SHE COMES FIRST!

spotangel, DNP, RN, NP

"Annie, I need your help!"

My usually unflappable ED charge nurse Nilda look frazzled "What's going on?"

"I just spend 20 minutes with that guy in room 14, Mr. Uptown. His heart rate is 186; he's dizzy and refusing treatment. He wants to go home."

"OK, Nilda, I am on it. Thanks!"

I quickly scanned his EMR. HTN and 76 years of age, rarely was in the hospital, no allergies.

I went in. Mr. Uptown was thin and frail looking, hooked up to the monitor. He was tachycardia and hypotensive. He was on IV fluids. I introduced myself as evening manager of the ED and asked him how I could help him. "Get me out of here! I want to go home."

"Why did you come to the ED then if you did not want help?"

"I thought my pressure was up and they would give me something and send me home. I don't want to stay!"

"Who do you live with at home?"

"My daughter Celine. She is 55 years old."

"What about your wife?"

"She died 12 years ago. I have been taking care of my daughter Celine."

"What do you mean? Why are you taking care of your daughter?" I was puzzled.

"She cannot take care of herself. She is mentally retarded (his words) and cannot get out of bed herself. I feed her, bath her, clean her and do everything for her."

"I see. Do you have any help?"

"No. I cannot leave her by herself. I only run to the store and then come back. I have to go. She is alone for 4 hours now and is probably peed and pooped on herself." He was tearing up.

"Is there anyone that can watch her when you are in the hospital?"

"No! She is my only child and I don't have anybody that could stay with her. She comes first! I have to go. Please help me Nurse Annie!" The tears were falling down those worn cheeks. I knew we could not let him go as he was unstable and symptomatic with dizziness. My mind went into overdrive.

"Mr. Uptown, you came for help and we will help you. Do you live nearby?"

"20 minutes by cab".

"If I can get your daughter to you, will you stay?"

"Yes! I want help but I am worried about her. I cannot leave her alone."

"I understand completely. I am a mother and would want my child to be safe too. Will you trust me with your house keys? Give them to me. I will speak to the social worker; we will call the police, go to your house, pick up your daughter and bring her to the ED in an ambulance. How does that sound?"

"Can you really do that?"

"I will try my best and keep you updated ok?" I said as he handed me a bunch of keys and showed me the keys to the front door. I went out the room, discussed the situation with Pamela the social worker who was all for it! I called the local police precinct and ambulance service (EMS).The cops were there in 5 minutes and EMS promised to meet us at Mr. Uptown's house.

I went back to room 14 and informed the patient who consented to treatment. I informed his team and they swung into action trying to stabilize him. Meanwhile Pam and I took a ride with our friendly cops (sirens on request!) sitting in the backseat of a cop car, our knees touching the front seat, the windows barred on the sides and in the front! Definitely cramped and not a luxury ride! I met Sasha and Kim, EMS staff, at the front door, after a 7 minute high speed ride! I unlocked the door and we stepped in, the cops in the front with their guns ready just in case. We rounded into the dining room of the silent house and stood with our mouths open. A rooster was walking around the dining room table and 2 cats sunning themselves at the window sill. Outside in the backyard, I counted six hens and a few chickens. The rooster ignored us as Sasha grinned and said "Dinner, anyone?!" Past the dining room was Celine's room as Mr. Uptown had told me. I entered first and saw her lying on the bed, staring at me, frightened. The others waited outside the room. I slowly approached her and knelt by her bed. I spoke to her softly.

"Hi Celine! I am Annie. I am a nurse. Your dad sent me to get you to him. He is in the hospital."

She did not reply as she was nonverbal and made only few sounds but no words. She smelt of urine and feces. "I am going to get Shasha and Kim my friends to help you get ready." I smiled at her as Shasha and Kim slowly came into the room. The cops kept out of sight, to keep her calm. We quickly put on gloves, gown and cleaned her thoroughly and got her ready. Her back was soaked with urine and so were her sheets. I was in awe as her skin was intact, soft and healthy looking. The house was clean and well kept. I admired Mr. Uptown for doing this all on his own, day after day. Within 15 minutes we had her ready and in the ambulance. The cops left after I carefully locked the front door on our way out.

"Maybe we can come back for fresh chicken!" Shasha said with a smile.

"Not on my watch!" I laughed as I patted the keys, safe in my pocket. We took off in the ambulance sirens blaring. When we reached the ED, I had Nilda triage her and get a set of vitals. I went to room 14 and checked in on Mr. Uptown whose condition was stable. He was admitted to Telemetry. I gave him an update, his keys and he was very grateful. A little later, we got their stretchers side by side and Celine smiled when she saw her dad. We admitted for 'weakness" workup. I coordinated with admissions and expedited beds for them and got them out of the ED. I high fived Nilda and left for the day, happy.

They were not on the same floor. We got her a sitter who took care of her and dad was allowed to visit her. Social work got involved and helped dad find placement near his house as he could clearly not take care of her at this point. The day before she was placed in a nursing home, I spoke to the Nursing supervisor of the hospital and got them in the same room to spend their last night together as family. She was placed in the nursing home close for him to visit, once discharged. I saw him twice after that in the ED for cardiac issues. His daughter was safe, secure and he was at peace although he missed her and was lonely. I always wondered what happened to him and Celine.

Since then, I have seen many older parents with disabled adults and they confide their worries and lack of support or help. I always hook them up with the social worker to get them started with services and planning for the future. As nurses we are in this unique position where patients confide their inner fears once you gain their confidence. What we do with that information can go beyond the physical complaint they come for and address what is truly important to them.

SHE COMES FIRST!

About spotangel, DNP, RN, NP

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