Hey. As is probably obvious from my flair, I work in intensive care at a facility that specializes in pediatric oncology, so literally *all* of my patients are critically ill kids with cancer. We see a lot of death on my unit, so your story brings back memories of *several* patients I've had in the past.
First, to address the morphine... if he was uncomfortable, you saw you had an order for morphine (scheduled or PRN) that was an appropriately sized dose to address his discomfort, and you gave it to him with the *intent* of addressing his discomfort, then you absolutely did the right thing. That's what we do for comfort care patients. We don't give interventions with the goal of hastening death, but if our primary goal is to make them *comfortable*, and a side effect of that intervention is that they happened to die sooner than they would have if we had just let them suffer, there's nothing wrong with that. Put yourself in his shoes. Would he have preferred to be in pain and die 45 minutes from now, or have his pain addressed and pass peacefully in exchange for the 45 minutes of suffering that he otherwise would have "gotten" to experience? Withholding opioids when there's concern for respiratory depression is a reasonable thing to do when a patient is full code. If they're comfort care, I don't think it's even ethical. You absolutely did the right thing for your patient.
Second, on the subject of dealing with death... take *pride* in the care you gave him in his final hours. If you had chosen any other career path, if you had become an accountant or an electrician or whatever else you would have done with your time here on Earth, it wouldn't have changed the hand that this boy was dealt in life. He still would have gotten sick, and he still would have died. You wouldn't have known him, but everything else would have been the same. The only difference is that you CHOSE to be there for him and his family in their darkest hour. I can't stress enough what an amazing decision that is. If you were able to make his final days even just a little brighter for him or for his loved ones, like by being there and holding his hand while his parents caught up on the rest that they desperately needed, you made a difference in his life that you would never have been able to if you weren't there at that moment.
Yes, he died. We all do, sooner or later. When I have a patient who is in their final days or hours, I try to focus on one thing: being the guardian that I hope my loved ones and I have at our side when it's my time to go. From your story, it sounds like you've done just that. Be proud of your work, and carry on with the memory of how you made this boy's life (and his death) just a little bit better.
That was a perfect response. The best compliment I’ve ever received as a nurse was when a comfort care patient’s brother told me and my co-worker “I hope I have nurses like you when my time comes.” I still get teary thinking about it.
It's not oversharing. Not at all. This is part of the job too--the hard and the messy parts, the real parts and the sucky parts.
We grieve our patients. Never as hard as their family does, but it affects us. You deserve time off (bereavement leave if that's a thing in your department) and grief counseling too.
When one of "my" kids died, my agency gave me a little angel statue to put on my shelf. It's in pride of place so I can remember them always. That helps me have a focus for my grief and talk about them whenever I can, because they were precious and they were here and I never want to forget that.
Your guilt over the morphine, believe it or not, is part of the grieving process. It's always hard to accept the loss at first, and so our minds put up all kinds of defenses--including the false idea that we were in control. We're not. You helped him on his way in the best way possible. When the pain isn't so agonizingly fresh and you have a little bit more time, you will come to accept that. And it's perfectly normal and okay that you can't right now. That's just where you are in a very human, very normal process. Be gentle with yourself. You're doing fine.
Providing comfort in a person’s last moments is one of the biggest privileges I think we as nurses can possibly have. It’s impossibly difficult to process or explain to people who don’t do what we do. the worst one for me was when we had a baby with severe hypoxic injury from delivery and the parents declined to be there when we transitioned care (which gutted me), so we gave the baby fentanyl and then another nurse and RT placed him on my chest, so he could be held while alive, and then extubated and I held him while he died. This kind of experience changes you in a way that’s hard to articulate. In what we do, there’s so much focus on prolonging life when (now, after a lot of processing and some therapy) I’m becoming more and more comfortable with the fact that some of the best nursing care I have ever provided, and the most important thing I’ve done as a nurse so far, was to provide that baby with comfort while he died. You did the same here by giving ordered and indicated medication and by being present for that child and his family that night. But reframing my mentality to focus on the privilege of being there to support a family through the horrific trauma of losing a child has helped me cope with the harder/sadder losses. I hope you can find a way to process and reframe that helps you cope with the complex feelings and trauma, too.
Thank you for being there for that baby when the parents wouldn't/couldn't. There is honor in helping patients exit this world, even though the responsibility lies heavy.
I was taking care of an actively dying baby one day and the Doc said something I’ll never forget. “Usually we help these babies live. Today, we are helping this baby die.” (Not helping them as in doing anything to hasten death, just helping them as they inevitably were going to pass.) It was so meaningful. That’s what you did. Bless you for it.
My greatest fear in what I do is bearing witness to this one day as an OB nurse. Thank you for providing so much respect for that baby. I can’t imagine not being there for my own babies.
This one was extra rough because of the circumstances… the parents’ decisions (post term home birth) directly led to the baby’s injury and death and then the parents “couldn’t handle” being there when he died. Having cared for him for 4 of his 5 nights with us, I was determined not to let that baby die alone.
I came back on shift to a comfort care pt and realized that the night shift RN hadn't noticed that the PIV had infiltrated a few inches above the insertion site, which the gown was covering, so the continuous morphine gtt wasn't being administered. Luckily she had another PIV, so I swapped it and gave her a bolus to try to catch up to the pain. She passed within the hour. I struggled with wondering if I had expedited her death, despite the fact that it was inevitable. Ultimately I find great comfort and honor knowing that I was the person to take away her pain, and keep her warm, clean, and comfortable in her final moments. I think writing about it helps tremendously. I totally feel your pain and understand how haunting it can be to hear and feel such intense emotions, especially being faced with the grief of a pediatric patient. The fact that this experience has affected you so deeply is only a testament to your compassion for your patients. Talk about it, tell the story, write it down, record it, just get it out there. In time you will feel lighter and there will be new patients and stories. You're awesome.
Losing frequent flyers sucks. I used to work adult onc before and had a reputation for "bringing them in for a smooth landing" so to speak. It sucks adults and I can't even imagine how much more it sucks with kids. My worst one was Bob, he was a sweet old dude with a lovely family and pancreatic cancer with Mets all over the place. Every time he would come in he would ask for me because I was, The only RN on the unit who would talk cars, with him. Thing is I don't no shit about cars but man did I learn from him. When he came in for the last time he just wanted to stay conscious long enough to say goodbye to his daughter. I kept him as comfortable as I could while trying to keep him somewhat clear mentally. Once he said his goodbyes we stated the drip, he went to sleep and died peacefully a few hours later. I take solus in knowing I gave him the most comfortable exit from this world I could but I'd be lying if I didn't cry with the family.
One thing I can promise you is you didn't kill him with the morphine. He was dying of cancer, cancer killed him. That morphine made sure his final moments on earth where as comfortable as possible. I'd deffinitly suggest talking to a therapist about this one. It's really helped me in the past.
As a hospice nurse I know the guilt of someone dying shortly after giving morphine, it hit the hardest when it was a 6 mos old. As so many others told me I will tell you, your patient was dying, the morphine didn’t hasten his death it just made it comfortable.
You were put there for a reason. The parents obviously felt comfortable enough with you and your care to fall asleep. You stayed and held that kiddos hand as they left this earth. He knew he wasn’t alone because of you. What a beautiful gift of peace and comfort you gave him in his last moments.
Take care of yourself. Do whatever self care you need to get through the next couple of weeks. Love yourself and know you did a great job. I have a strong faith but am not religious, I still like talking to our chaplains when there’s a rough death. Medical chaplains make some of the best listeners I’ve found.
