One night I received a patient in transfer from another big hospital in the state. As the coordinator, it was my job to take report on the patient who was being Life Flighted to our hospital. She was a lawyer from New York City who had been traveling on holiday with her husband to Bar Harbor. Along the way, they stopped at a hotel in Augusta. Per the report I received, she had been swimming when her husband saw her struggling from the second floor. By the time he got downstairs to her, she was at the bottom of the pool. EMS arrived and resuscitated her. At the hospital, they pulled several liters of pink, frothy fluid out of her lungs. She was coming to our hospital to undergo the therapeutic hypothermia protocol, which is done for patients who have cardiac arrested, been resuscitated, and have poor neurologic response initially.
Some cardiac arrest patients who come to us look very much alive, pink, well perfused. This woman looked dead. Maybe it’s having been around so much death, maybe it’s working at night and having too much time to think about morbid things, but in the time I have spent thinking about the topic of death, I have decided that one of my least favorite ways to die would be from drowning.
I will never forget listening to report on this particular patient because it made my gut turn over. And seeing her didn’t do much to help the cause. I had to detach as we slid her body from the stretcher to the bed, as we transferred IV drips and lines and hooked her up to our monitoring system, our ventilator. Her husband was driving down from Augusta. My heart ached at the thought of this poor man driving down the highway alone to see his wife, whom we already knew had a very sick brain.
Carolyn took care of this patient for several days. She is also the nurse who oriented me to critical care, has been a critical care nurse for 14 years at the time she oriented me. Her brain is a masterpiece when it comes to critical care nursing. Tie that together with her life experience, her heart of pure nursing gold, her compassion, perfectionism, and what sometimes becomes a crutch for all of us- wearing her heart on her sleeve- she is a near-perfect nurse. I wouldn’t want anyone else to care for my family.
A week or so into this hospitalization, many of us knew that survival of this patient was futile; she was not going to wake up. Her two daughters had flown in from New York, and were in to visit every day. One of her daughters had a mental health history, and her mother was her primary caregiver when it came to her mental health. She visited her often and was her rock. Her mother’s now imminent death was destroying her. She confessed to some staff that once her mother passed, she would get her affairs in order and then take her own life. We were very concerned, and alerted providers, whose initial response was, “she’s not our patient, there’s nothing we can do.” We were in a tough spot. We knew we could take her to the ED, and likely she would be admitted, but then she would not be able to be there when her mother died, which seemed like the worst thing we could do for this woman.
Sometimes, no, not sometimes- often, we care for our patients who are brain dead, or we know will be pronounced at some point in the near future, whose families hold on to hope, thinking that their loved one will wake up when we know they will not. It’s heartbreaking to watch. The patient lingers for far too long. In these instances, I have seen many different reactions from staff, all staff, not only nurses, who are trying to process the emotion that comes along with caring for a patient who is not going to survive. There are certain protocols that need to be in place for patients who have foley catheters, who are ventilated, and who have central, arterial or venous access, to prevent infection, stress ulcers, etc. Some nurses have a hard time caring for a patient who we are keeping alive in what seems at time like an act of futility. Sometimes it feels like it threatens our moral code, knowing that we would never want to live this way. Our defense mechanisms in these situations can be off kilter.
Carolyn takes care of each patient as if they were her own child, mother, or sister. Each patient is cared for with a meticulous level of perfection. She asks the correct clinical questions, stays on top of every lab value, medication, and number. She makes sure her patients are carefully bathed, linens are always fresh, and her patient is turned and positioned perfectly in the bed, not only to protect the skin but also to protect the dignity of the patient.
This particular patient’s daughter came in every night between ten and midnight to sit with her mother, lay her head down on the sheets, hold her mother’s pale hand, and talk to her. Once in a while, her eyes would close, her dark hair lying on the white sheets, and a tear would fall down her cheek onto her mother’s hand. It broke my heart to witness this love, this sorrow, and grief. Some nurses need to detach. Carolyn dove in headfirst. We had named Thursday as the day we would “pull the plug”. A few days before, as the patient’s daughter was leaving, around twelve thirty, Carolyn explained to her that each morning we bathe our intubated patients who are sedated or unresponsive, around five o’clock, and invited her to come in and bathe her mother with her. That morning at five AM, and the morning after, the patient’s daughter arrived at the hospital. Carolyn closed the curtains and together, they bathed her mother. Bearing witness to this act of pure kindness both warmed and broke my heart. What an incredible gift Carolyn chose to give this daughter, to be able to bathe her mother in her final days. Not every nurse would have the strength or ability to do that for a patient or a patient’s family member. It was a demonstration of the pure essence of what it means to be a nurse.
Carolyn taught me, and continues to teach me, so much about cardiac critical care, about pathophysiology and medicine, but in this instance, she showed me what it means to be a nurse, to wear compassion on your sleeve and to give it, even when it is the most difficult thing to give. I describe Carolyn as fearless, as fierce, as a beast. As the sun rose that morning, I saw tears in her eyes. We went to breakfast that morning, to debrief, to take care of each other, which we must do in moments like these, when we give literal pieces of our hearts to do the work that we do.
There’s a phenomenon in cardiology which I have always loved. There are arteries that wrap their arms around the heart and feed it the blood and oxygen it needs to continue to beat. When these arteries become diseased over time, the heart forms collaterals that allow the heart to survive longer with this collateral circulation. In essence, it grows new arteries as old ones become diseased. I describe it to students like a starfish, which has the ability to have an arm cut off and grow back. It has always blown my mind. Each day, that we give a part of our heart to the work that we do, we must also do the work of taking care of each other, to help to grow back that part of the heart that we gave up. Otherwise, we become souls with nothing left to give.
Carolyn is one of those nurses who grows collaterals and wants to have a forever well of love and knowledge and wisdom to give her patients, her family, her colleagues, and her friends. She is one of the most beautiful starfish I have ever met.