Genalyn Miranda
June 2021
Genalyn
Miranda
,
RN, BSN
Blood and Marrow Transplant Unit
Presbyterian St. Luke's Medical Center
Denver
,
CO
United States
Genalyn truly impacted this family in a way they will never forget and to say that they appreciated what you did for them is beyond an understatement.
I had a patient named R that had a severe unexpected decomposition after autotransplant. He passed away yesterday. R had only been admitted to the hospital for a week and a half. Two days after the transplant for his lymphoma he developed septic shock and was transferred to BMT North. He unexpectedly died 2 days later- only 4 days after his transplant. I called his wife today to check-in. She and her family are understandably devastated. I talked to her for a while today and she said that Genalyn was her saving grace during this most difficult of circumstances.
Through the night, R had become increasingly more unstable and was experiencing multi-organ failure resulting in CRRT treatment for his kidneys, multiple vasopressors for his blood pressure, and intubation for his respiratory failure. After the intubation in the morning, R continued to decline which resulted in a code status discussion. The concern was that a cardiac arrest was impending. At the time the wife was not ready to change his code status, so the team prepared for a possible code. Genalyn started a fourth pressor and within minutes reached the maximum dose for all. During this time, Genalyn was in constant communication with the wife- explaining her step-by-step the changes that were occurring and the actions she was taking to treat the patient.
Unfortunately, the patient continued to rapidly decompensate. The attending on duty rounded with Genalyn and the wife again to relay the changes and likely poor prognosis. The wife made the difficult decision to change the code status to DNR. This was devastating for the wife. Genalyn could see the toll this was taking on the wife and the necessity that she have support during this time. The wife shared in great detail about how Genalyn helped get family members approved to come to the bedside. Genalyn was able to arrange for the daughter and son to come be with their mother at their dying father’s bedside. This allowed the children the time to say their goodbyes to their father.
Genalyn also recognized how important spirituality was to the patient and wife. She contacted the family’s pastor and got him to come in and pray with them at the bedside. The pastor was able to provide the reassurance and spiritual support she needed during this difficult time. Shortly after, the patient continued to decompensate. Genalyn and APP discussed with wife and children the option for comfort care measures and what that would look like. Once the decision was made to withdraw care, Genalyn went above and beyond to address all of the family’s questions, provided thorough explanations of the process, and what to expect. She explained everything she was doing and what was happening. The patient passed 9 minutes after they took him off the ventilator. The family surrounded the patient and expressed all of their love for their father/husband as he passed peacefully. Genalyn shared her condolences and the patient’s wife gave her a big hug and thanked her for her exceptional care that day and for all she did for the patient and the family. It is hard to put into words the emotions that the patient’s wife was expressing and how grateful she was. Genalyn truly impacted this family in a way they will never forget and to say that they appreciated what you did for them is beyond an understatement.
Through the night, R had become increasingly more unstable and was experiencing multi-organ failure resulting in CRRT treatment for his kidneys, multiple vasopressors for his blood pressure, and intubation for his respiratory failure. After the intubation in the morning, R continued to decline which resulted in a code status discussion. The concern was that a cardiac arrest was impending. At the time the wife was not ready to change his code status, so the team prepared for a possible code. Genalyn started a fourth pressor and within minutes reached the maximum dose for all. During this time, Genalyn was in constant communication with the wife- explaining her step-by-step the changes that were occurring and the actions she was taking to treat the patient.
Unfortunately, the patient continued to rapidly decompensate. The attending on duty rounded with Genalyn and the wife again to relay the changes and likely poor prognosis. The wife made the difficult decision to change the code status to DNR. This was devastating for the wife. Genalyn could see the toll this was taking on the wife and the necessity that she have support during this time. The wife shared in great detail about how Genalyn helped get family members approved to come to the bedside. Genalyn was able to arrange for the daughter and son to come be with their mother at their dying father’s bedside. This allowed the children the time to say their goodbyes to their father.
Genalyn also recognized how important spirituality was to the patient and wife. She contacted the family’s pastor and got him to come in and pray with them at the bedside. The pastor was able to provide the reassurance and spiritual support she needed during this difficult time. Shortly after, the patient continued to decompensate. Genalyn and APP discussed with wife and children the option for comfort care measures and what that would look like. Once the decision was made to withdraw care, Genalyn went above and beyond to address all of the family’s questions, provided thorough explanations of the process, and what to expect. She explained everything she was doing and what was happening. The patient passed 9 minutes after they took him off the ventilator. The family surrounded the patient and expressed all of their love for their father/husband as he passed peacefully. Genalyn shared her condolences and the patient’s wife gave her a big hug and thanked her for her exceptional care that day and for all she did for the patient and the family. It is hard to put into words the emotions that the patient’s wife was expressing and how grateful she was. Genalyn truly impacted this family in a way they will never forget and to say that they appreciated what you did for them is beyond an understatement.