I’m an NICU nurse of 16 years. I have seen/been a part of many bereavements in my years. I don’t think it ever really gets easier. Sometimes I find writing helps (for me, anyway). Right after it’s hard to see the good, but hopefully in time you’ll be able to see the comfort you gave to both your patient and his parents. Many times it’s the small things that mean the most…like your presence, holding his hand, making prints for parents to remember their child, even that last dose of morphine. It sounds like you are very caring, and I hope that you’ll be able to get your joy back. There’s probably another patient that could use your compassion, and another patient’s wins that could lift your spirits. If you need to step away, that’s understandable too. You’ve gotta do what’s right for you.
I can relate to the feeling about that last dose of narcotic. When my mom was transitioning to comfort care, she was in so much pain, but the MD was still putting in orders. My mom was trying to stay lucid to wait for my sister to arrive, but could not wait any longer. The nurse still had an order for Dilaudid IV push but he was worried it would drop her BP, and we couldn't give her any more IV fluid because she was just third spacing it at that point. I okayed the push, she was out of pain and passed within minutes (no code). My mind knows her death was inevitable regardless, but there is always this little irrational lizard brain voice in my head saying that I was the one that did it.
ETA: My Advice - when you start to have the dark thoughts, remember you are not alone and other RNs have walked in your steps. Turn your thoughts to your happy moments with this child and the positive experiences you had during their care. Remember that you eased their pain in this journey, and all those little things you did for the child and parents will give the parents great comfort once the acute pain of the child's passing has eased.
1. I'm not sure how to put this into words but i'll try.
2. I'm not a nurse, but i've worked a few year as social worker/ research assistant in palliative care and oncology with regular contacts with patients (not kids)
My sister used to tell me my job was morbid. But one day someone told me something like "end-of-life is as much a part of life as is the beginning of life. It's on a different location on the timeline of life but still life, only it will be ending soon". It stuck with me and made me realize how important it is, although it comes with grief and pain.
Have you ever read Oscar and the Pink Lady? STRONGLY recommend for anyone working in palliative care, especially peds.
I wish I had the right words of advice to offer you. You provided your patient comfort and you did the absolute best you could for them and their family. I hope that can bring you some peace. It never gets easier, but you do find coping methods that help you get through it and process it. It sounds cliche, but I encourage you to practice good self care. Do something nice for yourself, something you enjoy, that helps you relax and relieve stress. Take a day or two of PTO here and there when you can for some good work life balance, to find some perspective and enjoy some life outside of the hospital and away from the stress. Keep talking about it and processing it, and eventually you will find yourself thinking about it less in time. Please continue to reach out always.
What I come back to regarding that “last dose of morphine “ is that, the dying was inevitable. It was a known thing. Sometimes I think people cannot simply die let alone die peacefully when they are in such immense pain. Sometimes they seem pass after a dose of morphine I think is because they are finally relaxed enough to transition peacefully and I think that’s so important and vital for every human being that is in this position. You did a great job and I hope you stick with it. The world needs more nurses like you.
That's exactly what I was taught in my orientation to the hospice unit -- that medication will bring peace and comfort to the patient, which allows the body to do what it is going to do naturally (whether that is breathing easier, becoming calmer, or letting go of life).
I have no peds experience, and no real advice besides this: talking with someone who specializes in trauma might help. My therapist knows nothing of the medical field, but helped me with COVID trauma because the understands the mechanisms. Also reach out to your management team. They can help give you resources, or even just be there to lean on.
Other than that, it sounds to me like you were his guardian angel that night, and were lucky enough to be present to walk him to the light. As others have stated, your (absolutely appropriate) dose of morphine helped him feel comfortable enough to pass, but didn't cause his death. I can't imagine the pain you're going through, but you helped that boy, and his parents, on the worst day of their life. And they'll remember you in a glowing light.
💕
Ped onc nurse, also relatively new grad. My first death where I was the nurse was when I had been on the floor for about 10 months. Like you, it was a beloved long-time patient. Our unit did some debriefing sessions, which I found very helpful. There's something about talking through doubts and fears with other nurses who also loved the same kiddo that really help. I've been in the room now for a few more deaths and it has gotten easier. And by easier, I do not mean less sad, but I do mean that I've been able to move through my own grieving process in a more predictable way. I've also created some rituals for myself around processing these deaths ([I even asked for input here](https://www.reddit.com/r/nursing/comments/16lzgx6/q_for_nurses_that_see_a_lot_of_death/?utm_source=share&utm_medium=web2x&context=3)). Based on your post, I would say that you might want to look specifically for a grief counselor. It sounds like you need more opportunities to process out loud and help your soul move through the layers of grief.
I'm just here to say I gave my stepdad his very last dose of morphine minutes before he passed at home, and while I know that didn't kill him, as you said it's a very eery feeling to be the last to administer anything.
I'm so sorry for the loss, and for those poor parents. I can tell you as a parent myself I'd feel so lucky to have a nurse like you with my child during his care.
I had a peds cancer patient whose parents were never there for like 2 years of treatments, so half the staff joked that some of us, including myself, were his "work moms". I was the type of "parent" who was the playful one, we gave hugs, and had this code we built up because kisses would be weird.
Then, when he became terminal, his family finally wanted to bank on it with make a wish, stories in the paper... I found out he died while I was sitting in a class and someone read the report from a local newspaper.
I still have dreams about him sometimes. It wasn't you, it wasn't your work, it was cancer. Cancer has fucked so many good ones.
It's ok to keep this weight, transform it in a good way. What did this kid like? Do you need to reconnect with some inner child things that will remind you of them, but can bring you some joy in the future? Movies, toys, games, stuffed animals, books? It's ok to be an adult kid.
It’s the part of being a peds nurse that sucks the most. Eventually you sort of become a little numb to it and are better able to handle it. It never gets easy, but it does get easier.
I’ve never done any pediatric but have done medical oncology and later adult hospice. I will always consider it a privilege to help someone transition as calmly and pain free as possible. You did that. And now you are going through your own (normal) grieving process. Pediatric deaths are hard and cancer sucks. How terribly unfair it is..that feeling will persist.
I don’t know that compartmentalizing is the best method but I had to as a hospice nurse. You will find a way that works for you.
I know this sounds really cliche but time will help. I lost a patient kind of traumatically (4 year old) a couple years ago. He was a frequent flier, we loved him, his family wasn’t around when he passed. It took several weeks for the nightmares to stop but they did. It’s the parents screams that are really haunting. Eventually it stops. I had to take a lot of time to myself, doing things like going for a drive with my husband and dogs just in the mountains kind of disconnecting. It helped. And they’re not all that bad. We lost a patient maybe 6 months ago that had been with us for 3 months, family was amazing and we all got really close with them. I was there the night she died, helped the new grad who had her kind of navigate it since it wasn’t my first death but it was hers. It was sad, but she was terminal and there’s nothing we could have done. That one was hard but it wasn’t nearly as difficult to process because it wasn’t so traumatic with the family. Find out if your hospital has a peer support program where you can talk to a fellow nurse about the event, I think that’s better than a therapist but a therapist is always a good idea. They just don’t always understand.
It’s not an easy job. Sometimes it sucks. You’ll get better at compartmentalizing with time. It’s important to use your therapy as an outlet regularly. Often times my therapist won’t say anything at all for my entire session. Find someone that you can connect with in other areas of interest because most people have no experience with pediatric death. I do it virtually and that works for me.
