It's official!

Yes...it's official!!!  Well, a few things that are official.

1)  I'm officially on vacation!  I got someone to cover my last 2 shifts so as of right now, I am on vacation & don't need to return back to work until June 27th.  Ahhhhh!!!  It feels good, although I'm tired after working last night.  I can't complain though, I had a good night.  I only had 3 patients & they were really easy to care for.  I don't think any of them even used the call light once they went to sleep around 11 pm.  They actually slept the entire night.  I think that's a first ever. 

My first patient was a man that had pancreatitis last month & was treated at a different hospital.  His wife did not like the care he was receiving there, so she had him discharged & then drove him straight over to our hospital.  He was diagnosed with sepsis, uncontrolled hypoglycemia (low blood sugar) and coronary artery disease.  He had a peg tube (feeding tube) put in & was started on tube feedings.  He was tolerating it well & seemed to be getting back to his normal self.

My second patient was in with chest pain and had a positive stress test.  He was scheduled today for a cardiac cath.  He was a pleasant guy that just wanted to get home & go on with his life. 

My third patient was in with hypotension (low blood pressure) and chest pain.  The day nurse somehow missed on her chest CT a pericardial effusion.  I told the day nurse that she should let the admitting doctor know of this.  She just blew it off saying he only wanted to know if she was positive for a pulmonary embolism.  I really don't think she understood what a pericardial effusion was.  It's when fluid accumulates around the heart & causes pressure which changes the way the heart can function.  She just had surgery a few weeks ago to replace an aortic valve, so this could be a complication as a result.  The day nurse wouldn't call the doctor.  So I did just to cover myself.  The result = the doctor said "We'll worry about it tomorrow."  Ahhhh...scary!  Luckily she remained stable without any chest pain during my shift.  So it was a good night overall.

2)  It's official...my favorite high school baseball team won the state championship!  I went to Sarasota for the weekend & watched them bring the title home.  It was fun & exciting.  This team has been to the state final four the last 5 years straight...but this is the first year they won it all. 

3)  It's official...I will be getting a puppy when I get home from my vacation.  I've been thinking about it a lot & I have no doubts anymore.  I miss the fun & companionship of a dog.  Now the decision is whether to get one puppy or two (to keep each other company) and what breed to get.  I'm partial to mutts.  I've had purebreds and I've had mutts and I find the mutts are much better dogs.  There's just something about them.  I'm leaning towards a lab mix or a german shephard mix.  I'll decide when I get back & see what's available out there. 

That's all for now!

Pushed to the Limit

Happy Belated Mother's Day to all the mom's out there.  I was supposed to work Sunday night, so I went to visit my mom on Saturday morning and bring her a few presents.  I worked Saturday night - it was a pretty good night with one exception...a patient that was ringing the call bell literally every 5 to 10 minutes.  When she wouldn't get a quick response, she'd take off her heart monitor because she knew someone would show up quickly to get it back on her.  She did that a few times as well as pulling out her IV.  At that point I decided it was time for some wrist restraints.  I went home that morning telling my clinical leader that I refuse to care for this patient again. 

To my surprise, I got a call from work at 5 pm Sunday night saying they were overstaffed & if I didn't want to come in, I didn't have to.  Yay!  I immediately got ready & headed over to my brother's house...where the rest of my family was so that I wouldn't have to hear my mom say "Remember the year that you missed Mother's Day?"  She had already said the day prior "You've never missed a Mother's Day."  I felt bad, but I told her the reason I scheduled myself that night was so that someone that actually was a mom could have the entire night off - it was their day, not mine.  She understood, but I know it made her day to have us all together for her holiday. 

I went into work Monday night only to see I had got the patient back that I had on Saturday night.  I wasn't happy, but by this time she had been in the hospital for about a week & pretty much every other nurse refused to care for her either.  She wasn't only bothersome, but she was also in a private room under "rule out TB" precautions...which meant having to put on a mask & gloves every time you were in the room.  Those masks can make your face pretty hot after only wearing them for a few minutes.  I don't like isolation rooms because of the extras we have to wear. 

