Several months ago, Kelly and I had patient assignments next to one another for several nights. Kelly was caring for a patient whose clinical condition had been tenuous, requiring continuous renal replacement therapy, frequent administration of medications for agitation and anxiety to keep him safe and frequent linen changes, due to his loss of bowel control. She had cared for him for several nights, and had developed an excellent rapport with his wife. Every evening, when we made our family calls, Kelly took extra time to talk with her patient's wife. You see, the patient had expressed to his wife, prior to his illness, that he would never want to be "kept alive by machines," including chronic dialysis, and this was exactly the point that his health condition had reached. The patient's wife was certain that she would honor her husband's wishes, yet she was conflicted. She wasn't ready to say goodbye to the man she loved, and there were adult children who also needed input. Kelly spent a great deal of time being a sounding board for this patient's wife. She listened, she reassured her, she offered support.
Whenever the patient's wife was expected for a visit, Kelly made sure that her patient was as comfortable as possible, that his glasses were on, that the room was as orderly and as peaceful as rooms in the MICU can be. Kelly requested to be assigned to this patient as often as possible during his hospitalization, to provide continuity for both him and his wife. She communicated well with the day shift nurses who cared for him, so that they would know the difficulties that his wife was facing. She also communicated extensively with the medical staff responsible for his care. Kelly demonstrated and facilitated exceptional teamwork for this patient and his family, and I was deeply moved by her dedication.
I wasn't working the day that Kelly's patient passed away, but I am certain that the determination of goals of care by his wife and the medical team was made easier because of Kelly's efforts. I have no doubt that his wife and family felt the caring with which their loved one was attended to, and knew that they were important in the planning of his care. Witnessing Kelly's efforts on behalf of this couple was humbling to me. It certainly served as a reminder that in spite of the technology in our environment, and the intensity of the work we do, the kindness and caring the we show to our patients and their loved ones is as valuable as any other skill we use.