I've been searching for words of encouragement since my first patient death the night before last--anything that will help me get back to my nursing job.
I graduated in May 2009 and began my first nursing job on a telemetry monitored vascular unit in August. I just ventured on my own after three months of orientation. The night before last was just like any other night. However, around midnight I took down one of my patients to CT due to possible pneumonia. We came back, the patient was alert but slightly confused, which from the shifts I learned was normal for this patient at night time.
The patient's midnight vitals signs were all stable, and the patient had remained afebrile. The patient was admitted for a non-healing wound to his right leg, which was just amputated four days prior. There were no complications other than his prior history of CHF(cardiomegaly), PVD, several open heart surgerys, and an AICD due to chronic AFIB. The patient did have crackles in his lung bases but the CT had been done, so treatment was in progress. The patient had a decrease in appetite and urinary output with an increased BUN so we were encouraging fluids, but being careful due to CHF. His potassium had been elevated in the prior shift but he had been given IV reg. insulin and kayexelate to treat it.
However, the patient refused the recheck of his potassium later that evening. At 0230 yesterday morning the patient's heart rate dropped to 24, I ran into the room and found the patient unresponsive. I called a code, we dropped the bed, and began chest compressions, and bolused the patient.
I had just sat with the patient 15 minutes prior. But I told him I had to go check on my other patients and would be back in 15 minutes. I should have stayed. His AICD had fired three times but was not effective. After 45 minutes of trying to rescuscitate the patient, the code team stopped.
The rest of the shift my eyes were weighted with tears. Spending that morning doing death notifications and calling the organ donor center was not at all what I had expected to do that morning.
So the past two days I have been searching for answers: Did I miss something? Did I not act soon enough? Under another nurse's care, would this patient have lived? Was this MY fault?!?!
During the code I couldn't catch my breath it was like watching my nightmare in real life! I have this impending feeling of guilt, even though I know I took the right action and sometimes people just die.
I even had to talk to the wife. I cried some with her while still being professional.This is by far the worst feeling in the world, having to look into the eyes of someone who wants the answers to all the same questions I have. All that I could say was, "I wish I could've done more for you."
To all the troopers out there who have had a similar experience, any words of advice?
Rachel White
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January 16th, 2010 at 10:57 am
Hi Rachel,
It is very difficult to make the transition from student nurse to staff nurse. It took me about 2 years to feel comfortable with my new role. I remember pulling into the parking lot and hoping the ambulance outside of the ER wasn’t bringing in a new patient for me. I remember feeling very unsure of myself and praying during the shift that I wouldn’t hurt anyone. Feelings of inadequacy are common among new nurses and you are not alone. It sounds as though you did a very good job caring for this patient. Sometimes despite aggressive treatment patients do not survive. Death is a part of life. And, there are worse things than dying. This client’s suffering is over and he is in a better place. Please don’t loose the caring concern you have for patients. Compassion is an important nursing characteristic and one that is strongly reflected in your posting.
January 30th, 2010 at 9:15 am
life is just like a glass..easy to break it up..but as a nurses or paramedic..we need rescue till d end..a lot of death had been happen in front of my eye..as a rescuer, we pray for the dead, save the live..may the spirit of rescuer always be with u..
January 30th, 2010 at 12:55 pm
Hi Rachel,
My first patient death, I cried for three days afterwards. I couldn’t watch anything on tv that portrayed death, and I just couldn’t get the awful feeling of how unnatural it is for someone to die out of my head. The worst part for me was taking all the tubes out, and trying to stop the bleeding from the IV, and realizing that if the blood ran out, it would never be replaced because her heart was gone.
I had never once considered that as a nurse, I would deal with death. I always thought I would save everybody. This experience happened to me on a regular med-surg floor, with hospice overflow. Everyone had expected this patient to die…she was 90 some odd years old and had lived a good long life.
I now work in the Pediatric ICU, and my second shift there, a little three year old died. Watching her parents wrench in anguish brought back all the feelings of inadequacy and wondering how much more we could’ve done.
I feel your pain. I try to tell myself that no matter what happens with a patient, at least I did the best I possibly can to make them comfortable. If your patient absolutely refused the K+ check, that may have been the only thing that would have alerted anybody to an impending code, and it was his right to refuse.
It gets better. The first death is always the hardest. However, I prayed after my first death that I would never loose that pain. I’ve seen too many nurses become calloused by death, and the day I become that way, it is time for me to quit.
I will be thinking about you!
February 1st, 2010 at 12:29 am
I too remember my first patient death. This guy was in his 50s and supposed to go home the next day, came in for a revision on his feeding tube. About 20 min from change of shift, I was trying to get everything in order for a smooth report so I could get home! Night shift is so tiring! I was at the nurse’s station getting paperwork and the monitor tech suddenly yelled for the nurse for that particular patient. When I got to his bedside, he was unresponsive, and the feeding tube that was connected to suction was full of blood! After working on him, he was pronounced. I just remember feeling so hopeless, when his family came and I saw his son crying, I broke down into tears so yes I can completely understand how you feel. This happened over a year ago and I will never forget that morning, but luckily I have a strong support system of family and friends, they can help you get through anything, especially if they are fellow nurses.
March 4th, 2010 at 8:17 pm
im a student nurse, in school to become an rn. ive seen dead bodys before, but never watched someone take their last breath in front of me. they called a code on my pt. and after about 20 minutes of doctors and nurses coming in and out of the room, they decided there was no way she was going to survive, she was DNR, comfort measures only. The charge nurse told me to stay in the room with her, to encouarge her to hang in until her son got their, so i did. Seconds before she passed i said to her, your son will be here soon, he wants to see you. He arrived a minute to late. She cried out of her right eye, closed both eyes, took a breath, opened her eyes, and that was it. its a surreal expereince, ill never forget it.