As we eventually learned, a very sweet, special, funny, and loving patient was admitted to our hospital several months ago. Her previous health history had been challenging but manageable. This time, however, her condition declined rapidly, requiring intubation within the first few hours of admission. Unfortunately, maximum medical therapy was insufficient, and she required placement on Veno-venous ECMO shortly after intubation.

Over the next couple of weeks, we searched extensively for a source of her lung failure, but we could not identify a treatable cause. Her lungs had completely shut down, and she became 100% dependent on ECMO. We knew we were in for the long haul as we waited for her lungs to hopefully regain function. Having cared for several long-term ECMO patients since starting our program, we understood the importance of waking her up and allowing her to participate in her care. This proved to be more challenging than expected, but after getting a tracheostomy and managing her anxiety, she was walking just two weeks after ECMO cannulation.

We also knew that establishing a daily routine and maintaining a sense of normalcy were essential for her mental health. Thanks to our excellent collaboration with PT, OT, and Speech Therapy, we worked with her daily on walking, eating, and performing activities of daily living (ADLs). This was not without its difficulties, as she could be quite stubborn at times, but our nurses built rapport, encouraged her, and even resorted to bribery when necessary to ensure she continued progressing.
After two months on ECMO, she had become “one of us” and was a beloved celebrity in our unit. She would go on daily walks and greet everyone with her signature “princess wave,” her smile brightening the entire unit. On sunny days, we would take her outside to enjoy the sunshine. As her ventilator was not helping her lungs recover or regain volume, we decided to remove it entirely, allowing her to be more comfortable, mobile, and—most importantly—able to eat a regular diet. Our nurses spent a considerable portion of their paychecks ordering Uber Eats or DoorDash to feed her, and they would even receive late-night calls about snack deliveries from convenience stores she ordered through her phone!

Three months into her ECMO journey, she faced a major complication that gave us all quite a scare. However, with expert care from our nurses and physicians, she recovered quickly. Not long after, she was back to her signature “shimmy/dance” in bed. By this time, Christmas and New Year's had arrived. Her room looked like it had been decorated by Clark Griswold! It was filled with decorations, including lights on the ECMO pump. Our team helped facilitate a Christmas dinner for her and her family, and staff members visited on their days off to wish her a Merry Christmas. New Year's was just as festive, with decorations, party favors, and even a "ball drop" in her room when the clock struck midnight. The entire unit gathered to celebrate together.

Unfortunately, her clinical course had not improved, and we began reaching out to a lung transplant center. Fortunately, she was accepted at a hospital not far from here. Though the decision was difficult for her, she knew it was her best chance for survival. Her “favorite” nurse even came in on her day off to transport her to her new “home away from home.” We were hopeful, but we understood that the path to a lung transplant would be long and complicated. Nevertheless, we were committed to providing her with the best possible care, and we knew that receiving new lungs would give her the chance to return to her family and her son.

After 20 days of evaluation by the transplant center, which included consultations with several other centers, it was determined that our patient was not a candidate for lung transplantation. With no path to recovery, we accepted her back with open arms, knowing we would need to transition to comfort care and assist with end-of-life decisions. This process was handled with an unparalleled level of compassion, love, and understanding—some of the most remarkable care I have witnessed in my 20 years of nursing. The collective decision was made in partnership with her, her family, and our ECMO team. We ensured that all of her final wishes were honored, including sharing her story via video, spending time with her family at another family meal that several of our staff helped cook and provide food for, and arranging a sleepover with her son. She was removed from ECMO and passed peacefully, surrounded by the people she loved most. Her celebration of life was attended by many of our nurses and staff and will always be remembered by our team.

This patient had a profound impact on our team, but I believe our team also had a significant impact on her, providing not only the highest level of nursing care but also meeting every one of her needs. For this reason, I am nominating our ECMO team for the DAISY Team Award.

I would be remiss not to mention one nurse in particular who went above and beyond in caring for this patient. Many of the actions described above were spearheaded by this nurse. She built a bond and trust with the patient that could only be described as a close friendship. When she wasn’t working, she would call the patient to chat about life. When the patient was at the transplant hospital, this nurse visited her several times and checked in often. When it became clear that recovery was no longer possible, this nurse was asked by the patient to be her son’s godmother, knowing she would treat him as lovingly as she had been treated. This nurse has already started fulfilling this role, taking him for a day of fun. She deserves recognition for her amazing care, love, and compassion—not just in this case, but for all the patients she cares for.