Dealing with my first patient death

30 Mar 2011 2 Comments

by littlenursey in Experiences, Placements Tags: acute stroke, cancer, death, dignity, dying, last offices, LCP, Liverpool Care Pathway for the Dying Patient, nurse, nursing, stroke, student nurse

So as you may have guessed, there is a bad side of nursing.
The topic of death may be a depressing one, but I feel it is something that all student nurses must think, talk and learn about. Nothing will ever prepare you for that first patient death – it is something that everybody reacts differently to and deals with in their own way, but it can help to know a little about what to expect and how hospital wards manage death. Of course, some of you may have already experienced a death before becoming a student nurse and know exactly how it works already.
This is quite a long post, but I have included things I feel were very important with my experience.

My experience happened during my first ever placement – I think it was during my 2nd or 3rd week. I was not with the patient when he died, but I was given the opportunity to take part in the giving of last offices for this patient. If you are afraid of dead bodies, it is a good idea to combat this fear by taking part in or at least observing last offices with another nurse or healthcare worker. I myself had seen a dead body before and do not have a fear of them. It can be a valuable learning experience, a privilege and sometimes a way of bringing comfort if one is grieving over the patient’s death.

My first placement was on an acute stroke ward and it was a very heavy placement to say the least. I was definitely ‘thrown in the deep end’ as they say. It is an experience I never forget. The patient (whose real name I will not identify – I will rename the patient as Tom) was an elderly gentleman and was on the care of the dying pathway. He had suffered many ordeals during his last few weeks – several cancers had spread around his body and he needed help with all activities of daily living.

I grew quite fond of Tom – I felt that I had built quite a bond with him and I enjoyed attending to his needs. He rarely had any visitors as his family lived abroad. Being a student nurse, I found that I had a little more time than the registered nurses, which of course is understandable. I used most of this time to assist Tom with eating meals and drinking fluids, ensuring that he was comfortable and settled, and sometimes just holding his hand. Tom told me some things about himself. His wife had passed away some time before he died, and I felt honoured that he could tell me that he wished to die and be with her. He missed her everyday and she sounded like a caring woman who loved nothing more than looking after Tom. Tom was always happy to let me assist in his hygiene needs – it was always a pleasure to perform bed baths, shaving and toileting needs for him as he was very compliant, well-mannered and grateful for any help.

His last days:
In the last few days of Tom’s life, he had become increasingly agitated, distressed and angry. One of my worst memories was when a consultant wanted to send Tom for an abdominal ultrasound scan (USS) during his last few days to see if any more tumours had appeared. Tom was in pain and wanted to be left alone. Myself and the nursing staff were so angry – we found it pointless at that stage and could feel his frustration. We tried to change the consultants mind. Even so, the USS went on and I was chosen to escort Tom down to the USS department. Just me. No other staff from the ward. I was terrified – convinced that Tom would have a stress-induced cardiac arrest on the way. All the the way there, Tom lay shaking his head, desperately trying to express that he did not want to leave the ward and wanted to be left alone. At this stage he could no longer open his eyes or speak. I was absolutely heartbroken and very angry. I did not feel like I had the power to stop this from happening as a student nurse and could only do my best to be supportive to Tom despite what we were putting him through. When the porter left me and Tom in the waiting area, all I could do was stand beside him and hold his hand as he shook his head.

The death:
A few days after Tom’s scan, I began an early shift at 7am. When handover had finished, I went onto the ward to begin my duties. The curtains were drawn around Tom’s bed, so I went over to see him. He was dead.
The nursing staff had been with him as he died during handover, and when he did, they lay him flat, tidied his bed area and drew the curtains. They had folded a pillow in half and placed it under his chin to push his jaw up, so that his mouth would stay closed as rigor mortis set in.
I felt very numb – I did not ask any of the staff any questions as I was very unsure about what I had seen. I continued with my duties.
Ten minutes later a healthcare assistant (HA) came over to me and asked, “Sarah, one of the nurses has asked me to ask if you’d like to take part in the last offices for our Tom. You don’t have to.”
I told her that I would not mind and would like to as it was something that I knew I wanted to do for Tom when he died. She told me that Tom died peacefully and that we were able to begin last offices very soon as no family were coming to see his body.

Last Offices:
Now this is the unpleasant part, and was nothing like what university had taught me (months later) using dummies in the clinical room.
The HA was however very lovely and made the experience very easy and dignified. She gave me some information before we started: 1. That it was ok for for me to want to stop and leave at any time throughout
2. That I can observe instead if I wanted to
3. That sometimes when you roll a dead body over, they can make groaning noises as gas escapes

The last one frightened me a little.

The HA began by opening the window – many people believe that when people die, opening the window allows their released soul to escape. This is not a religious belief but rather a spiritual one.
We removed the pillow from his chin, which had successfully kept Tom’s mouth closed. I had to close his eyes a few times as they sometimes opened (this is possible after death as the muscles relax and the eyeballs shrink). I then removed his urinary catheter and disposed of it. We washed the front of Tom’s body with warm soapy water, cleaned his face and combed his hair, and dried him with a towel.
There was a moment where the HA needed to leave the bed area to go and get more towels. Being alone with a dead body was a strange experience and I found myself staring at his face and fingers to look for any movement. His hands felt very cold already, but his flesh did not feel that different compared to a living person. He looked very peaceful.
When the HA returned we began turning Tom onto his side so that I could wash his back. As we rolled him over, dark green bile poured out of Tom’s mouth and onto the bed sheets below him. This alarmed me and I began to panic. The HA quickly calmed me down and explained that was also normal and that it was just bile from his digestive system. Although we were trying our best to perform last offices in a dignified manner, the HA decided that it would be wise for us to place some tissue into Tom’s mouth to prevent any more bile from coming out as I quickly washed his back. His entire back was already blackening.
Once Tom was washed, dried and presentable, we placed his patient details on his chest and dressed him in a white gown to prepare him for the morgue. Before we covered his face, we said goodnight to Tom. This upset me a little. We then wrapped him with a bed sheet, like a mummy, and waited for the porters to come and collect his body.

The nurse I was working with that day asked me later on if I was ok and offered me the opportunity to talk about the death or ask any questions. I felt fine and could not think of any questions. When I finished my shift and went home, I told my mother and cried. Although Tom died at an old age and in peace I still felt very sad, particularly because no family were present.