She still had on her wrist restraints and I was told in report that she had what appeared to be "fake" seizures.  She had been sent for a CT of the brain to rule out a stroke and that was negative.  When I went in to assess her, she began to have what appeared to be a seizure...but it also looked like she was watching my reaction at the same time.  I looked at her & asked "Are you in pain?"  Because Saturday night she was continuously asking for pain medication and she had a history of IV drug abuse.  I wasn't even finished saying the word pain when she perked up & said "Yes, my back hurts.  I need pain medicine."  Hmmm...not the usual response when someone is having a seizure.  I questioned giving her any pain medication or anything to help her sleep because she was acting different than when I had her on Saturday.  She was more lethargic & not so demanding.  I figured I would play it by ear through the night as to whether to give her this medication or not.  She was brought into the hospital on the 5th because she developed chest pain while having dialysis.  I should also mention she was only in her late 40's.

My second patient that night was someone I have taken care of in the past.  She was also in her 40's and in with congestive heart failure.  She looked miserable & uncomfortable.  She has to sleep sitting up because it's the only way she can breathe.  That has to be uncomfortable night after night.

My third patient was a woman in her 70's that had a stroke.  She was having difficulty reading, writing & thinking of what to say.  Her speech was ok, but there was a delay in getting answers when I asked her questions.  She was very prim & proper...and a name dropper.  She mentioned to practically everyone she came into contact with that she was a neighbor of the CEO of the hospital.  I don't like name droppers.  She was not very happy as she was in the same room as my patient with congestive heart failure who happened to cough quite often.  My stroke patient thought the other patient was contagious and started to demand to have a private room.  Sometimes we can accomodate that, but not that night as the hospital was full.

My third patient was an elderly man in his 90's.  While I was getting report on him, I saw that he was wandering in the hall.  Hmmmm....he's not supposed to be.  He was asking "Can somebody help me get home?"  I walked him back to his room & called for another nurse to get me a posey vest.  This man had climbed out over the side rails!  I am sooooooooooo glad he didn't fall.  I didn't want to take any chances, so I put the vest on him to keep him in bed.  He was ok with it...at the time.

I got a fifth patient about an hour later - directly from the cath lab.  It was an outpatient procedure that had gone wrong & now he was being admitted.  The report I got was this "The patient had a AV graft for dialysis put in 5 days ago & it clotted.  So he came in today to dissolve the clot & they ended up with a perforation & couldn't stop the bleeding without extreme pressure.  They finally called in the surgeon who did what he had to do & the surgeon also spent about an hour applying pressure to stop the bleeding."  This was not sounding good to me at all.  I was told his blood pressure was ok, but his heart rate was in the 120's to 130's and he was in a lot of pain, but the pain medication was making him vomit.  Inside I was groaning about what a night this was going to be.

Two years ago I would have been scared completely as well as nervous.  It's amazing how relaxed one becomes after a little bit of experience.  Before my cath lab patient got to the floor, my confused elderly man was busy pulling off his heart monitor.  I tried to reorient him, tell him what he was in the hospital for, etc.  Shortly after that, my congestive heart failure patient started coughing so much that she was having difficulty breathing.  She was hunched over trying to catch her breath inbetween coughs.  The stroke lady was freaking out with all the coughing for fear that there were some contagious germs floating around the room.  She had pretty much barricaded herself behind the curtains that separate the two beds.

I called the doctor for the one coughing & got an order for Tessalon Perles - such a fancy name, isn't it?  It sounds like it should be a bath soap or something.  They do work...her coughing resolved rather quickly.  Yay!  Her roommate seemed content hiding behind the curtains. 

My confused man was still confused & not happy about being kept in bed.  He kept yelling out for help.  I called his doctor to get something to relax him.  I gave him Ativan which I silently prayed would do the trick...because you never know if it will help or if it will make things worse.  This time I lost...he got worse instead of better.  Oh well, at least he was safely restrained, right?

I got my cath lab patient.  He seemed pretty stable except for the pain.  I gave him Lortab as he didn't want the Morphine because it made him ill.  Lortabs aren't very strong & I didn't think it would really help all that much with the pain he was in.  He was a very patient man though & gave the Lortabs time to work.

I went to check on my isolation patient as I found it odd she was not using the call bell at all.  She was rather lethargic.  I thought maybe the lack of sleep had finally caught up with her.  She would wake up whenever I entered the room though, so it wasn't like she was out of it. 

