Ms. X has a lot of complex medical conditions that has left her with near to impossible vascular access. Due to her poor vasculature, we were struggling to obtain accurate pulse oximetry or accurate blood pressure readings, along with numerous attempts to obtain peripheral IV and central line access, which were made without success, all while she is AAOX4.
   
Nonetheless, I’m telling you all of this because even out of this rough situation we dealt with, something positive came from it that I feel you should be made aware of. Briana Clauss ended up getting Ms.X the next day from me. Multiple teams were unsuccessful in obtaining central venous access. The family was notified as well and came in immediately to discuss the goals of care. The team had to have the uncomfortable and difficult conversation with both the family and Ms. X (who was awake and oriented) about how they have exhausted their resources and ultimately have no other options or solutions to help improve her overall outcome. Ms. X and her family specifically expressed how Briana was so helpful and compassionate during this difficult situation today. She would not stop until the family said it was okay to stop and that they had accepted this for her. They just wanted to make her comfortable. Briana made her comfortable, was compassionate, brought out every resource she could think of, and was emotionally and physically drained. But she did not want to give up. The patient and the family could not have said enough wonderful things about her. 
   
I think working in critical care, we so often deal with patients who are not oriented or even conscious during the death and dying process that it really puts things into perspective when we have to tell a patient who is completely oriented that there is nothing else we can do to help them and ultimately, they are going to die likely soon. 
   
When I walked into the room tonight to see her, she told me she just wanted to make it to her birthday, but even if she does not, she is very thankful that she had Brianna and the entire staff to help her through this situation. Briana did come in the next day and brought birthday decorations and had a birthday party for the patient. 
   
I feel proud to be able to tell you this story, often times situations like this go unnoticed or overlooked with the challenges this profession and particularly this unit faces dealing with high levels of patient acuity and often staffing challenges we are working through. Knowing that I work with such professional and caring coworkers like Briana, who can meet a patient who is a complete stranger and provide such an impact on a situation that is so dire, makes me proud to work here in the MICU and gives me a lot of hope for this unit going forward. She is absolutely an Extraordinary Nurse. She is a true role model and leader in this organization.