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Old 07-16-2011, 06:45 AM
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Default 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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Old 07-24-2011, 10:10 PM
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It is so very difficult to lose a patient. I too almost left nursing after my very first death of a resident. CPR also failed me and I felt like a failure, that if only I would have done things differently, if I would have noticed the signs, maybe the residnet would be alive. I remember that day so vividly and I will never forget the date.

But here I am, still a nurse. The pain has gotten better, time heals all wounds.
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Old 07-25-2011, 09:17 PM
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I can't imagine having a child die as my first death. As experienced nurses we need to remember how hard it is to loose your first patient.
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Old 07-26-2011, 12:54 AM
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The death of my favorite patient this past December hit me worse than my first patient death did. With my first patient death, I didn't know any better. I had been a Nursing Assistant all of 4 months maybe, and the patient was one I had just been assigned to that day, so I never got the chance to introduce myself to them as they died right at shift change when we were all in report.

It was really odd. Nobody would help me do post mortem care. The nursing students were on the floor that day and they got special permission from their instructor to help me. It was really strange.

I still miss my favorite patient. I miss hearing "BELLA!!!!". He always called me Bella.
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Old 07-26-2011, 04:41 AM
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What an incredibly inspiring story, Thanks Dutchie
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Old 07-26-2011, 07:42 AM
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I knocked off 2 patients in one week during my last MedSurg clinical. Seriously!

Gave 1 Morphine and came back from lunch and she was gone. It was a huge relief as she had been in horrible pain.

Then later that week the same thing happened again. Same situation.

The ones that tormented me were always the ones that were in horrible pain without adequate relief and hung on forever.

I think having worded as a monitor tech/Unit sec. in ICU and all over the hospital for 15 years prepared me well to deal with it. I had already helped nurses prepare patients bodies etc.......

Only did CPR once. I was 16 and working as a CNA in a psych facility (a nursing home really for psych patients - this was the old days!)

I entered a room and a young guy had hung himself with a bedsheet on the bathroom door. I called the nurse and we worked on him. Never knew the outcome as I was agency. Never opened a door the same way again!
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Old 07-26-2011, 10:42 PM
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My first pt. death was during my first nursing job in a brand new NH that only had about 4 residents at the time. I was alone (of course, with so few people to care for, and the place had just opened), and the lady was a 95-year-old woman. Her daughter, who came every day, told me she had had a premonition, and asked if she could stay beyond ordinary visiting hours. Since I respect premonitions, I said yes, and the lady died peacefully later that evening. I was surprised at how very inanimate she felt, as if she had left her earthly self behind as if her body were nothing more than the garments she had worn in this life. Her daughter and I had plenty of time to talk, and I was never intimidated by death at all after that. In fact, when nobody else would help with post-mortem care, I would volunteer, and I once Shanghaid a brand new nurse to help by explaining that it was one of the last acts of compassion one human being can do for another (the NM hugged me when she heard that).

BTW, long before I went to nursing school (I was 3 months along with Shoshana), I was at services in the synagogue when a man died suddenly from heart failure. The rabbi was scared half to death, and tried to start CPR, but didn't know (or couldn't remember) how to position the head (I had picked up the technique during one of my reading addiction fits), so I did it. I knew he was gone, because I could hear the fluid in his lungs. All the old women were yelling at me that I was "going to hurt the baby" by going near a corpse. (This was during the time that I couldn't feel fear.) CPR doesn't always work, but it's one thing to stand by, wringing your hands, and something else to have a go at it, whether or not you consider yourself someone who should know how to do it. Dutchie, I feel terrible that you had no one to talk to about that. I'm very familiar with fighting to get images out of my head all by myself. You did what you could; never forget that.
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Old 07-26-2011, 11:07 PM
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My first death was in School. I had the honor of having the only patient to die in my class. It was my Sr. year and they were giving the pt somthing so they could take a contrast x-ray to r/o metastasis. I didn't feel bad--I think the teachers thought I should fall apart or something. I was basically calm and took care of things fairly rationally (as much as a student can).

This made me recall another conversation I had around that time. There was a 40 something black woman who was facing surgery (hysterectomy) She point blank asked me if she was going to lose her heat......after a lengthy explanation from her with a few smiles it finally dawned on me that she wasn't worried about being cold............. I must say I learned something that day . . .
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Old 07-28-2011, 02:35 AM
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I had no choice but to move on quickly after my first patient death:

I was on my own, as a new nurse, for the first time, literally less than a full day. My preceptor had to leave early (it was technically my last day of being precepted) and told me I could handle it for a few hours on my own. I just had to pass a few meds and watch for new orders until 11P and I'd be done and off orientation.

Sure enough, the DNR CHF patient who was on tube feeds took a turn for the worse. Looking back, I think he started going bad........oh, probably about the time she was getting off the elevator and walking to her car. He was desaturating and sounding very wet. I turned off his tube feeds, called Resp. Therapy and contacted the attending (who, lucky for me, happened to be in the building).

Sure enough, here comes his daughter to visit. She noticed the change in him too. The attending arrived, talked to her, and the patient was placed under "comfort measures only." He died shortly before my shift was to end. I stayed and took care of the family's needs and w/e else I could help with and went home thinking "Is this an omen?".

Went in the next day. Talked to the nurse I precepted with and she said she wasn't all that surprised. She had gone over my nurses notes and said there really was nothing else that could have been done. With this, I felt a little relief.

Then came [false name, just to be kosher] Joey, our little, bald, soon to retire grouch of a CNA. He walked straight up to me, looked at me through his round glasses with an expression on his face that resembled that of one who has just drank very bitter/soured milk or beer and said to me "If you were my nurse, I'd hold my breath until I died too. At least you didn't fumble the ball with how you supported the family afterwards anyway."

After I got to know Joey better, I learned this was a close to giving a compliment as he got.
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