Over the last week, I have had the opportunity to work with James on two occasions. The first was when he called the chaplain because his patient was likely moving towards comfort measures, and he wanted support for the family. I found James in the room, fully present with the patient and family. As the support and prayer, requested by the family, were offered, James stayed fully present to address the patient's needs, allowing the family to be relaxed as they processed what would be the last hours of their mother's life.

It quickly became clear that the patient was not feeling calm, as her face was tense, and she pushed against the bed with her arms and hands. When I inquired in the room about her comfort, he was clearly already at work giving everything he could as ordered. He remained very calm and present as he worked, and there was no indication that there was any problem. When an opportunity happened to step out of the room with him, I found out he had already paged the doctor twice (without response) to get more meds on board and had gotten permission from the charge nurse to add what he could. He was proactive and persistent before I even asked for more help.

I was present for at least 45 minutes, and he was fully engaged in her care the entire time. The goal of a peaceful death, which is the expectation for CMO, was accomplished because of his advocacy for the patient, his skillful action, as well as his compassionate care.

Last night I again worked with James when he was taking care of a younger cancer patient who had coded and wanted to make himself DNR. James asked for the chaplain's presence for the patient and his wife, especially since this was a major shift from his earlier plan of care. As the trached patient tried to communicate and eventually wrote an extended note to me, he again stayed fully present in the room. He respectfully stayed silent as he stood by to suction as needed and provided some help as I navigated the communication relating to the spiritual concerns of the patient and his spouse.

This patient has been at our hospital for an extended period and there have been several challenges between staff and the family. James again personified highly skillful nursing as well as compassion and respect for me and the patient as he got permission from him to suction, which was extremely necessary though uncomfortable for the patient. While never overstepping, he was calmly bearing witness to a sacred encounter that was only possible because he was there. The patient and his wife felt heard and understood, and the encounter ended with a sense of acceptance, appreciation, and reverence.

After seeing that the patient's status had changed back to full code the next night, I checked in with James to see how he was processing the events. It is very clear to this chaplain that James is highly introspective and is constantly self-assessing to stay attuned to the needs of the patient and family, as well as his role as the nurse providing care. His thoughts and challenges with this encounter were perfectly aligned with what it means to stay compassionate as a medical caregiver. In my years as a chaplain, I cannot remember being so impressed with a nurse's care of a whole person. He provided a model of world-class care. I am so proud to work alongside him at TGH.