Dealing with Death

After my husband died, I went into nursing.

Seems like an odd choice of careers – after spending 159 days watching my husband get better, get sicker, get better, get sicker and finally die – that I would choose a profession that would force me to watch people get better, get sicker and die.

I’m a Licensed Practical Nurse now. I work with people who are mostly stable. My scope of practice says that I deal with patients who have a stable, predictable state of health.

Except when I’m a part of a code team.  The code team deals with trauma, cardiac arrest and other life threatening situations.

The hospital I work at allows LPN’s to do 1 of 2 jobs on the code team: compressions or record.

In order to record, you must have taken a course – which I have not – so I frequently am the compressions person. (Or code white – but that’s a different role)

At 0625 this morning, Code Blue was called. ETA 5 mins or something like that.  That means – 3 of us from the floor are running to the ER prepared to try to save someone’s life. And we ran. And heard the 2nd call – Mat (something I didn’t hear) Stat.

On the elevator, waiting to go to the 1st floor, we talked – was the Mat call related to the Code Blue? We hoped not.

We were wrong.

This was my first code where I was responsible for compressions.  My first code where I was not a student, or a new grad or anything but JUST ANOTHER TEAM MEMBER.

And my job was as important as the others. I was part of the team.

The report we were given when we got to the ER?  14 day old baby in cardiac arrest.

W. T. Everloving F?

My brain raced – do I remember how to do compressions on an infant? I didn’t get to do the NRP – will I be enough? Should I excuse myself? Could I handle this? Tears were welling up in my eyes and the baby wasn’t even there yet. How can I possibly be an effective nurse, an effective member of the team when I can’t control my emotions?

And then they arrived. I watched the EMT perform compressions. I took several breaths.  Waited until they were done report before tapping him on the shoulder and letting him know I could take over.

And then I did.

And my world narrowed to just what I was doing.  Trying to focus on the tiny human in front of me, willing her to breathe on her own, her heart to beat on its own. Listening and watching the RN’s around me do their job with amazing precision and execution.  Watching the doctor and the nurses move together like a well orchestrated team.

And I was doing my part.  Ignoring the cries and heartbreak of the parents behind me, beside me, in front of me. Because the moment I allowed them to penetrate my consciousness – my emotions came back.

We worked on that baby for 43 minutes.

43 minutes we kept going – hoping beyond hope that we weren’t too late.

43 minutes.

That beautiful little girl did not get to see her 15th day. She won’t get to see her 1st birthday, her 16th, have kids, get married, break hearts. She won’t get to learn to crawl, walk or talk.

It’s moments like this – that I question my ability to be a nurse.  Moment’s like this that I wonder if I have the emotional fortitude – especially given my own trauma and grief – to carry on and support the families of those who die.

I walked out of the ER, down the corridor and was overcome with big ugly cries at the elevator.  Grieving for a life cut short.

I got to the top of the elevator, grabbed my stuff (end of shift and all) and got to the staff entrance to the parking lot and just outside, my knees buckled… more big ugly cries. Grieving with the parents who have to face life without their child.

In my car – crying on my way home – pull into my driveway and bawl. Grieving for myself having spent about 1/2 those 43 minutes hoping for a miracle.

I will cry over this little girl – who’s name I never got – for a while. It will make me a better nurse, better caregiver. I will learn the things I want to learn and do and be because we learn from the mistakes we make, the situations we experience and the things we do in nursing.  We don’t learn from books -we learn from experiences.

I wonder.  Did Mark’s nurses cry with me when they got off shift?  Did they grieve? I like to think so. They’re who inspired me to become a nurse – and I can’t imagine they were not affected by what happened.

I get it now though. I remember asking at the beginning – how do you separate feelings from work?

You just do.  You stuff it into a box, and let it out when you’re in a safe place and can feel.

Because when you walk away from the tiny human who doesn’t get to go home… you still have a job to do – and the rest of your patients need you.

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The Patient who Died

In my very short nursing career (super short! I’m not yet a licensed nurse!!) I have been a part of 3 deaths.  3 deaths over 2 years of theory and clinical.

Two were very expected.  The patients were on palliative care orders, they’d had a decline and death was expected.  I cried a little, moved on and continued my day without much pause.

The third and last (latest?) was not.

He wasn’t expected to die.

His death was not only unexpected, it was unusual and traumatic.

An artery blew and he bled out. He was my patient. I had sat him up for breakfast, and 45 minutes later I was walking by to get another patient a drink and saw him slumped over.

His bed was covered in blood and non-responsive.

I discovered this.

I didn’t respond well – there were things I didn’t do that I should have, and there were things I shouldn’t have done that I did.

I learned so very much from that man’s death.

I walked out of the room as they were continuing the code and thought to myself… what did I miss? What didn’t I do right? What could I have done differently?

The answers?

Don’t leave the patient.
Hit the emergency button.
Put oxygen on the patient.
Open the IV to run a bolus.
Look for the bleed.

The last two are probably interchangeable. Stopping the bleed is important but getting volume back into the patient is important as well.

So I learned.

And now… the grief has hit me again and again.

I talk about it, and I cry. I think about it, and I cry. I’m blogging about it, and I cry.

It was the first traumatic death I’d experienced. And in the words of the nurse who was working with me… it was VERY traumatic.

My husband’s death wasn’t traumatic like that. It’s not reminiscent. It’s only reminiscent in that it wasn’t an expected death. We expected Mark to get better.  He didn’t. I expected the patient to get better.  He didn’t.

I am grieving over this patient who’s name I don’t fully remember (just remember his first name) and his death.

People tell me it’s normal. That I will learn to adjust. That it will stay with me. That I learned from it and from this point on, I will ALWAYS remember to check my emergency equipment, hit the emergency button and put oxygen on a patient who is suddenly not stable.

But I’m grieving.  And I’m sad. And I suppose it will eventually be a part of me. I’ve also been told that if I wasn’t compassionate and caring – I wouldn’t feel this. But in the meantime…

I grieve.  For the man who’s last name I can’t remember. For his dog.  For the children who lived across the country. For a death that shouldn’t have happened even though I know that there probably wasn’t anything anyone could have done differently to change the outcome.

The images in my head flash randomly.  The memory of his voice haunts me. And I grieve.