I witnessed an example of exceptional patient care recently.  I don’t remember the patient’s medical history or reason for hospitalization, but he was a prisoner with significantly altered mental status who was somewhat combative and clearly end of life.  It is often difficult to manage these patients when they are altered given their complicated social situations due to being incarcerated.  Family is often not available or aware of their circumstances.  When they are altered (as many end of life patients are) this is complicated by the presence of guards who often react strongly to their altered state which is predictable to us but seems very unpredictable to them.  There are many needs of many individuals to balance in these situations particularly when they are altered and unable to make their own decisions.

Early in the morning I just happened to answer a call bell that was activated by the guards because the patient was “pulling off all his stuff” (which to them was primarily his sheet and gown), a situation that was not unexpected or dangerous for this particular patient. However, I quickly noted that it was difficult to manage the guards’ reactions to the patient’s altered mental status and this had the effect of sometimes escalating the patient’s behavior.

Throughout the day, I watched our nurse, Amy Anderson, provide exceptional and compassionate care to this man while also providing education and context to the guards in the room.  She de-escalated the patient on many occasions without force or restraint by using her exceptional nursing and communication skills.  I watched her spend long stretches of time at this patient’s bedside talking with him and gaining insight into what his desires and needs were.  I watched her advocate for this patient and help coordinate care across many disciplines: physicians, PAs, nursing, the prison system, the secure care unit, palliative care, the guards, and eventually this patient’s family.  At the end of the day, this resulted in the patient’s family being able to plan a visit to see the patient and for the patient to potentially transition to palliative care.

Amy’s care of this patient really touched me.  In particular, this patient and his family are extremely unlikely to ever tell their story.  I know we get accolades from time to time from our more health-care literate families but I don’t want the stories from our most vulnerable patients to go untold.  Amy, in particular, is a MRICU treasure.  I learn from her every time I work with her.  She is an amazing example of compassionate care and exceptional communication skills.  As I left my shift on Sunday, one of the last things I saw as I walked off the unit was Amy sitting at this patient’s bedside talking with him and listening to him.  It provided needed healing to *me* in the context of the entire weekend which included the incident we had with another patient having been assaulted on the unit.  It’s amazing how much we care for each other as a team even when we don’t intentionally do it.

Thank you, Amy, for your example of communication and coordination of care that made a significant difference to our extremely vulnerable patient.  Your compassion for every patient you care for does not go unnoticed.  Thank you!