Meldina Ahmetovic
October 2023
Surgical ICU
Mercy South Hospital
St. Louis
United States




Mel gave me a compassionate but honest look to tell me that "this could be it" and verbally told me to get my brother on the phone immediately.
My dad, N, was transferred to the Surgical ICU after a rapidly declining BP, unstable O2 level and septic shock following a motorcycle accident days earlier. B was amazing Saturday night explaining all of his complications to my brother and me in a compassionate but honest way. She treated our Dad with the utmost respect as we all attempted to come up with a good plan of care moving forward. Sunday, B was on shift, but Mel was his assigned nurse. He had declined more overnight and had a central line put in as well as numerous additional medications. Even though my brother and I were aware of all of this, Mel made sure to explain everything to me in detail when I arrived that morning. Throughout the day, Dad continued to decline, rapidly. Around 1:30, Mel brought me in the hallway and explained that he was in fact the most critically ill patient on the unit and that he had a high chance of intubation because of his unsteady BP and O2 level. She also explained that if he were to need intubation, there was a very high chance of mortality (he also had a fractured C1). About 30 minutes later, both Mel and I noticed that he was extremely calm and was not moving (he was in constant movement and very agitated for about 24 hours), Mel went in to check his vitals to find his O2 had dropped to 70% (even with a flow of 30 liters of oxygen at full blast) and his bp was dropping. His skin was mottling and his color was graying. She called the trauma doctor immediately, and I was tasked with allowing them to intubate him. Mel gave me a compassionate but honest look to tell me that "this could be it" and verbally told me to get my brother on the phone immediately. He was intubated, sedated, and was on 100% life support as the trauma doctor worked with his transplant surgeon (he also had a liver transplant in 2021) at Barnes to get him transferred to Barnes as there was a risk of ischemic bowel or potentially a dead bowel.

Upon my brother's arrival, she explained everything that we had been through and where he stood medically. She reassured us as we questioned our decision that we were performing a life-saving measure to buy us time to get to Barnes to hopefully save his life. He was transferred later that evening and at one point had regained consciousness and communicated with my brother. This was the last time we would see our dad communicate. Monday morning at Barnes, as we spoke with the nurses, we barely got any information other than he's critically stable.

This continued to be the case all week. We were told day after day that "he might go to the OR today." Unfortunately, that never happened, and on late Friday afternoon, after being on a ventilator with no neurological responses for 6 days, they decided they wanted to take him for an exploratory procedure to determine if his bowel was repairable. Best case-it was ischemic, and he would come out with an ostomy bag. Worse case, the bowel was dead. We finally spoke with an honest PA Friday evening who basically said, it was time to put a trach in and hope for the best. My Dad had always shared with my brother and me what his wishes were, and we knew that he would be furious if the rest of his life was spent with a trach and an ostomy bag with little neuro function.

Saturday, we decided to move to comfort care for him while we awaited family members to say goodbye. Our Dad passed away soon after. Had it not been for Mel's honesty and compassion, we would not have been fully aware of just how critically ill he was. I truly believe that when Mel and I realized that he was too calm, that he was dying at that moment, and we saved his life long enough for all of his family members to come to terms and be able to say good-bye. I cannot thank her enough for her honesty during one of the most difficult times of our lives.