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Reality Unscripted
Moving On After Your First Patient Death

My first nursing job was as a camp nurse the summer I graduated. It seemed like a great way to spend my last free summer while studying for boards. Lots of sun, water, and friends. A week or so after boards (the whole country took a two-day written test on the same days) was the first time I considered quitting nursing. I was shocked at my own emotions.

One afternoon I was napping in my cabin when someone came in screaming for me. They said there had been an accident in the kitchen. As I arrived seconds later, I saw a teenage boy lying face down with his hand clenched in a big floor fan, which was lying beside him. I checked to make sure the fan was unplugged before I touched him. I unclenched his hand and rolled him over. He made some noise as I turned him, but soon realized he wasn't breathing. Nor did he have a pulse.

The other nurse arrived, and we started CPR. Ten minutes later the ambulance arrived and took him away. We heard an hour or so later that he had died. Electrocution. He was seventeen.

It was a pivotal point in my life. I spent weeks rocking myself to sleep doing the CPR count in my head: One and two and three and four...every night. I couldn't get his face out of my head. I was tormented by the fact that everything I knew had failed me. Failed him. I thought maybe I had picked the wrong profession after all. It was my first encounter with losing a patient, and it hurt like hell. It will be 25 years this July--and it still hurts.

We go into nursing to help people. We want to save lives. We want to make a difference.

The first time we find out it doesn't always turn out the way we would like, we have to re-up. We have to make a conscious decision to stick with it and try again. It can be a painful process. But the truth is, people die. Sometimes way too young. Sometimes in horrible ways. Sometimes because we screwed up. It's all a huge load to bear.

A couple weeks after the accident, I had to teach a CPR class to a group of high school campers. It seemed like a cruel joke that I would have to pass on this skill that had failed the only time I had ever used it. However, I did my best to be positive about all they were learning as I shared my own experience. I had five kids in the class, and I knew two of them from home.

That fall one of them saved a choking child she was babysitting, and the other did CPR on her own father when he had a heart attack! To me, that was the affirmation I needed to keep going. I can't save everyone, but I can impact everyone. My own story didn't end well, but I changed two other peoples' stories. And theirs ended great.

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11 Responses to “Moving On After Your First Patient Death”

  1. Jen Says:

    This couldn’t have come at a better time. I am a nurse extern in a busy ICU. Last night (3/19) a patient that I had cared for numerous times passed. It was really hard to remain professional, but some how I did. When I got home last night, I just broke down. Thanks so much for showing me that you can move on and continue to do positive things.

  2. Joseph J. Neuschatz M.D. Says:

    If I could, I would first eliminate the word “FIRST” from the title. You never get used to losing a patient, no matter if it is your first or your fourteenth.

    But, from my narrow point of view of systematic anesthesiologist, I would like to divide such demises in two chapters:

    1) Expected death. Losing a suffering, hopeless terminal patient on the O.R. table, is (maybe) a blessing in disguise for the moribund and the immediate family, but remains a traumatic experience for the surgical team. To top it all off (and due to the fact that there is not such a thing as D.N.R. in the O.R.), a totally unnecessary C.P.R. has to be attempted.

    2) Unexpected death. I would also divide it in two chapters:

    A) Explainable. Brings stress, guilt feelings and the harrowing decision on when enough is enough. When to stop an unsuccessful resuscitation. But, when the cause of death is finally understood (and not preventable), the sensation of guilt slowly disappears.

    B) Unexplainable. Produces all of the above, with no reduction of guilt and, often, a lifetime obsession on finding an explanation. In my case, such obsession forced me to write a book, many years later.

  3. Carl Bishop Says:

    I have been working in hospitals for over 30 years. My first place to work was a Hematology/Oncology, I have many people die during that year, some we tried to resuscitate and some we did not. Since then I have worked in many areas. I have been working in a Hospice for the past three years. I can truthfully day that every person that I have taken care of that has died, whether we tried to resuscitate or not has affected me in some way. When it comes to when it does not affect me is when it is time to stop working in this field. I have heard that you are not suppose to become emotionally involved with your students, but the death of someone needs to affect you in some way. You look to see if you did everything you could to help that person. I have had a 2 year old die on me at the beginning of a shift and you have to keep working because you have other people who need you. I didn’t break down after that until I got home, then I cried. It is hard but every time it affects me in someway.

