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End of Shift: Stories from the bedside

To celebrate you — our valued readers — we share your tales from the bedside and beyond. Here, we feature a brand new collection of our award-winning End of Shift stories about nurses’ unforgettable experiences.

These articles get to the heart of nursing and its everyday trials and triumphs with patient care … so keep a box of Kleenex handy; you just might need it. We hope you enjoy this end-of-year tribute to nursing and find inspiration in these nurses-turned-writers’ life-changing memoirs.

Nurse.com’s “End of Shift: A Treasury of Real Stories by Real Nurses” is a Folio Eddie Award finalist in the Standalone Digital Magazine – General category and was the winner of an APEX Award for Publication Excellence in the Regular Departments & Columns category.

Helping hands — and paws — bring peace

Leslie Gurrisi, RN

By Leslie Gurrisi, BSN, RN, PCCN

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-Hodgkin’s lymphoma. The moment we met, we connected, and though she seemed very withdrawn and quiet, we started to talk about her illness and how she thought she was doing.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-Hodgkin’s lymphoma, after which 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 couldn’t do this anymore. She was fighting for her family and understood they wanted her to get better, but that it wasn’t 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. 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.
While we were waiting for test results, the intensivist advised the husband to come to the hospital. He arrived at approximately 10:30 a.m. “I can’t watch her breathe like this,” her husband kept saying. “I don’t want her to suffer.”

In the meantime, her respiratory rate was increasing 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 patient’s 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 patient’s 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 — were there. 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 Hannah’s 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. •

Leslie Gurrisi, BSN, RN, PCCN, is an ICU nurse at Exeter (N.H.) Hospital.

Pay it forward

Michelle Dang, RN

By Michelle Dang, PhD, RN

Have you had an experience that helped you realize you were part of something bigger and your purpose became crystal clear? I don’t mean moments that make you think about your existence or the vast universe. I mean experiences that help you understand the true essence of being a nurse.

That moment came to me one afternoon when I was finishing my shift as a volunteer nurse at a low-cost vaccine clinic I had co-founded with colleagues. Due to the recent economic downturn, many other public-funded clinics in our Sacramento (Calif.) region closed their doors, leaving uninsured and underinsured families with limited options.
The clinic took a year to plan and implement, but once we opened our door, families came rushing in. To help in the purchasing of supplies, we decided to charge $10 per child for our immunization services regardless of the number of vaccines that a child needed and waived fees for families who couldn’t afford it. To sustain the clinic, I and other nurses as well as student nurses worked at the clinic as volunteers.

On this particular afternoon, it was an extremely busy day at the clinic. I administered one vaccination after another while the families kept coming in. It was a few weeks before a new school year and children needed their vaccinations for school. I felt tired, borderline cranky and started to question whether I had the energy to continue volunteering. At this point, a friendly woman in her 40s came in. She was accompanied by her 14-year-old son who needed the Tdap vaccine.

After giving the adolescent his shot, I gave his mother the vaccine paperwork and told her about the cost of $10. She then proceeded to give me two $20 bills. I gave her back the money and explained that we only charged $10. The woman stopped me from giving back the money and stated, “I want to give you the extra $30 so you can pay for the next customers who can’t pay. I used to be on welfare and I know what you are doing here for people.” When she saw the surprised look on my face, she smiled and said, “I want to pay it forward.” I didn’t know what to say to her but to utter the words, “Thank you.”

The woman’s son was the last client that day. I made a mental note to use the money to pay for families who can’t afford to pay. As I put away supplies and closed up the clinic, the agency’s manager approached me about a woman and two children who just walked in and asked if I wouldn’t mind seeing them. I was exhausted and was ready to tell them to come back another day. However, there was something in the manager’s face that told me I should see them so I said, “Sure, send them back.”

The mother approached me quietly holding her children’s hands and thanked me for seeing them. It was evident when the mother spoke that English was not her native language; however, she was able to communicate what she needed. She handed me her children’s immunization records and said they needed shots to return to school.
As I reviewed the records, I couldn’t help but notice the disheveled appearance of her children. I asked the mother how she found us and where the children went to school. The mother explained that a staff member at the woman’s crisis shelter told her about the clinic. She and her children had been staying at the shelter after she left her husband who had been abusing her. The shelter staff found her housing in a nearby apartment complex and the children would be attending a new school.

After I finished giving the children their vaccinations, the mother looked at me apologetically and said, “I’m sorry, I don’t have money to pay today. Can I pay you another time?” I smiled at her and said, “It’s not necessary. Someone already paid for you.”

