rather down post

Sorry but this is a rather depressing post but I just need to clear this out of my system.

As a nurse I strive to save lives and it is a fact of life that everyone dies someday.

It has been a very tough month- I have had three patients pass away (one on my watch, two after I had went home).

The most recent death has hit me harder than I expected. I can't speak much about the patient but what I can say is they developed aspiration pneumonia and had an acute exacerbation of CHF.

I have never heard someone speaking and their voice is gurgley and they sound like they are speaking under water because their lungs are literally drowning in excess fluids and aspirate (the family gave orders to let the patient continue eating despite failing a swallow-evaluation with recommendations for nothing by mouth- they felt it was a quality of life issue). Despite the best suctioning I could provide I wasn't able to handle it on my own.

I called respiratory therapy and had them suction the patient- you know what they suctioned out of the patient's lungs?

Not just fluid... but tuna fish which is what the patient had for dinner. Yes folks- the patient aspirated tuna fish into their lungs.

Anyway, after respiratory left the patient was back to sounding gurgley and having trouble breathing by the end of the shift. I sat with the patient holding their hand while the patient kept on mumbling "I am going to die", "I am scared" and mixing in prayers (this person has dementia and for them to recognize their impending death is humbling). The patient held my hand and didn't want me to let go. I felt terrible leaving the room but I had to check on my other patients. The patient eventually fell asleep (they had a lot of trouble sleeping earlier in the night and I was betting the patient was exhausted) and I kept on checking on them to make sure they were comfortably sleeping and still alive.

I knew the patient wouldn't last too much longer. Since this person wasn't on full comfort care measures I was able to provide more suctioning, a one time does of IV push lasix to hopefully get rid of some of that excess fluid, and some low doses of IV morphine to help with breathing & pain. If the patient had full comfort care measures I think I would have felt better about this whole situation.

I went home and the patient died later that day. I was happy to find out that in the morning the doctors talked with the family and the patient was placed on comfort care measures.

Still- having seen this person for seven days and didn't know the family or the patient that well I formed a bond.

I guess it is experiences like this that harden nurses for the future.

What I can say right now is that I am hurting inside and just writing this out brings tears to my eyes.