Working 7p-7a, what is on our minds at 6a? Our cozy, warm bed and counting sheep. This was what I was thinking of when a pt, we'll call him John... John Doe, came rolling into CCU. He was a transfer from an outside hospital. Standard chest pain, had some nitro tabs, needed a cardiac cath. We see it all of the time. He was actually smiling and cracking a few jokes as we got him settled into his room (of course we're rushing - he's stable, we need to give report, and get home!). This is common too; pts tend to joke when they're a little scared or nervous. But it has been a long night for us nurses, the night is nearly over, and we're not feeling incredibly comforting at the time. I went home, and didn't think much else of it.
I'm back at 7p that night. I happen to peak in to see how John is doing. He had a cath. And in the process bought an IABP (for those non-CCUers ... it helps the heart rest and gives it more perfusion; usually when pts are in some sort of heart failure or cardiogenic shock, certain MIs) and some dobutamine. He's in cardiogenic shock. He's no longer smiling, joking, but rather he's sedated. He's not my patient, I move on.
Through the next few weeks, I just keep up on the progress of John. I watch him go through emergent intubation... twice. He weans off dobutamine... then is put back on. He's septic. Then he's not. He acquires a trach, C-diff, MRSA. Nurses begin to moan and whine "I have him again?" or "ugh, isolation!". He fails swallow study after swallow study. Mouth swabs and tube feeds are the only food he knows. One night I had him and when I ask "can I do something else for you before I step out?" He cracks a rare smile and writes "coke". I gave him diet coke mouth swabs - you would think the man was in 7th heaven.
Months later he moved out of CCU to a long term care floor. 2 days later, he was back in ICU with sepsis.
John had an ongoing battle with his family. They had hope that he'd get better - after all, he shows a good blood pressure and heart rhythm on the monitor, he's "breathing", so he'll get better... right? And he wanted to be let go. His body had tried to go several times to no avail. The family wanted escalation of care always. He did not. And doctors are too afraid of legal issued to listen to John.
This is the battle we so often see in critical care. What is "living"? This is different for everyone. But one thing John has taught me is to be the best patient advocate I can be. Nurses are often the best allies the patients have. We are the ones who bring the diet coke mouth swabs, fluff the pillows, see the best and the worst. And we need to remember that the trached, isolation, chronically ill pts are still people with wants and wishes.
As for John, he did finally get his wish - a nurse helped his family listen to him and his wishes rather than their own. :heartbeat
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