I go to see my confused patient who is sharing a room with my cath lab patient.  The confused one has now taken off his heart monitor again as well as pulled out his IV.  Out come the wrist restraints - he wasn't happy.  I knew starting an IV on him would be next to impossible, so I asked if anyone wanted to volunteer to do it.  The patient was now becoming very agitated & rude.  He was calling us b*tches and wh*res.  Nice, huh?  Our cute pregnant nurse decided she'd take a chance.  She didn't last more than 30 seconds in there as he was yelling at her to kiss his ass.  I elected my clinical leader to do the job as she can be quite entertaining & if anyone can calm someone down, it's her.  As she was checking out his right arm for good veins, he attempted to kick her.  Ok, I don't play that game!  Out come the ankle restraints.  He had plenty of nasty things to say.  All I kept thinking was "The poor guy in the bed next to him who is in pain & just wants to sleep...yet has to put up with this disrespectful, confused individual."  We need all private rooms I tell you!  Luckily, the cath lab guy was very patient and I could hear him chuckling at times.  I thought "Hmmm, maybe this is helping to distract him from his pain."  The IV was put in & I once again prayed the Ativan would kick in at any minute now. 

Not more than 10 minutes later, I bring a pain pill to the one in pain and I see that the confused guy has his hands free & they are over his head.  Hmmm...how the heck did he do that???  He's a natural Houdini!  He was lying still & appeared to possibly be sleeping so I left him the way he was.  That was a mistake...it wasn't long before the heart monitor was off & the IV was pulled out again.  At this time, I told the patient care tech that we should probably change his sheets & his gown as he was incontinent & needed to be cleaned.  After that I'd simply put the wrist restraints back on & another IV in.  He cooperated for about 5 minutes, but then threatened to punch me.  I had been sweet prior to that threat...but I sternly told him that was no way to speak to me & he better not even try it.  He sat there looking at me....but it was a crazy enough look that I thought he might do it, so I called in the clinical leader again to diffuse the situation.  The three of us managed to clean him up, change his sheets & apply double wrist restraints all while the confused patient was threatening not only to sue us, but to also shoot us with his gun.  I don't care who you are....you aren't going to get the opportunity to punch me.  Another IV was started and we were out of there. 

It was about 1 am at this point and I hadn't even begun charting yet.  That's another 2 hours at least.  I manage to catch up and around 5 I hear my confused patient and my cath lab patient yelling at one another.  Uh oh.  The confused patient is yelling at the other guy to untie him.  The cath lab patient is yelling back that he deserves to be restrained, that he's rude & disrespectful and needs to learn how to treat people right.  This goes over well as the confused one begins swearing at the other one.  Ugh!  No one that is sick should have to put up with this!  The poor cath lab guy is in pain & just wants to sleep but is being kept awake & verbally assaulted by his roommate.  It didn't last long and when I went in to give the cath lab patient more pain medicine, he joked that he was now added to "the hit list."  I apologized to him that he had to put up with this.  He took it all in stride.

By now I could see the light at the end of the tunnel or so I thought.  It was about 6:30 when things went in another direction.  My isolation patient's heart rate went from 75 immediately up to 170 & then plummeted to 40 just like that.  Whoa!!!!!  Within a second she was back to her 75 beats per minute.  We checked on her & she was now pretty much non-responsive...I mean she would look at you if you said her name, but she wasn't talking...just moaning.  Not only that, but the rhythm she was now in...none of us knew what the heck it was.  There was no P waves to be found, but it wasn't a-flutter or a-fib either. 

I called the neurologist as it appeared that she had been having a seizure.  I described to him what was going on & he replies with "Well, what do you want me to do about it?"  Huh?????  You're the doctor, you tell me.  So he orders Ativan 1 mg & that's it.  I give her that & she's still not responding.  We got an EKG on her that was showing a new heart block.  My clinical leader who has been studying 12-lead EKG's recently was saying "it looks like she is starting to have a posterior MI (heart attack)."  Uh oh.....time to call the cardiologist only the cardiologist already signed off of her case like 8 days earlier.  So I call the primary doctor & luckily got the one that actually knows all about her.  I was dreading having to explain her entire history to someone on call.  He ordered for the cardiologist to be reconsulted.  That's it?  So I say "Dr., do you want the patient to be moved to ICU where she can be more closely observed or kept here in PCU?"  He said it was ok to transfer to ICU & the PCU day shift nurse coming onto duty was thrilled I got the transfer as this patient looked like she was going downhill fast.

