When my patient dies, I try my hardest not to cry. I try to look composed and act all professional as I deal with the paperwork and flurry of phone calls that comes with a patient expiring. Most of the time, a pool of tears threaten to spill down my eyes as I try to swallow that big ball of sadness going up and down my throat. Sometimes, a tear slips down quietly unnoticed. I quickly wipe it away.
I may have been a nurse for more than ten years and you would have thought that dealing with death and dying is all but normal for us. Yes, it comes with the job. It is part of a nurse’s world. We even studied post mortem care in nursing school. And you would have thought that four years in nursing school would prepare me for that too.
If a very sick patient does not get better, death is inevitable, everyone knows that. Heck, death is a part of life itself! Easily said. But not when it is YOUR patient. Not even when that patient is a DNR (Do Not Resuscitate). Not even when hospice care is involved. What will I say to the family members? Is hugging okay? Offering tissues perhaps?
But why do I get affected that way when I do not even know this person, at least, not personally? I do not know their families, what kind of lives they have, their issues and conflicts, their hopes and dreams.
All I know is that that patient expired on my watch. Maybe, there is a feeling of guilt attached. That I was not vigilant enough. That I didn’t take care of him enough. That I didn’t do enough. Be it an expected death or not, I always, always find it hard to do THAT phone call, especially in the middle of the night. I don’t know how surgeons or physicians break bad news to patients and families. They just do it.
Of course, it is harder if it was an unexpected death or say, the patient coded (either from a respiratory or a cardiac arrest) and the code blue team (that amazing team of doctors, nurses and respiratory therapists) is busily resuscitating and has been for several minutes now, the prognosis looks dim as the patient is elderly and has a multitude of medical conditions to begin with, and we do not know for certain if the patient is going to survive being intubated and sedated with a million other IV drips going, or if he does, for how long is he going to be this way. These are ethical questions and dilemmas that we as health care providers face everyday. And when that situation arises, you, as the primary nurse taking care of that patient being coded is responsible to call the next of kin and let them know what is going on. In short, you have to ask them what they want for the patient’s best interests. If they want everything to be done, then so be it. The team will work their hardest to succeed and let the patient live another day. If the family wants enough and no more has to be done (at this point, the patient has suffered maybe more than enough), then the team stops all resuscitation efforts and let nature take its course. However, that call that you make to the family is as close to or almost exactly the same as telling them that their beloved family member has passed away. And it is never easy for me.
More often the public may see us as calloused, hardened people. We talk about the grossest things, especially when eating. We laugh about the silliest medical jokes which others may perceive as offensive. We act like we do not care at all when the truth of the matter is, we are affected deep inside to our very cores that to show emotion would mean having to break down our barriers that we have ever so carefully put up and then not being able to deal with the situation in an objective manner. Everything we do at work has a purpose.
Even crying just a little bit at that patient who just passed away.
Nursing is a tough profession. Not everyone called gets to be chosen. I am blessed to be one of them, as hard as it is.
When my patient dies, I also pray that they journey well to the next world.