Do You Remember Your First Patient Death?

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Beth

Beth

The reason I’m asking is that over the last few weeks, Patient Advocate and Author, Martine Ehrenclou and I have launched a new blog duet, called Real Stories From the Streets of Healthcare and our first topic we discussed was entitled “Time for an End-of-Life Conversation?”.  We had many skype and email conversations as we took turns contributing to a dialogue about the topic that we knew would eventually become public.  And for good reason, as hard as it is to talk about, holding conversations between healthcare professionals and patient advocates seems vital.

Anyways, I shared some nursing stories with Martine and she shared some of her experiences with her Mother, GodMother, and Uncle that involved so much suffering.  Over the course of our conversations and shortly after, I began to remember different patients and their deaths and wondered if we talk about ‘it’ enough and if maybe we talked about it more we could become more comfortable talking about ‘it’?  And if not more comfortable, maybe ready?

So, I’d like to know what you remember and would share about your first patient death,  (honoring HIPPA and overall privacy of course).

For me, I remember a woman in her 30s who had advanced breast cancer.  She had internal and external metastasis and was on a med-surg floor at a large teaching tears crying hospital where I was in my first year as an RN.  She was on oxygen and morphine and was in and out of a confused consciousness.  She was restless and her parents had just spent some time with her.  My supervisor and I got her up into a geri-chair thinking she’d be able to breath better.  We talked about restraining her and decided against it.  (Back then it was an option, but we felt that it would restrict her breathing even more).  Back out in the hallway at the med cart I heard a crash.  I ran in and she had tried, it seemed,  to stand up but fell and hit her head on the TV in the room.  She was gone.  My supervisor came running in.  I remember her telling me that she thought she had died before she hit the floor because there was so little blood.  That moment of hearing the crash and an intuitive knowing have stayed with me.  I took the next day off and my supervisor called me at home.  I was kind of shaken up and I still appreciate that she made contact with me, but I’m not sure I even knew how traumatic this was.  I haven’t talked about it over the years.  Sigh. It is part of our job and yet it does feel good to share the experience with you.

Thanks for reading.

Beth

This post is part of a nurse blog carnival dedicated to the topic of “End-of-Life”.

blog carnival

This entry was posted in Communication in Healthcare, Complexity in nursing, Diversity, Holistic Health, Listening, Nurse Entreprenuers, Nurse Leadership, Patient Advocacy, Patient Safety, Real Stories and tagged , , , , , , , , , , , , , , , , , , , , , , , , . Bookmark the permalink.

18 Responses to Do You Remember Your First Patient Death?

  1. Heidi Orstad, RN, BSN, CCM says:

    Thanks. Beth. I hold tight to the belief that the Primary Nurse model is why Mary (and all of our kids) felt safe in their care; they trusted us and we knew and honored them. And the team had each other and the leaders the team. I was fortunate to start in the hospital where Marie Manthey implemented the Primary Nurse model in the 1960’s.

    • Beth_Boynton_RN_MS says:

      That relationship piece is so important. The trust and honor as well as continuity of care are all so important. The value of this kind of ‘stuff’ is elusive and hard to measure, but we can feel it and your example helps highlight it.

  2. Heidi Orstad, RN, BSN, CCM says:

    The first passing I had the honor to attend was that of an eight year old girl.

    I was a rookie nurse at the University of Minnesota Hospital on the pediatric cancer unit in the 1980’s. Those were the days when the doctor’s orders were written by hand on carbon copy, the orders were copied onto MAR’s and kardexes, nurses added intake and output on paper records, dietitians calculated and mixed formulas for individual patients, and nurses managed several chemo, blood products, hyper-al, lipids and IV fluid pumps (all while entertaining the agile toddler patients to whom those lines were attached!)

    I learned a lot of the important technical parts of what I would need to know as a nurse while an aide, secretary, and nurse on 7A. But the lessons that stuck the most were found outside the procedure manual: Mary was one of my greatest teachers.

