Death

4 I sitting here reading allnurses and I've realized something that I didn't quite put into context like this before..... I have no experience with death. None. I am 31 years old, and in my life, no one close to me has died. I'm reading threads in the peds section and some of them are talking about kids dying and I'm thinking to myself.... death is inherent in every field of nursing, and I'm sure I could handle it as long as I get a few minutes to have a good cry.

But then I thought about the critical patients that might be there for a long time, and how things will feel different going to work and not seeing them there anymore because they've passed. This is what made me realize I've never experienced death before. I DON'T know that I can handle it. I DON'T know how that next day at work will feel. I DON'T know that it wont destroy me inside.

Don't get me wrong-- I'm not bailing on my program and plans over this. But.... well..... crap. Shouldn't this be a prerequisite or something-- knowing what it feels like to lose someone? *sigh* I'm a little scared now. I guess the critically ill patients will be "expected", and so there will be time to emotionally prepare for that. I understand that in some cases there could be a feeling of relief at knowing they will no longer be suffering.

Is it normal, or even acceptable, for a nurse to become a giant sobbing mess if she/he loses a patient she/he was close to? Does the skin thicken after time? Is it okay if it doesn't thicken? I don't know how I feel about the idea of not feeling sadness at the loss of life.

Can you tell I'm all over the place about this? When you were a noob, what were your experiences with death? Had you experienced it in your personal life before professional? How do you cope with it now?
I've only been a nurse for a year and before that, I was in your shoes - I had a few older relatives die when I was a kid, but nothing that really affected me deeply. I found that dealing with death as a nurse didn't effect me as severely as I thought it would. As a LTC/short term rehab nurse, I would get to know these patients. Many of them were in my care for several months before they died. When death got closer though, I became stronger so I could be there for the family. Mourning was left for later, in private with other nurses and CNAs who were close to that person. Sometimes I cry, but most of the time I don't. Most of the time, like you said, there is a feeling of relief from knowing they are no longer suffering.

My first patient death was an elderly woman who had breast cancer. The cancer had eaten a hole through her breast and it was rather ugly.I did not cry because it was a relief for this woman.I also reminded myself that this was going to be part of my job, so I needed to learn to deal with death in a detached way. I couldn't be sobbing over every death. I needed to do my job.If I did cry (and I recall doing this only twice), it was the pain of the surviving family members that broke me down and I had to retreat to the utility room to suck it all up, take a deep breath and carry on.Most of the time, I felt a sense of awe with the fact that I was there when the patient died and that I was responsible to make sure I handled the deceased with respect (whether I liked that patient or not).There is something undescribable in the awareness that I was a part of the patient's last moments and I was doing whatever I could to make those last moments as comfortable as possible.To me, that is huge.This was when I was a CNA in a nursing home and working for myself as a private-duty aide.Overall, it is no good to fall over in a heaping sobbing mess.The patient needs you to keep it together to provide good solid comfort care and the family needs you to keep it together to give them some much needed support.You need to be able to do your job.I did have one younger woman who died unexpectedly (in psych) and it hurt us all.Her problem was medical and it still bothers me today as I wonder about the preventability of it.She had a young son (who was the same age as my boy) and I remember him visiting the day before she died.It was bad enough this poor boy's mother was so mentally sick, but for her to die (unexpectedly) when he was so young and still needs his mother...This tears me up and I need to remind myself to "separate" and move on... or else I would have no heart to continue to do what I do.I do not see anything near as extreme as some who work in the ED or ICU (for example) but death is everywhere-- On one hand, it can be a blessing and relief... a privilege to be a part of that patient's care.On the other hand, it can be a WTH happened??... leaving you feeling very disheartened and maybe a wee bit angry.

It DOES get easier with time. Usually my first question when someone tells me that their patient died is "Were they old?" The younger ones, the traumas, the cancers, the unexpected ones are the ones that take a little more emotional reserve to deal with. A few silent tears as you're comforting family is ok...if you feel that you're going to break down, though, that happens in private.

