Dealing with death in the ICU

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    Profile photo of Genabenna

    Working in the ICU, you get used to dealing with death. Most of these patients are very sick, and many of them, you just know, aren’t going to make it. But there are those that are with us for many weeks, with a wife that is just so sweet, you want to adopt her as your grandma and take her home with you, and then the inevitable happens. The PE that had been undetected because the patient couldn’t have a CT with contrast d/t his renal failure, blows during his bath. We work the code, we yell at the patient, “Come on, come ON! Get back here!” And the yelling isn’t for the patient’s benefit. In truth we have never even talked to the guy. But his wife… Oh his wife will be so devastated because he is literally all she has, and you are honestly worried that if you can’t save him, she will be your next patient, that she will follow him very closely and that is just too much to think about. So after the fight, she is there outside the door, sitting in a chair and silently crying, biting her fist to silence her wracking sobs, with no one to call. She begs us all by name, in turn when she doesn’t get the answer she needs, and because she knows every single one of us, “please, tell me its not true, it can’t be true”. And instantly, and because it was inevitable, we have three bad ass, hardened ICU nurses in tears and flocking around this wife who has become our surrogate grandma, trying to comfort her.
    I wrote this this morning, after the worst shift ever, and I wanted to share it because I am still having a hard time dealing…
    Every day we spend in this profession is a risk. We risk losing our patients and we fight death constantly. Sometimes we win, sometimes we lose. With each loss we risk losing a piece of ourselves. We do everything we possibly can, knowing from the start that it just may not be enough this time. But we keep on, even when we know it is futile, because we get to know these people and learn to love them and their loved ones as family. So as you look down on us from Heaven dear patient, please know that we tried our damnedest and think kindly on us as we grieve your passing. And thank you to my fellow troops who are fighting the specter in the black robe, for laughing with me, for crying with me, and for being there to support me, as I do you, when we lose the fight.


    I have no doubt this is going to come out wrong, but this is how I learned an important life lesson … I’m pre-sorry if I offend you or anyone else who reads it.

    I had been a volunteer EMT before nursing and had worked as a “runner” at a hospital during nursing school, which included attending all Code Blues and doing CPR or running things to lab, etc, so I had seen a fair number of people die, but none of them where ultimately my responsibility. After I became a nurse and went to a busy tele floor, I had some of my patients die on me, and even those that weren’t DNR, they were pretty much expected to die, and it was usually a relief when death would come. I had been a nurse for well over a year before I had switched to ICU and had my own patient, who wasn’t supposed to die, code and die on me. I didn’t like it. Kept wondering how I could have prevented it.

    A couple days later my girl friends 8 year old son found her pistol and accidentally shot himself in the head. I was in the ER when the pediatric code came in, so I went to the trauma room and started working on this little pile of blood and brains. A few minutes into the code, while we are still getting everything hooked up and seeing what we have to work with, I see my GF standing in the door. I couldn’t finger out why she was there because she had been low censused that night. Looking up at her and then down at the boy and then back to her and back to the boy it finally dawned on me that I was coding her kid. She came up to me, I’m hugging her with one arm and doing chest compressions with the other arm. Shortly thereafter the MD tells her that there is no way we are going to bring her son back because of the massive head trauma and she agrees to stop efforts.

    After that, I was feeling pretty bad. I had lost my very first patient of my own who wasn’t supposed to die, and then I coded, unsuccessfully, my girl friends son. I was feeling pretty sorry for myself when my brother (an ER doc) called to see what I was up to. I told him I was having a pity party for myself because of the above and he said something I will always remember. He said, “You know, if you had been a better nurse, they would both still be alive today.” Gotta love family! In his own, ER doc, kind of way, he was giving me a message. He knew there was nothing I could have done about either of the cases and that I was a good ICU nurse. By stating that both were my fault, he made me get a little defensive and realize for myself that they weren’t my fault. People die and sometimes there is nothing you can do about it.

    I still felt bad, still had a GF who had just lost a son and needed my support more than I needed to feel sorry for myself, and I still needed to show up for work prepared to do it all over again. Seeing too much death does take its toll on people, so find ways to cope with the grief (and no, pushing it deep down into your soul with hopes that it doesn’t stain too much does not count.)

    Yes, we need to be there for the family members right after a death of a patient, but be there for yourself and your coworkers after that is taken care of. Too often I see people just walk away with their heads down, pick up another chart, and continue about their business as if nothing significant had just happened. If it is busy, sure, you have to do that sometimes, but before the shift is over, touch base with everyone who was there and make sure they aren’t blaming themselves or remembering the death of a loved one who looked just like the patient that died, or other sources of pain and anguish.

    Remember: If you were a better nurse, all of your patients would still be alive today!

    Profile photo of Genabenna

    Thank you Jason! I certainly am not offended by anything you said. For me, it takes a decompression session with my coworkers, and then one with my family to remind me of a few reasons why I keep going back. Not every death hits hard, and some are honestly a blessing when they go.
    I can’t even imagine how you dealt with coding your girlfriend’s son. Such a crap situation.
    Thanks for your feedback!

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