    Mary did not have cancer, but instead a rare lymph-hemangioma tumor in her lung. Mary was 8 years old when I met her and had been through several doctors before landing at the U of MN for what her parents hoped would be the answer to her rapidly spreading disease. A little blonde, Mary was what one might call an “old soul”, and her parents understood well how to honor her maturity. I was
    one of two primary nurses, and, as a team with Mary and her family, we were all on board with how Mary’s life plan was to play out. As part of the unofficial plan to “honor Mary”,
    she learned how to draw her own labs from her hickman catheter (and which labs needed how much blood and which vials). She learned how to change her own sterile dressings, which meds were due when, and how to push her meds into her buretrol. When she needed a painful procedure (eg. interferon injection), Mary was in charge and determined how best to administer the med (with a certain song on the tape player, an ice cube prepping her skin, and a special counting and breathing exercise). Mary found comfort in knowing the “hows and the whys”. If she had those pieces in hand, she wasn’t afraid and her life was peaceful- She
    was honored.

    Mary left this world about a year after I came to
    know her, and I remain connected to her wonderful family 30 years later. I will always remember the lessons learned from this small child –lessons outside of any procedure manual.

    • Beth_Boynton_RN_MS says:

      Thank you so much for sharing your lovely story about Mary and her family, Heidi. Humbling for me to think of this brave little girl and you too. There is something powerful and intimate that you shared with her family and I don’t know, but obviously Mary is not forgotten and your continued relationship with her family seems like a testimony to the experience.

  3. Wow, Joyce a scary memory! And so much so you even considered leaving the profession! I’m glad you didn’t and you got some support from a colleague! Thanks for sharing your experience.

  4. My first patient who died when I was a student died of a medical condition that I cannot even remember. All I remember was I could not sleep that night, I was scared that her ghost would haunt me, and I wanted to quit nursing altogether. The next day, I shared this experience with a fellow student who said she had the same experience with her first death, and encouraged me to carry on with my course. I guess I was traumatized -but with seeing more deaths, It became easier to deal with.

  5. eileen spillane says:

    Beth, this is a great dialogue to get us talking because we all had our first death at some point. I remember mine so clearly as a student nurse with a cancer patient with a spontaneous cerebral bleed. I wrote about it last year, here is the link: http://www.thebalancednurse.com/the-balanced-nurse-blog/how-my-first-death-left-me-perplexed-and-humbled?rq=death

    • Beth Boynton, RN, MS says:

      Hi Eileen, thank you so much for your feedback and story. I think you have captured some vital aspects of our role, our privileged role in our patient’s death and dying in that we bring our best selves forward and be open…really really really be with.

  6. Pingback: Nurse Blog Carnival: End-of-Life Decisions | This Nurse Wonders

  7. KevinandJennifer Jonely says:

    My first death as a student nurse was so frustrating to me. It was a lovely lady, whom I’m convinced knew she was dying but the family refused to tell her or allow anyone else to tell her that she had leukemia and was dying. I, as a very meek and shy student nurse was so angered by this that I actually confronted her provider to talk to him about it. He tried to scare the bajeebies out of me and let me know that it was not up to any student nurse who was mingling in the mix to even think about such lofty thoughts as discussing end of life with this patient. Sadly, she died without the discussion and I came to her empty bed to be informed of her death by other personnel after the internal struggle and failure to disobey what everyone else was telling me to do and obey my gut whom I had not yet learned to trust. After 40 years in nursing I still remember her. I have worked in labor/delivery and beginning of life my whole career but now I provide perinatal palliative care and loss for a population that faces end of life at beginning of life. I know that this patient, the first one, helped to influence my path to where I am today. End of life can be just as beautiful as beginning of life if we would just allow it to be. There is pain in both processes but absolute joy abides there as well if only allowed in. ~ Jennifer

    • Beth Boynton, RN, MS says:

      Hi Jennifer, thank you so much for sharing your story albeit a frustrating one. I applaud you for taking all possible steps that you could as a student nurse to honor this woman’s truth. Why do we think we should keep it secret and create an isolation? Sounds like the experience was profound! I wonder if you or others might share stories about beautiful even if sad death and dying? This seems like it might be very therapeutic for our society? I’ll be thinking if I have any, but you for sure do. No pressure though.

