You always remember your first. He was in his sixties and I was 22. As a nurse, dealing with death and dying is inevitable. It is an ever present possibility. Sometimes, it is a peaceful, uplifting experience that reminds you why you do what you do. A doting husband holding his deceased wife's hand, crying softly while telling you what a wonderful life they shared, and how happy he is that she is at peace. Children and grandchildren sharing stories, laughing, singing, and even praying by the sides of their loved ones. These are the good ones.

My first time losing a patient was slightly different. For some reason it has been on my mind today and I find that writing about it is cathartic in a way, so bear with me.

It was my first month off of orientation working in the ICU. In those early days I was terrified of making a mistake. You know on some level as a nursing student that you are responsible for keeping people alive. Mistakes on your part can lead to patient injury, and in some extreme circumstances, death. But when you actually have your own patient assignment, knowing you are solely responsible...well, it is a tad overwhelming as a new grad. That night I was working in the step down part of our unit. My patient was transferred from the critical care side to step down right as I came on shift. I even helped move his bed over; the distance from one unit to the other is only a couple of feet, with an open doorway in between. I received report, he was recovering from a brain tumor resection and had a pretty good prognosis. I met his son, who was very worried and anxious and had not been home the entire time his father was in the hospital. He was using a hotel room to shower and change, taking all of his meals at the hospital and sleeping in a recliner at his bedside. I reassured him over and over again in that first hour. His father was doing great! He was being downgraded to a less critical area, his speech was improving and his vitals were stable. I joked around with both the patient and the son. At some point in the night, I told the son to go home. Get some rest. Sleep in a real bed. He was very hesitant, and felt that if he left something would happen. I told him not to worry; I would personally guarantee his father's well being and if anything were to happen, I would call him right away. Reluctantly, he left. But not before giving his dad a kiss on the forehead and triple checking I had the right contact information.

You already know where this is going. His father did not survive that night. Without going into too many details, he went into respiratory failure and eventually cardiac arrest. In my heart I know the events that led to his death were out of my control. His death was unpreventable. But I sent his son away on the one night he wanted to be there. I wasn't even able to call him when he started to become unstable, it was that fast. We coded him for 40 minutes. If you work in healthcare, you know that's a long time to be doing CPR. When we finally called it and I was able to think straight, my heart broke as I realized the phone call that I needed to make. It was the single most difficult conversation I have ever had with a patient's family member. I felt responsible. I felt guilty. And his son was in no mood to assuage my guilt. He screamed. He cried. In the end, he didn't even come to see his father's body. His brother called me soon after we hung up (or rather, he hung up on me) and told me he would make the arrangements but to please not call his brother anymore.

I have had many patients die since that night 5 years ago. Some were expected, some were not. I can't even say that my first experience of patient death was the most unexpected; there have been worse cases. But it was the one that had the most impact on me as a nurse. It made me more humble and compassionate, I think. You never know what can happen, life is not a given. I have never again promised with certainty the health of a patient. I have never again pushed for family to leave the bedside to get rest. I love my job, I love the feeling of accomplishment and sense of purpose that comes with being a nurse. But it can also be very difficult.

There really is no point to this entry, except to put my thoughts into writing. I hope my career continues as it has, with the good experiences outweighing the bad. And I certainly hope that somewhere, a son can forgive the well meaning nurse who sent him home on the night his father died.