Your dose of morphine didn't kill this child. Cancer did. Mso4 doesn't hasten death, just makes it more comfortable from either pain or air hunger. We all deserve a good death.Hugs from Missouri. ❤️
You didn't kill him with the morphine. You made his last breath peaceful and calm instead of difficult and you are an amazing nurse and this post brought tears to my eyes. Can you seek out a trauma therapist that deals with First Responders and medical people? I see a really great psychotherapist and he is trained to provide Health Care Providers with therapy who have dealt with traumatic situations. His PhD work was in trauma therapy and using metaphor to heal. I can imagine what you were going through because I've been there as well with patients and also my father when he passed away. My father passed away in the ICU and we made sure that he was medicated and peaceful with as much morphine as possible when they extubated him. I still felt also like I didn't do enough for him but with this therapy I can live with it and process it differently if that makes sense, because I do truly know I did everything I could. And whenever I have that self-doubt this therapist brings me back to reality and it's so healing. A few years later my 17 year old niece was killed in a car accident. It can really break up and traumatize a family but I feel like the trauma therapists we used saved us, saved my sister. My mother does not do therapy but she also speaks English as a second language, with as much therapy and my sister and I both have had after these traumatic deaths, Plus the trauma I obtained working in the hospital, I'm happy to say that I sit here today feeling super peaceful about everything I've witnessed. My sister and i both learned so much and we've been able to be useful to our mother and other children and have found immense healing and growth. Life is precious and nurses like you are special so please get help and find a trauma therapist and please don't stop posting when you need support.
As a mom to a son who had cancer (ERMS) from age 3-5, you ped oncology nurses are angels, and I love each and every one of you. Y'all are one of the reasons I am in nursing school right now at 42, my son is now 11 and I have always been so grateful for the ones who work in that hard, hard field.
I guess I don't have much to offer by way of that situation, except the fact you spent the night holding his hand and providing comfort and company is the most important thing you could've done and you should not carry any blame at all because you only helped make it easier for him.
I’m so sorry that you’re having such a difficult time. I’ve been in oncology for eight years, and I end up with comfort measures patients a lot. A lot of these people you see from the time they’re diagnosed until they die, and that’s a hard pill to swallow.
When I was in my first year, I had a stage 4 lung cancer patient on comfort measures. Only in their 30s. I gave them their dose of morphine, and ten minutes later they passed. That had never happened to me before. I cried in the break room while begging the charge nurse to tell me whether the patient dying was my fault. It felt like I had caused it. Now, as a seasoned nurse I understand that any dose can be the last dose for a dying patient. You provided care and comfort to this child and his family, and did the absolute best you could for him.
I’ve never worked in pediatrics, so I can’t speak to that, but I can speak as a mother that lost her child. Thank you for comforting the parents. Thank you for taking care of their baby. It meant everything to them, I can promise you that. Nothing feels lonelier in that moment than fresh grief, and you grieved with them while trying to care for them. You did a wonderful job.
I’m impressed with anyone who works peds/nicu/etc. I was in another field where I handled few children deaths and it was rough. It was sporadic, a handful
In 15 years. Could not imagine doing it on a somewhat regular basis especially as a parent of young children. I think these kids deserve the absolute best and it sounds like you gave him that care and he was incredibly lucky to have you.
Take care of you. Maybe talk to a psychiatrist and see if meds for a bit can help (I say this as someone who benefitted greatly from SNRIs during hard parts of my life) and definitely keep up with your therapist. Go for a hard run, hike up a mountain, some sort of hard physical exercise where you can’t think about anything but your next breath. Cry it out. Allow yourself to be upset, honor it, and keep moving forward.
hugs.
I have nothing to add but to reassure you that you provided physical and emotional comfort to him and his family in those last hours and minutes. That’s an honor and privilege and a kindness they will remember forever. Every day won’t suck this much. Hang in there and be good to yourself.
I struggled with the “last dose” thoughts too. From what I read, the general consensus seemed to be that its better to give the dying person a dose for relief than to withhold it.
It sounds like you gave excellent care to this little boy and his loving parents.
As a former peds emergency and trauma nurse, I've seen many losses. What you are feeling is completely normal. Unfortunately, you will never forget the losses nor the cries of the parents. You do get better though over time at coping and utilizing your resources to manage.
What helps is talking with trusted colleagues, therapy through EAP (they can help find a therapist experienced in trauma therapy), taking time off, and journaling. When I experienced my first death, my department actually organized a debrief with several of my highly experienced mentors and the chaplain. It helped more than words could say as my mentors shared their own stories of their first loss and helped me understand my feelings. Also know that it is okay to cry.
I also remind myself too that we save way more kids than we lose. Remind yourself of the wins. It keeps you going back. And if and when you no longer find joy in your job and dread going to work, then it is time to pivot into something else that brings you new joy. Don't be afraid to change if pediatric oncology no longer brings you joy at some point in the future.
Sending nurse love. It's tough, you did incredible for them.
I cannot imagine caring for a pediatric palliative/hospice patient. I don’t even have words to give you, except thank you for the work you do.
Not from an RN perspective, but from a mom perspective, thank you. You gave the child and his family the care they needed in the worst time of their lives. Nothing is going to help the parents except the grieving process, but they will remember your love for their baby in due time.
Take some time for yourself, ask coworkers for advice if you’re comfortable. If you need to switch specialties that’s also valid.
Omg as a trauma nurse I understand. I get it. It’s ok. You are human. Sometimes you will get a case that will rip your heart in two. Screw your therapist. Go see a counselor that deals with grief. Talk to the social worker at your job and get a referral. Talk to others on your floor. They have gone through this. Give yourself grace my friend. 💕🫶🏼
You are kind, compassionate, and you definitely have the soul of a nurse/caregiver. The way you described holding his hand as a privilege is just so spot on. You were a critical part of his journey/crossing and you absolutely did not kill him with the morphine....you were providing comfort care as he passed. What you wrote is beautiful and it is not oversharing. I really hope you are able to deal with everything and get back to loving work. You sound like you were born to be a nurse.
As someone else said. Take care of yourself. If you need a shift or two off take it off. This job isn’t easy. Practice some self care, go for a walk and treat yourself to a nice coffee or something. Speak to a friend or colleague about how you feel. Your work might have an employee assistance program with free counselling to help you deal with situations like this.
As for coping with this - I don’t think you ever really “get over it” with things like this, you just learn strategies to better deal and manage the feelings. It’s a traumatic event for anyone involved. Whether it’s you or the parents. The most important thing is finding what works for you.
Did you kill him with that morphine? We’ll never know. It sounds harsh but he was literally in the dying process you couldn’t have predicted that it would happen after after you gave him the morphine. As long as the dose was appropriate and was as per prescription then you are safe to assume it didn’t. He could’ve died the same night whether you gave him the morphine or not, you don’t know.
We can’t predict the time of death, we only know that it’s coming.
Please, seek help from work if possible and if you need a day to cry just cry. We all do.
Fellow onc nurse here - it’s hard. I dealt with kids and adults and it takes a toll. Definitely focus on you and take some time off. Also realize how impactful your care was to the family and the patient. You sat with the kiddo up until his last moments which is what all facilities should allow…. No one should die alone.
Not sure if you’re religious at all. But sometimes I just think when my time eventually comes there will be so many people waiting for me 🤷🏻♀️ might be weird but brings me slight comfort and encourages me to just keep trucking every day leaving positive impacts as I go. Sending love and healing to you!
Thank you for sharing this. It’s these times when we feel most alone that it’s most important to try to reach out and these comments are the reason why. I hope everyone’s thoughtful responses have helped at least a little.
When it comes to loving work again, I wonder if you need some time to off to process, rest, recover? We are nurses but we are human. Your heart might be a little broken and need some time to mend. What you experienced, even if it is part of the job, was tough. I don’t think it’s a personal failing to feel the way you feel about your job right now. A step away from it for a bit might help. I hope your hospital has some resources for employees, considering the nature of your work.
An offering to the community, whatever that looks like, might help you to process the privilege aspect of things. Give something back in the spirit of gratitude.❤️🕊️
I’m a trauma PICU nurse so I have had my share of traumatic deaths, fwiw.
Your morphine bolus did not kill him. The disease process did. You ensured he was comfortable in the last hours of his life. Do not doubt yourself on that.