  4. liz Says:

    Like Jen, this came at the right time. I am a graduate nurse and on Monday, a 94yr old patient passed away. I came on the ward that morning, and her BP was fine, then I did it again before I gave her the beta-blocker and it was a bit low so i withheld the medication. Come back 10am and her BP was very low and so i told the NUM and she said to get the ECG lady to do one. That revealed AF with abnormal waves. She had been in AF before the op anyway. She had very little urine output, was very sedated, compared to the previous day and was hard to wake her up. When she did wake up, she was very confused.

    Then I went to do stuff with other patients and then she told the nUm that she had chest pain. They called the ICU doctor and she started giving her GTN patches, morphine, maxalon and adrenalin or soemthing like that.

    The doc didnt think she was going to do too well. She had a hip replacement and was on the table for over 2hrs so that didnt help.

    She eventually got transferred up to CCU and at the end of hte shift, the NUM up there called our num to tell us that she had pased away.

    I was more upset when she was under my care coz i didnt know what to do exctly and that was stressing me out. I was very relieved that she was on the other ward when she went. I kept thinking to myself, did i give her the wron medication, was it the wrong type etc etc, nad what do i do? One of the level 2 nurses was suppotive which was good and he said that its a good thing that it happened in a control environment.

  5. TheCannulator Says:

    ‘Losing’ a patient sounds like you failed at your job.

    We are not physically immortal and our care is more about impeding eventual physical death. Some people will just die.

    When I moved from nursing to Ambulance to my primary job, I realised that I can only do my best. If my patient succumbs despite my best efforts then that’s it. It’s terrible when anyone dies, but if I can be supportive and the person that loved ones look to for help then that’s a good thing. I find I don’t bottle it up, I just look at my own mortality more realistically and humbly now.

  6. SelenaK Says:

    I am in nusrsing school and am working as a pct and had a patient die about 4 mos ago-while sad I at least knew that her last hours of life were filled with dignity, respect and compassionate care. She was a sweet lady and it was a pleasure and a priviledge to care for her. Unfortunately as healthcare professionals we will have to deal with death and dying more often that we’d like -but I think if you can look back and know that you did the best you could, and the patient was treated with respect and diginity, tenderness and caring then is can still be a positive experience. Also to realize that we all have limitiations and are human and not be so hard on ourselves and that every experience with a patient is a learning opportunity no matter how long you’ve been in the field. The patient’s nurse and I kind of decompressed together and talked over the whole experience which helped us to process the whole thing-

  7. aimee Says:

    My first patient death happened twenty nine years ago; the patient died unexpectedly and the thing I remember the most is the smell of gangrene after he died. He had infarcted his gut, and as a new nurse, all I could think about was that we had done everything right and he still died….how naive I was… nursing school hadn’t taught me that sometimes people just die when it’s their time…I had to learn that on my own.

  8. Stacey Says:

    I would like to say thank you to you all. I am a 3rd year nursing student and this week I witnessed my first crash. I can honestly say that it is probably one of the most horrific things I have ever been a part of. I have been left with an overwhelming sense of self doubt, despair and generally sadness as it was unsuccessful. Most of the staff on the ward did not seem to notice I was there, I was barged out of the way, and felt like I was watching some horrific but realistic movie.

    I have been trawling the internet for the past few hours hoping to find something about someone who felt the same way. After reading this article and also the other posts I cried. It gave me a sense of relief to know that I do have a right to be upset and to feel this way.

    I probably won’t give up the course now, as I was thinkiong well if I can’t do this, what can I do?

    Thank you so much to you all x

  9. selms312 Says:

    i think that we have to remember that nursing care should be holistic. sometimes the death of a patient, is a gift, a mercy to them, and their loved ones. i always cry, even when death is expected, even prayed for by the patient… i don’t think that’s wrong. So often we get caught up in extending life… when we know eventually, everyone dies. mortality is a fact that we will deal with. and i think that sometimes we need to give ourselves a break.

    by the same token, i’ll never forget my first death as a nurse. He was an 84 year old GI bleed, who i was transfusing… i still remember EVERY detail of his care that morning. i remember how cold and clammy his skin felt when i first realized he had crashed. i remember calling the code, and beginning cpr. i remember weeping in the med-room, after he had passed. i remember his wife and daughters shocked anguish… i remember post-mortem care for him.

    i don’t remember anything else about that day… other than what happened with him.

    it still torments me, but i have learned from the experience.

    we are human. we live, we learn, we move on, we get better. we have to keep pressing forward.

  10. Victoria Grace Says:

    Thank you to everyone who posted something. It has all helped me, as I experienced my first patient death as a CNA last week.

  11. rondodondo Says:

    Try and maintain some professional distance with the patient. You simply will not survive in this business if you fall apart with every patient death esp. when they are very elderly. It will happen to all of us some day………………..

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