My brother was admitted to the hospital with shortness of breath, fluid overload, and congestive heart failure. The initial reason for his symptoms began as a result of prostatic hypertrophy and anuria due to a blockage of the urinary system. He was admitted to Gagnon 1. After five days his words to me were, "Help me. Nothing seems to be working and I think they are going to let me die". I promised him, I would be there as soon as I could and would do something to help him.
I visited him on Gagnon 1 where he had been treated for 5 days with very little urine output and congestive heart failure. He had bradycardia and hypotension. When I explained to the medical and nursing staff that my brother's bradycardia and low blood pressure were "normal", he was treated with furosemide intravenously. Unfortunately, there were rapid metabolic changes that took place and he developed encephalitis. His son, his health care proxy and his wife assumed that he could not recover from this and that death was imminent. They decided to withdraw treatment which included disconnecting his defibrillator, IV fluids and medication. He was evaluated by the hospice nurse who recommended pain medication and transfer to palliative care. As I watched this scenario unfold around me, I couldn't believe what was happening. My brother could not speak for himself. He could not act as his own advocate. He could not tell anyone that he was not ready to die.
I reached out to Abbey McClain, the RN assigned to his care. "Abbey," I said, "the family is not knowledgeable about medical matters. They don't understand that his condition is completely reversible." I explained that I was his sister and loved my brother, but my hands were tied, I couldn't save him. His son and wife were his health care proxy. They did not have all the information they needed to make an informed decision. My brother had summoned me days before because of his fear of dying and because he knew I would watch over his care. His fear had become a reality. If something wasn't done immediately he would die. Although I had tried to explain more about the options to his son, he didn't understand. He didn't believe that the decision to withdraw treatment was premature and that his condition could change with treatment. He believed that it was better not to let his father linger and allow him a peaceful death. I knew that Abbey would be able to do what I could not. She was his nurse. Her opinion would be viewed objectively rather than subjectively as that of a family member. I pleaded with Abbey, "Please talk with them, they don't understand, his life depends on it". Abbey understood exactly what to do. She took my hand, she assured me that she would do what she could. Immediately, she got to work. She explained to the family that my brother's condition was reversible. She spent an hour teaching my brother's wife and son. She advocated for him when he could not do it for himself. She explained to them that what happened to my brother was the result of the chemical changes in his body that caused his brain to swell. She explained to them that medication could make a difference and that he could recover. As a result of the actions of Abbey McClain, treatment to reverse encephalitis was started. ln a matter of hours, my brother was no longer comatose. He was able to speak. I will never forget the first words he said to me when he opened his eyes. "Aribe", which meant "I want to get up".
His level of consciousness improved rapidly. Within 24 hours he was verbally responsive, alert and oriented. He was able to ambulate using a walker. He was very much alive. Ethics, knowledge, and advocacy are some of the factors that made the difference in the outcome of care. Abbey McClain was the nurse advocate whose actions made the difference between life and death for my brother.