The Impact of Losing a Patient to Suicide

“Healer, heal thyself”

When we become nurses, we witness the beginning of life as well as the end. In many specialties, it can be common and we learn to process the loss. I’ve worked in the ER, the rational brain knows some injuries are just not survivable. I spent a year in the NICU and shared in the heartbreak of parents but also understood the odds stacked against the tiniest of patients. In primary care, age and natural disease process could be anticipated and understood.

But no one talks about the loss of a patient in mental health. My first experience was as a green ER nurse. A quiet, reserved young man came in with suicidal ideation. He was polite, wished to remain a silent patient and cooperated with the assessment process. I provided a warm blanket, sandwich and compassionate care. The mental health team deemed he was not in imminent danger and he was discharged. Just a few days later we learned he left the hospital and completed suicide. I will never forget his face 15 years later even though we spent only a few hours together.

This week as a nurse practitioner, I lost a patient that I cared for for over a year. They had a difficult past and had been through every level of care. We worked hard to find the right medication regimen but as we know, they come with unpleasant side effects and feeling disconnected. We met just a few weeks ago and they seemed optimistic. Then I got the call no provider can prepare for, their mother let us know they had died by suicide the night before. I was absolutely gutted. They were my kids’ age. They sat across from me so many times, some days at their lowest and others with a confidence for the future. But as we all strive for, I thought I could make a difference.

I left for the day, unable to process all of the emotions and tried to go back to care for my other patients two days later. Halfway to the office, I had a complete breakdown. I pushed down the emotions and thought I could do it. But you know what, I couldn’t. And that’s ok.

We recite the mantra, it’s ok to not be ok. But then when we as mental health professionals are not ok, we shove it down deep and push on.

This is what burnout does. 17 years as a nurse and I’m tired. A level of fatigue that can’t be put into words. Self-care isn’t bubble baths, girls’ nights out and the other lies we tell ourselves

Self care is knowing when to step back. Take a break. We put years in to our education and feel like a quitter, too weak if we

consider leaving a profession we chose. Caring for patients that are at their lowest, darkest days. Vicarious trauma and real trauma happens every day. And it’s something rarely talked about, whether in nursing school or two decades down the line.

So yes, it’s ok to not be ok

But it’s also ok to say, my wellbeing is more important than the ones I am tasked to care for.

Sincerely,

A Tired Nurse

The Invisible Trauma of the ICU: What Attorneys Should Know About Damages in Personal Injury Cases

Amber Gates, PMHNP, FNP, AGACNP

When we think of the Intensive Care Unit (ICU), most picture ventilators, monitors, and life-saving interventions. But what often goes unrecognized—especially in litigation—is the deep, lasting psychological impact of the ICU experience. As a Legal Nurse Consultant with a background in both critical care and psychiatric nursing, I urge attorneys to give serious consideration to the emotional and cognitive toll ICU stays take on their clients.

ICU Survivors: Physically Alive, Psychologically Changed

Studies show that up to 60% of ICU survivors experience symptoms of Post-Intensive Care Syndrome (PICS)—a cluster of physical, psychological, and cognitive problems that persist well after discharge. These may include:

• Post-Traumatic Stress Disorder (PTSD)

• Anxiety and panic attacks

• Depression

• Delirium or ICU psychosis

• Cognitive impairments (e.g., memory loss, difficulty concentrating)

Many patients describe vivid hallucinations, a sense of helplessness, and the fear of dying alone. Others report nightmares, flashbacks, or an altered perception of reality. These are not fleeting feelings—they can last for months or years, impacting one’s ability to return to work, maintain relationships, or live independently.

The ICU as a Traumatic Environment

The ICU is an inherently disorienting and dehumanizing space:

• Continuous alarms and invasive procedures

• Mechanical ventilation and physical restraints

• Sleep deprivation and sensory overload

• Loss of control and personal dignity

These factors combine to create the perfect storm for psychological trauma, particularly for patients who are sedated, intubated, or chemically restrained. Patients that are intubated or sedated often still have a level consciousness and are able to recall conversations that occurred around them or procedures performed. My father in law experienced this during an open heart operation. The surgeon didn’t believe him until he was able relay what the surgical team talked about during his prolonged surgery.

Legal Relevance: ICU Trauma as a Compensable Injury

Too often, damages in personal injury cases focus only on visible injuries—broken bones, surgical scars, or loss of income. But for those who have endured prolonged ICU admissions, the invisible injuries may be just as profound.

When preparing a personal injury or medical malpractice case, attorneys should:

• Request psychiatric and psychological follow-up records, not just hospital records

• Include ICU-related trauma in expert reports or narrative summaries

• Document post-discharge therapy, counseling, or medication needs

• Use the testimony of a qualified medical consultant to explain the nature