I met N.C. and became her primary nurse a few days after she was placed in the ICU with bilateral pneumonia and a history of non-Hodgkins lymphoma. Pulmonologists had been following her as she previously had required biPAP and had significant lung compromise in her history.
The moment we met, we connected, and though she seemed very withdrawn and quiet, I sat down and we started to talk about her illness and how she thought she was doing. Rheumatologic arthritis had caused scarring in her lungs, as had chemo for her non-Hodgkins lymphoma, then she developed pneumonia that hampered her already compromised respiratory system. I heard through other staff members that there had been many family meetings about and with this patient and her prognosis was 50/50, but the family wanted to get her to rehab and then eventually home.
N.C. said she knew she was very ill and had a long road ahead of her. Her hopeful and encouraging family told her, Eat and you will get better. After family members left one day, N.C. told me she couldnt do this anymore. She was fighting for her family and understood they wanted her to get better, but that it wasnt their fight, she said. What is the one thing I can do for you today? I asked her.
Well, she said. I did have a dog visit. Could we do that again?
I responded absolutely and mentioned I would leave a note for the charge nurse for the following day. She thanked me. I left that night and did not return until Tuesday.
When I returned, she was on an oxymizer at 6 lpm, and any activity would drop her oxygen to 70%. That afternoon, she was requiring slightly more oxygen. I titrated her up to 8 lpm and gave her morphine to ease the effort to breathe.
She told me she had a good day.
I came back to work the next morning to find out her night had been more eventful.
She was placed on a non-rebreather mask, could not maintain her SO2, was spiking temps and needed more morphine. She was comfortable and stable from midnight until I arrived that morning and received report. I informed the intensivist she was spiking temps again. Her WBC went from 17 to 29. He instructed me to place her on biPAP, obtain blood, urine and stool cultures and that we were going to start her on Vancomycin and Mycomycin. While we were waiting for test results, the intensivist notified the husband of the turn of events and advised him to come to the hospital. He arrived at approximately 10:30 a.m.
I cant watch her breathe like this, her husband kept saying. I dont want her to suffer.
In the meantime, her respiratory rate was increasing to the 50s despite receiving morphine every 30 minutes. The intensivist told the husband things were not looking good. The husband asked us to wait until his children arrived before they made any decisions.
The family had a good rapport with our social worker, who did not know of the patients current situation.
When the social worker arrived, she said, I have the dog visit lined up for 12:30.
The doctor and I looked at each other and he said, Should we still do it?
Absolutely, I replied.
I went into the patients room and she still was able to open her eyes and speak short sentences.
I approached her bedside and whispered in her ear, I have a surprise for you. Hannah, the dog that visited you in the ICU, is on her way.
She looked up at me, started to cry and repeated, Thank you.
At the nurses station, I told the social worker that the patient started to cry. Then I burst into tears.
The family meeting took place at 11:30 a.m. The plan was to start a morphine drip for comfort. The family asked me to start the drip but to wait to pull off the biPAP until after all of the grandchildren and her special visitor arrived.
At about noon, Hannah arrived. We slid the patient over and placed Hannah on the bed. The calming effect was immediate and amazing to watch. We placed her hand on the dog and her respirations immediately decreased to the mid-20s. Hannah stayed for about an hour with the whole family in the room.
The drip was started and the biPAP was removed. N.C. passed away peacefully within minutes.
Her husband later told me about the impact I had by arranging for Hannahs visit. The family recently moved and could not take their dog with them. N.C. was very upset because she loved dogs and her house was full of canine figurines. I cried as the husband expressed his gratitude for making N.C.s last few hours comfortable, knowing we left an everlasting impact on the family.