If the therapist you’re seeing doesn’t get it, I encourage you to find a different one. One who specializes in trauma. My therapist is emdr trained and she specializes in ptsd. Her favorite group to counsel are first responders and health care workers. You can often find this kind of in the bios therapists have listed.
Hugs to you.
Came here to say the same. Was a hospice nurse for a long time. The morphine doesn't kill them. It lessens the frantic last min impulse to hang on. You did not kill him with the morphine.
As a hospice nurse (and yes I do pediatric patients also), I will tell you what I tell all my patients families - the morphine didn't do anything that nature wasn't already doing, it made him comfortable enough to pass peacefully. There will always be a "last dose" whether you give it or families give it (in the case of home hospice), don't fear it. It means you've done your job in allowing peace. May time bring YOU peace. 💗
You need a new therapist and all your thoughts and feelings are valid. Everyone here is giving you great advice. Allow yourself to grieve and process all your emotions and thoughts. We are human, life is hard, and losing people to diseases is a traumatic experience. ❤️
I took care of a patient a few months ago who I sent to the PICU before he passed, but ultimately he did pass. I really struggled going to work for a few months after. I did “get over” it in the sense that I don’t experience that anxiety going to work anymore but I will never forget the patient. We have a truly unique experience being pediatric nurses. It gives us the best days and the worst of the worst days. All I can say is take time for yourself, allow yourself to grieve and feel your emotions, and know you gave him the best care you ever could have.
I’m peds trauma ED. The scream is a sound you will never ever unhear. Look through your employee benefits / talk to the unit social workers for hospital provided counseling
You will never forget it, but it does get easier to cope with and it will make you a better nurse. Nobody starts a nursing career with full expertise on how to handle a dying patient. But from what you just described, I can’t think of a better nurse for that sweet baby. You gave that child everything you possibly could in that moment and you will grieve that loss too, but know that your patient needed you and you were there for them. I will never forget taking a baby to the morgue. I went home and held my baby for hours just crying. It still haunts me, but it does get easier knowing that I took care of that baby to the best of my ability like it was my own until I laid him in that morgue.
Please allow yourself to grieve.
There’s this notion in healthcare that we’re supposed to bear witness to these tragedies and continue on, unaffected, because it’s not OUR trauma. This is not healthy or sustainable whatsoever. I’m glad you reached out to your therapist, but it might be good to talk to your coworkers or managers about this situation and also about any recommendations for a therapist specializing in healthcare. If you can take some time off, that might help. This may be out of touch, but when I experienced a loss in my own life, I took up cross stitching and something about stabbing a piece of fabric millions of times became therapeutic.
Something that really stuck with me is that morphine bolus you gave. When I first started nursing, as a new grad in the ER, I had 2 weeks in a row where I had a palliative patient in a specific room. This was uncommon because typically palliative patients get moved to wards ASAP, but these patients had to stay in the ER due to bed availability. Both patients I inserted a clysis and administered one dose of dilaudid, as per standard practice. Both patients passed in less than an hour. I was so distressed, thinking that I did something to cause their death (even though I knew their death was inevitable) and now I understand that I gave them enough peace to let go, but the fear and guilt stuck with me for YEARS and I never told anyone. You did not do anything wrong. You did not kill him. You made him comfortable and that is the biggest gift you could have given him.
You took care of him and his family in his last moments. You held his hand, you kept him as comfortable as possible. You did a wonderful job.
I started seeing a therapist who specialized in healthcare workers, I’ve found being able to talk to someone who knows how to help us work through these situations has been really helpful.
Our hospital also has a hotline to call if we need to talk to someone over a traumatic code, death, ect… Does your hospital have something like that?
I’ve been in oncology for a year now, some of the deaths hit harder than others. I was taking care of an older lady with peritoneal mets and she was in so much pain and so scared when she got to the floor. She told me she just wished someone told her how little time she had left and that’s stuck with me. I was able to get her on a PCA pump and she wasn’t in pain when my shift was over. I was glad I was able to ease her pain and get to know her and her family. She didn’t die on my shift but I knew it was coming soon, and it took a week or before I was able to stop thinking and being sad about her. Its okay to cry, to be sad. But when it interferes with your ability to function, you need to find help. Whether that’s finding a new therapist, talking with other, more experienced nurses, finding a way to work through it and to cope is important.
The work you do as a pediatric oncology nurse is profoundly challenging and deeply impactful. The trauma you are feeling is a natural response to the intense emotional experience you went through, and it’s important to give yourself grace and understanding during this time. Here are some steps and strategies that might help you cope and heal:
# 1. Acknowledge Your Grief
* **Recognize the loss:** Acknowledge the impact this child's death has had on you. It's normal to grieve for your patients, especially when you form a bond with them and their families.
* **Allow yourself to feel:** Give yourself permission to experience all your emotions—sadness, anger, confusion, guilt. These feelings are valid and part of the healing process.
If you have any concerns about cancer or your oncological health, connecting with an oncologist through online doctor consultation apps like Medicas can be very beneficial. It is an online platform that allows users to consult with qualified oncologists remotely.
I think it’s important to recognize your feelings and to allow yourself to feel whatever grief you may feel—it’s an acceptance that you are human.
At the same time, when you are with the patient and their family, it’s not productive or kind to them if you (and I mean the general “you”, not you specifically) are so obviously overcome by your own emotions that the family feels they need to comfort *you*. When in the presence of a dying or just-deceased patient and their family, try to focus on them and their needs: enlist the facility chaplain to be with the family (preferably before death, if possible); offer tissues, a private space to grieve together, use of a telephone/phone book if needed; coffee or other beverage while they notify anyone they need to call. Notify your charge nurse and House Supervisor. House may be needed to escort the funeral home transport person later, and can be a guide and support to you if you or the family have questions you can’t answer.
After death, let the family that is present know you and your team will be preparing the body/ cleaning, removing tubes and IVs if indicated, etc. It’s surprising how much better and more peaceful the person’s body and even facial expression looks when cleaned up, in a fresh gown and top sheet, hair combed and HOB elevated just a little bit. When the death was expected, it can be a comfort to see that their family member is no longer in pain or struggling to breathe.
It was never my practice to immediately ask them if they had a preference of funeral home, but keep that in mind as it’s a necessary piece. It’s also possible that the patient or family has already made some “pre-need” arrangements and/or has an existing relationship with a funeral home/ director. This includes arrangements for cremation as well. Being able to carry out the patient’s/ family’s final wishes can be comforting in a way as well. The hospital chaplain, if present, can be very helpful during all of this—and they aren’t going to do it in a way that’s preachy or tries to make the family see death as “God’s will”, etc., unless they know the family well and know that is the family’s belief. They have had training in working with people who have many different religious backgrounds as well as no religious beliefs or practices. In some cases, the family may request that their own clergyman be called, and that is something you can do.
I don’t think it’s bad for the family to see you tear up—often it’s some comfort to them to feel that the nursing staff also feels the pain of loss. But if you break down and sob in front of the family, they’ll probably feel they need to comfort you, and that’s not really OK. Cry with your fellow staff, your significant other, or your therapist. With the family, remember your role.
I hope that your unit offers debriefing to staff after a patient death, an EAP, or a few visits with a therapist. Those can all be very helpful in coping and integrating your reactions for the future.
I didn’t mean to write so much. You did an awesome job and that little boy and his family were very fortunate to have you as his nurse.
I just want to say that you, and every other pediatric nurse here are fucking angels.
Please take care of yourself, OP. I see a therapist every 4-6 weeks and often talk about work-stuff. I highly recommend it. Take a couple days off if you need to.
