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?
I am sorry you had to witness such a hard death. I understand how you feel. When i first graduated from nursing school three years ago (when I was 21) I worked for a very small Oncology office where it was just the MD and I (and a girl who did medical billing.) I worked there for three yrs until recently. I loved my job and became very close with the pt's as I was in charge of giving a number of them chemo and saw them almost on a weekly basis. To me it was the most rewarding job and one where it actually changed my life. I learned to appreciate life. They showed me that many times in life some of us only exist and are not actually living the way we should. Life starts to become a routine and we start to put off the things we want to accomplish in life. They would tell me that even though i was young to view each day as a gift...not to hesitate and to go for my goals which i eventually did. i moved across the state to a place where I always dreamed of living and couldn't be happier. I think its a gift to work with cancer pt's. I am now looking for a job in hospice. You seem like you have the compassion that these people need. I believe that its a struggle to be born and a struggle to die... which we must help our pt's to pass on as comfortable as we can. Its a calling to work with Oncology pt's. Some I still think of my pt's everyday..especially the ones who were around my age who passed on. Those were very hard. I had about five who were in their early 20's and were dying. I never knew how much COURAGE and STRENGTH we have until we are faced with death. Even though my pts were suffering greatly they still fought as hard as they could and didn't give up. I never had a pt say to me, "why me?" Instead they would say, "I don't want this cancer to win there is more that i want to do in Life." Even if they could just live a couple more weeks to them that was like a year...just to accomplish a few more things before they had to go.... You were put in that line of work for a reason and one you will soon see. Good Luck whichuote=Grad In May '07;2302707]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?
I am sorry you had to witness such a hard death. I understand how you feel. When i first graduated from nursing school three years ago (when I was 21) I worked for a very small Oncology office where it was just the MD and I (and a girl who did medical billing.) I worked there for three yrs until recently. I loved my job and became very close with the pt's as I was in charge of giving a number of them chemo and saw them almost on a weekly basis. To me it was the most rewarding job and one where it actually changed my life. I learned to appreciate life. They showed me that many times in life some of us only exist and are not actually living the way we should. Life starts to become a routine and we start to put off the things we want to accomplish in life. They would tell me that even though i was young to view each day as a gift...not to hesitate and to go for my goals which i eventually did. i moved across the state to a place where I always dreamed of living and couldn't be happier. I think its a gift to work with cancer pt's. I am now looking for a job in hospice. You seem like you have the compassion that these people need. I believe that its a struggle to be born and a struggle to die... which we must help our pt's to pass on as comfortable as we can. Its a calling to work with Oncology pt's. Some I still think of my pt's everyday..especially the ones who were around my age who passed on. Those were very hard. I had about five who were in their early 20's and were dying. I never knew how much COURAGE and STRENGTH we have until we are faced with death. Even though my pts were suffering greatly they still fought as hard as they could and didn't give up. I never had a pt say to me, "why me?" Instead they would say, "I don't want this cancer to win there is more that i want to do in Life." Even if they could just live a couple more weeks to them that was like a year...just to accomplish a few more things before they had to go.... You were put in that line of work for a reason and one you will soon see. Good Luck
We use levsin, scopalamine, ativan and morphine to help people be as free of pain and fear as we can accomplish. Don't forget positioning on their side can help, if they are having difficulty managing secretions. Even though there was blood, I'm sure there was additional secretions so keep that in mind. Minimal suctioning, the less invasive the better. But I might do shallow suctioning with a flexible catheter periodically if I thought it would help. never ever worry about 'euthenasia', I always focus on my patient's comfort first and foremost and don't hesitate to contact the doctor if I feel something else needs to be done. I also have to tell you, ten years of nursing has enabled me to keep some distance, but sometimes when one of my patient's die it really gets to me. I think that's ok, nurses are human after all!
I have been a nurse for 28 years. I have seen people die of many varied diseases and for many varied reasons. I too have issues with the administration of of drugs by nurses to make the dieing comfortable. The issue of taking part in what seems to me an act of euthanasia causes me a much painful moral delimma.
I feel that if the patient and/or their family wishes the patient to be kept comfortable the use of PCA(Patient Controlled Analgesia) pump would be quite useful in administering the requied dose of morphine needed to maintain, what some have termed, a comfortable death. It can be administered by a family member simply by pushing the button on the PCA pump, utilizing bolus dosage, it can be administered by continuous infusion, or both methods can be used, low dose continuous infusion with bolus doeses. Some argue that for a PCA pump to work, the patient must be conscious in order for the analgesic to be patient controlled. But, when we have orders on a terminal unconcious patient to administer MSO4 and ativan at very frequent intervals at the behest of the family, I am unable to see the differnce in allowing them to push the PCA pump button.
