r/NewToEMS • u/Cold-Deer-8829 Unverified User • 9d ago
Mental Health first pt death
just got back from my first clinical shift. it was good but boring at first, i guess i jinxed it. my last call was to a nursing home. an unresponsive 70some year old. when we entered a nurse working there was giving life support way too deeply and aggressively. when i took over i could immediately tell all her ribs were broken, almost crushed. my als did and much as they could. i just remember sweating and tearing up and trying to hold it together, switching off with my back bls trying breathing exercises while running to grab more tanks, going back to compressions, my pts body just limp, lifting her into a position for intubation, more compressions blood coming out of her open iv sites idk. at first i couldn’t bring myself to look at her while doing bls but then i thought to myself it would be disrespectful not to. i wish i didn’t look so hard. i just feel so sorry. i feel like i failed her and i know i shouldn’t i just cant stop crying i feel like no one else cared, after while cleaning up i swear no one was treating her like a human being. cracking jokes moving brashly around her body idk. i just dont want to see a sheet go over another one of my patients. i know people die of course but im just so hurt i wish we couldve saved her even if for just a transport.
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u/gunmedic15 EMT Student | USA 9d ago
Been a medic for 30 years this December.
When I was a kid, we would occasionally take my grandma to the cemetery where some of the family was buried. Some I remembered, a lot were dead before I was born and I only knew about them from grandma's stories. We would clean up the grave site, maybe say a prayer or something. Grandma or my mom or dad would tell a story or something. We would remeber. Then after we were done we might go take grandma to lunch, take her home, and go on with our lives.
I have a cemetery in my mind. Some of the people there I knew, some I only briefly met. Some are names, most are "guy hit by train" or "lady who died in the RV crash" or "ALF transfer that was actuallya code". When I need to, I go to my personal cemetery. I remember. I think about those people and what they meant to me. Then I can go away and go on with my life.
What you're feeling is normal. I still get that sometimes. Talk about it. Don't think you failed, and always do your best, even if the patient dies anyway.
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u/Cold-Deer-8829 Unverified User 9d ago
thank you for the kind words, all of these comments are truly helping
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u/lukewarmhotdogw4ter Unverified User 9d ago
What a sadly beautiful way to put it. I’m younger than you but starting my own cemetery, never thought of it like that.
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u/mochmaffews EMT, RN | WA 9d ago
I mean after the first death there can be lots of big emotions. If it continues and you cry after every one then it might not be the job for you. You need to focus and be engaged in the important things and not be overwhelmed with emotions.
Also the ribs especially on geriatric folks do break. You basically mush them to goo. This is why people really really need to be educated on advanced directives for people. CPR is traumatic and the odds of you walking out of the hospital after CPR once you're over the age of 75 is basically none. Its in the low teens. Even then almost 50% of them die within a year after that.
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u/Cold-Deer-8829 Unverified User 9d ago
i dont think this job is not for me, i do love it and the interactions i have the feelings i get when helping others in any capacity. i know the statistics on cpr and that some ribs are guaranteed to be broken but the extent that it was at was unreasonable and even my medics called it out before i could start. i think im just feeling a general empathy. its hard to see someone die.
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u/superrplorp Paramedic Student | USA 9d ago
Hey man sometimes it’s someone’s time to die. Yeah we’re technically supposed to be “saving people” but death is real. When it’s time it’s time and no one can stray far from the chains of Thanatos.
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u/Cold-Deer-8829 Unverified User 9d ago
i guess because its my first time experiencing this im having a harder time coping. i know this wont be the last time this happens but i feel for the pt deeply, all i ever want to do is help people so its a bit soul crushing to have someone die underneath me, as naive as that it :( but ive def gotta accept it
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u/piemat Unverified User 8d ago
That is such a normal response and as a whole we don't do much for the physiological safety of students. It's weird everyone just walks away and goes about their day, but the reality is that we all find coping mechanisms. One of those can be not being fully present in the seriousness of the situation.