      • KevinandJennifer Jonely says:

        Beth,
        I think about death a lot now in my work. The way I like to describe to others what thinking about it can do is this. When I think of my own death, if I could plan it and have it just the way I wanted it, I would be in my 90’s, having just attended the wedding of my youngest grandchild to the most perfect spouse I could have wished for. I would be surrounded by all of my dearest family and friends and I would be in very soft blankets and there would be kittens, lots of kittens mewing all around me. They would be kneading on me and cuddling me and they would be pouncing on eachothers tails. Then I would like to comfortably fall asleep, the way Ms Maynard chose to do it and be content with life and death. Now, if I contrast that death with one which would be my absolute ‘please don’t let it happen that way’ kind of death, it would be to think about our dear patriots who died on 9/11/2001 and had to choose between being burned to death or jumping to their death in a moment of sheer terror. When I have a family I am working with, I tell them, because we know about this impending death and can think and plan for this death, we might get to have the kittens. What are your kittens? Thinking about death can be a favor, a positive and very life affirming to get to have wishes fulfilled. ~Jennifer

        • Beth Boynton, RN, MS says:

          This is beautiful, Jennifer. I want to make it into a blogpost so a lot more people can read it. It is inspiring and transformational. Do you have a brief bio and pic you could send me and your permission to do so. I’d call it something like, “If I could plan my own death”. Let me know here or write to me beth@bethboynton.com

    • eileen spillane says:

      I agree Jennifer that the end of life can be just as beautiful as the beginning. I also work in OB and if people put as much thought into their death as they do in birthing their babies, we would have a much needed culture change.

  8. Darren says:

    I was very fortunate to have an excellent student facilitator for my first patient death. I was a student nurse on my first ever prac day at a small rural hospital just outside Sydney. After a rudimentary orientation to the ward I was asked to sponge an elderly female patient. My Facilitator must have recognised the look of worry on my 18 year old male brow and volunteered to assist me.
    The patient was a very elderly lady, after all these years I can’t actually remember what her presenting diagnosis was, but it was apparent to my neophyte self that her death was imminent.
    I was shown how to effectively sponge and change the linen on a real patient, somehow doing a quick sponge on a fellow class mate didn’t quite cut it in the real world environment. The patient was barely conscious but regardless, the facilitator spoke quietly to the patient calling her by her first name and politely explaining what we doing to her. After sponging the patient the facilitator and I discussed the patient’s poor prognosis and she enquired about my well being.
    A short time later we were told that the patient had just died and were asked if we would like to help “bag and tag” the patient’s body. I already felt a vested interest in the care of this patient and I agreed to the task with the assistance of my Facilitator.
    Upon walking into the room and viewing my first dead patient, I was initially shocked but then I was equally impressed and in awe of my facilitator’s care. The facilitator walked up to the patient and gently spoke to her, as she had previously and explained to the now deceased patient exactly what we were about to do her. Throughout the whole procedure my facilitator treated the deceased lady with such respect and dignity. I learnt so much from that experience. Over the years I have seen a number of terrible and equally pleasant deaths. And sadly I have had on the rare occasion to care for some of the most abhorrent of humans but I never forgot my first experience and always treated my patient alive or dead with dignity and respect.

    • Beth Boynton, RN, MS says:

      This is a beautiful story, Darren and I thank you so much for sharing it. Your facilitator gave such important gifts and lessons and also to your patient. I think that it is so wonderful that you carried them forward into your work. For your patients and likely for the nurses you work with…a positive rippling effect of dignity.

  9. Lynn says:

    I worked in the emergency room on the night shift and about 3 a.m. each weekend night, there was usually at least one car accident. One family arrived to see their son who had died in a car crash. The father punched the wall so hard that he broke through the sheetrock. The patients sister was a nursing student, and quit school. I heard the father never spoke another word ever again. That death ruined that family. I remember it was the family who was always harder for me to deal with.

What are your thoughts?