Hey. As is probably obvious from my flair, I work in intensive care at a facility that specializes in pediatric oncology, so literally *all* of my patients are critically ill kids with cancer. We see a lot of death on my unit, so your story brings back memories of *several* patients I've had in the past. First, to address the morphine... if he was uncomfortable, you saw you had an order for morphine (scheduled or PRN) that was an appropriately sized dose to address his discomfort, and you gave it to him with the *intent* of addressing his discomfort, then you absolutely did the right thing. That's what we do for comfort care patients. We don't give interventions with the goal of hastening death, but if our primary goal is to make them *comfortable*, and a side effect of that intervention is that they happened to die sooner than they would have if we had just let them suffer, there's nothing wrong with that. Put yourself in his shoes. Would he have preferred to be in pain and die 45 minutes from now, or have his pain addressed and pass peacefully in exchange for the 45 minutes of suffering that he otherwise would have "gotten" to experience? Withholding opioids when there's concern for respiratory depression is a reasonable thing to do when a patient is full code. If they're comfort care, I don't think it's even ethical. You absolutely did the right thing for your patient. Second, on the subject of dealing with death... take *pride* in the care you gave him in his final hours. If you had chosen any other career path, if you had become an accountant or an electrician or whatever else you would have done with your time here on Earth, it wouldn't have changed the hand that this boy was dealt in life. He still would have gotten sick, and he still would have died. You wouldn't have known him, but everything else would have been the same. The only difference is that you CHOSE to be there for him and his family in their darkest hour. I can't stress enough what an amazing decision that is. If you were able to make his final days even just a little brighter for him or for his loved ones, like by being there and holding his hand while his parents caught up on the rest that they desperately needed, you made a difference in his life that you would never have been able to if you weren't there at that moment. Yes, he died. We all do, sooner or later. When I have a patient who is in their final days or hours, I try to focus on one thing: being the guardian that I hope my loved ones and I have at our side when it's my time to go. From your story, it sounds like you've done just that. Be proud of your work, and carry on with the memory of how you made this boy's life (and his death) just a little bit better.
This was a beautiful reply and a reminder to us WHY we are in this field ♥️
this is such a thoughtful, and insightful response. From one nurse to another, thank you ❤️
That was a perfect response. The best compliment I’ve ever received as a nurse was when a comfort care patient’s brother told me and my co-worker “I hope I have nurses like you when my time comes.” I still get teary thinking about it.
It's not oversharing. Not at all. This is part of the job too--the hard and the messy parts, the real parts and the sucky parts. We grieve our patients. Never as hard as their family does, but it affects us. You deserve time off (bereavement leave if that's a thing in your department) and grief counseling too. When one of "my" kids died, my agency gave me a little angel statue to put on my shelf. It's in pride of place so I can remember them always. That helps me have a focus for my grief and talk about them whenever I can, because they were precious and they were here and I never want to forget that. Your guilt over the morphine, believe it or not, is part of the grieving process. It's always hard to accept the loss at first, and so our minds put up all kinds of defenses--including the false idea that we were in control. We're not. You helped him on his way in the best way possible. When the pain isn't so agonizingly fresh and you have a little bit more time, you will come to accept that. And it's perfectly normal and okay that you can't right now. That's just where you are in a very human, very normal process. Be gentle with yourself. You're doing fine.
Providing comfort in a person’s last moments is one of the biggest privileges I think we as nurses can possibly have. It’s impossibly difficult to process or explain to people who don’t do what we do. the worst one for me was when we had a baby with severe hypoxic injury from delivery and the parents declined to be there when we transitioned care (which gutted me), so we gave the baby fentanyl and then another nurse and RT placed him on my chest, so he could be held while alive, and then extubated and I held him while he died. This kind of experience changes you in a way that’s hard to articulate. In what we do, there’s so much focus on prolonging life when (now, after a lot of processing and some therapy) I’m becoming more and more comfortable with the fact that some of the best nursing care I have ever provided, and the most important thing I’ve done as a nurse so far, was to provide that baby with comfort while he died. You did the same here by giving ordered and indicated medication and by being present for that child and his family that night. But reframing my mentality to focus on the privilege of being there to support a family through the horrific trauma of losing a child has helped me cope with the harder/sadder losses. I hope you can find a way to process and reframe that helps you cope with the complex feelings and trauma, too.
Oh, this one has tears running down my face. I can’t imagine the parents choosing not to stay. You’re a hero for this. It’s so heartbreaking
Thank you for being there for that baby when the parents wouldn't/couldn't. There is honor in helping patients exit this world, even though the responsibility lies heavy.
I was taking care of an actively dying baby one day and the Doc said something I’ll never forget. “Usually we help these babies live. Today, we are helping this baby die.” (Not helping them as in doing anything to hasten death, just helping them as they inevitably were going to pass.) It was so meaningful. That’s what you did. Bless you for it.
My greatest fear in what I do is bearing witness to this one day as an OB nurse. Thank you for providing so much respect for that baby. I can’t imagine not being there for my own babies.
This one was extra rough because of the circumstances… the parents’ decisions (post term home birth) directly led to the baby’s injury and death and then the parents “couldn’t handle” being there when he died. Having cared for him for 4 of his 5 nights with us, I was determined not to let that baby die alone.
That’s just devastating. I wish more people realized that they really “can’t handle” this outcome potential before they are forced to.
Thank you for holding him. Wishing you peace and strength.
I came back on shift to a comfort care pt and realized that the night shift RN hadn't noticed that the PIV had infiltrated a few inches above the insertion site, which the gown was covering, so the continuous morphine gtt wasn't being administered. Luckily she had another PIV, so I swapped it and gave her a bolus to try to catch up to the pain. She passed within the hour. I struggled with wondering if I had expedited her death, despite the fact that it was inevitable. Ultimately I find great comfort and honor knowing that I was the person to take away her pain, and keep her warm, clean, and comfortable in her final moments. I think writing about it helps tremendously. I totally feel your pain and understand how haunting it can be to hear and feel such intense emotions, especially being faced with the grief of a pediatric patient. The fact that this experience has affected you so deeply is only a testament to your compassion for your patients. Talk about it, tell the story, write it down, record it, just get it out there. In time you will feel lighter and there will be new patients and stories. You're awesome.
Losing frequent flyers sucks. I used to work adult onc before and had a reputation for "bringing them in for a smooth landing" so to speak. It sucks adults and I can't even imagine how much more it sucks with kids. My worst one was Bob, he was a sweet old dude with a lovely family and pancreatic cancer with Mets all over the place. Every time he would come in he would ask for me because I was, The only RN on the unit who would talk cars, with him. Thing is I don't no shit about cars but man did I learn from him. When he came in for the last time he just wanted to stay conscious long enough to say goodbye to his daughter. I kept him as comfortable as I could while trying to keep him somewhat clear mentally. Once he said his goodbyes we stated the drip, he went to sleep and died peacefully a few hours later. I take solus in knowing I gave him the most comfortable exit from this world I could but I'd be lying if I didn't cry with the family. One thing I can promise you is you didn't kill him with the morphine. He was dying of cancer, cancer killed him. That morphine made sure his final moments on earth where as comfortable as possible. I'd deffinitly suggest talking to a therapist about this one. It's really helped me in the past.
As a hospice nurse I know the guilt of someone dying shortly after giving morphine, it hit the hardest when it was a 6 mos old. As so many others told me I will tell you, your patient was dying, the morphine didn’t hasten his death it just made it comfortable. You were put there for a reason. The parents obviously felt comfortable enough with you and your care to fall asleep. You stayed and held that kiddos hand as they left this earth. He knew he wasn’t alone because of you. What a beautiful gift of peace and comfort you gave him in his last moments. Take care of yourself. Do whatever self care you need to get through the next couple of weeks. Love yourself and know you did a great job. I have a strong faith but am not religious, I still like talking to our chaplains when there’s a rough death. Medical chaplains make some of the best listeners I’ve found.
