First death

[Londonmaine]

I’ve been a posting member of Mumsnet for as long as it started. I’ve not posted in a few years.

Some old people may remember, moved from London to an island in Maine, had a child etc etc. Did the whole poo/diaper gate thing that went viral. Had the MIL from hell.

Anyway, just trying to prove I’m credible. So on my journey of trying not to be shit and useless I’ve become an EMT. So basically an ambulance person/ first responder.

I had my first death today. They made me do the CPR (fine with that, I need the experience) and the gentleman (who I knew well, it’s a small island) didn’t survive. He had clearly been dead a while when we got there but when family are present it’s protocol to do as much as you can.

I can’t reach out to anyone here, I don’t want them to think I’m weak or unable to cope so I’m posting here because I just feel so sad. We couldn’t have helped him, but he was so frail (and naked) and I feel like everyone was so experienced they treated him like a piece of meat and with no respect. Given that I’ve been crying for three hours I completely understand why they do that.

Dont get me wrong, at the time I did everything I needed to do. 25 minutes of CPR and and AED I just feel really bloody awful to witness the end of a life.

Is this something that will be a great, empathetic skill or should I just quit?

You need to talk to your teammates. Take one aside who you get on with or chat easily or see as a bit of a mentor and let it all out. I would imagine their first experience was very similar too. Focus on all the lives you will SAVE, not the ones unavoidably lost x

People need to see and know that everything possible has been tried. It may have felt disrespectful, but they saw you try everything. And it's not your responsibility to say it's not worth it; isn't it the job of a doctor to declare death, anyway?

Detachment protects those who do this every day, just as I protect myself from taking the unhappiness of the people I can deal with at work home with me; my responsibility is to do what I have to, to the best of my ability, not letting my feelings interfere with how well I do it, consciously or otherwise. Your job is far more important than mine.

You can do this. You will be wonderful at it.

I hate to say it but you will learn to live with it and hopefully be at peace with it. Being a (volunteer) first responder here over the years I’ve learned that death is very much a normal part of life. It comes too early for some, too late for others. Being an EMT for that person is a privilege - you can give them a chance with resuscitation if that’s appropriate, you can be a calm soothing presences if it’s not. I am not at all religious but I say the 23rd psalm for everyone I go to who has died and I generally open the window too.

I’m lucky in that my area is very big on ReSPECT and we have a high threshold for starting resuscitation so people can be treated with dignity.

OP do you think it was the fact he was obviously dead with no chance of a positive outcome that has traumatised you as much as the death itself?
Its not your fault this protocol is in place, and it’s not wrong to question your line manager why you have to do CPR on someone who is dead and has been for a while.
There’s probably an option to have a debrief with a senior member of staff if you’re finding it difficult.
It sounds horribly traumatic.

When my sister died (in the States) after a long illness, her husband rang the emergency services. They rushed in and started pulling her around to do cpr, and I said no, she’s dead now, leave her alone. They were hesitant and checked with her husband who was an absolute mess and had been completely un accepting that she was dying, but I was adamant and thankfully they listened to me and didn’t proceed.
25 minutes pounding on a dead man sounds pretty undignified, I expect they would have done that to my sister if we’d asked.
Can you have a debrief with your senior/manager person and ask why you couldn’t have confirmed he was dead and left it at that? Maybe it’s standard policy to avoid litigation. My sister had been dead for more than ten minutes and looked extremely thin and frail from her illness, in a room that was set up like a hospital room, so not an accident like falling down the stairs, but they still would have done it.
Well done for your training, so sorry for your loss , it will get easier to navigate.

I’m sorry that this was such an awful trial by fire for you. My first CPR was on a six week old infant on a plane. When I handed the baby over to paramedics, I had an instinctive urge to grab the baby and keep going. Even though the baby was cold and grey when handed over and my logical brain knew that things weren’t going to be all Grey’s Anatomy, I was still stunned by the look the paramedic gave me to imply that there was nothing to be done. I went into shock and slept for over 20 hours when I came home that day, shaking the whole time.
An EMT’s job is not to save everyone, but to TRY to. Your island is so lucky to have such an empathetic, caring person in this position. When you work in these positions you hold onto every happy ending and it really is worthwhile.

@KangarooKenny @PerseverancePays there will be strict protocols around who does and who doesn't get an attempt at resuscitation, Maine probably didn’t have any choice. That said, in the UK your sister would never have been resuscitated in our Trust Perseverance, that was awful.

Sending you kind thoughts. It must be so much harder when it’s a member of your own community. Don’t quit because of this but do talk to your colleagues who will understand what you are going through. Some people stay with you and that’s because you care.

