Maria has excellent clinical judgment; she is compassionate and a good patient advocate. I recently had occasion to work with her while caring for a 100-year-old Russian lady. This lady had declined a TAVR in the past. She now presented with decompensated heart failure and was initially cared for in the CCU until she was stabilized. Her family was concerned regarding her decision to decline a TAVR. They decided to pursue a workup to determine if she was a candidate before declining the TAVR.

The patient was primarily Russian-speaking at this time and did not do well with the video translator. She deferred her medical decision-making to the family. The patient continued to decline as the family opted to pursue an aggressive workup despite being advised of the patient's wishes and previous workup. Maria was concerned regarding the patient’s well-being and reached out to the physician team, facilitating a visit with the family and encouraging them to look at her overall situation and remember her wishes regarding the end of life.

She used her knowledge of Russian and her empathy in the patient's best interest. The patient was then transitioned to comfort care, and she passed away peacefully surrounded by her family. Ms. Kashnikow’s persistence, compassion, and diligence regarding the patient’s condition allowed the team to ensure that the patient’s wishes at the end of life were honored.