While working a weekend shift to meet up with weekend option team members, I was able to observe extraordinary care delivered by Irene Mendez, RN on HVU. Irene and her preceptee were caring for a very complex cardiac patient who had been on the unit for about 2 weeks. He had very advanced heart failure and had been exploring therapeutic medications and adjustments in his biventricular pacemaker to try to pull off fluid, make his heart pump stronger, and offer him the best quality of life with the latest technology. He was a challenging patient and very set in his ways. He became frustrated easily, especially when he felt like he was not in control. He decided what and when he wanted to do things and especially valued his privacy, adamantly refusing things like our skin assessment, wound care, etc, without a lot of explanations and patience.

Prior to this particular day, physicians had come in and told the patient and his family that nothing was working and that they had nothing else to offer him with regard to his dire heart function. They recommended he pursue hospice care and consider changing his resuscitation status. While they were not completely surprised, there was anger and grief displayed, and they were grasping at straws for any other options. The day Irene had him, he appeared sad, dejected, and frustrated. She displayed her usual tremendous amount of patience as she went through the morning routine, administered medications, assessed the patient, and discussed the plans. He was emphatic that he wanted to go home--the sooner the better. A lot of things had to come together on a Sunday for this to happen. His family requested a different hospice provider; we needed to turn his implanted defibrillator off, and coordination of discharge considerations needed to come together. Realizing this would take someone coordinating this process, Irene began by calling the cardiologist and reviewing the need for the ICD actions. She then coordinated the device rep and had this done. She also reached out to the preferred hospice team with the provider's blessing, and they agreed to see the patient first thing the following day. This really required a lot of focus to get this to happen all in one day on a Sunday.

All the while, Irene kept checking in and updating the patient on the progress and didn't give up on the quest to get him home that day. Her calm demeanor and respect for the way he liked to receive care were evident in each interaction. Fortunately, the hospice team's ability to see the patient made the discharge possible, and Irene completed the coordination and plan to the patient and family's satisfaction. By mid-afternoon, the patient had his wish to return to the comforts of his home, see his two beloved grandsons, and enjoy the days he had left surrounded by family, making each day count. They were very appreciative of her efforts. I am confident that without Irene's persistence and focus, all of these things would not have come together to allow this patient's wishes at a very important time in his life.