My personal perspective here comes through working in critical care for many years and then working in end of life care. I found it easier to cope after unsuccessful resuscitation if the protocol had been followed. The algorithms have been developed through world wide evidence and using them gives people the best chance. Clever dick juniors who want to put up a litre of blueberry juice when it’s time to let people go with dignity, not so much.

Within palliative care people often talk about what a privilege it is to care for someone at the end of their life and I feel this too. Even when it’s an unexpected death, and resuscitation is attempted, you can care for people to the end. And it sounds like you did. I’m sure his family will be grateful for your kindness.

You will always remember your first death with a clarity that fades for others. Not because you care less as you experience more, I think you get more skilled at coping with it. It is a profound experience and even after 20 years, some deaths still affect me more than others.

Delivering CPR is particularly traumatic especially when, despite everyones best efforts, the person dies. Take time to process it, but make sure you get support as well if you need it. It is really important you don't channel your sadness about this in to blame or a "what if" loop. It is OK to feel sad and it is OK to wish it had a different outcome. You did your best, but whatever caused this was not recoverable by the time you attended.

The fact you feel the way you feel shows you care. Just dont let it consume you.

I think this will get easier for you as time goes on OP. The first death is always going to be the worst, and probably the one you'll always remember.

You'll learn to detach yourself a bit so that these situations don't make you cry. Try not to lose all your empathy though, because that counts for a lot and will mean a huge amount to any loved ones present.

I'm a funeral arranger and have learnt to detach my emotions so that I'm not affected by deceased brought into my care, whether it's an elderly person or a young baby. I hope I'll never lose that part of me though that cares about them and treats them with respect and dignity.

The chance of surviving to discharge following an out of hospital cardiac arrest is 7-8%. This person was clinically dead and you did what you could. Plus if this person was older the chances of them surviving would be even lower. There needs to be more education given on a non emergency basis to people with multiple comorbidities to decide if CPR is actually something they would want.

Your team need to debrief, you have all the adrenaline and can get pretty messed up but the only people who really understand are your team. It's not a sign of weakness to debrief an arrest. We would all come together for one of the team and help them through it

Resus I is brutal. I also work in the ambulance service and I would strongly encourage you to talk to you team leader. We are all human and this stuff does affect us - and your team leader knows this. As a service we are rubbish at putting on a front, the longer you are in the service you will notice everybody at some point going into the team leaders office and shutting the door.

I would also encourage you to look into end of life courses/CPD. I found this very helpful as the hospice staff changed my way of thinking about death. Modern day society is scared of death as a process, and we treat people to keep them alive even when it's not always in their best interest. 100 years ago it was normal to see relatives on their death bed. it is something that will happen to us all one day one way or another, and it is a process. There is even a belief now that when a person reaches end of life that the body is so relaxed it's a peaceful for the patient - just doesn't look that way as their last breath gets slower and you hear what's called a "death rattle". I hope you can take some comfort in that if he was already gone before you got there that he would have experienced the relaxation (and wouldn't have been aware of what you were doing).

Also as an EMT you are more than a responder/ambulance person you are a qualified clinician, never put your skills down as you do an a lot of amazing work , you are not a glorified taxi service.

OP if he was my relative I'd be so happy to know that someone like you was there.

LondonMaine. You did what will have helped the family. My BIL dropped dead one afternoon and my DH drove the hour plus journey to his house where the ambulance team continued to work on him for some time after that. It gave my SIL and him time to process that he was dead, that every avenue had been tried and nothing had been missed. Rationally, nothing would have helped him but the crew was helping the family.

Take some time for yourself and talk to your line managers and some old hands. You are doing great work.

My Dad died at the the beginning of the year of Covid. He was on a Covid ward and died at a good age and died peacefully. He had terminal cancer. One of the nurses that cared for him was really crying when it was established there was nothing more that could be done. She had been on the COVID ward since the beginning of the pandemic so I'm sure she must have seen dozens and dozens of deaths. I wasnt even crying or that upset myself. I thought it was very sweet of her.

I don't think everyone gets used to people dying but there is nothing wrong with getting sad. As long as you don't dwell on it too long. Just be sad. It is sad.

I wouldn't get too hung up on the fact you didn't think your colleagues were showing enough respect to the man. They were not being disrespectful.

Thank you all so much. Most of the crew that were there (including my mentor) have reached out to me and all completely understand. They’ve all developed think skin as a necessity to do their jobs and not go insane.

I’m sure it’s as many of you have said, there has to be some amount of compartmentalisation and emotional distancing to do this job without falling apart. Especially as we’re such a tight knit community where everyone knows each other. We’re so short staffed the protocol of not being allowed to work on a family member or loved one is waved here.

It’s funny, you always hear phrases about ‘team work’ and I’ve never really got it. But last night everyone did their bit to try and help and completely without a thought for themselves. That was special to experience.