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?

mac, the op is a new nurse.

her feelings/reactions are perfectly normal.

i believe she's been working onc for only 2 mos.

it's a journey she will have to take, until relative security is achieved.

any nurse who works with the dying, needs to discover their own comfort zone.

i'm confident she will do wonderfully.

leslie

one pulumary ca [early 40s] asked for a priest when we called he said he was about 20 minutes away, she replied 'i won't last that long'

and she didn't she started to hemorage copious about of blood, covered the bed down the sides to the floor, family was screaming but it didn't last too long

it was very stressful for nurses with 20 yrs experience i know that a new nurse would really have a time trying to cope

but with experience you know that the pts and their families are better off because you were there

death is not always the enemy

Specializes in Endo, Outpt Surgery, Hospice, LTC, MH,.

All of these are wonderful responses to the concerns you have shared. I have been working in Hospice for a couple months now and I have to admit...even though the mind tells you that Hopsice is about quality of life it can still be a difficult switch from aggressive treatment that nurses are so trained to perform. I have learned so much about who I am, what I believe, what I have within me, and what nursing truly is from the Beginning of Life to the End of life. I have found in my experience of nursing that there are two great areas to work...OB and Hospice...Helping bring life into this world and helping one at the end of their life live it to their fullest...and then tranisition out of this life; they are two rewarding areas to experience....

Scop patches do help..So does Levsin for the upper respiratory girgling. Ativan and Morphine are wonderful tools.

Above all; being there for the family and pt, preparing them for the process which is ahead....sometimes leading, supporting, or following them down the journey.....this is the greatest thing you can do....And at the end....prayerfully....the pt will go peacefully...and the family and friends will be so greatful for your assistance, education, and help in preparing and saying their goodbye's....:wink2:

I have been a Hospice RN Case Manager for just coming up on one year, and there is no easy way to view death in our profession. It is a part of life, and all we can do is our best to make it comfortable. But sometimes in spite of our best efforts, it just isn't enough. The hardest deaths in my experience are the ones where the pt has advanced lung cancer, coupled with COPD and invasive masses in the large airways like the bronchi and trachea.

One thing I have learned is that you can give nebulized Morphine using the IR solutabs, dissolved in either Albuterol or normal Saline. Oner of our hospice doctors educated me and a family member on the usefulness of that treatment for pts with lung cancer. The idea is to deliver the Morphine right to the lungs and eeaden the nerve impulse that tells the brain that the body is choking for air. The result is the patient will not be gasping and struggling to breathe. You also use Scopalamine gel applied to the wrist, or Atropine drops on the tongue to dry up the respiratory secretions that cause the gurgling. Now understand that easing the gasping for breath and the gurgling doesn't mean that the pt is any better off, because if you are also monitoring the SaO2, you will see that it is slowly going down. But it IS a palliative measure to ease the pt's passing into the Light, and gives some comfort to the family members who can't handle watching their loved one die gasping for air. If it is properly done, the pt will breathe close to a normal rate, and just gently slip away.

This doesn't always work, of course. There are some pts that no matter what you do, their death isn't easy. The thing as nurses that we have to remember is that our job as nurses and particularly Hospice nurses who deal with palliative care, not curative care, is that we cannot under any circumstances allow a patient to be in pain or in distress. If that last does of Morphine is the one that stops the breathing for good is the only thing left that can stop the pain the pt is feeling, then that fatal dose has to be given............note that documentation of the Dr's orders, and the Pt's signs and symptoms and discussion of all alternaitive measures to stop pain need to be in the chart, so that you're protected.

As for how we deal with death, it's .....well, hard. The first couple of deaths I witnessed as a Nurse at a Nursing Home, and as a Hospice Nurse, I cried all night, until I understood that it's just something I have to be strong about. I was better until a family member said something really hurtful to me one night when I was sitting with a dying patient. She said "She's my mother.....I am having a really tought time dealing with that she is actually going to die...I know that to you she's just another job, and you have others, too. " I was stunned at first, but then said "Yes ma'am, it IS a job.....and I am paid pretty well for it, but when I go home at night at the end of my workday.....those are not fake tears that come from my eyes."

Point is....it's ok to cry, it shows that you're a human being who cares about human life.....and human death, too. Please don't let it freak you out, or you'll be toitally ineffective as a nurse. Talk to whover you can as a counselor, learn to set your internal boundaries, and get back in the ring.

Steve

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

I've seen excellent sx mgmt achieved w/ both high flow 02 and nedulized MS04.

Different approaches for different pts.

Very true, neb'd Morphine does have variable efects, but when you're dealing with someone who is clearly not going to last the day, and is gassping and in distr3ess, you'll try anything, anything at all that is left to try to ease their passing. If it doesn't wotk, you still know that you did your best.

I feel for you. My first CA death was my grandmother from Lung CA--I was her hospice nurse 4 months prior to graduating. It's an awful way to pass, that's for sure. Just know that it's perfectly "normal" (hate that word!) to be shaken by such a scene. Take some time to reflect on it, write about our feelings, and certainly talk about it! The images will fade with time, and just know that you did a wonderful job helping this pt and her family!