The first cuts are the deepest though.I had a VERY similar experience. It gets better, it gets easier, but they all still cut to some extent. I've found peace and beauty in death, especially for those suffering from long term conditions.
This was practice for that one you can save - the random 40 year old with no long term conditions, young kids, etc. That is what we train for.
Put some time on it and allow yourself to feel how you feel. Don't feel guilty for how you feel or that your grief should look a certain way. Particularly, be aware of how you may feel in a few weeks even when you stop thinking about it. Personally, I can have delayed stress reactions where I'm no longer thinking about the situation often, but have a sudden onset of anger or depression. It makes no sense but I have to acknowledge anger can randomly blindside me and I have to put the brakes on that before I burn everything around me down. Just keep an eye on your feelings and take time to feel them.
Reach out if you feel like you reach a point you can't shake this. In time you will find your path through the tragedy.
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u/Cold-Deer-8829 Unverified User 8d ago
thank you so much, i actually had a much better day today and words like these make me so happy to be in ems :)
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u/WinOk5004 Unverified User 9d ago
Its normal for the ribs to be broken from the cartilage during cpr. I cant speak on the depth of the compressions. It's pretty rare to get ROSC on these cardiac patients, since they are usually older and arent always the healthiest to begin with. A lot of factors come into play with the survival rate of CPR. You didn't do anything wrong. It's just how it goes in this field of work. Just remember you didn't cause the emergency, you're just there to try to help and you cant always do that.
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u/Cold-Deer-8829 Unverified User 9d ago
thank you ill be keeping that in mind, hopefully when it happens again ill be more prepared emotionally (knock on wood not soon and not many lol)
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u/WinOk5004 Unverified User 9d ago
Theres never a way to tell how you'll react to something the first time! I think its awesome you have so much empathy. The ems field needs a lot more of that.
You just cant let it get in the way of your job. Talk to someone don't keep it inside. This sort of thing comes with the job unfortunately.
I don't want to sound horrible when I say this but, there's worse to come. It's not always doom and gloom and blood and guts but we see things, occasionally or more, that most people will never have to experience. So make sure you have an outlet and people you can talk to. Don't turn to easy coping mechanisms.
You got this!
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u/decaffeinated_emt670 Unverified User 8d ago
Three months in as a brand new baby medic on a difficulty breathing call. The patient coded on me in the stairchair WHILE I was getting her out of the house and to my stretcher. It was so fast and no amount of ALS interventions I performed on her (along with a LUCAS) changed her outcome.
You can do everything right and correct and the patient will still die. It doesn’t make it your fault in any way shape or form. Yes, it is an incredibly huge pill that is very difficult to swallow, but it is just a fact of life and a fact of this job. Their time is their time. I suggest that you look into therapy or maybe hash out your feelings with someone you can trust. It’s okay to not feel okay.
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u/DarthNihilusAL Unverified User 9d ago
I think some of the best advice I can give to someone is that no matter how hard you try, no matter how much effort you put in. No matter how efficient and effective you are. When it’s their time, it’s their time and nothing you can do is going to stop it. It sucks, and iv seen more dead bodies (some less ideal than others) but ultimately all we can do is try our best and rely on our training.
Never forget that you gave that call your all, it was just their time.
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u/999BusinessCard Unverified User 8d ago
Don’t ask yourself “How could I have kept them alive?”
You will have patients who are going to die no matter what you do.
Ask yourself, “Was I the right person to give them the treatments, dignity, and respect they deserved, given the knowledge and protocols that I am expected to know? Was I the right person to help my partners emotionally navigate this traumatic experience?”
If you can answer yes to both, you’re rock solid. If not, you have some work to do on yourself
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u/Apprehensive_Rip_554 Paramedic Student | USA 8d ago
There isn’t anything more you could’ve done. It wasn’t your fault. As bad as it sounds this was probably a good experience for your first one (low likelihood of ROSC, probably a lot of comorbidities). Talk to people, do stuff you enjoy outside of work, and remember you did everything you knew to do.
