JC was admitted to the hospital originally for necrotizing fasciitis to his lower extremity. The patient had a history of heart failure, AICD, multiple CABGs, stents and multiple surgical attempts on his lower extremity. What was supposedly a simple hospital stay to receive some antibiotics and wound care turned into a devastating, life-changing journey. JC found out that he had a clot in his heart and BLE, no viable arteries for grafts for any procedure cardiac or peripherally, and extreme decompensation of his heart. He was placed on an inotrope and continually day by day "let's see what we can do" from the heart failure team. Eventually, there had been talk of hospice, home health, maybe this and maybe that, but nothing was decided at this time.
One day Shula had the pleasure and honor of taking care of JC. At promptly 1000, the heart failure team rounded outside the patient's room. The plan was to tell JC there was nothing more we can do for him and that if he would like to go home, the best day to do so would be today.
Shula had never witnessed a physician bring such devastating news to a patient. She had always taken care of patients after the news was told to them, but never as a witness first-hand. She knew it was going to be hard and emotional, but she knew more than anything, she needed to be this patient's and his family's advocate. She needed to be strong for him, to help him understand what his options were and to aid him achieving his goals leading to a peaceful death.
The team delivered the news and the patient was in shock but then asked 'what now?'. The team asked him what he wanted, the patient stated, "I want to die at home with my family"; the team said okay and his discharge was planned for ASAP that day. With this being said, the patient had multiple questions/concerns/desires and Shula spent a great deal of time with him and his son making sure what he wanted was possible.
Hospice came in and the patient became confused and panicking because he thought he was being sent home to "die" and nothing medically would be done such as checking INR, receiving Coumadin, if he could travel, wound care to his leg. The main point of contact was able to smooth things over between the patient and hospice, but after they left for a brief moment, Shula sat with the patient, next to him on his bed, and held his hand and said, "JC, what's wrong?". He had the look of uncertainty and fear on his face; he simply said, "I want to go to West Virginia, and I want to go to the beach and if I go home to die, I won't be able to do those things". Shula told him there were no limitations on his travels, that he can take the pump with him, and the son can help him into the truck and off you go. He asked her "are you sure or just saying that?". Shula reassured him that if that's what he wanted, there was nothing holding him back. Shula continued to make sure the family and patient felt their questions were answered and that all pieces of the discharge were in place. It was a team effort involving multiple disciplines from wound care, to EP, to physicians, care coordination and Shula continuing to contact all services for this patient.
Eventually, he was discharged with all things in place by 3:30 pm. The entire family arrived (approx. 15 people) and Shula walked down with the family and patient to the gateway. Shula said goodbye to his wife, his sister and she gave JC the biggest hug; she couldn't stop the tears and neither could he. JC said Shula was extremely helpful and made him the happiest man so he could spend his last days with his family and do the things he wanted to do.
Several weeks later, his sister came to the unit to personally tell Shula that JC had passed away. She stated that JC wanted Shula to know that he went to West Virginia-hit the jackpot and won $3600! He also went to Virginia Beach; he wasn't feeling very hungry, he was surrounded by all his family members just like when he was leaving the hospital, he had told his wife and sister to make sure the nurse who had taken care of him, Shula, knew that he died peacefully and a very happy man and this was possible because of Shula's care. JC passed away shortly thereafter.
Shula was very grateful the sister came to tell her; she also told Shula that the family wants to bring her a gift/a cake but Shula insisted that she didn't need any more calories. Shula sent her regards to the family and hugs to JC's son.
Shula made such a lasting impression on the family and they felt it was the care they received from her that made JC's final journey possible.