Meghan wrote of her loving relationship with her patient, Mary:

Every once in a while nurses are reminded why we chose the profession we did. For many of us on 1-5, July 1st was that reminder. Unfortunately when I met Mary in room 1517, her prognosis had been quite poor. With much research and trials, the chances of Mary living without the ventilator began to decrease, but if you walked into Mary's room not only were you greeted with a reaching hand looking to hold, but a great big soft smile. Mary's family had been tremendously involved with her care and always willing to help.

As the week progressed and events unfolded, Mary's wishes became clearer. Life on a ventilator was not what she had wanted. The patient had always voiced her opinion on whether to fight or advance her treatment. When Mary lay in the hospital bed on Tuesday, June 25th and for the first time stated clearly, "let me go," it took not only the family but staff by surprise. This was a very well determined and strong woman who never gave up a fight. I assigned myself as Mary's primary nurse and aided the family's search for where to go next. I suggested a family meeting with the entire vent team and all the physicians playing a part in Mary's healthcare team. The patient's daughter Phyllis thought highly of the idea. With tremendous help by Dr. X(palliative care), X(pulmonary PA) and X(ventilator management NP), we were able to quickly arrange a meeting for Friday June 28th. The family and staff only felt right that as long as Mary had been awake and oriented to her care, she would make the decision to let nature take its course. After the meeting Dr. X and I returned to Mary's room to present Mary with options, and more importantly, hear her honest wishes. Mary said it again, "I want to go home to heaven." I asked Mary when she would like to go and her response had been, "soon." To get a better idea we had asked days, a week, or today. I told Mary that her family would like to visit with her and take some time before she had passed. Mary asked for the weekend with her loved ones and we would revisit her decision on Monday morning, July 1st.

After staying with Mary and holding her hand for some time, I let her collect her thoughts and revisit with the family. This had to be the toughest and most peaceful decision a patient can make for themselves.

Our team got to work. Mary's physical therapist had been visiting with her daily to get her stronger and out of bed if she had wished. Even when the family had said, "not today," we still saw him coming around asking how she was doing and poking his head in the room to say hello. Dr.X had worked vigorously to put the plan into action and gather necessary team members including X of social work, X from speech therapy, X from respiratory and the rest of the 1-5 team. Mary's speech pathologist had stopped by Friday after hearing the decision was made and asked Mary if she wanted to try to eat anything over the weekend. Mary's one wish was, "A sundae on Sunday."

Our staff on 1-5 had grown to love this patient and family as if they were our own. As we passed assignments on to the next shift, every oncoming or departing staff member who had the pleasure of taking care of Mary spoke in high regard of how wonderful she was as a person and how respectful and caring the family was. Most nights, Mary's children had slept in the room with her right next to her bed ensuring she knew they were right there. We were able to supply the family with recliner chairs and necessary items to keep comfortable. In the time Mary had been on 1-5, it was a group effort to provide and organize the great care we were able to give.

When Sunday had come and Mary got her first scoop of vanilla ice cream, you could see an ear to ear smile and eyes open wide with excitement. X from speech therapy and I asked if she had any other foods she would like to try. We discovered she liked pumpkin pie, rhubarb, and homemade apple sauce. These were within the consistency Mary was able to tolerate so X and I got planning. I went home that night and baked a pumpkin pie, while X handpicked rhubarb from her garden and gathered apples to cook up homemade products. In my time spent with Mary, we often joked about the discomfort of the NG tube she had placed down her nose. Mary explained that if the tube had not been there, swallowing may not be as tough. Because it was Sunday and we did not discuss the idea of removing the tube until late, I ensured the family I would bring it up in ventilator rounds first thing in the morning.

Tomorrow was the day. We knew Mary's wishes and although we knew we were going to revisit her stated wishes from Friday, we wanted to make certain she would get the favors she desired before she had passed. Monday was a very important day to the family as it was her daughter's birthday. In our work of preparing Mary's food, I was able to get a card, birthday cake, and ornament for the daughter which stated, "Faith brings miracles." X from speech was quick to get a balloon and we had ourselves a little birthday gathering.

