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Rookie Wit & Wisdom
My First Patient Death: A Nightmare in Real Life

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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10 Responses to “My First Patient Death: A Nightmare in Real Life”

  1. Janeen Says:

    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.

  2. jason Says:

    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 a rescuer, we pray for the dead, save the live..may the spirit of rescuer always be with u..

  3. Rachel Says:

    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!

  4. Judith Says:

    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.

  5. keri Says:

    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.

  6. Lia Says:

    Hi Rachel,
    I’m a student nurse and last Wednesday was my first patient death.
    It was my third day ever working on placement. I had just come off lunch break and was called into this woman’s room. No more than five minutes later she died. I was a state. They left me alone with the body and I just stood there praying. Her family arrived 20 minutes later. Even though she was 101 and we all knew it was going to happen, I couldn’t believe it. Luckily the Health Care Assistants took care of me and helped me through it.
    I hope everything is going well for you!

  7. loretta Says:

    Hi Rachel,
    I am a new RN. I had a lady a few weeks ago pass away in front of me. She told me she couldn’t breathe, grabbed me and then closed her eyes. I called my preceptor in, and screamed for the nurse I was giving report too, no one would come in. I felt alone and scared to death…I began CPR and hit the code button and the trauma team came in and took over. I was shaking so bad and was so confused as to what just happened. I felt like I was in a tunnel with everyone running in and out of the room. I felt like I did everything right, but didn’t have a good support group at this facility. I was told to quit crying and buckle my boot straps and move on, if I couldn’t be tough, I wouldn’t make it as a nurse. It took me some time but as I play that day over in my head, I pray that my pt is at peace and her family has the strength to move forward soon. I questioned myself if being a nurse was the right career choice for me and after several weeks I’ve decided it is. I am a sensitive person with a big heart and I love each and everyone of my patients. I hope everything is going better for you and its great that you have a support group. Take Care!!!

  8. pauna Says:


    I’m a new nurse as well and this year I started to do Home Health. I had a patient who I visited every day for a wound on her coccyx. She had DM which as you know caused her to heal very slowly. So I spent alot of time with her. I was the only one who actually spent time with her. Long story short I found her dead. This happened in August and now its November, and I’m still carrying this heavy heavy burden like I could have done something more. And I say this because she was self medicating herself which at times I thought were under control but the last two days I should have known, she declined to go to the ER , so there wasn’t much I could do, but I should have done what my gut was telling me. I also don’t know how to deal with this.

  9. Lisa Says:

    I’ve been a nurse for 7 years. I’ve worked in PACU for the past 3 years. Although I’ve had a handful or so patient die under my watch, each and every one affects me. When the code goes on, I feel like a doe in the headlights. It is all so surreal. Today was the first patient I lost since the death of my mother. I feel that my lost has really helped me with the little bit of sharing sympathies that I have to do. I guess it gets easier with time, but my eyes still fill up. Blink your eyes and pinch yourself.

  10. Bethany Says:

    I had a patient die last week. She was 68 and broke her femur. she was going to have surgery the next afternoon. After shift change i went in to find her only breathing 6 times a min… after increasing her O2, shaking her awake, and calling RT her sats came up to 94%. i checked on her every hr to monitor her breathing. I came in at 4am to find her dead… I had a moment of panic. She was DNR, but she wasn’t suppose to die. So hard, I felt like she was ripped away from me, I didn’t even know her or talk to her really but i felt like her death was a big loss. Wasn’t expecting to cry about it for the next week.

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