I gave report to the ICU nurse who hadn't even been there 10 minutes and looked like she was ready to cry.  She already had a patient that died a few hours earlier, but the family was just coming in to see the body....about 30 family members.  And she had another patient that was going to be taken off of life support and that family was coming in also.  She knew it was going to be an emotional day. 

She ended up getting my patient around 8:15 am as I was on my way out the door to go home & get some sleep.  I found out later that my patient coded & died around 9:30.  Her daughter was there watching - hysterical - as could be expected.  I'd be the same way given the situation.  It was too much for this ICU nurse to handle.  I heard she was crying so much that they told her to finish charting & take the rest of the day off.  I feel for her, I feel for the families.  There is no easy way around something like this...emotionally or physically.

I had that guilty feeling after finding out she died - like did I miss something earlier?  Could the outcome have been different?  She did have a heart attack like my clinical leader picked up on, but at that point...the damage was already being done & there was no reversing it. 

I worked again last night and it was a pretty good night.  I had 5 patients again.  Two of the were the same (congestive heart failure patient and stroke patient).  Three were new to me.  I had asked not to have the confused mean guy back & wouldn't you know it...he barely said a word last night.  I have no idea what medications they gave him, but he did not cause one ounce of trouble.  I also didn't have the patient that was in pain - he had been transferred to ICU earlier that day as his heart rate went up to the 150's during dialysis and wasn't coming back down.  I was glad that at least now he had a private room without anyone yelling obscenities at him. 

I did have to call a doctor at 5 am this morning because of an elevated blood pressure.  I first paged him at 4:30 & got no response so the second time the answering service connected me to him directly.  He says "Hello?"  I explain to him who the patient is, why she's here & what the blood pressure is.  He asks what kind of cardiac meds is she on.  I tell him...then I hear......snoring!!!!!!!!  SNORING!!!!!!  I was wondering if it was him or if maybe his wife just snored loudly...lol.  I wait a few seconds hoping he'll say something & he does...he says "Hello?"  Ugh. So I say "hello" back to him.  He says "Ok, admit to tele & that's it."  What?????  She already is on the tele floor & how is "that's it" going to help her blood pressure?  So I say to him "Ummm, she is on PCU."  He replied "Then keep her there."  What??????  What else am I going to do with her??  Push her out the door?  He's ready to hang up & I say "Don't you want to do anything about this blood pressure?"  He asks me to repeat it again & finally gives me an order for Vasotec.  I looked it up in the drug reference to make sure it was ok for her to take...just in case since he obviously wasn't thinking with a clear mind.  It's scary getting orders sometimes.

I have the rest of the week off.  I'm going to take it easy today.  Tomorrow I think I'm going to go to Sarasota for the high school baseball finals.  My favorite team in in the final four and they just may win it all this year.  Go Bishop Moore!  If they do keep winning, I'll be in Sarasota until late Saturday night...then back to work on Sunday for just 2 nights.  After that I'm officially on vacation for over a month...woo hoo!!!  8 days to Hawaii - the countdown is on!!!

 

Crying Clinical Leader

I finally get a few days off after working 8 out of 9 days in a row.  It wasn't bad, but I'm glad to be at home for a few nights. 

Tuesday morning we found out that one of our usual clinical leaders/charge nurses was assigned to be a floor nurse that day.  It's not unusual to see clinical leaders take nursing assignments - especially with all the constant changes that seem to take place at work.  However, this clinical leader was beyond shocked...to the point of crying about it.  CRYING!  What kind of message does that send to the rest of us that are on the floor day after day or night after night?  Does she think she's somehow above bedside nursing?  This is suppose to be someone in a leadership position - yet she's crying that she has to do our job for ONE day.  Just for that fact alone, I think they should be assigned to the floor more often.  It shows them the reality of being a bedside nurse.  This one in particular is so very quick to point out what we are doing wrong & not in a nice way either.  I lost any respect I had left for her after seeing the way she behaved on Tuesday.  I'm glad she doesn't work nights.