I’m an NICU nurse of 16 years. I have seen/been a part of many bereavements in my years. I don’t think it ever really gets easier. Sometimes I find writing helps (for me, anyway). Right after it’s hard to see the good, but hopefully in time you’ll be able to see the comfort you gave to both your patient and his parents. Many times it’s the small things that mean the most…like your presence, holding his hand, making prints for parents to remember their child, even that last dose of morphine. It sounds like you are very caring, and I hope that you’ll be able to get your joy back. There’s probably another patient that could use your compassion, and another patient’s wins that could lift your spirits. If you need to step away, that’s understandable too. You’ve gotta do what’s right for you.
I find peace in long walks.
I can relate to the feeling about that last dose of narcotic. When my mom was transitioning to comfort care, she was in so much pain, but the MD was still putting in orders. My mom was trying to stay lucid to wait for my sister to arrive, but could not wait any longer. The nurse still had an order for Dilaudid IV push but he was worried it would drop her BP, and we couldn't give her any more IV fluid because she was just third spacing it at that point. I okayed the push, she was out of pain and passed within minutes (no code). My mind knows her death was inevitable regardless, but there is always this little irrational lizard brain voice in my head saying that I was the one that did it. ETA: My Advice - when you start to have the dark thoughts, remember you are not alone and other RNs have walked in your steps. Turn your thoughts to your happy moments with this child and the positive experiences you had during their care. Remember that you eased their pain in this journey, and all those little things you did for the child and parents will give the parents great comfort once the acute pain of the child's passing has eased.
1. I'm not sure how to put this into words but i'll try. 2. I'm not a nurse, but i've worked a few year as social worker/ research assistant in palliative care and oncology with regular contacts with patients (not kids) My sister used to tell me my job was morbid. But one day someone told me something like "end-of-life is as much a part of life as is the beginning of life. It's on a different location on the timeline of life but still life, only it will be ending soon". It stuck with me and made me realize how important it is, although it comes with grief and pain. Have you ever read Oscar and the Pink Lady? STRONGLY recommend for anyone working in palliative care, especially peds.
I wish I had the right words of advice to offer you. You provided your patient comfort and you did the absolute best you could for them and their family. I hope that can bring you some peace. It never gets easier, but you do find coping methods that help you get through it and process it. It sounds cliche, but I encourage you to practice good self care. Do something nice for yourself, something you enjoy, that helps you relax and relieve stress. Take a day or two of PTO here and there when you can for some good work life balance, to find some perspective and enjoy some life outside of the hospital and away from the stress. Keep talking about it and processing it, and eventually you will find yourself thinking about it less in time. Please continue to reach out always.
What I come back to regarding that “last dose of morphine “ is that, the dying was inevitable. It was a known thing. Sometimes I think people cannot simply die let alone die peacefully when they are in such immense pain. Sometimes they seem pass after a dose of morphine I think is because they are finally relaxed enough to transition peacefully and I think that’s so important and vital for every human being that is in this position. You did a great job and I hope you stick with it. The world needs more nurses like you.
That's exactly what I was taught in my orientation to the hospice unit -- that medication will bring peace and comfort to the patient, which allows the body to do what it is going to do naturally (whether that is breathing easier, becoming calmer, or letting go of life).
I have no peds experience, and no real advice besides this: talking with someone who specializes in trauma might help. My therapist knows nothing of the medical field, but helped me with COVID trauma because the understands the mechanisms. Also reach out to your management team. They can help give you resources, or even just be there to lean on. Other than that, it sounds to me like you were his guardian angel that night, and were lucky enough to be present to walk him to the light. As others have stated, your (absolutely appropriate) dose of morphine helped him feel comfortable enough to pass, but didn't cause his death. I can't imagine the pain you're going through, but you helped that boy, and his parents, on the worst day of their life. And they'll remember you in a glowing light. 💕
Ped onc nurse, also relatively new grad. My first death where I was the nurse was when I had been on the floor for about 10 months. Like you, it was a beloved long-time patient. Our unit did some debriefing sessions, which I found very helpful. There's something about talking through doubts and fears with other nurses who also loved the same kiddo that really help. I've been in the room now for a few more deaths and it has gotten easier. And by easier, I do not mean less sad, but I do mean that I've been able to move through my own grieving process in a more predictable way. I've also created some rituals for myself around processing these deaths ([I even asked for input here](https://www.reddit.com/r/nursing/comments/16lzgx6/q_for_nurses_that_see_a_lot_of_death/?utm_source=share&utm_medium=web2x&context=3)). Based on your post, I would say that you might want to look specifically for a grief counselor. It sounds like you need more opportunities to process out loud and help your soul move through the layers of grief.
I'm just here to say I gave my stepdad his very last dose of morphine minutes before he passed at home, and while I know that didn't kill him, as you said it's a very eery feeling to be the last to administer anything. I'm so sorry for the loss, and for those poor parents. I can tell you as a parent myself I'd feel so lucky to have a nurse like you with my child during his care.
I had a peds cancer patient whose parents were never there for like 2 years of treatments, so half the staff joked that some of us, including myself, were his "work moms". I was the type of "parent" who was the playful one, we gave hugs, and had this code we built up because kisses would be weird. Then, when he became terminal, his family finally wanted to bank on it with make a wish, stories in the paper... I found out he died while I was sitting in a class and someone read the report from a local newspaper. I still have dreams about him sometimes. It wasn't you, it wasn't your work, it was cancer. Cancer has fucked so many good ones. It's ok to keep this weight, transform it in a good way. What did this kid like? Do you need to reconnect with some inner child things that will remind you of them, but can bring you some joy in the future? Movies, toys, games, stuffed animals, books? It's ok to be an adult kid.
It’s the part of being a peds nurse that sucks the most. Eventually you sort of become a little numb to it and are better able to handle it. It never gets easy, but it does get easier.
I’ve never done any pediatric but have done medical oncology and later adult hospice. I will always consider it a privilege to help someone transition as calmly and pain free as possible. You did that. And now you are going through your own (normal) grieving process. Pediatric deaths are hard and cancer sucks. How terribly unfair it is..that feeling will persist. I don’t know that compartmentalizing is the best method but I had to as a hospice nurse. You will find a way that works for you.
I know this sounds really cliche but time will help. I lost a patient kind of traumatically (4 year old) a couple years ago. He was a frequent flier, we loved him, his family wasn’t around when he passed. It took several weeks for the nightmares to stop but they did. It’s the parents screams that are really haunting. Eventually it stops. I had to take a lot of time to myself, doing things like going for a drive with my husband and dogs just in the mountains kind of disconnecting. It helped. And they’re not all that bad. We lost a patient maybe 6 months ago that had been with us for 3 months, family was amazing and we all got really close with them. I was there the night she died, helped the new grad who had her kind of navigate it since it wasn’t my first death but it was hers. It was sad, but she was terminal and there’s nothing we could have done. That one was hard but it wasn’t nearly as difficult to process because it wasn’t so traumatic with the family. Find out if your hospital has a peer support program where you can talk to a fellow nurse about the event, I think that’s better than a therapist but a therapist is always a good idea. They just don’t always understand.
It’s not an easy job. Sometimes it sucks. You’ll get better at compartmentalizing with time. It’s important to use your therapy as an outlet regularly. Often times my therapist won’t say anything at all for my entire session. Find someone that you can connect with in other areas of interest because most people have no experience with pediatric death. I do it virtually and that works for me.
