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

Nurses General Nursing

Published

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 Rodeo Nursing (Neuro).
i know grad said they provided palliative care on her unit, but it doesn't sound this way.

comfort care and palliative care are not the same.

actually, it's a rather new trend in onc units providing palliative care.

just because oncology deals w/dying, doesn't equate with providing the specialized care that eol necessitates.

as an aside, providing hi-flo o2 isn't going to do squat, if the lungs/airways are partially obstructed with tumors.

i personally don't like nebulized morphine.

its' effects are too variable.

leslie

My facility has a palliative care team. I know this because I've had docs say they were going to have palliative care see the patient in the morning. Thank goodness end-of-life issues never arise on night shift!

I think I may have to put a note in the suggestion box--well, its electronic equivalent.

Then again, part of the problem may be that families can be slow to let go, and wait until the patient is symptomatic at 0300 before agreeing to palliative care. Still, maybe we could at least have a palliative care nurse on noc, to help our docs get things rolling.

Thanks, grad and leslie, for giving me some good things to think about.

We do have a palliative care team, but I don't know if they were consulted. Again, I wasn't the primary nurse for this patient, so I don't have all the details. All I know is that it was a horrific scene. I'm not sure what meds (other than morphine) she was being given.

But I'm still confused about the difference between palliative care and comfort care. Can anyone explain this to me?

But I'm still confused about the difference between palliative care and comfort care. Can anyone explain this to me?

palliative care and comfort care are often used interchangably, and they do overlap in many areas.

the most notable difference is under the palliative care benefit, pts can still receive treatment and diagnostics, even in the absence of a cure. palliative care can reduce the severity of a life-limiting disease, or slow its' progress. but like comfort care, its' focus is on preserving the quality of life.

when a pt receives comfort care, treatment and diagnostics are stopped, with focus on literally keeping them comfortable.

hope this helps...

leslie

What a unique position we often find ourselves in--advocating for our patient while following doctor's orders and the "wishes" of patient and family. I know that the Advanced Directive was created to help sort out this interaction but when you are in the midst of a dying patient, surrounded by family and friends.....................sigh, I really admire and hurt for those nurses experiencing this nursing practice. I work in the OR where I don't deal with death on a daily basis or even 1:1 when it is the outcome. Gosh, what a tough job. Give yourself a hug for choosing to help your patient in this way. It sounds like you are trying to honor the memory of your grandmother, which in itself is admirable. It also sounds to me like you would honor her no matter what you choose to do in nursing--for you think of her often and that appears to be the driving force for you. She would not want you to "suffer" by memorializing her so try very hard to "have a conversation" with her and see if you can feel her speaking to your heart. I wish you well.

Specializes in Spinal Cord injuries, Emergency+EMS.

comfort care is I suppose a subset of palliative care...

for someone with a diagnosis of Ca. that is not going to be 'curable' or the end stages of other life limiting diseases palliative care should start there and thean and encompasses not only symptom control but psychological care and support to get your affiars in order etc...

as earle says in his post comfort care generally won't be looking at diagnostics or even treating other problems just purely looking at sympton control, oxygenation and hydration...

Specializes in peds med surg,.

Sorry to hear that you've had such a rough time. Seeing pts die is never easy. I have cared for adults with cancer and now children with cancer and it is heartbreaking. You just have to know that you have done all that you can do for them. Sometimes it is being there with them, or even crying with them. I've tried saying "I'm not getting close to anyone again", but it always happens. Not with everyone but for some reason certain people will have an impact on you even more than others. The pts. that you become close to are the deaths that will be harder. We have a special meeting that the nurses can go to and journal and then share out loud with the group their stories. I didn't think I could do it at first and ended up crying while sharing the story of the death of one of my peds cancer pts. It happened 3 yrs ago, I thought I had dealt with it and suddenly I was right back in the moment, sounds, smells and everything! It turned out to be very therapeutic and the facilitator of the group was able to help me come to terms with it. Don't keep your feelings in because that is never productive and will likely lead to burnout or wanting to leave oncology. It sounds like you are very caring and empathetic. Give yourself time, it sounds like you had a lot that happened in a short period of time. Also, if you can talk to a nurse on the unit or your manager or resouce nurse about your feelings, this may be helpful.

Hang on and continue to share your feelings.

Specializes in med surg, oncology, outpt and hospice.

I agree with earlee, I too am a hopspice nurse with an extensive history in oncology. Mso4 works for patients who are having trouble breathing it relaxes the patient therefore relaxes the breathing.

It is ok to cry and there will always be days or patients who because of some connection with you or just because you will find it hard when they die. Thats ok you are human.

I am sorry you had to go through that. The Pt and family are lucky to have had such a caring nurse to see them through it.

Tweety, I hear you, and thanks for your message.

Maybe the horrific grimace on her face was O2 deprivation and not anxiety, but she was grasping weakly at her daughter's hand, and I could almost make out "oh god" at times along with all that terrible gurgling.

ATIVAN--yes indeed. I wasn't her primary nurse and I don't know if there was an order for ativan, but that would have worked I think.

How do you resolve the euthanasia issue though, when giving morphine and ativan to someone whose sats are like 40%?

I understand, to a lesser degree, what you went through. I'm not a nurse but will be going to school for lvn. My sister and I cared for our Mother at home for eight years. She was in a 'coma' from '97 to '05 (brain aneurysm) From the beginning the doctors wanted us to let her 'go' which would have definitely been euthanasia. For eight years, she never had an infection (she had mild seizures the first year) and we suctioned her constantly. We did not suction her the way the hospital protocal calls for. In fact we did very little that they told us to do but then we were in an 'at home' situation. There wasn't the 'hospital' factor of sepsis et al. She also had a stomach tube which we changed ourselves as well as the canula. In 05 she went into renal failure, which we found out about when she went into the hospital to have a broncosocopy (sp). They put her on fluids and meds and her bp plummeted. I have my own theory on that!. They moved her to icu and by then it was sepsis. Since I never left her side, I had the chance to observe the staff. I think the nurses had to wear two faces and yes many of them probably cry in private. I think it is worse for the nurses also because they are carrying out the doctors orders and have little say in the events which they have to monitor. In my Mother's case I asked the doctor to stop all meds. My Mother died within hours. At the end she did a gasping thing (like a fish out of water) and I asked them to administer more morphine. I think that was easier for them also. I consider what I did to be euthansia. It reminds of a movie I saw years ago called "they shoot horses don't they". I didn't want the medical staff to have to carry the burden for decisions I had been making all along. I think nurses are the strongest people I've ever met----and they do it in silence. As the years go by you'll develope a coping system that will allow you to live in both worlds. Good luck!

As a nurse it is a luxury to have families that are so engaged and advocating so well. We appreciate daughters like you. Thanks.

you did what u were to do. being there for your patient and family. Hospice pt sometimes takes hugh amount of analgesics that would damage other patients. the morphine did not kill the patient; please believe that

Specializes in critical care; cardiopulmonary.

maybe as a new nurse you might want to transfer a medical unit until you are more experienced and comfortable with pt. dying. it is common to cry and feel a loss with your patients. but you can also burn out fast if you are getting emotional with all of your deaths.

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?

+ Add a Comment