The Hard Reality of Nursing: When your Patient is Dying

Nursing is one of the craziest jobs out there, in the sense that you deal with a ton of really BIG situations in life on a daily basis! You’re there when lives are born. You’re there when lives are transformed. You’re there when lives are taken unexpectedly. And you’re there when a family witnesses every single one of these. The array of emotion that this job brings on is unexplainable. It’s like, if you were to google “types of emotion” and every emotion that existed popped up, it should be copied/pasted and placed under the definition of “nursing.” Because that’s how it is. It’s a crazy roller coaster of emotion! 

I’ve been a nurse for 3 years now and have gotten my fair share of patient diversity. I thrive in situations where I am able to talk with my patients and their families. Getting to know them and educating them about disease processes are my strong points. I love being able to go out of my way to make someones stay in the hospital a little better! Whether it be thinking outside of the nursing box, making patients laugh, or just “talking life” in the midst of an unexpected hospital stay. This helps patients and their families. Nursing is amazing and I love what I do, period! But….for the first time in my life, I hit a wall in my care. I couldn’t think of anything I could do to make this situation better for this family or my patient that I’m about to tell you about. I’ve had patients before who have died from the natural death process on my shift, but never like this. This situation was by far the hardest that I’ve ever had to deal with in my short 3 years of nursing. I feel the need to share because chances are, you have or you will experience this too. I want you to be prepared and feel supported. I want you to know that you are still an awesome nurse, and sometimes we need to do just that: be a nurse and nothing else. Here’s my story….

I walked into my shift like I do on any other day. I called the house coordinator at 6:30am to find out where I was placed (Float Nurse). She told me that I was assigned to one of my favorite units! I love floating there because the nursing staff is awesome and the patients are typically very sick. I enjoy this kind of care. When I arrived, I picked up my assignment and received report on my first two patients. Nothing new, just the typical diagnoses and care for that floor. As I waited for the third report, I was looking through my assigned patient’s charts. When I went through the chart of my third patient that I hadn’t received report on yet, I noticed that this patient was very young. I wasn’t much older than him. Naturally, I wondered what he was doing here? I then stumbled upon a “DNR” in the chart. My heart sunk a little. I had no clue why this patient was here or what was going on, but I knew right then and here that this was not going to be a “typical” day on this floor.

I started to receive report from the night nurse. She explained all that had gone on the night before and the patient’s story. My heart absolutely sunk into my stomach by the time she finished. This poor paitent had come in with a very unfortunate diagnosis and things had progressed too quickly. So quickly that the family had to make a decision to make him a DNR within three days of him walking into the ER. HE WALKED into the ER yall, and NOW is a DNR. The night shift nurse also explained that things had progressed so quickly that there really was no plan on board just yet. No palliative care notes. No hospice notes. No nothing. Not only was I having to sit down and plan my care for these other two patients who weren’t nearly as sick as my third, but I had to mentally and emotionally prepare myself for what I was about to dive into. For the first time in a long time, I was scared to be a nurse.

I walked in to introduce myself to the family. It was covered with family members sleeping in chairs and on the ground. I remember thinking “this would be my family” as we are very close knit, too. I quietly and kindly said hello and told them that if they needed anything to PLEASE let me know. Their eyes were tired and swollen from lack of sleep and tears all night long. I walked over to my patient and touched his hand. I remember thinking, “YOU ARE WAY TOO YOUNG!” I held his hand, introduced myself, and laid my head to his bare chest to give him a “hug” and tell him I was going to be his nurse today. I don’t know that he could hear or feel me, but in that moment, I put my game face on and wanted this family to know that I was here for them, and I was here for their son! My shift began….

The morning was quite rough. Lots of agitation and impulsivity. Obviously as a nurse, your first priority is to keep the patient safe. We still didn’t have a “plan” on board as far as comfort care went, but I knew it needed to happen soon. Seeing a loved one in this state, agitated and uncomfortable, you want any relief for them! It makes a family very anxious and they feel helpless. All of these emotions and thoughts are running through their head in that moment. I can’t even imagine how they felt! My heart hurt SO badly for them, my entire shift.

We finally got palliative care on board and a comfort plan. I spent the day suctioning, pushing pain and anxiety medication on the hour, and cleaning up any incidences. This patient was too sick to be transported anywhere else for comfort care and he didn’t have the “time” to do it. That was a hard concept for me to wrap my mind around.