You are very lucky if, at 31, you've never experienced death. No grandparents, great aunts and uncles, no tragedies in high school or college, no friends' parents? As far as whether or not it should be a prerequisite to a nursing program, no one can predict these kinds of circumstances and I would honestly hazard to guess that the vast majority of people have experienced some kind of loss by the time they are old enough to enter nursing school. I had MANY experiences with death long before I became a nurse- I remember when all my great aunts and uncles died, my elementary school principal committed suicide when I was in the 3rd grade, I had a cousin who had some kind of fatal dwarfism who died hours after she was born when I was 9, I was 14 the first time I was in the room when someone (my grandfather) died, we had 3 deaths in my high school in a period of 3 1/2 years (2 car accidents and a suicide) and all of my grandparents were dead by the time I was 21. I have only ever had to do post-mortem care once, though, and it was when I was an aide and it was a patient with metastatic lung cancer who died very quickly. I have been a pediatric nurse for 5 years and I have long since lost track of all the children who have passed in that time. We would sometimes go months without a patient's death and then lose 7 kids in the course of a few weeks. It DOES get easier with time. I probably commented one of the pediatric threads you were referencing and I do find it to be a relief when these children are free of their earthly bodies and all the suffering they've endured. My best friend's father died suddenly of a heart attack earlier this year at the age of 58 and I found that to be much more emotionally challenging than the death I regularly experience at work, even though we're talking about kids there, because those kids are suffering.

Death didn't bother me like I thought it would. I actually stood right at the bedside of the first woman I saw die. I watched her die....and kept feeling her pulse just to see how it changed...until it stopped completely. That sounds morbid, but I was actually standing there to comfort her because her family wasn't there. I didn't cry. Some of the nurses around me were crying and one of them said, "I can't help it. I cry every time." I thought I must not have a heart or something because it was the first death I witnessed and I didn't get upset. It shocked me actually because I've always hated funerals and the thought of dead people in general. However, I had the same experience Hygiene Queen posted about dealing with the family members of the person dying or who has just passed. I remember standing in the room while a doctor was answering questions for the mother of a 42 year old patient who was on a ventilator. She asked if the machines were the only things keeping her daughter alive and the doctor said, "yes." I started looking up at the ceiling trying not to let any tears come out and then I excused myself to go get some tissues for the family. It killed me to think how awful that would be to hear as a mother and since i'm a mother it was even harder. It's okay to cry...like in the example I just posted. If you can tell a mother her child is dying or just passed and not feel their pain (because that's the worst pain i've ever witnessed) then i'd question if you have a soul. It's okay to hug them too. Then, as the others stated, you have to separate yourself from the situation and gain your composure. In reality, you are still going to have other patients who need you and more than likely they'll be putting someone else into the room of the deceased asap.

Quote from kelrn215[color="#0000ff"]you are very lucky if, at 31, you've never experienced death. no grandparents, great aunts and uncles, no tragedies in high school or college, no friends' parents? as far as whether or not it should be a prerequisite to a nursing program, no one can predict these kinds of circumstances and i would honestly hazard to guess that the vast majority of people have experienced some kind of loss by the time they are old enough to enter nursing school.

As a new LVN 11 years ago, I was ashamed of my tears regarding a patient's death. One terrific, seasoned LVN told me, "Honey, if you lose the ability to cry at a death, grt another job". Her words were such a comfort to me; I practice that philosophy to this day.I agree: death is part of life and often, it is welcomed or a relied to the patient or family. In those cases, I am not affected so badly.But when it is an unexpected death or the death of someone I have grown "close" to, I shed tears---often a lot! (I am very sensitive and emotional--just part of who I am)I have cried about a patient, with a family, doing postmortem care. But I have never allowed my tears to overstep a professional boundary if there is anyone else present. I would NEVER place the burden of consoling me on a patient or family. But the families understand and appreciate my compassion. Who wants a totally unemotional, unfeeling caregiver?Each patient or person that dies WAS an important, special human being. Doesn't that mean a frw taers are okay? I think so.

Quote from ixchelbut then i thought about the critical patients that might be there for a long time, and how things will feel different going to work and not seeing them there anymore because they've passed. this is what made me realize i've never experienced death before. i don't know that i can handle it. i don't know how that next day at work will feel. i don't know that it wont destroy me inside.for me, its not like that. you may have someone for a long time, and room 405 may be 'ruths' room even after her passing. but room 405 will soon have a 'jane' and she needs your help too. at work you don't really have time to keep greifing because you have more patients to look after. when someone dies, you can cry, it is okay. but then you move on. it not the same as loosing a family member. however there are always a few that will hurt more then the rest. what were your experiences with dead you experienced it in your personal life before professional? how do you cope with it now

