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?

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've seen nebulizeded MS given in conjunction w/ PO/SC MS. The med director of the unit did not like IV MS, so we didn't give it that way.

The neb MS worked well to control severe coughing and dyspnea.

It wasn't used often, or with very many pts, but it was effective.

Specializes in Geriatric, Pediatric.

I am too a new nurse and have not experienced the death of a patient yet but I was told be an instructor at school to read the book..."Final Gifts" the author is Callanan. This book has so much info to help you understand the dying and the experiences that they have near death and some parts of the book are true life stories that we printed with the permission of the patients that were dying. It gives you a whole different outlook on life and I know that I feel better prepared for the death of a patient now. Please consider reading it. I am so sorry for your awful experience and I hope that you will soon be able to cope and feel better about things. Keep your head up.

Specializes in acute, sub acute, long term, homecare.

In response to the euthanasia question... the orders were present... and i ask , if that were u lying there .. what would you want done for you. I have been an lpn for 18 years.. to have my rn completed in May. I have struggled with this same thing over the years, I always ask what is the right thing for this person, and what would I want if I were in that bed...

Have peace in knowing that her suffering is over

Specializes in Long Term Facilitly.

Working in a long term facility, I work with this a lot. I see these patients daily and they are like a second family to me. I also get to know the families very well, some rather personally. When a patient is actively dying Roxanol and Ativan is always on board. We usually don't suction due to it usually isn't effective for very long and is upsetting to the family, scapalomine is usually used. When it is close I stop taking blood pressure, sats, etc.............and pretty much sit with the family as needed for support. If I personalize it too much, I can start to think about my mom and dad who are still living, so I try not to allow my mind to go there. I've seen as many as twenty or so people in a room with a dying patient, and I think...........how lucky is this woman/man to have so many people that love him/her. As funky as it sounds it almost reminds me of a labor room. As God brings forth life He also brings forth death. It's the circle of life. I pray for my residents to go forth easy and without pain. The strangest thing I have had to do yet, the patient had a broken arm that was in a cast. The family asked me to cut the cast off. At first I was shocked and not sure what to think. I called the doctor, told him how close this patient was to death.....and he told me to cut the cast off. Thus along with the help of this patient's son, we cut her cast off. Indeed she looked much more comfortable. Thanks for your thread.

You can't control everything. Just do your best. It does get easier. You will develop a certain detachment and numbness in order to survive. Don't fight that.

[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.

I've always heard that expresssion used to mean that no one was going to die on my shift because it would mean lots of paperwork and explanations.

I don't think we ever "get over" the horrific experiences we have faced. I remember, after 15 plus years, the sounds my first dying patient made as if it were this morning. I see him bleeding out and the uremic frost that I tried to wash off but that kept coming back. I believe when I am no longer able to "feel" that feeling I should cease being a nurse because those feelings are what keep me grounded. They remind me that I act only as a conduit for the patient and family to successfully make the transition. Experience the feeling, learn from it and grow as a result of it.

Specializes in LTC, CPR instructor, First aid instructor..
i work in hospice and see this all the time.

anxiolytics are always given w/ms04.

scopalamine helps alot in drying secretions.

it is not euthanasia if your intent is to relieve suffering.

giving ms04 continuously is very common.

i can't tell you how often i've continued in giving the mso4, even with long periods of apnea.

as long as i continue to see a grimace, fretted brows, soft groans, tense muscles, grabbing hands, etc., then i know they are not completely comfortable.

i'm sorry you feel so helpless.

there will always be some who struggle til the end.

your pt is finally at peace.

may you find the same.

leslie

Ilove you, Leslie. You're such a wonderful caring nurse.

It is okay to cry. When I worked in the PICU I cried with every death. I cried with every dressing change along with my burn patients. I cried when kids got sicker and when they were well enough to go home. It is okay to cry and I can tell you that families appreciate it.

Mary

Specializes in MedSurg/OrthoNeuro/Rehab/Consultant.

I think watching patients die of lung CA is one of the worst things to see. I'm sorry you are hurting. I wish you peace.

Specializes in LTC, CPR instructor, First aid instructor..

I was with my grandmother when she died. Nobody in the family wanted the job. We brought her home from the hospital, I placed her in my bed. Then when she fell asleep, I went to the pharmacy and purchased a tank of oxygen cepacol lozenges for her sore throat, and lots and lots of pudding. She loved it, and she said it soothed her sore throat.

She was a natural musician in her earlier days, so I recorded some songs she played on her harmonica, accompanied by a friend's violin. After the tape was made, I put it away.

When the time came I played it for her. She thought she was listening to a radio, and she said she loved it. I told her it was her playing her harmonica. She just smiled.

I bathed her daily, changed her ostomy, and changed her underclothing.

I slept on the couch in the livingroom right around the corner.

I awakened one night around 4 AM, hearing her cough. I went to her, and she asked for some Vicks 44 cough syrup to quiet her cough. After that, she quieted down, but I didn't like the way she was breathing, so I asked her if she felt she needed some oxygen. She said she didn't think so, but I put it on her anyway, then I said I was going to lay down on the floor by the side of her bed in case she needed more care. That made her feel good, and we said goodnight to one another. About 10 minutes later, I didn't hear anything, so I got up, and saw Grandma was leaving this world. I got in bed beside her, and held her in my arms until she stopped breathing.

Today, I have a good feeling about that, because when I was a tiny 3 lb, very anemic baby, it was Grandma who I'm sure gave me back my life. Those types of babies were mostly not named, and were buried those days.

So my hat's off to you dear Grandma. I look forward to seeing you again one day.

Fran

Specializes in ER/Ortho.

I am not a nurse yet, but begin the nursing program on Aug 25, 2008. I have seen people die, and been present when they passed (my aunt, and grandma). I watched my grandpa linger for months in the VA with lung cancer, but wasn't present when he actually passed.

I took a class called end of life issues a couple of semesters ago which focused on this very topic. We had to come to terms with our own death. We roled played telling the loved ones the bad news, talking to the patient about making the tough decisions etc. I really think the class helped me prepare, but we will see how well I hold up when the time comes.

In response to the pain killers. I have often heard people say things like "You don't want to give too much pain killer because it could cause them to pass". I remember with my grandma we were told that when they gave her the morphine there was a really good chance that she would pass within a couple of hours.

If I have some sort of chronic life ending disease and I AM going to die then I want to be made comfortable. It's not a matter of IF the patient is going to die...they are going to die. It's really not even a matter of when because once they are to that point you know its going to be a short time. It's more a matter of do you want them in unbearable agony during that short time. I personally want to be sky high, and if it helps me to pass on a couple of hours early then god bless you.

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