C came as a transfer from an outside hospital. He was found face down with a gunshot wound to his face by his uncle. He was rushed to an outside hospital where he was emergently trached, received multiple blood transfusions, stabilized, and then transferred to UC Davis Medical Center. He was quickly triaged in our ER, sent to the OR where the ENT surgeons worked on him. He arrived on Tower 7 MSICU Gold where he would spend the next 6 weeks of his life. His injuries were extensive. They included a shattered jaw, maxilla, zygoma, and all the muscle and soft tissue of the face, so he had no cheeks, no nose, no mouth, and no chin. His eyes were so swollen he could not see. His hearing was compromised from the gunshot so he could not hear. He was trached so he could not talk. On top of all this, he was experiencing active DTs.
T7 MSICU Gold was prepared to give him the best care. The unit specializes in post-operative ENT patients so the staff knew how to care for his wounds, his flaps, experts with leech therapy, and tracheostomy care. They also knew how to manage medically complicated patients and furthermore, they also specialize in adolescent/young adult care, so they knew how to manage his alcohol withdrawal, agitation, and delirium complicated by his inability to communicate. But there was that special nurse who was devoted to his care, not just his physical needs but his emotional, mental, and spiritual needs. She was there for his hurting family, she was there to educate, to comfort, and to advocate for. She was there for his entire six weeks in the ICU and beyond. That nurse was Cina.
You see, this unfortunate young man was never diagnosed with mental illness or substance abuse, so this act of violent self-destruction was a shock to his family and friends. As far as they knew, he was a typical 24-year-old young man. The visual of what was his face was shocking and disturbing. His injuries were extensive, and he was critically unstable. His agitation and physical aggression were scary to family. Cina took responsibility for his care immediately and she would visit him long after he was transferred out of the ICU.
In the beginning, the patient was scared, very agitated, and combative requiring multiple nurses for multiple occurrences during each shift. Cina would coordinate with different teams and staff to ensure patient and staff safety as well as compassionate care and emotional support. Cina deeply empathized with the family. When she was not caring for the patient, she would sit and talk to the family. She would listen to the family's grief, their pain, their worries about C's condition, and their anxiety about his future.
The first couple of weeks were tough and challenging. His wounds were raw and open, susceptible to infection and tissue damage. His delirium and agitation challenged his safety and the safety of those caring for him. Eventually, his delirium cleared, and his wounds stabilized.
Cina worked to maintain his dignity, fiercely protecting and advocating for his needs. She encouraged his autonomy and supported him. She would talk to him as he touched his face and his wounds to process all that had happened to him. She encouraged his mobility and autonomy. Cina would speak words and her expression was one of hope and promise, not of horror. She knew C would have multiple surgeries, his emotional healing would take time and that his journey would be long so she maintained a positive outlook for him when he and his family could not.
He became the recipient of a face transplant and his story would be featured on a national TV program. He specifically recalled the care of the nurses on Tower 7 MSICU Gold as being pivotal to his recovery. He spoke of the connections he developed with the nurses and how much it affected him.
The fact that he remembers the Tower 7 MSICU Gold nurses for their kindness, their caring and compassion two years later is humbling. I am inspired and in awe of the devotion to extraordinary care for this extraordinary young man. I am truly honored to work with such extraordinary colleagues. I believe that Cina epitomizes all that DAISY envisions all nurses to be, clinically skilled, compassionate, and caring. And yet, if you ask her, she would say, "I was just doing my job". For the care of this young man and many more, Christina Pontes is a true DAISY Nurse.