I left the clinic that day with a sense of wonder. How often do these serendipitous moments happen? Do things really happen for a reason? Thoughts of the woman who wanted to pay for people she didn’t know and the courage of the mother who left her abusive husband made me feel like I was part of a larger purpose that day, like I was part of an unseen movement where people were quietly making the world a better place and that our collective actions were connected in unexplained and fantastic ways.
I was proud to be a nurse that day as it permitted me to be part of this wonderful experience. Today, I continue to volunteer in my community and pay it forward. •

Michelle Dang, PhD, RN, is associate professor and coordinator of the RN-to-BSN program at California State University, Sacramento.

A broader meaning of wound healing

Laura Crissinger, RN

By Laura Crissinger, BSN, RN, CCRN

Wound healing has taken on a broader meaning to me as an ICU nurse at the Tampa (Fla.) General Hospital Regional Burn Center. The healing our patients strive to achieve means not only the physiologic process of wound healing, but also integrates the holistic concept of the interconnectedness of the body, mind, environment and spirit. This concept also extends to our patients’ families.

Some patients’ conditions are so critical and unstable that you become immersed in their care as soon as you cross the threshold into the ICU. This was the case in caring for a gentleman named R.L., who was in his early 70s. He suffered deep burns to over 80% of his body when superheated gasses seared his lungs as he attempted to re-enter his house to rescue his wife from a fire. As I took over R.L.’s care, a breathing tube was in place and he was on full ventilator support. Two medications along with intravenous fluids were infusing to support his blood pressure. Long, shallow incisions to his arms, legs, chest and abdomen had been made to restore circulation and alleviate the tourniquet-like effect of the deep, circumferential burns.

In response to a burn injury, blood vessels lose their patency and allow fluid to leak into the surrounding tissue causing a fluid shift. R.L.’s skin was so compromised by the burn injuries and incisions that it was unable to support one of its vital functions — to prevent fluid loss. His dressings and bed were so saturated with fluid that it dripped from the bed sheets and pooled on the floor. I set up a bed drainage system and inserted two suction catheters under the patient. Within minutes, more than two liters of drainage filled the canisters. The greatest initial threat to anyone suffering a major burn is hypovolemic shock, so it is crucial to evaluate and respond to all forms of fluid loss. I responded by increasing his intravenous fluids to account for the additional drainage.

R.L. continued to have difficulty maintaining his blood pressure despite my adjusting his vasoactive medications and infusing substantial intravenous fluid boluses to counteract the fluid loss. A third blood pressure medication was started, but it was not long before it also reached its maximum dose and the first of four codes was called by mid-morning.

R.L.’s family arrived at the hospital shortly after the first code and received an update on his prognosis and treatment options. The family continued to want everything done despite R.L.’s extremely poor prognosis. The chaplain, whose presence was invaluable, brought the family to the patient’s bedside. The family chose not to come into the room, but congregated at the doorway, silent. Lying in the bed was someone they hardly recognized and, conversely, someone I did not recognize when shown a picture of R.L. and his wife by his family. I explained to the family that R.L.’s extremely swollen appearance was a result of the burn injury and the intravenous fluids he was receiving to sustain his blood pressure. It was obvious that the moment was visually and emotionally overwhelming for the family, but the explanation seemed to reassure them. They watched as I feverishly replaced bags of fluids, emptied canisters and titrated analgesic and sedative medications to keep R.L. as comfortable as possible.

As the day progressed, R.L.’s condition deteriorated even further. Late in my shift the fourth code was initiated. R.L.’s family members returned to his doorway as they had the two previous codes. However, he failed to respond to the resuscitative efforts and passed away. R.L.’s family members lingered at his doorway for a few moments then left after thanking the staff for the care they provided to R.L.

Many of our burn patients are with us for weeks or months, which enables us to engage with our patients and families in a personal relationship. We understand the context of the patient’s life, recognize his or her uniqueness and assist the family to become participants in the patient’s care. As nurses, we not only care for the patient, but also the patient’s family. At the end of a physically, mentally and emotionally exhausting day, I knew I had done all I could to respect and fulfill the family’s wishes that, in spite of his clinical picture, everything be done for R.L. Even though R.L. endured a difficult death, I could only hope he knew how relentlessly I fought for him and that he was cared for with respect and compassion. I was also hopeful the family’s presence at the bedside allowed them to comprehend the seriousness of R.L.’s condition and, knowing that everything possible had been done, eased their grieving and started to heal their wounds. •

Laura Crissinger, BSN, RN, CCRN, is an ICU nurse at Tampa (Fla.) General Hospital Regional Burn Center.

Eve’s heart belongs to home

Anthony Ayag, RN

By Anthony Ayag, BSN, MSCN, RN

It is 8 a.m. on a Monday, and my patient Eve refuses her PICC line insertion procedure for the third time. “No! I’m not having it. Tell them I changed my mind,” Eve says to the seemingly timid brand new house officer who acts uncomfortable, but is also convinced he can persuade Eve eventually to have the procedure.

The house officer’s beeper goes off and he says, “Let me just answer this page. I’ll be back.”

