An elderly woman came to the ED as code STEMI. She was taken emergently to cath lab and subsequently to emergent bypass surgery. Surgical intervention was a success and she was eventually discharged from the hospital to a rehab program at a local facility. However, she was shortly thereafter readmitted to the hospital with vague complaints of not feeling well. During this second admission, patient seemed to have lost the will to live. She was refusing necessary medications, refusing therapies, requesting DNR measures and comfort care. Despite staff's efforts to ensure her that she was in a better state of health than she was before surgery, the patient continued to refuse treatment and care.
Our team was consulted to explore patient's reasoning for change in her medical treatment and discuss goals of care. Several doctors met with the patient at the same time. This included an EP cardiologist, a cardiothoracic surgeon, and the palliative care physician. This meeting lasted a little more than an hour. I was part of this meeting and the patient was extremely set in her course of action, which was trying to propel her towards death. She didn't seem to quite understand that her body was not cooperating with the dying process since she had been essentially "fixed" during her surgery.
However, we did notice that repeatedly throughout the conversation, patient kept referring to her "one good day with this nurse". She mentioned it at least 4 times during the hour meeting that she had "one good day" and that "she was walking better than ever" and she was going through the halls and this was all with the help of this nurse. When the physicians were done talking with her, I asked her who this nurse was. I inquired as to whether he was someone who worked at the hospital or someone who worked at the rehab facility. It turned out that this nurse is one of our very own from Critical Care Unit who helped care for her during recovery from her bypass surgery.
In discovering this, I called critical care and Matt happened to be working. This was late in the day on a Friday afternoon/evening. I briefly described the situation and asked if he might have time to visit with the patient. He said he would be happy to if he had the time to leave the unit. Not only did he find the time on Friday evening to visit the patient on PCU, he visited with her on Saturday and Sunday as well. Beginning Friday evening, that patient began eating again, participating with medications and care, and began working with therapies again over the next few days. She gained strength and was again discharged to a rehab facility for therapy in hopes of returning to her home independently as she was prior to surgery.
Matt demonstrated our core values and went above and beyond to make sure this patient was heard, respected, and cared for to the best of our ability. I am proud to call him a colleague.