As Monday morning began, I was working with an LPN. I did my normal routine to go into Mary's room and assess her, sneaking around family members making sure not to wake them. Only Monday morning, the family had already been wide awake and Mary was wide eyed. I asked if everything was okay and if the family needed anything, "We just need today with Mary. The whole family is coming in today, we have one more day." I could tell that the family had been quite upset and worried as they knew the time was near. We got Mary comfortable, adjusted her positioning, and an extra blanket for warmth. As I left for ventilator rounds, the team gathered one last day to discuss our plans. Our goal was to keep our word true by revisiting Mary's decision from Friday and see what her wishes were today. I had brought up the NG tube and the nutritionist and X both agreed, we would get the tube out as soon as possible to make Mary more comfortable. As X and I went to speak to Mary with the family, it was very clear she had made up her mind. Mary wanted to be in heaven and she wanted to go today. This decision had been heart wrenching on the family, they believed they had another day with their loved one. As the morning passed and I revisited with the family, Mary's daughter, son, and I sat at Mary's bedside with her discussing our plans. I ensured the family that this decision was solely based on Mary's wishes and that we would support them in any way we could. The family one hundred percent had supported their mother's wishes and wanted to carry them out. As any of us would be the utmost upset, this close knit family felt such grief. Our staff on 1-5 visited in with the family nearly every fifteen minutes ensuring their comfort and asking if they needed anything. At this time, the family gathered to spend the afternoon with Mary and planned to say their goodbyes later in the day.

With the NG tube out, Mary was ready to try her homemade food. X from speech came back to the unit and we let Mary eat some of her favorite items. Mostly, she wanted ice chips which we were more than okay with! About anything to see a smile on her beautiful face, we were willing to do. We had a great celebration for the daughter's birthday as family gathered and they spent endless hours laughing, crying, and reminiscing on childhood memories. I could not have grown any closer to this family as they had always involved me in their conversations of home, vacations, and future endeavors. They felt like my own. In my time spent with the different relatives of numerous generations, I spoke to Mary's daughter in law. She shared with me that she had prior conversations with Mary about certain music she would like and funeral arrangements if anything was ever to happen. To me this was quite personal, and for the family to share this with me and reach out amazed me. The daughter in law expressed trouble finding the song Mary was interested in and asked for my help. On my break I searched throughout the Internet for this song. Finally, I got it! I brought my phone at Mary's bedside and played the song. Mary smiled so big, reached out her hand to grab mine, and said, "I love you:" Three words that mean so much. Tears began to fall down her cheek. I will never forget the song, "Mary's a Grand old name," by George Cohan.

The day passed and it was time to grant Mary's wishes and switch her care to comfort. The family went in one by one to say their goodbyes, as others gathered in the hall. The LPN was able to arrange for a large comfort care tray with thanks from the kitchen due to the large number of guests. I also suggested to X we call spiritual care, as I had discussed in the past with the daughter her religious views. Chaplain was quick to respond to the evening call and came down to support the family and the 1-5 staff. When the family was ready, we gathered in the room all around her bedside and watched our loving Mary get her final last wish, to be in heaven and to go home. This was such a moving and supportive time with the help of so many hospital staff here at St. Joseph's hospital. Mary was able to be weaned off the ventilator, made comfortable, and spend one more hour with her family and staff who loved her so very much. The daughter held onto me tight, brought me right up to Mary's bedside to hold her hand and said, "Here was your guardian angel Mary, Meghan's right here." I have never witnessed such love and support from all members of the healthcare team to come together and show this family how much we loved and cared for Mary.

Every once in a while you remember why you chose the profession you did. A sundae on Sunday for Mary specifically, and often, reminds me of why I made this very rewarding choice.