Then the issue of a nurses actual participation in this act of euthanasia is minimal.
The argument that the nurse is assisting the patient to a comfortable death doesn't set right with me, because as your patient can attest death is neither comfortable nor painless. That is my belief.
I have only been an lpn for 2 years, but was a CNA for 12 before that. I have experienced many deaths, deaths like you are talking about and deaths that are so quick. I have sat with the family, and patients and just cried with them. sometimes thats all you need and thats all they need to know that they count, or that their family member matters to you. Sometimes you run into families who just don't want you in the room even after you have taken care of this patient for months. (I work on an ECU unit with a couple of hospice rooms) Thats when its the hardest for me.
Its ok to cry though, Its totally natural! you aren't a wimp. And the other nurses were probably touched as well they just probably deal with it another way.
Specializes in Med/Surg, LTC, Agency(facility and home).
:idea:You guys are great!!! This is my first post. I see everyones point of view. Been there, done that, kind of thing. When I was a new nurse I was made aware of a study that was done with people facing end of life issues. These people were asked if they were afraid and what they were afraid of. The majority of the patiens listed two fears 1.) being in pain and 2.) leaving their loved ones (i.e not being there for them).
When I come on shift and I find I have a patient that is on Comfort Measures the first thing I do is check to see that I have the MS and Ativan orders. (also any other orders as in respiratory secretions) If I don't I try to get it right then. Sometimes the Doc's won't give it until you actually need it but I argue that I like to have it available in case I need it. I am a very strong patient advocate which sometimes doesn't make me very popular with the other nurses. What I have learned is that sometimes we are too busy or inexperienced to know what to ask for from a doctor. So...at the risk of stepping on another nurses toes I would say "I know you are very busy would you like me to give your patient ativan or whatever or would you like me to get an order for this or that for you."
Some nurses believe strongly that they became nurses to save people. I use to work with a nurse that would say "not on my shift". Even if the patient was comfort measures. I was like a badge of honor for him that the patient lived through his shift. This led me to evaluate my thinking. This is a big life event. Birth, marriage, children.... WOW death. It is so natural. I have had the priviledge(that doesn't seem like the right word but for want of another) of being at many of these events. While I don't remember all of them at this moment I am pretty sure family members will always remember "that nurse". I decided that easing suffering was more important than saving lives in a comfort measures situation.
There are alot of nurses and doctors out there that don't address a comfort measures patients pain or anxiety. In my opinion if you are an advocate for these things then you are truely a blessing to these patients.
I never know when I am going to cry. I don't cry in front of the families but I still am surprised at my response to these situations. Sometimes I cry for a life lost to alcoholism and drug abuse. Sometimes I cry because the earth just lost a fantastic person. I guess that means I'm human.
ativan as well as MS if restless, Atropine gtts SL are very helpful for the gurgle.
The simplest thing might simply have been to reposition your patient, lots of times lying on the back with head hyperextended causes pooling of secreations in the back of the throat than the air moving past the secreastions as they breathe cause that horrible noise. Moving patient to their side with head of bed elevated to a comfortable level allows families to remain close and hold hands and stroke patients brow. Often just repostioning redistributes the fluid that has pooled and the gurgle will quit or greatly decrease.
Also it sounds like you are describing Agonal breathing when you talk of the horrible facial grimaces. Agonal breathing may be present in the last moments before death, sometimes it is barely noticable and some times it can last several moments. It is the bodies last reflexive attempts to take in air. At this point the patient is very close to death, I generally teach families that this could happen and that at that time the patient is not really taking in enough breathe or oxygen and the body is using extra muscles in an attempt to breathe.
Never having done it myself I can't promise it is a pain free experience but most of the patients I have been with are not as disturbed by agonal breathing as we are and family teaching helps them to understand what is going on a hopefully make a bad situation a little more tolerabl.