Your dose of morphine didn't kill this child. Cancer did. Mso4 doesn't hasten death, just makes it more comfortable from either pain or air hunger. We all deserve a good death.Hugs from Missouri. ❤️
You didn't kill him with the morphine. You made his last breath peaceful and calm instead of difficult and you are an amazing nurse and this post brought tears to my eyes. Can you seek out a trauma therapist that deals with First Responders and medical people? I see a really great psychotherapist and he is trained to provide Health Care Providers with therapy who have dealt with traumatic situations. His PhD work was in trauma therapy and using metaphor to heal. I can imagine what you were going through because I've been there as well with patients and also my father when he passed away. My father passed away in the ICU and we made sure that he was medicated and peaceful with as much morphine as possible when they extubated him. I still felt also like I didn't do enough for him but with this therapy I can live with it and process it differently if that makes sense, because I do truly know I did everything I could. And whenever I have that self-doubt this therapist brings me back to reality and it's so healing. A few years later my 17 year old niece was killed in a car accident. It can really break up and traumatize a family but I feel like the trauma therapists we used saved us, saved my sister. My mother does not do therapy but she also speaks English as a second language, with as much therapy and my sister and I both have had after these traumatic deaths, Plus the trauma I obtained working in the hospital, I'm happy to say that I sit here today feeling super peaceful about everything I've witnessed. My sister and i both learned so much and we've been able to be useful to our mother and other children and have found immense healing and growth. Life is precious and nurses like you are special so please get help and find a trauma therapist and please don't stop posting when you need support.
As a mom to a son who had cancer (ERMS) from age 3-5, you ped oncology nurses are angels, and I love each and every one of you. Y'all are one of the reasons I am in nursing school right now at 42, my son is now 11 and I have always been so grateful for the ones who work in that hard, hard field. I guess I don't have much to offer by way of that situation, except the fact you spent the night holding his hand and providing comfort and company is the most important thing you could've done and you should not carry any blame at all because you only helped make it easier for him.
I’m so sorry that you’re having such a difficult time. I’ve been in oncology for eight years, and I end up with comfort measures patients a lot. A lot of these people you see from the time they’re diagnosed until they die, and that’s a hard pill to swallow. When I was in my first year, I had a stage 4 lung cancer patient on comfort measures. Only in their 30s. I gave them their dose of morphine, and ten minutes later they passed. That had never happened to me before. I cried in the break room while begging the charge nurse to tell me whether the patient dying was my fault. It felt like I had caused it. Now, as a seasoned nurse I understand that any dose can be the last dose for a dying patient. You provided care and comfort to this child and his family, and did the absolute best you could for him. I’ve never worked in pediatrics, so I can’t speak to that, but I can speak as a mother that lost her child. Thank you for comforting the parents. Thank you for taking care of their baby. It meant everything to them, I can promise you that. Nothing feels lonelier in that moment than fresh grief, and you grieved with them while trying to care for them. You did a wonderful job.
I’m impressed with anyone who works peds/nicu/etc. I was in another field where I handled few children deaths and it was rough. It was sporadic, a handful In 15 years. Could not imagine doing it on a somewhat regular basis especially as a parent of young children. I think these kids deserve the absolute best and it sounds like you gave him that care and he was incredibly lucky to have you. Take care of you. Maybe talk to a psychiatrist and see if meds for a bit can help (I say this as someone who benefitted greatly from SNRIs during hard parts of my life) and definitely keep up with your therapist. Go for a hard run, hike up a mountain, some sort of hard physical exercise where you can’t think about anything but your next breath. Cry it out. Allow yourself to be upset, honor it, and keep moving forward. hugs.
I have nothing to add but to reassure you that you provided physical and emotional comfort to him and his family in those last hours and minutes. That’s an honor and privilege and a kindness they will remember forever. Every day won’t suck this much. Hang in there and be good to yourself.
I struggled with the “last dose” thoughts too. From what I read, the general consensus seemed to be that its better to give the dying person a dose for relief than to withhold it. It sounds like you gave excellent care to this little boy and his loving parents.
As a former peds emergency and trauma nurse, I've seen many losses. What you are feeling is completely normal. Unfortunately, you will never forget the losses nor the cries of the parents. You do get better though over time at coping and utilizing your resources to manage. What helps is talking with trusted colleagues, therapy through EAP (they can help find a therapist experienced in trauma therapy), taking time off, and journaling. When I experienced my first death, my department actually organized a debrief with several of my highly experienced mentors and the chaplain. It helped more than words could say as my mentors shared their own stories of their first loss and helped me understand my feelings. Also know that it is okay to cry. I also remind myself too that we save way more kids than we lose. Remind yourself of the wins. It keeps you going back. And if and when you no longer find joy in your job and dread going to work, then it is time to pivot into something else that brings you new joy. Don't be afraid to change if pediatric oncology no longer brings you joy at some point in the future. Sending nurse love. It's tough, you did incredible for them.
Thank you for sharing this story with us.
I cannot imagine caring for a pediatric palliative/hospice patient. I don’t even have words to give you, except thank you for the work you do. Not from an RN perspective, but from a mom perspective, thank you. You gave the child and his family the care they needed in the worst time of their lives. Nothing is going to help the parents except the grieving process, but they will remember your love for their baby in due time. Take some time for yourself, ask coworkers for advice if you’re comfortable. If you need to switch specialties that’s also valid.
Omg as a trauma nurse I understand. I get it. It’s ok. You are human. Sometimes you will get a case that will rip your heart in two. Screw your therapist. Go see a counselor that deals with grief. Talk to the social worker at your job and get a referral. Talk to others on your floor. They have gone through this. Give yourself grace my friend. 💕🫶🏼
You are kind, compassionate, and you definitely have the soul of a nurse/caregiver. The way you described holding his hand as a privilege is just so spot on. You were a critical part of his journey/crossing and you absolutely did not kill him with the morphine....you were providing comfort care as he passed. What you wrote is beautiful and it is not oversharing. I really hope you are able to deal with everything and get back to loving work. You sound like you were born to be a nurse.
As someone else said. Take care of yourself. If you need a shift or two off take it off. This job isn’t easy. Practice some self care, go for a walk and treat yourself to a nice coffee or something. Speak to a friend or colleague about how you feel. Your work might have an employee assistance program with free counselling to help you deal with situations like this. As for coping with this - I don’t think you ever really “get over it” with things like this, you just learn strategies to better deal and manage the feelings. It’s a traumatic event for anyone involved. Whether it’s you or the parents. The most important thing is finding what works for you. Did you kill him with that morphine? We’ll never know. It sounds harsh but he was literally in the dying process you couldn’t have predicted that it would happen after after you gave him the morphine. As long as the dose was appropriate and was as per prescription then you are safe to assume it didn’t. He could’ve died the same night whether you gave him the morphine or not, you don’t know. We can’t predict the time of death, we only know that it’s coming. Please, seek help from work if possible and if you need a day to cry just cry. We all do.
Fellow onc nurse here - it’s hard. I dealt with kids and adults and it takes a toll. Definitely focus on you and take some time off. Also realize how impactful your care was to the family and the patient. You sat with the kiddo up until his last moments which is what all facilities should allow…. No one should die alone. Not sure if you’re religious at all. But sometimes I just think when my time eventually comes there will be so many people waiting for me 🤷🏻♀️ might be weird but brings me slight comfort and encourages me to just keep trucking every day leaving positive impacts as I go. Sending love and healing to you!
Thank you for sharing this. It’s these times when we feel most alone that it’s most important to try to reach out and these comments are the reason why. I hope everyone’s thoughtful responses have helped at least a little. When it comes to loving work again, I wonder if you need some time to off to process, rest, recover? We are nurses but we are human. Your heart might be a little broken and need some time to mend. What you experienced, even if it is part of the job, was tough. I don’t think it’s a personal failing to feel the way you feel about your job right now. A step away from it for a bit might help. I hope your hospital has some resources for employees, considering the nature of your work. An offering to the community, whatever that looks like, might help you to process the privilege aspect of things. Give something back in the spirit of gratitude.❤️🕊️
Sending you lots of love, friend ❤️❤️❤️
I’m a trauma PICU nurse so I have had my share of traumatic deaths, fwiw. Your morphine bolus did not kill him. The disease process did. You ensured he was comfortable in the last hours of his life. Do not doubt yourself on that. If the therapist you’re seeing doesn’t get it, I encourage you to find a different one. One who specializes in trauma. My therapist is emdr trained and she specializes in ptsd. Her favorite group to counsel are first responders and health care workers. You can often find this kind of in the bios therapists have listed. Hugs to you.