“Don’t come back, please,” she says. “Go see your other patients. l only will talk to you when my sister gets here.”

Eve is unflinching and uncompromising. The wrath and fury of metastatic gastric cancer may have weakened her already frail body, but when she speaks, it is rather forceful, unapologetic and intimidating. She rolls her eyes as soon as the house officer leaves, then turns her attention to me. “Anthony, can you give me my Moxie, please?”
I grab the orange-colored soda can and hand it to her. She pours its content in a glass and drinks it like she’s really parched. I mention I haven’t seen that soda before. She talks about how she loved this bitter-tasting soda even as a child. “It’s been around that long?”

Eve gives me a playful, yet sarcastic so-what-do-you-care-if-I’m-85-years-old look and says, “They must not sell this in … where you from again Anthony? China?”

“No, France,” I say. Eve laughs.

If we had not bonded a week before, I would not have just retorted as I did. But knowing Eve, I am sure she really needs a good laugh. When I first met Eve, our initial interactions were a little rocky because she isn’t a patient who makes it easy to care for her. I set some realistic expectations and explained how nurses and patients need to work together for the good of the patient. I knew that I won her trust when just before I bid her goodbye before my weekend off, she playfully reminded me not forget to eat my vegetables. “I’ll think about it,” I said.

Eve laughed at my quip. It was so nice to hear her laugh.

A few days before a family meeting to discuss Eve’s care with the interdisciplinary team, I realize she wants to chat, so I listen. For the next few minutes she cheerfully talks about her much beloved Moxie soda, how as a teenager she worked in her father’s shoe repair shop and that when she dies, since she has no children of her own, her niece will get her jewelry.

Instantly, her mood transitions to sadness and she is quiet. “It must be very hard,” I say. She takes my hand and holds it tightly.

“Anthony, I don’t know what to do,” she says.

“This must be very overwhelming for you; I am with you,” I say. “You have options on how to proceed with your care. We are here to help you understand your options and to make sure you receive the care and treatment you really want.”

Eve says she wants to go home and die because the chemo is just going to make her sick.

On the day of the meeting, Eve’s niece and her sister, who also is her healthcare proxy, the interdisciplinary team and I are present. Eve cuts to the chase, asking, “So how much time do I have left?”

The oncologist carefully discusses the benefits of chemotherapy and at the same time emphasizes the need to set realistic goals and expectations. Finally, Eve agrees she will go for a PICC line insertion — the following day. Silence engulfs Eve’s room as everyone leaves. “Anthony, I would rather go home and enjoy whatever time I have left,” she says.

I can tell she’s thinking about living six to nine months with chemo or three to six, without it. I can’t let her be by herself so I pull a chair up to sit with her. For the rest of my 12-hour shift, I make sure I attend to her needs. Each time I check on her, she only asks for one thing — to make sure she had her can of Moxie within reach.

I have taken care of a lot of Eves in the past and I know I will take care of more. The only way for me to replicate the same empathy I gave Eve is to constantly remind myself to treat patients as I would want to be treated when I’m sick, vulnerable and powerless.

I did not take care of Eve after that last day since I was assigned to work offsite. I learned the day she was supposed to have the PICC line insertion, she refused yet again.

She eventually was discharged home with hospice. •

Anthony Ayag, BSN, MSCN, RN, is a med/surg/telemetry nurse at Mount Auburn Hospital, Cambridge, Mass. He also is a staff nurse at the Harvard University Health Services, Cambridge.

A daughter who happens to be a nurse

Sonja Mitrevska-Schwartzbach, RN

By Sonja Mitrevska-Schwartzbach, BSN, RN

A nurse is a nurse is a nurse, and once you become one, you can never not be a nurse. Generally speaking, I’ve considered it a rule to do my absolute best to treat my patients as if they’re members of my own family. That way, despite annoyances and inconveniences, I can chalk it up to the situation at hand and not that the patient feels like a burden to me. But I discovered I haven’t been treating my patients like family after all.

When I have to treat and care for a family member, I morph from a gentle and compassionate patient advocate into a Hulkified version of a medical professional with glowing green eyes, spewing orders as though my scope of practice is more of a suggestion than a rule. Because when your mother is the patient you can be anything but reasonable, at least in the beginning.

On my mom’s 55th birthday, we celebrated with a Chinese food lunch special and stale graham crackers at a local hospital. She was very lucky to be sitting in a telemetry unit on IV antibiotics; but she endlessly complained about getting out and going home already. Days before, she was in the ICU with a fever of 106 degrees, an extremely high blood glucose and a pneumonia that just wouldn’t quit. My nurse side and my daughter side struggled to come to terms with what would save her from this event: Massive amounts of fluids and antibiotics? An insulin drip and electrolyte replacement? Or bargaining with God as I sat helplessly in the corner, because I only could suggest but not act?

