As a cardiothoracic intensive care nurse it’s easy to get lost in nursing tasks and lose focus on how your 12-hour shift can make a difference in the lives of others. When you are caring for patients who have been through an unbelievably difficult hospital course, you can lose hope for a meaningful recovery. There always will be patients who don’t make it home to their loved ones; you’ll remember some of them for the rest of your career. The patients who do make it through treatment also stay with you. They recharge your hope. Nurses who maintain their sense of hope and belief in what they do pass on this positive energy to patients, their families and co-workers.
Mrs. S was one of these success stories. A 52-year-old wife and mother, who was diagnosed with idiopathic cardiomyopathy one year before, had maintained an active lifestyle at home on inotropic therapy until her heart began to fail. Heart failure was nothing new to Mrs. S and her family. Her son, who was now in medical school, had gone through heart failure with a ventricular assist device implant and later an explant, with spontaneous return of heart function eight years ago. Mrs. S and her family had been living normal lives until her life-changing diagnosis. Because of her condition, Mrs. S was to receive an LVAD implant as a bridge to a heart transplant.
Mrs. S’s hospital course was not the smooth road every patient hopes for. After her initial LVAD implant she developed right-side heart failure, requiring a trip to the OR for an additional pump and leaving her with a biventricular assist device. After that there were trips to the OR for complications. Her ICU stay involved a short stint on continuous renal replacement therapy followed by temporary dialysis, extubation and re-intubation, which eventually led to a tracheostomy.
It was later in her hospitalization when I met Mrs. S. However, thanks to our morning unit huddle I was up to speed with the course of her stay. Mrs. S was out of bed sitting in a chair, able to speak and off dialysis. Her family was by her side through it all. She was the sweetest and most determined women I had ever cared for — the type that looks a challenge in the face and says, “I can do this.” Seeing how far she had come and seeing her strength was an inspiration.
When things were at a critical stage, I wondered if it was really possible for this frail little lady — barely weighing 110 pounds with dozens of tubes and wires — to overcome the cards she was dealt. I remember thinking if she was going to pass away during this hospital stay, that it would be better to go peacefully, rather than putting her through a torturous battle and taking her family on an emotional rollercoaster.
Why do we instill such hope when there is the possibility of death or no meaningful recovery? We do it because there is a chance for improvement, and if the patient and family want to take that chance, then we need to be there for them. It is our duty to help them hold onto the hope of a meaningful recovery. We have to put our doubts aside and remain positive.
Mrs. S made it home to her family after her extended hospital stay. About seven months later, in the fall of 2015, I cared for her again. This time it was post-op day one, after she received her orthotic heart transplant. While taking report from the night shift nurse, I recognized her name. As the report continued and the patient’s story began to unfold, I felt a knot in my stomach and goose bumps all over. I looked in on this strong little lady sitting in the chair, comforted that she was doing so well, that she had made it through her transplant and was going to once again make it back home to her family with a new sense of freedom. Mrs. S would get a new chance at life free of machines and from the constraints that heart failure had placed on her. She was going to grow old with her loving husband, and she would see her son graduate from medical school.
As an ICU nurse, I realize that not every day is glorious — most days are challenging. However, when I see a patient at the lowest point in health, I think back to how well Mrs. S is doing now, and I am reminded of how important it is for all parties involved to maintain hope — starting with me. •
Written by Anna Franklin, BSN, RN, CCRN, is a clinical nurse in the cardiothoracic ICU at Tampa (Fla.) General Hospital.
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