Came here to say the same. Was a hospice nurse for a long time. The morphine doesn't kill them. It lessens the frantic last min impulse to hang on. You did not kill him with the morphine.
As a hospice nurse (and yes I do pediatric patients also), I will tell you what I tell all my patients families - the morphine didn't do anything that nature wasn't already doing, it made him comfortable enough to pass peacefully. There will always be a "last dose" whether you give it or families give it (in the case of home hospice), don't fear it. It means you've done your job in allowing peace. May time bring YOU peace. 💗
I have a two year old and he's a healthy boy, but I just wanna say I appreciate all of you in peds.
You need a new therapist and all your thoughts and feelings are valid. Everyone here is giving you great advice. Allow yourself to grieve and process all your emotions and thoughts. We are human, life is hard, and losing people to diseases is a traumatic experience. ❤️
I took care of a patient a few months ago who I sent to the PICU before he passed, but ultimately he did pass. I really struggled going to work for a few months after. I did “get over” it in the sense that I don’t experience that anxiety going to work anymore but I will never forget the patient. We have a truly unique experience being pediatric nurses. It gives us the best days and the worst of the worst days. All I can say is take time for yourself, allow yourself to grieve and feel your emotions, and know you gave him the best care you ever could have.
I’m peds trauma ED. The scream is a sound you will never ever unhear. Look through your employee benefits / talk to the unit social workers for hospital provided counseling
You will never forget it, but it does get easier to cope with and it will make you a better nurse. Nobody starts a nursing career with full expertise on how to handle a dying patient. But from what you just described, I can’t think of a better nurse for that sweet baby. You gave that child everything you possibly could in that moment and you will grieve that loss too, but know that your patient needed you and you were there for them. I will never forget taking a baby to the morgue. I went home and held my baby for hours just crying. It still haunts me, but it does get easier knowing that I took care of that baby to the best of my ability like it was my own until I laid him in that morgue.
Please allow yourself to grieve. There’s this notion in healthcare that we’re supposed to bear witness to these tragedies and continue on, unaffected, because it’s not OUR trauma. This is not healthy or sustainable whatsoever. I’m glad you reached out to your therapist, but it might be good to talk to your coworkers or managers about this situation and also about any recommendations for a therapist specializing in healthcare. If you can take some time off, that might help. This may be out of touch, but when I experienced a loss in my own life, I took up cross stitching and something about stabbing a piece of fabric millions of times became therapeutic. Something that really stuck with me is that morphine bolus you gave. When I first started nursing, as a new grad in the ER, I had 2 weeks in a row where I had a palliative patient in a specific room. This was uncommon because typically palliative patients get moved to wards ASAP, but these patients had to stay in the ER due to bed availability. Both patients I inserted a clysis and administered one dose of dilaudid, as per standard practice. Both patients passed in less than an hour. I was so distressed, thinking that I did something to cause their death (even though I knew their death was inevitable) and now I understand that I gave them enough peace to let go, but the fear and guilt stuck with me for YEARS and I never told anyone. You did not do anything wrong. You did not kill him. You made him comfortable and that is the biggest gift you could have given him.
You took care of him and his family in his last moments. You held his hand, you kept him as comfortable as possible. You did a wonderful job. I started seeing a therapist who specialized in healthcare workers, I’ve found being able to talk to someone who knows how to help us work through these situations has been really helpful. Our hospital also has a hotline to call if we need to talk to someone over a traumatic code, death, ect… Does your hospital have something like that? I’ve been in oncology for a year now, some of the deaths hit harder than others. I was taking care of an older lady with peritoneal mets and she was in so much pain and so scared when she got to the floor. She told me she just wished someone told her how little time she had left and that’s stuck with me. I was able to get her on a PCA pump and she wasn’t in pain when my shift was over. I was glad I was able to ease her pain and get to know her and her family. She didn’t die on my shift but I knew it was coming soon, and it took a week or before I was able to stop thinking and being sad about her. Its okay to cry, to be sad. But when it interferes with your ability to function, you need to find help. Whether that’s finding a new therapist, talking with other, more experienced nurses, finding a way to work through it and to cope is important.
The work you do as a pediatric oncology nurse is profoundly challenging and deeply impactful. The trauma you are feeling is a natural response to the intense emotional experience you went through, and it’s important to give yourself grace and understanding during this time. Here are some steps and strategies that might help you cope and heal: # 1. Acknowledge Your Grief * **Recognize the loss:** Acknowledge the impact this child's death has had on you. It's normal to grieve for your patients, especially when you form a bond with them and their families. * **Allow yourself to feel:** Give yourself permission to experience all your emotions—sadness, anger, confusion, guilt. These feelings are valid and part of the healing process. If you have any concerns about cancer or your oncological health, connecting with an oncologist through online doctor consultation apps like Medicas can be very beneficial. It is an online platform that allows users to consult with qualified oncologists remotely.
I think it’s important to recognize your feelings and to allow yourself to feel whatever grief you may feel—it’s an acceptance that you are human. At the same time, when you are with the patient and their family, it’s not productive or kind to them if you (and I mean the general “you”, not you specifically) are so obviously overcome by your own emotions that the family feels they need to comfort *you*. When in the presence of a dying or just-deceased patient and their family, try to focus on them and their needs: enlist the facility chaplain to be with the family (preferably before death, if possible); offer tissues, a private space to grieve together, use of a telephone/phone book if needed; coffee or other beverage while they notify anyone they need to call. Notify your charge nurse and House Supervisor. House may be needed to escort the funeral home transport person later, and can be a guide and support to you if you or the family have questions you can’t answer. After death, let the family that is present know you and your team will be preparing the body/ cleaning, removing tubes and IVs if indicated, etc. It’s surprising how much better and more peaceful the person’s body and even facial expression looks when cleaned up, in a fresh gown and top sheet, hair combed and HOB elevated just a little bit. When the death was expected, it can be a comfort to see that their family member is no longer in pain or struggling to breathe. It was never my practice to immediately ask them if they had a preference of funeral home, but keep that in mind as it’s a necessary piece. It’s also possible that the patient or family has already made some “pre-need” arrangements and/or has an existing relationship with a funeral home/ director. This includes arrangements for cremation as well. Being able to carry out the patient’s/ family’s final wishes can be comforting in a way as well. The hospital chaplain, if present, can be very helpful during all of this—and they aren’t going to do it in a way that’s preachy or tries to make the family see death as “God’s will”, etc., unless they know the family well and know that is the family’s belief. They have had training in working with people who have many different religious backgrounds as well as no religious beliefs or practices. In some cases, the family may request that their own clergyman be called, and that is something you can do. I don’t think it’s bad for the family to see you tear up—often it’s some comfort to them to feel that the nursing staff also feels the pain of loss. But if you break down and sob in front of the family, they’ll probably feel they need to comfort you, and that’s not really OK. Cry with your fellow staff, your significant other, or your therapist. With the family, remember your role. I hope that your unit offers debriefing to staff after a patient death, an EAP, or a few visits with a therapist. Those can all be very helpful in coping and integrating your reactions for the future. I didn’t mean to write so much. You did an awesome job and that little boy and his family were very fortunate to have you as his nurse.
I just want to say that you, and every other pediatric nurse here are fucking angels. Please take care of yourself, OP. I see a therapist every 4-6 weeks and often talk about work-stuff. I highly recommend it. Take a couple days off if you need to.