Caring for a Patient and his Family

Nurse Narrative
Sharon Levine, BSN, RN

I am a nurse because I enjoy helping people. It sounds so simple, but it is true. For most of my career, I have been an ICU nurse, and I have worked at Brigham and Women’s Hospital for over 27 years. ICU nursing presents many challenges because the patients are critically ill and some die regardless of the advanced care they receive. Caring for a dying patient and his/her family is not a pleasant experience, but it can be a positive one. I took care of such a patient and his family about seven years ago and their memory is still vivid.

Mr. Smith (not his real name) was only 64 years old when I admitted him to the CCU. He had just retired a few months earlier and was looking forward to spending some time with his wife, his five grown children and three grandchildren. He was an active guy and healthy except for several cardiac risk factors. He was only on a few medications, and retirement seemed like it would be everything that he had hoped for.

It was about one week before Easter, and Mr. and Mrs. Smith were planning a big family gathering for the holiday. They went to bed and toward morning, Mrs. Smith heard some strange grunting from her husband. She couldn’t awaken him and called her son who told her to call 911. She tried to do CPR but admitted that she was so nervous and emotional that she had trouble with it. EMS arrived and defibrillated Mr. Smith 15 times and intubated him in the field. He was rushed to BWH Cardiac Cath Lab, where a blocked coronary artery was opened with a few stents. I admitted him to the CCU from the Cath Lab, and he was still quite unstable. The next few hours were busy ones as I took care of Mr. Smith and tried to support his distraught family. I knew that it was vital to get the family in the room as soon as possible because I didn’t know if Mr. Smith would survive the next few hours. Mrs. Smith and her children gathered around the bedside while I juggled titrating pressors and explained what was happening. They didn’t ask many questions, this was new territory for them and they looked shell-shocked. When they did ask me if I thought that he might still die, I sadly answered yes.

The next few days were rocky for Mr. Smith, but he did survive. I successfully weaned off his pressors and although he was still intubated, he stabilized. However, he never woke up and showed no signs of response. Neurology was consulted and after more tests and examinations, it was clear that Mr. Smith had anoxic brain damage. The prognosis was grim. The family seemed to know this was coming. They were grief-stricken and were now faced with some decisions. Mr. Smith had been in the hospital for a week now and although his vital signs were stable, he still seemed dependent on the ventilator. The Smith family members were devout Catholics and were uncertain what to do next. I asked a priest to come and see them, and we also had several family meetings with the medical team. Caring for the Smiths was stressful at that time. Their days were filled with emotion, guilt and tears. I tried my best to support them and called in Chaplaincy and social service. Another few days passed and the family came to the decision to withdraw care and let Mr. Smith die peacefully.

The next day was designated and I prepared the family for what to expect. I had the family then wait in the family waiting room while I shaved Mr. Smith, washed his hair and covered him with a blanket from home. We then extubated Mr. Smith and started a morphine drip for his comfort. The family came back in the room and said that he looked peaceful, just like he was sleeping. We all sat and spoke about Mr. Smith. I asked his family about his hobbies and it led to some wonderful stories and even a few laughs. I waited as a few hours went by and although Mr. Smith’s blood pressure dropped, he was still alive. Not wanting to leave, I stayed several hours after my shift ended. Reluctantly, I went home with Mr. Smith surrounded by his family. About one hour after I left, Mr. Smith died. I felt saddened and grieved for the family that I had bonded with. I read his obituary in the newspaper two days later and saw that the family had asked that in lieu of flowers, contributions be made to the BWH Cardiac Care Unit fund. I was so touched by their gesture.

Two months went by and I received a small package at my home from the Smith family. Inside there was a note and a necklace with a charm. The charm was delicate and heart shaped with an angel carved into it. I was so surprised because I didn’t know how the Smith family even knew my home address. The note was written by Mr. Smith’s oldest son, Charley, and it said:

I spoke to the Smith family once after I had received this note and although they were still full of grief, they felt grateful that his death was peaceful.

Seven years have passed, and I still have Charley’s note. Most days I wear the necklace that the Smith family gave me and when I have a particularly stressful day, I touch the guardian angel charm. It is a reminder than even in the seemingly most hopeless situation, I can still try to help.