My Best Nursing Job Ever

Chico David, BSN, RN

But the very best period of my working life was when part of my job description was "cardiac liaison nurse". The bulk of my time in that job was spent in providing the pre- and post-op education for cardiac surgery patients. But the plum was that I would go into the OR a few times during each case and come out to give the family a quick update on how things were going.

Most of the time, it was just pure fun. At least 95% of cases went well. I just had to let the family know things were OK and how much longer to expect it to take. I do calm and reassuring pretty well, and had a good enough command of the technical side to answer almost any question that came up. Families were so grateful for the updates during the long and scary surgery that they thought I was wonderful just for being there.

But the memorable times, the times that stick with me many years later, are the few days that surgery did not go well. Those were the days I really earned my pay. They were the hardest days I've ever spent, but I was thankful for every one of them because they gave me a chance to touch families at such a deep level.

At that time, our surgeon, like most, was doing all his cases "on pump". During a normal case, I'd come out once early in the case to let the family know things were off to a good start. Then again about midway through and once more when we had come off pump - the re-starting of the heart. At that last one, I'd let the family know we had about an hour to go, to expect the doctor to come out at the end of the case, a little bit about ICU visiting and so on.

The most common scenario for a "not good" case was that everything would proceed pretty normally until we went to come off pump and found the heart unable to take the load. Usually, we'd go back on, let the heart rest a bit, give some inotropes and try again. Sometimes a balloon pump would be needed. But sometimes, nothing worked. We'd get a rhythm, but could not maintain a pressure with all the drugs and support devices at hand.

Once things started not being normal, my practice was always to let the family know they weren't going normally. I knew I owed them honesty. And that's when the tiniest detail would really start to matter. I wanted them to know things weren't right, that the situation was serious, but not make it sound worse than it was. Words, expression, body language, everything carefully calibrated to get the right degree of concern, but not destroy hope while any hope remained.

The longest case I dealt with had started at the usual early morning time. The first attempt to take the patient off pump was about 1130. The patient was finally pronounced dead at around 1800. For that last 6 hours plus, the surgical team was trying everything possible to get that patients heart to work. And I was back and forth every half hour or so to the waiting family with the latest news. With each of those families, I formed a special bond. Those were the families that would send the letters of gratitude.

I never was the one to tell the family that the patient had died - by ancient tradition that's the duty and prerogative of the surgeon. But I made sure it did not come as a surprise to them either. And walking down the hall with the surgeon to give that news, to be with him and them as he told them, I learned some lessons about accountability and what it was to be a "mensch" in the truest sense.

When all was done, I'd often cry with families and usually went to the funerals. But, as hard as those times were, I would not trade them for anything. I was grateful to be there to support those families, knowing that the most important thing I could share with them was not my knowledge or skill, but simply my humanity.

My Best Nursing Job Ever

About Chico David, BSN, RN

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