We had a 39-year-old gentleman who was admitted to the MICU from home with respiratory failure. The gentleman in recent months had been diagnosed with renal cancer and treated with radiation and chemotherapy. The cancer had spread to his liver, lung, and bone by this time. The patient on arrival to the ER was adamant that he did not want to be intubated. He understood that if he was placed on the ventilator, there would be very little chance he would ever come off the ventilator. His choice was to go home with his wife, and spend what time he had left with her and their two children, ages 2 and 7. He was admitted into the MICU in the middle of the night and provided supportive care until arrangements could be set up to get him home safely and comfortably.
We knew we needed a hospice team to assume his care at home, hospice equipment like a bed and hospice medications to treat his symptoms and allow for his comfort. The patient was currently on a low dose of Levophed to help maintained his low blood pressure. The team set out to get everything in order to make this transition as seamless as possible and sure this gentleman was allowed his wish of dying at home surrounded by his family. The Critical Care Team felt in order to get this patient home as he wished, we would need to send him home on the Levophed and disconnect it once he was settled in his hospital bed.
This created a bit of a situation, since the hospice staff was not comfortable with this medication or its management. The ambulance transport crew could monitor the medication on the transport home but could not ensure they would be able to stay long enough to allow the patient to get settled and comfortable. One of the MICU nurses, (Barb Moore, RN) who lived in Waterford, PA (near where this patient lived) was aware of the above challenges and offered to either assist the transport crew home or meet the crew at the patient's home to help with the transition, she had been working when the patient was admitted. The bedside RN on day shift called Barb later in the day to make sure she was still agreeable to meet the patient and hospice nurse at home to manage the Levophed drip.
The hospice equipment (bedside commode, hospital bed, and comfort medications) was set up to be delivered at 2pm, transportation was set up at 3 pm and the hospice nurse was to meet the patient, his family, and Barb (MICU RN) at their home. This was January (I should have started with this) in Erie, PA and as always the weather is often less than predictable or ideal. It seemed like, as the day moved along and we became closer to getting everything needed in place, the snow was falling harder and harder and there was accumulation.
There were a couple of delays due to weather conditions and transportation (Emergycare was getting a crew together of the patient's friends) so he had familiar faces for the final ride home. The patient was finally loaded on the stretcher and the ambulance crew left shortly after 4pm, everyone breathed a sigh of relief as he went out the MICU doors. The first hospice nurse went into a ditch on her way out to the home. The second hospice nurse was part way there when she had to turn around because of hazardous road conditions. Barb Moore, however, was there waiting at the residence. She had previously agreed to help with the transition of getting the patient settled and discontinuing the Levophed drip once the patient was surrounded by his family.
However, with no one able to make it to the home from the hospice agency, Barb stayed and administered some pain medication to ease the patient's labored breathing and some anti-anxiety medication to reduce the patient's fear and uneasiness. She gave the patient's wife some time to shower (since she was at his bedside all night and most of the day) and time to collect her thoughts before she had to explain what was happening next to their two children under 7 (2 years and 7 years). She (Barb) discontinued the blood pressure medication and stayed to offer support and education to the patient's wife. The gentleman passed away in his sleep at between 3 and 4 am the next morning surrounded by the ones he loved.
I can't even begin to thank Barb for going out of her way to make this patient's dying wish a reality. She showed how devoted and selfless the MICU staff truly is. Barb offered her assistance without being asked, and honored that promise without hesitation, despite working night shift that previous night and only getting a few hours of sleep if that. I wish as we all do that this story had a happy ending, but as with much of our works as nurses it does not. It does have a positive impact on a patient's dying wish and end of life care. If it were not for Barb this could have gone entirely in a different direction. This is why I feel it is necessary to nominate Barb Moore for the Daisy Award.