The Day the ICU Stood Still

As a part of the 50th anniversary of the BYU College of Nursing, a book was compiled called “The Healer’s Art: 50 stories for 50 years.” It has been 15 years since this book was first published and these stories were shared. We plan to regularly post selections from this book to help each of us remember and cherish the experiences of nursing and learning the Healer’s art. 

“The Day the ICU Stood Still”

Kent D. Blad

 

Mr. P was a 70-year-old Veteran of World War II.  He came to our hospital in need of treatment for recently diagnosed cancer of the esophagus.  After discussion with the family and physicians, the decision was made to take the patient to surgery to complete an esophagogastrectomy. Upon completion of his surgery, Mr. P returned to the Surgical Intensive Care Unit (SICU) for his post-operative care.  Mr. P’s wife and children spent many hours at his bedside, holding hands, praying, and offering words of encouragement to their recovering husband and father. Joy and smiles were seen when they witnessed his seemingly uneventful wakening from anesthesia and recovery in those first few days following surgery.  Mr. P was a delightful and pleasant individual who reciprocated his love for his family and shared his appreciation for their support on his behalf.

Mr. P’s condition held steady for little less than a week in the SICU, when the discovery was made that Mr. P was not tolerating his tube feedings well.  He complained of nausea and vomiting, abdominal pain, and just not feeling well.  The decision was made to discontinue his tube feedings and begin total parenteral nutrition through his intravenous (IV) catheter.  After a week’s trial of this and other treatments, Mr. P’s condition worsened.  The family shared a great deal of concern with the physician and staff, as they worried about his unusual behavior of not being so cheerful and happy.

During those couple of weeks caring for Mr. P and his family, I, as his primary nurse, became very emotionally attached to them.  I found myself spending more and more time in the room at the patient’s bedside, trying to do everything possible. I found my efforts were not achieving the outcomes of getting Mr. P over his illness and on to recovery.  The family and I began questioning the seriousness of Mr. P’s lack of improvement.  The concerns were relayed to the surgical team, followed by a lengthy discussion with the family on the best treatment to pursue next.  A decision was made to take Mr. P back to surgery to explore the possible causes of his pain and lack of improvement.

In surgery, the surgeons discovered that Mr. P had a new problem, coupled with his battle with cancer.  The tissue around the operative sight had eroded, causing the tissue to tear, with his tube feedings leaking into the surrounding area..  With such fragile tissue, the possibility of being able to secure that tissue closed was questionable.  In addition, his primary esophageal cancer had metastasized.  Mr. P’s surgery was completed, unsuccessfully, and he was returned to his SICU room.

The surgical team presented the findings to the family, with the outlook of an estimated one week survival for Mr. P.  The shock of the news saddened the family.  The rest of that day was spent grieving and trying to accept the facts that had been presented.  The family returned home that evening to consider their options with Mr. P’s care.

Upon the family’s return to the hospital the next day, they presented me with their proposal.  They wanted to take Mr. P home, so that his wish of dying at home in his environment could be accomplished.  My immediate reaction was one of, “We can’t do that, that’s never been done before.  He needs us to take care of him.”  I couldn’t see past his need for dressing changes, pain medication, oxygen, a hospital bed, etcetera.

Over the following hour or so, I thought intently about the family’s request.  I started questioning my response to them.  Why couldn’t they take him home?  Why couldn’t we teach the family the necessary tasks to care for him at home?  Just because it had never been done before, was this enough reason not even to try?  If this were my spouse or father, would I want his wish granted?  I became convinced this was not an impossible task.  We were going to get Mr. P. home!

The wheels started spinning.  I shared my desire with the family of wanting to honor their wish.  I told them of our slim odds of being able to accomplish this, but we were at least willing to give it our best shot.  The first hurdle was to get the surgical team to agree.  After a phone call to them and their visit to the room within a short time, permission was granted to start the process as soon as possible.  Orders were written to the effect, with the next couple hours spent arranging for necessary items to complete this mission.  In coordination with home health, a hospital bed, wound dressing supplies, morphine, oxygen, as well as many other things, were scheduled to be delivered to the home the next morning.  Since time was of the essence, transportation was arranged to take him home at the beginning of the next day.  The final few hours of that day were spent teaching his wife and children the tasks of dressing changes, medication, oxygen administration, etc.

The next morning arrived and I was excited for the day.  I arrived before the family, visited with Mr. P, and shared with him the excitement the day would bring for him and his family.  With limited energy, he continued to smile throughout our conversation.  His dream was to come true.  I hastily made a sign to put around his neck as his family arrived which read, “PLEASE TAKE ME HOME!”

The memory of that moment when the family entered the room that morning, prepared to take their loved one home, will forever be imprinted on my mind.  In spite of the tragic circumstances surrounding this situation, I will never forget the look on their faces of love, appreciation, and joy.  The emotions shared were not of sadness, but happiness.  This good and kind gentleman, was now free to go home and die with dignity and peace, with his loving family surrounding him.

Word came from the family that Mr. P died on the third day after returning home, with a smile on his face and his entire family surrounding his bed.  The lessons I learned were invaluable.  Things could be accomplished that hadn’t been done before.  I learned the power of dedication and emotional and spiritual strength at times of adversity.  I will never be the same, nor will I ever approach a patient in the same manner as I did before caring for Mr. P.

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