I had the 23-yr old kid again on Monday night.  He was downgraded to med-surg & I worked to transfer him as quickly as possible.  His personality...or lack of personality was starting to show by then.  I think he was starting to go thru detox.  Anything I asked him was either replied with a "yes", "no" or no response at all...just staring off as though I never asked him anything.  I could tell then that he needs a lot of help...beyond anything our hospital could offer him.  The rehab place didn't want him either.  They prefer people that willingly come in as opposed to being forced.  I agree I guess, not much is going to change unless the person decides they need to change their life.  Hopefully he won't go on to harm anyone else.

I had a transfer from ICU on Monday night.  He asked for a sleeping pill & I saw that he had one already ordered...Restoril.  So I gave it to him.  The next day it appeared that he had a stroke.  His left side was very weak, could barely move his leg or arm.  The admitting doctor blamed it on the Restoril.  Huh???  Sleeping pills don't cause left-sided weakness.  The cardiologist says it's a stroke.  The CT scan of his brain showed no stroke.  He was alert, so I can't say it was the sleeping pill either.  Very odd!  Hopefully it will resolve.

One patient I had for 4 nights in a row.  She used to be a housekeeper at the hospital.  She was a pleasure to talk to.  It was interesting to hear her stories and how she once repeatedly told a doctor to be quiet because she thought the doctor's continuous yelling was unnecessary.  Good for her!  I have to agree, some of these doctors are like 2-yr olds having tantrums.  They speak/yell first instead of thinking it through first. 

Only two weeks until my vacation.  I had planned on packing this week, but time off is going by so quickly.  I am going to my mom's house tomorrow because I'll be working on Mother's day.  The baseball team I like has advanced to the state semi-finals.  I'm debating about whether to drive 3 hours to Sarasota to watch them play or not.  That's a long drive! 

Time for me to catch up on some tv.  Have a good weekend everyone!

Day Two - Suicide Attempt???

I had the same patients I had the night before plus one more...for a total of 5 patients.  When I first got to work, I saw that they had switched my assignment around and given my easier patients to other nurses & gave me two total care patients.  I wasn't ok with that - it's part of the reason I like to work nights in a row...so that I'm already familiar with the patients I have.  So I switched it back.  :)  It's not just good for me, but I think it's also good for the patients to have a familiar face rather than a new one every day & every night. 

It was a pretty good night...not much really happened.  I had the 23 yr old suicide attempt patient again.  The drug rehab didn't have a bed available, so he's still at my hospital.  I tried to go into his room with a good attitude, but it still felt awkward to take care of him.  Carlene - I think you're right about the weird karma.  Something is really off.  He woke up around 1 am asking for something to help him sleep.  I told him I didn't have any sleeping pills ordered for him, not to mention he slept most of the time I was there.  About 10 minutes later, he seemed a little agitated.  He was saying he couldn't breathe thru his nose.  I asked "Is it stuffed up?"  He said "no, I just can't breathe thru it."  I have never heard of anything like that so I pulled another nurse into the room to assess him & give me their opinion.  As the other nurse was there, the patient then started saying it felt like his throat was swelling up and his jaw was locking up and he couldn't talk....except he was talking.  It was bizarre.  So I put some oxygen on him and got my clinical leader because I have never heard of anything like this happening just from laying in bed sleeping. 

She assessed him as well as the respiratory therapist - he was fine.  We all got the impression he was faking it or maybe he was starting to go thru withdrawal from drugs &/or alcohol.  His blood pressure, heart rate & rhythm and 02 saturation rate were great.  So I gave him some Haldol & back to sleep he went.  I did check on him a little later & he was feeling better.  I'm hoping he's discharged by the time I go back tonight.  Two of my other patients are being transferred to another hospital - so it will be like starting over tonight.  Hopefully it will be a good night.

 

Suicide Attempt???

I had a patient last night that was admitted because he tried to attempt suicide - although he denies it. I don't think it was necessarily a true suicide attempt, but I do think it is a cry for help. He's in his early 20's, was abused by his alcoholic mother for half his life before leaving to live with his grandparents. His father is also an alcoholic & also a drug abuser. This kid never got a fair start in life.