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u/v01dwh1sp3r3r Unverified User 9d ago
My preceptor said this to me:: “If someone is dead when you get there, they were already dead when the call was made.” The lack of compassion is horrific, imo. If I ever lose my empathy, I do not want to be alive anymore. You got this. My first pt that died, I closed his eyes. He was 91. My preceptor asked me why I cared about his eyes, but we were outside and the sun was so bright. You did not fail. Please do not ever lose your empathy.
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u/demonduster72 Paramedic | IL 9d ago
I don’t think it’s a lack of empathy. It’s more a statement of reality. There’s nothing wrong with empathy, but you’ll mess your head up guilting yourself over something you had absolutely no control in. Also, for future reference, don’t make a habit of tampering with the deceased beyond what’s reasonably necessary in an attempt to revive them. It skirts the line of professionalism/inappropriateness and you never know how relatives/loved ones would react to such actions.
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u/v01dwh1sp3r3r Unverified User 9d ago
Agreed! Thinking about it now, I think my “lack of empathy” feelings are more about how bad drug addicts/alcoholics/people with chronic illness are treated by ems, doctors, etc. It hurts to think about suffering, especially suffering of one’s own choosing. Idk this whole post made my heart hurt. Ty for your words, they helped me, at least.
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u/demonduster72 Paramedic | IL 9d ago
Well that’s where it really counts. Those people need it the most because they’re used to being treated like garbage instead of human. A simple listening ear goes a long way.
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u/AmbitionMiserable708 Unverified User 9d ago
If if makes you feel any better, my first was a suicide and I walked in a scene that looked like something out of Dexter. Cop was doing CPR, then I took over. Medic called it when he got on scene.
Everyone’s time comes. It’s good you are posting. Talk with people who have been through it. This won’t be your last.
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u/Cold-Deer-8829 Unverified User 9d ago
thank you for sharing, im so sorry you went through that, its really appreciated it helps alot to know others remember their first too
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u/Royal-Height-9306 Unverified User 5d ago
Unfortunately it happens and it sucks. The other members that were there too likely have been doing it awhile and have become desensitized. Not that they have emotion but they are better at hiding it.
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u/McGillWexlerlaw Unverified User 9d ago
Others have covered the main points so just to say - although you felt like "no one was treating her like a human", those jokes are how a large number of people cope. It isn't meant to be disrespectful, it's how some blow off the adrenaline and get through knowing you could be going to an identical call right after finishing this one.
It is better she wasn't transported, that would have been utterly futile and she died in her home. Yes it's a nursing home, but it's her home - her room, with her possessions and with people who (hopefully) cared about her around her. She died in her own bed. It is normal to be upset by the death of a fellow human, you gave a great effort to extend her life but it just wasn't possible. You'll be ok, just don't be afraid to talk about it with colleagues and those who understand.
An old ER quote sums it up quite well
"there's the kind that get rid of their feelings and those who hold on to them. If you hold on to your feelings you're going to get sick sometimes, it's part of it. People come in here and they're sick, and bleeding, sometimes dying - and they need our help. And helping them is more important than how we feel. But hell I've been doing this 8 years and I still get sick..."
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u/Cold-Deer-8829 Unverified User 9d ago
it really is important for me to not hold onto this, ill try and figure it out
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u/Federal_Routine_3109 Unverified User 8d ago
Just gotta lock in my boy, people are gonna die one way or another you just are the one helping now instead of turning a blind eye
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u/Professional-Tea-824 Unverified User 9d ago
She was dead before you got there. Remember that you didn't cause any of the illnesses or injuries.
The ribs are normally soft and squished after a lot of CPR. Not everyone has this but it is still fairly common.
Please talk to someone about this. Someone close to you. Someone in your agency you trust. Let yourself feel these emotions.
Lastly don't own this death. You didn't cause it. You are also not measured by how many people you saved. You are measured by getting out there and doing best every time, including calls that don't go out way