As I watched my mother fight through pneumosepsis, I struggled with the idea that I could not be her nurse. My few months as an ICU nurse have taught me more than I’ve learned in my entire 28 years, and though every clinical presentation I have witnessed and every skill I have learned have served as weapons in my arsenal of care, perhaps knowing too much is just as bad as knowing nothing at all.

As my preceptor taught me, a true ICU nurse never looks at her patients as stable; she assumes that at any moment, the worst case scenario can present and you need to be ready for it.

As you could imagine, my mind was racing and my patience was wearing thin. Yet, I remained calm, focused. Because my father was shaking like a leaf and my sister was still a state away, I had to hold it together. I politely explained to anyone who would listen that my mother had chronic issues that should be addressed, a medication regimen that should be honored and a pharmacist daughter, in addition to myself, who would make certain that mama bear was not to be toyed with.

To my surprise, the ICU nurses were amazing and competent and educated, in addition to being kind and compassionate and concerned. Much to my dismay, I actually found myself trusting them. Respecting them. Taking their advice. And suddenly I was able to let go — to step out of the forefront and into the background. I was able to relinquish control, to stop fixating on the numbers and the tubes and the wires and be the daughter who happens to be a nurse and not the other way around.

I stopped leading with my profession because she was changing, she was improving. It was subtle, but it was there. First her breathing steadied. Then her fever broke. Next her heart rate slowed and her blood sugars dropped and she was more like a sleepy version of her normal self. Little by little she got better.

She had been a fighter for 54 years and 361 days, and she wasn’t about to stop now. Thank God she had heavyweight nurses and nursing assistants in her corner.
Silly me. I should’ve known. When it comes to my mom, things don’t always come easy. But with a husband who loves her and a private medical team in the way of two daughters, she always pulls through. And as she sat with me for her birthday celebration in room 146-B, dozing on and off, offering me her hospital bed, so I can take a nap, I was able to rest assured that she was on the mend. And so was I. •

Sonja Mitrevska-Schwartzbach, BSN, RN, works in the CTICU at Robert Wood Johnson University Hospital in New Brunswick, N.J.

Making a difference: Dialysis patient’s desire to help others impresses RN

Susan Bartlett, RN

By Susan Bartlett, RN

Amelia was a patient I will never forget. She was 23, the same age as my daughter. And, like my daughter, she had gone off to college. Even better, Amelia had studied in Paris.

But while there, she developed a kidney infection, and acute renal failure followed. One kidney succumbed despite aggressive treatment; the other was compromised enough that she needed dialysis and blood transfusions to improve her anemic state. Let me tell you about the day I met her.

Amelia came to our department on a Tuesday morning trying to find out whether the anemia was due to blood loss in her GI tract. Because she was an outpatient, I knew little about her history. So when she strolled in with her gazelle-like legs and hair in a stylish cut making her look like a Nairobi queen, I cocked my head quizzically. I’d never seen a dialysis patient looking so healthy.

A quick review of her history and physical brought me up to speed, and after introductions, Amelia changed and made herself comfortable on the stretcher while I collected supplies to start her IV. Surprisingly, I had no difficulty finding a peripheral vein on her. No one else had checked in so I stayed with her and reviewed the care plan.

It was easy to engage her in conversation, and before long Amelia took over. She spoke passionately about a foundation she had started for children with kidney disease. She pulled a business card from her pocket and encouraged me to check out the website she had created for the foundation.

I again looked at her age on the chart: 23.

Patients were starting to arrive in pairs, and I wanted to offer other nurses my assistance, so I handed Amelia a call light. With her chart tucked under my arm, I stepped away, started an IV and helped a patient up to the bathroom. Before returning to Amelia, I sat at the desk with her chart and looked at the physician’s comments on her last diagnostic studies.

Her kidney function was deteriorating by 5% every month. She was going to dialysis twice a month. Her physician was about to recommend weekly visits.

Again, the one fact kept coming back to my mind. Amelia was 23.

She was spending her spare time raising money for children.

She was raising social awareness.

When I introduced myself and asked how she was doing, Amelia responded, “My cup is half full.”

Amelia was unlikely to get medical clearance to travel. There would be no return to Paris. She was unlikely to be around for grandchildren. For that matter, with all the medicine and treatment she was receiving, she was unlikely to be able to have children.
Amelia had a glow about her that defied what I was reading in front of me. I squeezed my eyes shut, then open, to slow the tears starting to come. Then I stood and walked back to the bay where Amelia waited, vowing to make every day matter, just like she was doing.

Amelia reminded me that the quality of what you do with your life is just as important, if not more important, than the quality of the life you live. •

Susan Bartlett, BSN, RN, is a perioperative nurse at Health Central in Ocoee, Fla.

By | 2020-04-15T09:17:18-04:00 December 8th, 2014|Categories: Blogs, Education|0 Comments

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