In this midst of this day, I was still dealing with my overwhelming frequent flyer, and my sweet patient with a cancer flare up. To say I was emotionally drained was an understatement. Thank goodness for the amazing floor I worked on and the nurses there to support and help me! I want you guys to know something about me. I dealt with a very similar situation a year ago, except this patient was a lot older. She had no family at her bedside during those last breaths that she took. It was just her nurses. I remember feeling so scared and nervous to take on that patient as the primary nurse, as I had never had anyone actively dieing like this before. With a morphine drip running at 20mg/hr in her final breaths, she passed shortly after shift change. I depended so heavily on my charge nurse that day because I was a fish out of water! That situation scared me, as it was a “first”. I realized this past week that going through that sad situation with that women equipped me and strengthened me to be a strong and confident nurse for this young man’s family! I told myself “I can do this today, and I will!”  I didn’t need to go running to others because “I just can’t!” That’s how I felt the last time. This situation “today” was a blessing to me. Because I was able to be there. I was able to care. There is no right or wrong way to do things in these kind of situations, but I just tried my best to honor the family’s needs and wishes. That’s all you can and need to do.

I did have a breakdown that day about halfway through my shift. The sadness just became overwhelming. I’m so glad this sweet patient had his family around to support him. We nurses know the heart break when family isn’t involved. Thankfully they were there for HIM, so I wanted to be there for THEM. I realized quickly on my shift that they wanted to be very involved in the physical care. They wanted to help suction. They wanted to help clean. They wanted to help reposition. This was them saying “ WE LOVE YOU.” I made sure to communicate with them what their needs were. I asked them permission and explained for everything I did. People just want to understand and be included in these situations. They want to feel that even though they are in the hospital, they are the primary care givers in the end. Not every family is like this, but some are! I completely get it!

Things I learned from this experience:

-When a dying patient has a strong family support, it’s okay to not be at that bedside every second. Families need their time and they will let you know when they need you. It’s not offensive to walk in, get your tasks done, say very little, and leave. Sometimes by just performing your tasks, and explaining to the patient (conscious or not) what you are doing is all they want to see! Don’t feel like you have to over do it with small talk.

-Including the family in care if you can sense that they are wanting to be involved. Some people want to be hands on and take care of their loved one in those final hours. It’s their way of being close and “communicating” with them.

-It’s okay to cry. I told myself at the beginning of my shift that I was going to be strong and be there for the family. They had cried so many tears, and I didn’t want to contribute to that. Well….that was a major fail! I didn’t cry with them, as I wasn’t in the room for long periods of time, but I had a breakdown in the bathroom just from being emotionally drained. It was healthy. It actually rejuvenated me and empowered me to give the rest of my shift my all, because if I was feeling this emotion, that family was most certainly feeling it a million times stronger.

-Ask for help. No one personally felt the emotional burden I had that day, but they were kind enough and smart enough to identify the situation at hands. I had a lot of help from my charge nurse, doctors, the palliative care NP, and the nurse manager. I was very thankful for helping hands and opinions/advice that day.

-Be available. Despite having many other things to do, in these situations, it means the world to the family when you can quickly get to the bedside when needed. These are people’s final hours and I think they see it as “can you just help now, we don’t have long.” It’s hard to drop everything, and frustrating, but give a heads up to your team leader. Again, ask for help. These little things make all the difference to a family, and personally, I WANT to make that difference no matter what.

One last thing….

Not just from my experiences as a nurse but my experiences from life:

There is really no right or wrong way to deal with death. This is one of the most wishy washy subjects in the hospital. Some doctors are really terrible about being honest and upfront, and some are absolutely amazing, transparent, and truthful about a patients prognosis. I’m thankful for THOSE Docs and Palliative/Hospice NP’s and PA’s because we need to understand the death process better. I think being informed and “prepared” is more comforting than the hope of the unknown. Families will mourn and grieve in different ways. As nurses, our presence and intentional care is everything: always treating patients with respect and love, the way you would any sick, alert and oriented patient. Be available to the family. Assist them. Hug them when necessary. Let yourself cry if it happens. Hold your patient’s hand when pushing medications. Ask the family about their love one: what they are like and things they’ve done.

I did the best I could that day. I was scared to death and I honestly wasn’t completely confident with my care. My emotions were so all over the place, and I couldn’t really think clearly. There is really no check list for taking care of a dying patient. My role that day was to support that family and show them that I loved their son and brother! He was MY patient and I was going to take great care of him that day because this whole situation just stunk! I got the best hug from the patient’s mother at the end of my shift! She actually ran down the hall as I was walking out, to come thank me. She hugged me and we both cried! That hug meant the world to me! This patient died hours later. This was one of the hardest shifts of my life, and it really didn’t have anything to do with the physical care.

We nurses never know what we are coming into on a daily basis. It could be the difference of life and death. I do know one thing. Nursing is my heart and it is my calling! I love what I do and I am thankful for every experience! They make us stronger and our hearts bigger! This day was absolutely bittersweet for me, but I can tell you this one thing: I was completely honored and would not have wanted to be any where else, doing anything other than taking care of this family and patient on that day!

Your Heart Is Mine,

Kelsey