He actually came into the hospital on Friday night and was admitted to the ICU by the next morning. When he got to ICU, he basically took off running out of the hospital. The cops searched for him...even had a helicopter looking for him. The search was unsuccessful. At noon, a charge nurse went to a local fast food restaurant & saw him there. She called the police and he was brought back to our hospital and admitted to my floor. By the time I got there, they had already given him Benadryl and Haldol so he was sleeping & stayed that way most of the night.

By morning, he was complaining that his IV was hurting. I didn't want to do anything to irritate him so I got a nurse that is great at IV's to start his. I knew she'd be able to get it on the first try. She is a really nice nurse too & she offered him some ice cream...which put a smile on his face.

He attempted to engage in conversation with me. Looking back, I should have made more of an effort...but part of me didn't want to. I didn't want to spend any more time in his room than I had to. I'm not really sure why I reacted that way. I know part of me didn't want to set him off in any way. I didn't want him to run off again. I don't know what the other part was though. I know he could have used some encouragement, some support, some compassion. I have encountered patients like that before...who needed an understanding word or gesture. I've never had trouble giving my patients what they needed. But I didn't have it available for this kid & it's something I need to think about.

He's supposed to be transferred today to a rehab center. Hopefully he will find the right path & straighten out his life.

My other patients were very easy to care for. I should have them back again tonight as none of them are scheduled to be discharged.

I went to a baseball game on Friday night. It was a high school baseball game - the team my oldest nephew was on last year. They won 7-4....barely, but they scored 5 runs in the 5th inning to come back & take the win. It was nervewracking, but I think that's what makes it exciting.

I'm working the next 3 nights in a row. After that I'll take a few days off to start packing and also to spend some time with my mom. I have to work on Mother's Day...so I'll have to spoil her a couple of days early!

Time for me to get some sleep!

"You have a way about you"

I worked 4 nights in a row.  I'm off tonight - going to a baseball game, then it's back to work for another 4 nights in a row....sigh! 

I had it pretty easy this week - three out of the four nights I had an orientee who basically did most of the work.  I had a few interesting patients, others I barely remember - can you tell I need some sleep?

The one that stands out the most is an older man who came in for a right knee replacement.  A couple of days after having the operation, he had a stroke and a heart attack.  He wasn't expected to survive at first, but he is making a pretty good comeback.  He was transferred to PCU (from ICU) Monday night and he was pretty much out of it.  By last night though...he was alert, oriented, had good hand grips...total improvement.  He does have some expressive aphasia which is when he speaks you can't always understand what he's saying.  I'm sure it has to be frustrating for him not to be able to express what he's thinking. 

I had another patient that was admitted 2 nights ago and he is scheduled to have a cholecystectomy this morning (gallbladder surgery).  He was very anxious through the night...which was very understandable to me.  I had the same type of surgery 11 years ago.  I tried to calm his fears the best I could, but it's totally normal to feel anxious the night before surgery.  He was very sweet...this morning he said "You have a way about you."  I'm glad I was able to make him feel ok just by talking. 

I had a very trying patient on Wednesday night.  He came into the hospital a couple of weeks ago & had to be transferred to one of the major hospitals in Orlando because he had a brain bleed & needed brain surgery.  He was transferred back to my hospital afterwards.  I tried to have compassion for him - I tried to understand how he must be feeling.  However, I did not like that he would flash me every chance he got.  It must be somewhat of a guy thing, because I have never encountered any female patients that aren't modest when it comes to their private area being exposed.  Men, on the other hand, are totally opposite.  This patient in particular wanted to show it all.  I thought maybe his thinking was a little off due to his diagnosis, but it didn't take long to see that he knew when to behave that way and when not to behave that way.  I don't think there was a single time that when he used his call bell to get me in there....that I walked in & his sheets were off & his gown pulled up.  It didn't matter that I was just in there 2 minutes earlier & had tucked him in to bed with the sheets up to his shoulders.  It got to the point that I refused to go into his room any more.  I don't need to deal with someone behaving that way.  Life is too short.  :)

Carlene - I'm glad your dogs are able to give you some comfort.  They really seem to know what we need exactly when we need it.  I do plan on getting another dog after my trip.  I miss Jagger a lot and I know another dog won't replace him, but it will at least let me get back to what feels somewhat like normalcy to me.  Thanks so much for your comments.  You are a sweetheart!

