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OPINION

Coping with death as a student

  • 11 Comments

Nursing Times blogger Clare Aubrey on dealing with death.

I’d already witnessed someone passing away on the coronary care unit but in the commotion of the emergency, I’d not really had time to take it all in and be really aware of what was going on. The machines, the equipment, the shouts for this and that, the oxygen, the angle of the bed, pulling the curtain round – it all needed dealing with and in that moment every minute task became the most important thing in the world, and quite rightly. However, these practicalities ultimately meant that I couldn’t sit beside the patient, comfort him, calm him or relate to him and I certainly could not mourn him afterwards – there was still so much to do…

I did not realise the impact of this until my second death, which personally allowed me to finally mourn that first poor patient, whose passing had been so fraught. And I finally realised the importance of taking that time to cope with these things, especially as a student. I realised that I’d coped in the first instance through sheer activity but in that, I had not allowed myself any feelings and by the time the second passing came, I had all that emotion bottled up inside.

The floodgates opened when the second person died – a little old lady who had just run out of time. It was inevitable really that I was able to let myself go, despite feeling entirely conspicuous. The staff were wonderfully supportive but I must admit, despite their kindness, I felt guilty about having so much attention on me when this lovely lady had just passed away. I left the area to cry so that people were dealing with her and not spending time comforting me.

However, I did go back to help with the last rites as I thought it was fitting for me, having spent that time with her as she lay dying. It was as the other staff began to put on their aprons and gloves that I realised what had just happened. Whilst the patient had been deteriorating, we had all worn our personal protective equipment, however, I now realised that as the patient had begun to die, we had removed our gloves and held her hands, skin on skin. It was that contact, that touch that had allowed us to feel like we were connecting with that patient and we were there to support her in her last moments.

I realised while reflecting that there must be so many occasions where it’s appropriate to slacken the rules a little, to prioritise support over infection control, to really give the patient the respect and comfort that they deserve. I felt consoled by the fact that as I grow as a student nurse, I am learning to use my best judgement. And this is why placement is such an important complement to university because I am able to see things in a real context, real people with all their problems and baggage. This allows me to see nursing for what it really is – the art, not just the science and now I have faced death and seen how to cope, I hope that I can go on supporting patients in their most vulnerable moments and always choose the best course, not necessarily the textbook one.

  • 11 Comments

Readers' comments (11)

  • Death is a very personal experience, and those who distance themselves from the emotional impact of that life ceasing, should question themselves. I have been nursing for only 20 years or so, and the bond that develops with patients is special - even more so, when they die. Each death is unique - to the individual and to the nurse, there are no two the same. It is an honour to 'be there' with someone who dies, and to subsequently provide the last offices. It makes nursing that patient to a comfortable death all the more rewarding.

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  • During my second year of training I can remember the feeling very privileged to be asked if I wanted to sit with & care for Helen during her last day on earth. Helen was a small 5 year old who had fought Leukaemia. She was such a brave little soul, who rarely complained, & had the most wonderful smile. I felt honoured & humbled by being allowed to spend my time with Helen & her parents & siblings during this time, I learned such a lot about courage from this experience. This happened 40 years ago, & I can still picture her now.

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  • what an excellent and helpful article, as well as the two comments which follow.

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  • Clare writes so well of her experience and the difference it made to her feelings of compassion when caring for a dying patient. I was on my first ward, female surgical, a nightingale ward. Sister asked me if i would sit with Miss H , her bed was just past the sluice room door. She had cancer and had been given testosterone, resulting in a full beard. I sat , held her hand , she was unconsious so talking was not an option. I listened to her rattling breathing remembering the phrase " Like dry leaves rustling " until it gently stopped. I have always thanked Sister so much for giving me the time and opportunity to observe and be part of a very important part of life.

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  • Judy, I am not sure how long ago this was, but by the time you are a sister ward management, human resources and time available might be very different from what it is now but I hope you will remember this valuable experience and be able to pass it on to your students and junior nurses regardless of the stress and hectic of all the other duties.

