America was having a mentally and physically challenging day. She was dealing with an obviously loving family who had to make some very real and very challenging decisions about their mother's care. Their mother had faced many health scares in the past several years including battling breast cancer. Unfortunately, the cancer had re-manifested itself in the form of nodules in her lungs. She was having a hard time catching her breath, even to talk to her family.
She had been intubated and sedated the previous evening, but only in order to do a bronchoscopy. This particular morning, she was to be extubated, according to her wishes. However, one family member lived in a neighboring state and was not present at the bedside yet. He had to travel 6-7 hours to get to his mother. The remaining siblings decided to leave their mother on the vent until the remaining son was able to arrive. They just didn't know how long she would be able to breathe once she was extubated, and once she was off the ventilator, she didn't want to be re-intubated, even if it meant she faced the end of her life.
America not only cared for the patient that day, but also the family. This was a very fluid situation and the plan of care seemed to change minute by minute. The family wanted a copy of the mother's living will, they asked to speak to several doctors, they wanted to wait for the oldest son to arrive...America handled all these situations with grace and answered many questions the family had.
One of the hardest things America had to handle was the question of a DNR status. What would happen when she was extubated? Would she be able to breathe on her own? Did they want chest compressions or did they want to just make their mother comfortable? I have never seen anyone handle this conversation better than America. She answered every question the family had and gave her honest opinion about the situation. Once the patient was weaned from her sedation and able to answer questions, America talked to her and asked the same questions to her. The patient was able to mouth words and make her wishes known to her family.
Once the patient was extubated, America again handled the situation with such grace. She gave the family hope and dignity in dealing with their mother. She treated each and every family member with respect and the utmost of care and concern. America may not have been able to heal the mom, but she was healing the family with her kind words and caring attitude.
At the end of her shift, America left the family with hugs and words of concern. She had a meeting the next day, (her day off) and before the meeting, she came to CCU to check on the family and her patient from the day before. I heard from the family that that one act meant so much to them. It showed that even though America wasn't physically caring for the patient that day, she was still showing she cared.