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.

 

She Died

I have said from day one that I need my first death in nursing to be during clinical, so that I had a safe place to process it. I wanted the support of my classmates and instructor to help me go through it.

I’ve been in my 2nd clinical rotation for the past 4 weeks. It was in a long term care facility.  The clients there are residents for the rest of their lives. They are admitted… knowing they’ll never go home.  Most of them have MOST directives of M1.

This means do nothing.  If they are dying, they get comfort care only, no extraordinary measures to save their lives.

Over the weekend, before my last 3 days of clinical, one of the residents had a huge decline. She was put on palliative care. Her daughter flew in to be at her side. They didn’t expect her to last long.

I advised my instructor, and followed the LPN/care aides in her care.  She wasn’t my assigned client, she wasn’t in my assigned “family” of residents, but in the 3 weeks prior, she had been someone I had seen frequently because she sat at the same table as my assigned clients.

One of the first things I remember about her is that she was singing along to the music playing during lunch. She was so sweet.

Her daughter was incredible.  She had taught nursing for many years, and was ok with nursing students watching and learning from the experience.

Yesterday, it was clear that she wasn’t going to be long in this world. I knew that this was my opportunity – that I needed to *be* a nurse in this instance.  I started with a “safe” family member – the son-in-law – and asked him if there was anything I could do for him, and let him know that I was available if he needed anything.  He seemed surprised and grateful that I had asked.

At lunch, a quick conversation with my instructor and having to take baby steps in learning to deal with it, letting her know that I wasn’t hiding from what was happening, that I was taking as much time with the resident as I had before.

After lunch, after feeding one of my clients, I felt brave enough to go in and talk to the daughter.

It was an incredible conversation. We talked about her dying mother.  We talked about my goals in nursing.  We talked about her cousin who’s an ICU nurse. We talked about her cousin’s daughter who was in ICU for the same thing that Mark was. We talked about books.  We talked about the waiting game.  We talked about my experiences with Mark and what killed him.

And I stood there, talking to a woman who was about to lose her mother, and I didn’t lose my composure.

My biggest fear: I was scared to approach any of the family and burst out in tears. I was scared I wouldn’t be able to maintain any sort of professional demeanor.  I was afraid that all the emotions and feelings and memories would overwhelm me and I’d breakdown, again, at clinical. I was afraid I would be unable to maintain the professional buffer of emotions I needed to be an effective nurse.

I am that person that confronts my fears, steps into the chaos to find the pattern and doesn’t hide from potentially painful situations.  When I am ready to face them, I step into them full force.  My counselor has called me the most self-aware person she’s ever worked with.

I confronted them yesterday.

And today she died. I had said to a friend of mine that while death sucks, we knew she was dying and could she please do it in the morning when there was time for me to learn from it?

Then, she died.

I had checked on the daughter almost as soon as I came in. Let her know that I was there, and was there anything she needed?  There wasn’t.

15 minutes into my shift, one of the other care aides came out asking for a nurse to come pronounce. I immediately walked back to the room to comfort the daughter. I needed to put myself in that space. I needed to confront that fear of what would I do if a client died?

I was there for her. I spoke to her and offered comfort, and stepped out when I felt appropriate.

I went with the nurse to help prepare the body.

I went with the nurse when the funeral home showed up to pick her up.

I watched as they pulled her over from the bed to a stretcher and zipped the shroud around her.

I watched as they covered her in their blanket.

I watched as they covered her in the dignity blanket.

I watched as they wheeled her past… and I hugged the daughter briefly and told the story about how the first time I met her she was singing along to the music.

I was able to face the one thing that terrified me as a nurse, and I was able to do it in a way that helped me to care for the client, the client’s family and myself.

She died today.  And I was able to learn from that experience. I was able to face fears. I was able to watch, remember and move forward.

I will always remember the sweet woman who sung wordlessly to the music that was playing on the radio, while eating her lunch. She may have died, but I will always remember her. In her last moments, she made SUCH a huge difference in my life.  For that, I thank her. And while I will maintain her privacy and dignity by not naming names, I will keep her in my heart forever.

Grey's Anatomy

Good, Bad, Ugly

How do I express the way the last 2 weeks have made me feel?

I got all heart stupid with the Metalhead Poet (he’s not MY Metalhead Poet, and he doesn’t want to be).

I got all triggered and shit over school.  To the point where I question whether or not I should continue the program.

How can I be a nurse if I can’t even get through the course without it throwing me into grief triggers?

I was bawling in the counsellors office.  I have moments where I am absolutely positive this is the path I want to take.

And then I’m shaken by something.  Or I hear something about my summer job.  And I’m devastated that I won’t be there this summer.

I didn’t know how HARD this would all be. I didn’t know that I wouldn’t be able to just breeze through it.

How could I have thought I would?   We’re talking about DEATH.  And HEALTH. And HEART conditions.  And fuck me really? Grief and death on day 1?

How could I have thought it wouldn’t trigger me all over the fucking place?

Oh wait. I just thought I’d grieved enough.  I just thought I’d gone through enough.

If I quit, I lose funding.  Do you know how much THAT sucks?  I lose the opportunity to go to school. I lose the opportunity to do good.  To do different.  To have a life that will make a difference in my kids’ lives, for other people.

And so tonight… I am alone. I am lonely.  I am drinking wine.  And time is slipping past me as I walk through the pain and emotions.  I am not studying for mid-term 1 tonight.  I should be.  But I’m hurting.  And I’m not studying.

And I’m fucking ANGRY that he died on me.  ANGRY that I’m left alone.  ANGRY that the man I love doesn’t love me enough to say FUCK YEAH! Lets DO this!  And I’m ANGRY about it all.

I need to get back to a place of “ok with just me” because I know that when I am in that place… I am good. I am at peace.  I am happy.

I want to be happy again.  I want to enjoy things in my life. I’m tired of being angry all the time.

Because I don’t fucking appreciate this:

Stages-of-Grief