    I find this website refreshing and calming after all the complaining and ill feelings in the comments following other articles and although there is an interesting exchange of views I feel it is not neccessarily contributing to the body of nursing knowledge in a constructive way. I think this page and its writers will be treated with more respect.

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  • It was a pleasure to read this article. The first death I sat at was a lady with a DNAR. Even though I knew it was her time and that the DNAR was in place I still had to fight the feeling that I should be doing something to stop what was happening. I was shaking when I got home and had a large glass of wine.

    I had performed last orders on patients before this many times but it was the first death that I sat with the patient and watched her slip away. I can still feel the slight lump in my throat when I think of her. And I hope never to forget it.

    Thank you for writting this.

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  • I've never had the privilege of witnessing a peaceful death. All the ones i've seen have been traumatic and mostly unexpected. The worse ones being a 21 year old lad brought in with a bleed on the brain. He was accompanied by his mum and girlfriend..we spent 40 minutes trying to resuscitate him. Another was a 36 year old mum of 4 who attended for DVT treatment and left the ward going to the mortuary.....i will never forget the screams of her husband when he arrived on the ward...never.

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  • I have been qualified 23 years now. The last death I witnessed was the all night fight to save a young woman brought in to the ward and then to ITU. She had been found at home by her husband, collapsed and barely concious. I can vividly recall the very personal attention to her care by senior ITU nurses, the ITU consultant who sat beside her bed all night. And her devasted husband, still dressed as he arrived from work, weeping into the phone, trying to explain to bewildered family what was unravelling before him. She did not survive. And in the midst of admiring just how good the NHS was in extremis and the supreme efforts of my colleagues, I cannot let go of that mans face or his voice that night. Your first commentator was right - when this aspect of our care fails to touch you any more, get your coat, go home, and ring somewhere else for a new job in the morning.

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  • Anonymous | 4-Nov-2010 2:33 pm

    it is wonderful to hear that the senior staff managed to take the time to provide this highly important level of care in such a busy and hectic health service. this patient must have been one of many but it is reassuring that the human touch still remains somewhere, sometimes, and is an excellent example for us all.

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  • from annonymous above

    May I be permitted to add a little anecdote on the lighter side here which took place in a convalesence clinic in the Swiss Alps where I was working in 1998? It is about a frail old lady of over 80 years who, previously in excellent health, had been knocked down in an RTA on a brief visit to Italy. She arrived on our ward covered in cuts and bruises from head to toe with multiple fractures including one to her pelvis. Eventually thanks to the patience of the physios they got her back on her feet again and, to her own delight and to ours, had her walking, eventually unaided, up and down the corridor.

    I can't remember what exactly happend afterwards but she may have had a heart problem and her blood electrolytes suddenly went beserk and she collapsed. Despite all the usual medical treatments she lapsed into a coma and we called her family, who because of the distance, found it difficult to come at such short notice over a weekend - however they were with her fairly rapidly as we felt that her death was imminent. The priest came and administered last rights. In her single room, when her family were not there, we sat with her quite spontaneously round the clock. First a German medical student and when I saw he was still there long after his day's work was over sitting with her in the dark, I took over, just being there for her and sitting in silence. We all did a few hours overtime just to be with her. During the day, despite our workload, an older nurse was the one most devoted to her care and attended to all her basic needs. In her semi-comotose state she was no longer taking any solids and only small sips of fluids periodically. My colleague then started giving her small sips of beer, much to my horror, and then she began taking in more and more and my colleague had a big twinkle in her eyes! This went on for about 48 hours as did the very subdued atmosphere on the ward that there is when there is a dying patient.

    Then a miracle happened and a few hours later this delightful old patient was seen back on her feet, trotting up and down the corridor with a lively gait and seemed totally oblivious to the last 48 hours and all the care and attention she had received! Perhaps she had just been in need of a rest!

    It just shows how wrong one can sometimes be in one's clinical judgement.

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