on before.

When it is my turn I hope someone like you will be there, I hope you will give me comfort and I believe you will because you have the makings of a fine NURSE.

Will you try one thing? Please stop smoking.

Emmanuel,

Luckily I was not the primary nurse for this patient last night. I was like a runner--more morphine...I'll get it, etc. I totally see what you're saying. As sad as I still am over my own experience, I don't think that if I had been the primary nurse that I would have been unprepared emotionally to care for the family--this feeling didn't really hit me until I got home this morning. I think that's a good place to be.

I will definitely talk with the resources--chaplain, etc--at my hospital. It can never hurt to do so.

I might be able to sleep now.

Thank you so much!

Specializes in ER,Trauma, ICU, Flight, Hme Hlth, CCath.

Seeing her is usual because of all the emotions that you felt during that time and that you are still going through. You did everything that you could and you cared which is the most important thing and she saw that in you.

Death is very difficult to deal with even for those that see it everyday. Do not bottle your emotions. It is more than alright to cry.

Feel better soon.

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