[Derick]

I think it may be unfortunate on my part or a blessing I don't know, but I guess i have kind of numbed myself. Death doesn't bother me anymore. When I first started the nursing school I worked as a health care aide in a long term care facility, I had lots of people dying around me and at the time it bothered me a great deal, I have a large amount of compassion and empathy and although I hate to admit it the smallest things pull on my heart strings.

But in November of 2001 my mom and dad asked me to move home as my dad was dying of cancer (his 5th tumour it was found in his lung, he had battled cancer since 1989 undergoing operations to remove 4 brain tumours ever 3-4 years). They asked me home as they knew I had the training from school to be able to care for my father who wanted to pass away at home. I agreed and set school aside and moved home. From then till the day he died I was basically, with the help of my mom, was his primary care nurse every day from November to January. I cleaned him when he was incontinent of bowel and bladder, I did the am and pm care, mouthcare, dealt with his medications and IV, had my finger on his pulse when it took its last beat, and helped the man from the funeral home load him in a body bag and lift the stretcher into the back of his car. Not once did I shed a tear from November until the funeral directors car rolled out of the driveway, then it was so overwhelming that I cried uncontrollably for well over an afternoon. Then that was that. I cried one more time when I read his euligy at his funeral.

But since that time, when a pt. or resident has passed or I have heard of a friends relative passing, I have not felt one ounce of sadness over the death. To be honest it bugs me it just doesn't feel normal to not feel something, anything when a person passes.

[morticiamom]

I would go with your intuition--since it "bugs" you, that you don't feel anything, that may mean you haven't finished grieving, that you are "stuck" over some issue. These things have been known to come back and bite people in the emotional buttocks if not dealt with. Local hospice services have bereavement counselors that might help, and there is also the ubiquitous EAP. I never liked counseling (going through it felt like having an emotional debridement) but I learned that the alternative was worse.

[mercynurse]

Judy,

I think we all have this happen at one time or another.
I'm able to vent and have a significant other in critical care also so he truely understands. If you have a close friend or collegue that would understand what you're going through...try. If you're able to vent.
Another alternative is the web sites and groups avaliable. When my spouse died, I was lost and floundering. I found great comfort and support form a web site called INDIGO...it's a site relating to loss in your life.

Hope this helps.

Bonnie

[Pat]

Hi Baby Nurse To Be,

I just wanted to provide a quick response to your note. Long ago (more than 20 years, that's all I'll admit to) we were taught not to get emotionally involved with patients, modern schools do not teach that nonsense any longer. I think one of the strongest attributes in a great nurse is the ability to empathize and become involved in their patient's lives. To this day, I make sure I become as involved in every patient's life that I can. It helps in your assessment, in helps in your planning, and it helps your outcomes. The better you know a patient, the more likely you'll choose options that will work!

An important part that must be learned is compartmentalizing this. You must be able to leave it at work, otherwise it will lead to many negative outcomes for you. None are certain, but you'll look at burnout, or even worse, not caring and seeing patients as nothing more than tasks that need to be completed before the end of your shift.

Finally, I like all nurses and doctors I met early on in my career, did not accept dying. We often tend to provide less care to dying patients, albeit unintentionally. Justifying our actions with a thought something like..."the patients that will survive need my care more"....or "at least I can do something for that patient". After more than 20 years of nursing I took some formal training in palliative care, I cannot tell you what a profound difference in made in my care and understanding of our role as nurses. Dying is every bit as important as any other part of our life and it's something that we can all be assured lies ahead in our future. The care you provide for a dying patient can indeed be quite gratifying. One of the most important lessons I learned was that no one, let me repeat, no one should die alone. If you can do nothing else for a patient but be there and hold their hand as they take their last breath, you have provided a great comfort and level of care. It is sad to think someone could spend a lifetime at work, family, etc., and then die utterly alone. Could there be a more final statement that your life meant nothing?

Best of luck to you as you continue your training. I have and will always love nursing.

[udali]

I once worked L&D. Having had an infant of my own die, I found it very hard to deal with miscarriages and stillbirths, but I found that I was more able to help the mother's and father's in my care than some of the other nurses who had not experienced such a death. All I had to do was say, "I understand, I lost a baby, too." And if I cried a little with them, that was understandable. Don't be ashamed of your tears, you are a compassionate nurse and your patients love you for it.

[1mg.epi]

My first code in the ER was a infant. I cry when I talk agout it still. That was 15 years ago.

[udali]

While a student nurse I was working at a local hospital. They called a nurses aid, and paid me as one, but I was doing total patient care, and before I had graduated from nursing school, I was charging the unit. While I was working there I got an inordinate number of death and dying patients. I came to realize that death is as beautiful as death in some circumstances. I learned to be thankful to the patients for sharing their last days with me.

After graduation I returned to working in the OR. There, thankfully, I have had fewer patients die, but there have been a few especially painful instances. One, I even went to a counselor about. I finally was able to work through my pain and anger by writing a poem about it.

[smbrn]

I currently work in adult medical oncology. We also care for hospice overflow patients. Helping a patient and family during the dying process is not particularly hard for me, but I have been a nurse for a long time. The most stressful deaths I experience are the ones when the patient has been in numerous times, is relatively young, and you see that whole process take place; the initial stunned disbelief followed by trying to find a source for hope and clinging to that, and at some point the realization that life may soon come to an end, leaving behind all its beauty; children, grandchildren, spouses; grieving for days that have not yet come; the wedding of a granddaughter now just six years old. There is so much loss. Many times when things are over family members will tell me they don't know how we nurses do it. I try to tell them it is an honor to be allowed into such a private aspect of their lives. For myself, though I am not a religious person, I try to remember that it is better to have done something than to have feared my own feelings so much that I am powerless to do anything. Sorry if that is too long.

[nursinghumor]

The worst is when you've got a sick dying patient ready to go, and a family that keeps insisting that everything be done to keep them alive.

I respect doctors that will fight for a morphine drip when indicated and let the families know that it is the right thing to do.

Many cave into the families and go right a long with them prolonging what turns out to be a slow painful death.

Andrew Lopez, RN
http://www.4nursing.com

[smbrn]

In reply to Andrew, this is kind of sick, I know, but also funny. We had a patient who was actively dying. She had a very hostile family. You probably know the kind; they watch everything you do with suspicion, etc. Well, along comes some estranged son who had been out of the picture for quite some time and he decides he wants a second opinion! I couldn't believe it! The woman was literally gasping her last breaths, etc. His wish was granted and the second oncologist agreed, of course, that she was terminal and only comfort measures were warranted. Still, I was stunned at the request. I actually find, in regards to physicians recommending morphine drips, that it is the physicians themselves who are reluctant to go that route. Our oncologists are quite good about preparing patients and families for the possibility of this coming up, but our medical doctors are just awful about it. More than once I have had to recommend that family members go to the ethics committee or the chief of medicine if they feel that the medical doctors will not honor their wishes.