Death isn't the TV death. Death is as natural as birth. There are deaths that are sadder than others or more traumatic to be a part of....you will cry sometimes, you will be sad sometimes, and sometimes there is a sense of relief that they are released from their tortured existence. There will be times you will cry all the way home. There are certain deaths that I have never forgotten. They remain forever etched in my mind for one reason or another whether is was horror, sadness, tragedy, the family. Each unique and have meaning....to me. I have even cried with families but when I say cried...... I mean those few tears that slip slowly down your cheeks unchecked because you just can't stop them. That heartfelt, heart wrenching, soul clearing cry has to be saved for your private time. Families will look to you to set the tone or use your strenght to bear the next few hours for they need you as well. I have been in an ED code while everyone.....while working furiously to save someone....have tears in their eyes and on their cheeks for the sadness, futility, and heart wrenching tragedy of it all. But we continue to do our jobs working furiously to save a life.I remember the first child I removed from life support when brain death occurred after fighting furiously for a few days to save her life. I will never forget her name, her hair, nor her mothers sadness. I will also not forget that when the coroner came and I had to place her in the coroners bag...when I went to zip it up......I LOST IT! I couldn't do it....I couldn't stop sobbing. My co-workers were stunned, took me from the room and care for her because I couldn't.Not every death will affect you so strongly. Some areas of the hospital are more prone to the "tragic" and frequency of death. I happen to be all 34 years except for about 6 months critical care and emergency medicine.It will get better for you. I won't say easier because it really isn't always "easy". But yoru skin will becime thicker. I was 18 years old when I graduated nursing school. Thre were many things I had neve seen nor done when I began my nursing journey......If you know what I mean.Nursing has taught me a lot about "Faith" and "spirituality" and how I and others find their path to comfort. I have learned amazing traditions and religious customs over the years to from candles, open windows, covering glass to prevent souls from becomming lost, or to celebrate the passing and to assist the grieving of the living. I remember my father in law refusing to leave my mother in law for he feared someone would steal her soul (old country)...so I stayed.If it's being around a dead body....I remember some aides I used to work with who were particularly "frightened" of the dead, culturally from the Barbary coast or Jamaica for example....and I reminded them it's not the dead you should worry about...it's the living that can hurt you.Don't worry yourself..when the times comes , hopefully, there will be someone to guide you. If not we're here.

Quote from ixchel...For the black part, I was being fairly facetious when I said that about it being a prerequisite. Obviously that couldn't really be a requirement...

You will totally be able to handle death. It will take some getting used to...but each one will be totally different.For example. I worked at a hospital that had no morgue...if someone died, the funeral home came to get them...well we had the guy all tucked in waiting for the funeral home. and they were taking their time.. I kept looking at him and I finally had to go put a pulse ox back on him because I was convinced he was breathing...yeah, not so much...I've left a room once, when a cyclist came in hit by a car and after a few minutes I realized I knew him...that was the worst. But most of the time, I just try to focus on what I can do to help the family...

Quote from Hygiene QueenMy first patient death was an elderly woman who had breast cancer. The cancer had eaten a hole through her breast and it was rather ugly.I did not cry because it was a relief for this woman.I also reminded myself that this was going to be part of my job, so I needed to learn to deal with death in a detached way. I couldn't be sobbing over every death. I needed to do my job.If I did cry (and I recall doing this only twice), it was the pain of the surviving family members that broke me down and I had to retreat to the utility room to suck it all up, take a deep breath and carry on.Most of the time, I felt a sense of awe with the fact that I was there when the patient died and that I was responsible to make sure I handled the deceased with respect (whether I liked that patient or not).There is something undescribable in the awareness that I was a part of the patient's last moments and I was doing whatever I could to make those last moments as comfortable as possible.To me, that is huge.This was when I was a CNA in a nursing home and working for myself as a private-duty aide.Overall, it is no good to fall over in a heaping sobbing mess.The patient needs you to keep it together to provide good solid comfort care and the family needs you to keep it together to give them some much needed support.You need to be able to do your job.I did have one younger woman who died unexpectedly (in psych) and it hurt us all.Her problem was medical and it still bothers me today as I wonder about the preventability of it.She had a young son (who was the same age as my boy) and I remember him visiting the day before she died.It was bad enough this poor boy's mother was so mentally sick, but for her to die (unexpectedly) when he was so young and still needs his mother...This tears me up and I need to remind myself to "separate" and move on... or else I would have no heart to continue to do what I do.I do not see anything near as extreme as some who work in the ED or ICU (for example) but death is everywhere-- On one hand, it can be a blessing and relief... a privilege to be a part of that patient's care.On the other hand, it can be a WTH happened??... leaving you feeling very disheartened and maybe a wee bit angry.