It's been a fun week, but a long one.  I'm gonna go get some sleep.  Hope everyone has a great weekend!

 

 

Dog People

I've taken the following story from another journal & hoping Nora won't mind.  It was very touching.  There are some out there that will truly understand it & there are some that just won't get it...but I wanted to share...

Dog People

There are many different people in this world; for example there are dog people, cat people, and non-animal people. If you are in the latter category, this story may not be for you. This story is for the people who understand that families come in many different forms
with many different types of family members; who believe a dog is not property you own, but are a component of the family unit.

I walked into SICU at about 0800 on a day that seemed destined to be very gloomy. Like many RNs, I have two careers. I am a staff RN on NSCU and I am also a Procurement Transplant Coordinator (PTC) for One Legacy, our area's Organ Procurement Organization.
On this particular day I wore the hat of PTC when I was called to go to SICU to check on a referral.

In bed 22 I found a 22 year old who was in a horrible car accident and was now showing clinical signs of brain death. While I was completing my assessment on the unit I ran into Rebecca, RN and Chris, MD, who informed me of another patient on the unit who may be considered a potential organ/tissue donor.   In bed 24 there was a man in his seventies who was suffering from end stage liver and kidney failure. He was admitted several days prior and had been alert and awake, with esophageal bleeding. Eventually he became confused, disoriented, obtunded, and finally needed to be intubated.

 

Before he was intubated he had one last wish; he turned to Dr. Chris and said,  "Please let me see my dog before I die". When Dr. Chris relayed his request to me, I was truly rocked by the depth of the tie that bound him to his pet.

Being an animal person, I wondered if only dog/cat people can understand this man's wish. I have told this story to many people and I can always realize when I am telling it to someone who doesn't have an animal as a part of their family. First I get the "blank face" stare while their eyes gloss over. At that moment I get the sense they are going over their grocery list in their head and not listening to me. Other times I get the "It's just a dog!" routine. It didn't matter to this patient that it "was just a dog"; this was his family…literally, his only family.

He had two close friends who visited him daily and one distant niece who never called back to the hospital to make decisions regarding his care.

Sometimes, your friends may be closer to you than your own family. Rebecca was told by the friends that they were watching the patient's dog and that the dog seemed depressed; not eating, and needing his owner. They said that his dog had been there for him when his wife died. He rarely left his master's side.

Later that day I was called back to SICU. Upon my arrival, I ran into the usual suspects. Dr. Chris and Rebecca were there to give me the latest updates on the three patients who were referred as potential organ/tissue donors. Rebecca also gave me an update on her patient in bed 24. It seems that at around 1500, Dr. Chris suggested that his friends bring in the dog to see the patient and fulfill his last wish. This man was now on two vasopressors and just possibly would not make it through the night.

 

Around 1600 the two friends walked into the SICU. One of the men was carrying a small Lhasa Apso dog. This was a man who had a tough exterior, and despite his grand appearance (which included a Harley Davidson shirt and several tattoos) he obviously suffered from a broken heart, for his eyes were filled with tears as he marched towards bed 24. As the two friends entered the room, Rebecca cleaned off the bedside table and pulled it next to the bed; it was a perfect perch for the small dog. The patient laid there in a coma, unable to respond, as all three of his closest buddies sat with him to say goodbye.

When I first strolled on to SICU that morning I had no idea what a moving experience my day would turn out to be. As an involved staff member at any hospital you will get to know the people you work closely with very well. It is natural to become "in tune" to other team member's emotions. By the end of this day I could read the compassion and concern on my co-workers faces. SICU had had a difficult and emotional day; three patients became "Withdrawal of Care" status and would expire by the next morning.

Despite this demanding day I noticed that the staff in SICU took time to comfort each other even after they each were emotionally drained from these sad cases. This level of peer support is very hard to achieve and maintain, and it shows what a strong team they have. The staff in SICU demonstrated an example of how to do things right; they weren't required to fulfill a dying man's last wish.

 

He was in a coma and wouldn't know the difference right?

 

That did not matter to them; all it took was one doctor, one nurse, and a unit filled with compassion to do the right thing and simply allow a patient to be with his dog one last time.