About a month or two ago, I had a patient with metastatic vulvar cancer who was transitioning to hospice care who had presented to our main hospital ED due to urinary retention because of her cancer. This was causing substantial pain, and she needed catheterization. The challenges were that her urethra was essentially unable to be visualized due to her cancer, and the providers and nurses in the main ED, as well as the transferring ED, were unable to place a catheter. In the middle of the night, I was called in from home to try to put in this catheter. Whenever we come to the emergency room for more complex gynecologic care, there can be challenges obtaining adequate nursing assistance, as they are not as familiar with the intricacies of gynecology. When I got to the emergency room, I was quite relieved to see two OB nurses whom the ED had requested for help in trying to place this catheter, given their experiences with laboring patients who sometimes have altered anatomy due to the edema associated with labor. They were unsuccessful, which was not surprising given how challenging her altered anatomy was because of her cancer. We were really hoping to avoid going to the operating room to place this catheter, as we are trying to get this patient home on hospice and wanted to limit excessive interventions.

Unfortunately, the main ED is limited in its ability to provide adequate visualization and other necessary assistance for me to place this catheter. What was really needed was a dedicated bed for pelvic examinations, which required transport to the Women's Hospital. These two nurses, although by no means did they have to assist the patient and me, provided excellent care, attitude, and support to help me transport this patient to the Women's Hospital, place her catheter without requiring a trip to the OR, and facilitate her discharge home to hospice the same night. I am highly indebted to these two nurses and the extraordinary care they provided. I cannot express enough how amazing they were and why it reminded me that the nurses of Women's Services at Brookwood are the best I have ever worked with, and where I would want my family to be cared for. The two nurses were Ashley Dorr and Brooke Gaylor. I want to make sure they are recognized for the care they provided for this patient, who was in a challenging situation.