Mr. D suffered an unfortunate accident. He was involved in a minor vehicular accident that brought him to UC Davis and into our lives. He suffered from a c-spine fracture as a result of the accident, something that many other patients have been able to have a full recovery from. However, his underlying conditions caused him to endure many complications from his hospital stay. Mr. D has ankylosing spondylitis, a form of arthritis that causes inflammation of the spinal vertebrae. When the condition is advanced, it can lead to new bone formation in the spine, causing sections of the spine to fuse and become immobile which is what happened to Mr. D. The immobility of his spine made it difficult for him to protect his own airway and he ended up being intubated within a few days of his stay, his first of many intubations. This was the beginning of his long road with us and the start of the bond between Tonya and Mr. D. As Mr. D recovered from his respiratory difficulties and got extubated, things were looking up, however, shortly after starting down the road to recovery, he took a few steps back and went into respiratory distress requiring intubation for the second time. Tonya took care of him every day that she was at work. Comforting him, encouraging him, educating him, advocating for him, and making his life livable as he became one of our unit residents. She held his hand and reassured him when the one failed extubation and reintubation turned into two, then three. The medical team decided that his best chance to improve was to get a tracheostomy. However, the team that performs tracheostomies refused to perform Mr. D's, as his underlying spinal defects made the tracheostomy difficult to place. Tonya advocated for her patient every day, pushing for what was best for the patient, arranging team conferences and plan of care meetings, involving the family and supporting them throughout the process. Finally, it was determined that a spinal fusion would be the best option to improve Mr. D's anatomy for a tracheostomy to be placed. So he underwent the long, complicated, and painful procedure. During this procedure, an epidural abscess was discovered, complicating the medical treatment and prognosis more than what already had. While waiting to recover from his spinal surgery complicated by pneumonia and blood clots, Tonya sat by his side, comforting him, consoling him. She was there for him and his family not only on the days that she was in the hospital caring for him, but also the days that she was not working, talking to the son, educating, advocating, pushing for the best care that he could have, and doing this on her own time.
Every time that it looked like Mr. D was recuperating and making a recovery, his condition would spiral down. He was intubated and extubated a fourth time, then a fifth time that also came with a cardiac arrest and complication after complication, and yet Tonya sat at his side supporting him. At this time, he had been in the hospital for over two months. Tonya advocated for him, being his voice when he couldn't talk, providing him comfort and the best nursing care when depression had overtaken him and he lost motivation to recover. Forcing him to push through the dark clouds, shining light on the possibilities of getting better and out of the hospital. After a long wait, Mr. D finally received the tracheotomy that he needed, but he continued to require the support of the ventilator to breathe. He then got a permanent feeding tube placed, his wife was overcome with an illness, and Mr. D slipped back into the dark state of hopelessness and another unfortunate cardiac arrest. His body had succumbed to the numerous complications. Despair and distress overshadowed him and his family and yet Tonya sat at his side, caring for him, comforting him, his light in the sea of darkness that surrounded him.
The family formed distrust with the medical team as time went on and complication after complication occurred, and life-threatening situations kept arising. Tonya advocated for him to have a change in primary team as his condition was no longer related to the motor vehicle accident but the respiratory and other medical complications that surmounted after. As simple as this sounds, it was a long struggle that Tonya endured, daily advocating for him to change teams with the best patient outcome in mind. After almost 4 months in the hospital, this feat was accomplished. With a change in the direction of care came hope for the family, but depression still plagued Mr. D. Tonya fought for him, encouraged him to push through, and jumped through hoops to make sure that he continued to improve.
On Mr. D's birthday he was still dependent on the ventilator and stuck in the ICU, but that didn't stop Tonya. Tonya single-handedly coordinated a surprise for his birthday, she gathered the necessary supplies, equipment, personnel, and his family and showed Mr. D what he hadn't seen in months: fresh air and sun! She had arranged for him to go outside while on a portable ventilator to celebrate his birthday with his friends and family, soaking up the sun, breathing the fresh air, not surrounded by the white walls of the hospital room and beeping of the alarms and machines. Mr. D smiled, and the hopeful twinkle came back to his eyes. The fight in him was reignited. Eventually, Mr. D got transferred to a long-term care facility on a permanent ventilator after six and a half months of care in the hospital. The bond that they created and the friendship that was formed didn't end with his discharge.
Last month, although Mr. D had been discharged from the hospital over a year and a half ago, I received a message with a picture that brought tears to my eyes: Tonya sitting aside him at his long-term care facility, with the biggest smile on his face and the twinkle still in his eyes. When I asked Tonya what he said when he saw her, she said that Mr. D had looked at her with a big smile and said, "Am I dreaming right now?"
Tonya saved Mr. D's life repeatedly during his long stay in the hospital. Without her, he never would have come this far. They continue to share a special bond that can only be formed between a nurse and patient. Tonya is an exceptional nurse, manager, peer, coworker, and friend that deserves to be recognized. She is the type of nurse that I strive to become.