Very true, neb'd Morphine does have variable efects, but when you're dealing with someone who is clearly not going to last the day, and is gassping and in distr3ess, you'll try anything, anything at all that is left to try to ease their passing. If it doesn't wotk, you still know that you did your best.

the nebulized morphine's effects are localized to the lungs.

one of the benefits of morphine is that it changes one's perception of pain.

the pt will not experience this benefit via neb'd ms04.

with ms04's systemic effects, most times the pt isn't even aware of how much they're suffering.

that's why i prefer it sl/po/iv.

leslie

I worked a palliative unit that had nebulized fentanyl on their pain algorithm. I didn't see where it worked any more effectively than other routes.

Specializes in Psych, Med-Surg, ICU, CVA, Hospice.

You sound like a good Nurse who will only get better with time. Keep caring and working, you will learn to let go of the bad experiences and hold on to the good ones with time. It is okay to cry with your patients and families. I will soon retire and hope you will be my Nurse when I need one.

Specializes in peds, OB/L&D, ER and peds ER.

Hello there!---What a situation for someone so new to this role in life! I have a few thoughts that might be of use. For one, what you have done is throw yourself "into the fire" much as many new grads did enteriing the military right out of training, and serving in Viet Nam, in my time. "Home Before Morning" by Linda Van Devanter, RN illustrates some of what I'm talking about. They, as you sound like, were altruistic with huge hearts; but it's overwhelmingly easy to get one's heart broken in nursing. In order to help others we MUST take care of ourselves. By that I mean look at the short term and long term goals. Long term it sounds as if oncology/hospice work is your choice. If it is not, but the only place you could start, you have a dilemma on your hands. Assuming it IS your true calling, honestly, I can't fathom why you were not steered by HR or Nursing Admin. to spend at least 6 to 12 mos. getting your proverbial feet wet on a routine med/surg type floor. The point is to learn to prioritize, think and analyze issues through quickly and---essentially---learn how to run a floor as charge nurse/air traffic controller. It's paramount to get an "internship" phase under your belt. It teaches you to see the big picture and roll with the punches. When you really have some quality time behind you, only then can you pick and choose which subspecialty you think you want, i.e.: L&D or ICU, or heme-onc. and all the attending issues such as the death and dying, long-term planning for extended care, medico-legal issues etc. It feels to me as if you jumped out of an airplane with a parachute on but no briefing. You're trying to figure out how to find the ripcord, gauge when to pull it, aim for a safe landing place, and wondering how to land, and actually DO this thing! Consider a nurse internship program. They have them at Johns Hopkins Hospital, and they should have one at VCU or U.Va. A year spent this way pairs you with a nurse/mentor for a year in the area you work out with the program--for YOUR best interest. You are coached and evaluated and you get the counseling as you need it right when you need it. I'm serious here. All I have read indicates you could adjust to all nursing requires in a much less painful way, with less odds of a flash burnout. Any of us who have been nursing since the 70's have burned out at least once. When that occurs you must figure out why you would want to go back in, what you want for your own growth, should you even stay? Is it mentally healthy for you to do this any longer? You change as you mature personally. Perhaps your needs evolve, too. One of the greatest things about having chosen nursing, for me, has been trying different subspecialties and starting all over again in a new venue of care. Presently, I am in home health care/hospice and case managing. Never would have believed I'd ever do that 37 years ago! You can go forward here, but get yourself some waterwings if you're going to swim in the deep end. Start off with an internship program and you'll NEVER regret it. You'll be hired and paid as the nurse you are. You'll just have a great deal more help making the adjustment to all the hats you wear as a RN. If you are transferring in dealing w/ grandmother's death, working personal issues out, etc. your mentor will teach you how to recognize what you are doing and guide you 'til you are ready to go it alone. Grieving is a beautiful thing, not meant to be gotten over with fast, and swept away. It polishes our souls and lends credibility to what we say and know what to do. Allow that, and get help with it if needed. I say it's beautiful because it allows us to transition from the loss to going on and growing through the loss. My husband passed in March. I do know what I talk of. I wish you blessings in being your own best nurse, for yourself.

]I just read your post concerning the death that you witnessed. I am a new nurse, and I've not had to go through that yet with a patient, but I'm sure when I do, it will be hurtful and affect me greatly. My mother died of cancer, and she is also the reason that I became a nurse, because I loved her nurses and what they represented to our family and the way they became like family to us. My mother was a wonderful women, and she died just like she lived, being wonderful to the end. Her nurses also told our family that she was a joy to take care of, and everyone loved her and her sweet spirit. Even while she was in extreme pain and suffering, she was peaceful and I believe that came from God.

]I feel that the main thing that we need to do before the time comes to deal with another's death, is to know what we believe about death and how we can help someone through this time. My mother was a Christian women and it was evident in her life and death. Her nurses noticed how she coped with the inevitable with such peace and trust in the Lord Jesus Christ. I feel that because I am also a Christian and believe in life after death that is taught in the Bible, that I am able to deal with death differently than someone who has nothing outside themselves to draw from. Maybe you should seek counsel from a chaplain or preacher that you trust, who believes the Bible and can help you with the issues of life and death from the truth of God's Word.

]I hope that you will find peace and rest from this experience that you had to go through. Just remember that even though we do everything in our power to make the patient's transition a more peaceful one, it is ultimately a higher power that is in charge and we need His help desperately in order to do our job as nurses. God bless you.

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