As a psychiatric nurse and a long time home health nurse who has dealt with death and dying, I salute you for your sensitivity and compassion. Death is a part of living and as care givers we have an opportunity to help the dying and their families make the transition. It is okay (my perspective) to feel the pain associated with seeing that modern medicine does not always end suffering, it is okay to grieve for each life that makes the transition during your tour of duty. What is dangerous is finding yourself stuck in the place of second guessing what could have happened if you had... You were there, you did what you could, death claimed it's prize, celebrate the fact that you gave to your patient and the patient's family all that you could and while the sounds of this particular transition were horrible, you provided stability and comfort. As one writer suggested having a chaplin available for staff is wonderful as is being able to commisurate with the other nurses who were involved with the patient. As the director of nursing of a home health agency, we provided a time for staff to get together for a debriefing after the death of a long term patient. We accessed the skills of the local hospice team. This really helped. Also encouraging nurses to take CEUs that deal with pallitive care to learn about pain control during the terminal experience was a great help.
God's peace be with you, you sound like a real angel.
I too witnessed the death of my grandmother and my mother to cancer.My mother had lung cancer and was coughing up blood. I was an awful thing to witness and felt so out of control and unable to do anything to help ease the suffering. Now, I work in long term care on an advanced Alzheimer's Unit. I am with the residents for long periods of time prior to their deaths. I get very close to family members,also. I find that there is nothing wrong with shedding a tear with the family as death gets close. It's only natural. I don't sob and get hysterical, but there is usually a tear or two that falls as I'm going about my job trying to end the suffering and fear. I give the family members lots of hugs and education as to the process of dying. My administrator has received alot of letters from family members stating how much they appreciate the compassion and education they receive from me. So, if you do shed a tear with the family, that's ok. Just remember your place as the caregiver and show your compassion to the family. Give them space and time alone with their loved one but DO NOT ignore the situation. Hope this helps in some way. I've been in nursing for almost 30 years and I have never had a family member complain about me being too involved or too caring. Good luck in your career.
Specializes in LTC, CPR instructor, First aid instructor..
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?
i witnessed 2 horrific deaths back in 1963 that still remain with me to this day. i think some are so bad you just don't get over them really, you just adjust so you can work. my first one was a man who had poo all over himself and his bed. i cleaned him up and changed his linens, then i went on down the hall to care for the other residents. when i was finished, i went back to check on him, and his eyes and mouth were wide open as if he was frightened to death. i can still see his face. i'm glad i didn't witness the actual death.
my second one was a little old man who drowned in his bodily fluids. it took him about 4 days to die. back then the physicians didn't believe in over medicating their patients either. if that occured now, i would immediately think of dr kavorkian.
my own mother also suffocated to death. thankfully i wasn't there to witness it. she suffered burns over 70% of her body, and was being infused with blood in her lower limbs, and for some odd reason her quack oops i mean doc ordered her to be wrapped completely in ace bandages. i'm convinced that that was what hastened her death. she was given a tracheotomy at 4:30 am the morning she died, and she suffocated around 7:am the same day.
I recommend the book "Final Gifts" Written by Maggie Callanan and Patricia Kelley, two hospice nurses. Some of us were thinking "We should write a book" when we ran across this one. Many of us could add stories for every chapter. It will give new nurses a whole new, great, view.
oncology01
23 Posts
I am sorry you had to witness such a hard death. I understand how you feel. When i first graduated from nursing school three years ago (when I was 21) I worked for a very small Oncology office where it was just the MD and I (and a girl who did medical billing.) I worked there for three yrs until recently. I loved my job and became very close with the pt's as I was in charge of giving a number of them chemo and saw them almost on a weekly basis. To me it was the most rewarding job and one where it actually changed my life. I learned to appreciate life. They showed me that many times in life some of us only exist and are not actually living the way we should. Life starts to become a routine and we start to put off the things we want to accomplish in life. They would tell me that even though i was young to view each day as a gift...not to hesitate and to go for my goals which i eventually did. i moved across the state to a place where I always dreamed of living and couldn't be happier. I think its a gift to work with cancer pt's. I am now looking for a job in hospice. You seem like you have the compassion that these people need. I believe that its a struggle to be born and a struggle to die... which we must help our pt's to pass on as comfortable as we can. Its a calling to work with Oncology pt's. Some I still think of my pt's everyday..especially the ones who were around my age who passed on. Those were very hard. I had about five who were in their early 20's and were dying. I never knew how much COURAGE and STRENGTH we have until we are faced with death. Even though my pts were suffering greatly they still fought as hard as they could and didn't give up. I never had a pt say to me, "why me?" Instead they would say, "I don't want this cancer to win there is more that i want to do in Life." Even if they could just live a couple more weeks to them that was like a year...just to accomplish a few more things before they had to go.... You were put in that line of work for a reason and one you will soon see. Good Luck whichuote=Grad In May '07;2302707]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?