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A growing number of hospitals have developed small and informal ways of helping nurses cope with occurrences of sudden death, ranging from holding quick "debriefing sessions" right after the death with someone from social or psychological services to bringing in the hospital chaplain.

As Ginger Chichwak, RN, left her post in the adult critical care unit at Community Hospital East in Indianapolis for a quick lunch one day, she was confident that at least one of her patients was in for a good afternoon. A woman in her early 70s had been recovering from a massive heart attack and was about to be discharged. As Chichwak stepped down to the cafeteria for a bite, the woman was sitting in her room combing her hair, nibbling from a food tray and waiting for her family to come take her home.

So when a Code Blue call brought Chichwak rushing back to her unit, she was shaken when she saw whom it was for: the elderly woman waiting to leave. Despite frantic efforts to revive her, the woman died on the spot-the victim of a ruptured ventricle, which occurs on rare occasions after a heart attack.

"She was feeling so good when I left," Chichwak said. "It was such a shocking experience."

Several months later, it happened again.

This time, Chichwak and her colleagues were preparing to discharge a middle-aged man after helping him for weeks to recover from a stroke. Chichwak had just phoned his family with the good news when she passed by his room and saw him slumped in his chair. It was over quickly after that, as the man died from a massive blood clot.

"It was the same eerie thing," Chichwak explained in a voice that still sounded a bit incredulous. "He was cheerful and more sociable than he had ever been, and then suddenly he was gone."

Death's toll

For many of the nation's nurses, particularly those who work in intensive care and other serious illness units, death is an unfortunate part of the job. Few nurses, however, will tell you that they ever get used to seeing patients die-especially when it occurs unexpectedly. As sad and difficult as the passing of the terminally ill may be, it is the sudden death of a patient who appears to be on the mend that many nurses find particularly difficult to handle. Such incidents, they say, often force them to deal with a number of complex issues that usually do not accompany an expected passing-issues that, if not properly addressed, can eventually take their toll.

First and foremost are the range of emotions that arise from such a traumatic event. In addition to feeling intense shock and grief, many nurses tell of feeling confused and helpless-and even guilt-ridden that the death somehow was the result of something they had overlooked.

As many in the profession can attest, taking time to digest all of these emotions during a rotation is a luxury few nurses can afford.

"The pace of nurse work is relentless and so there is little time to stop when we lose someone that way," said Alice Weydt, RN, director of patient care services at Immanuel St. Joseph's Mayo Health System in Mankato, Minn.

What's more, it is often the nurse's job to attend to the body after death-and so many nurses must quickly move from trying to save a patient to the grim task of preparing the deceased for the family. "We have to pull out all of their tubes and lines and clean them up to make them look as nice as possible for their family," Chichwak said.

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