My First Heartbreak as a Nurse

The first patient I watched die taught me that nothing in nursing school prepares you for it.

A hospital shift runs on "expect the unexpected." One moment everything is controlled, and the next you are running like the world is ending. Since nursing school I had dreaded the ER, the ICU, and the NICU, because I was afraid of seeing people die. Four years of training and I still had not beaten that fear. I empathize too much, and I feel exactly how hard it is to lose someone. So when I was hired and asked where I wanted to work, I chose the ward. There you talk with patients, learn their stories, and most of the time you see them recover and go home. I found that work therapeutic. Watching a patient die in front of me was something I never thought I would have to do.

Then I admitted an 83-year-old man with pneumonia. His family called him Grandpapa. We will call him Mr. Smith. He had been a pastor, and he had lost his wife the year before.

Two days after admission, Mr. Smith was moved to the ICU. After a short recovery he was transferred back to a regular ward under my care. He was bedridden and needed total assistance, so I kicked my care up a notch. I made my morning rounds with extra attention, checked his vital signs and his LOC, gave his standing medications through a nasogastric tube, and stayed close whenever he needed something. Shift by shift he seemed to improve, then he started declining on the fourth day.

I was checking the patency of his NGT when his breathing stopped for about five seconds of apnea, then broke into a series of rapid breaths. Cheyne-Stokes. I assessed the gastric residue from the NGT and it was tarry black. I called the resident on duty to reassess him. My shift was about to end in an hour, I was hungry and tired, but you do not walk out on your patient. Your patient is your responsibility.

I relayed my findings, and the resident suspected an upper gastrointestinal bleed. She ordered gastric lavage with cold water to constrict the vessels. Our head nurse stayed to guide me, and a few long breaths steadied my nerves before I started.

We stabilized him for an hour before he declined again. His vitals dropped, his pulmonologist arrived and called for the emergency cart on standby, and within another hour his O2 saturation was falling fast. We called a code. I worked the code and prayed for a miracle. I wanted to believe death could still be avoided.

It could not. The resident looked at her watch and said the words I dreaded: "Time of death: 8:50 PM."

Mr. Smith died in front of me. His chest never rose again after that last breath. His lips and nail beds went pale. His daughters began to cry. I wanted time to stop so I could process it, but everything moved too fast. I held myself together, stepped back to give the family their moment, and made it to the staff restroom before the tears came. Then I could not stop them. Seeing someone die was as hard as I had imagined, and it broke my heart.

I had read about death and dying in my textbooks. We even had a full lecture on it. Living it was something else. Standing there I felt powerless and green. Everything you learned fades when you hear a family wail, and what stays with you is how mortal we all are and how precious life is.

"There I realized that nursing is unfair."

That shift taught me our profession means witnessing the whole cycle of life and death up close. We build rapport, we tell people to beat the odds, and then sometimes we watch them go. You cannot control life or death. No matter how advanced medicine gets, some things are out of your hands, and sometimes it is better to let nature take its course. Christine Bell said it best: "Nurses are there when the last breath is taken and nurses are there when the first breath is taken. Although it is more enjoyable to celebrate the birth, it is just as important to comfort in death."

I did not sleep that night. My head nurse told me it would be okay, but I went home defeated, replaying it and thinking I could have done more. A week later Mr. Smith's daughters came back with a box of chocolates for the staff. One of them found me, thanked me, and gave me a hug I needed.

Death is part of life. You can do everything right and some things still will not go to plan. Life goes on.