A Nurse NarrativeBWH Nurse - For and about the Nursing Staff of Brigham and Women's HospitalA Nurse NarrativeBWH Nurse - For and about the Nursing Staff of Brigham and Women's Hospital

Skip to contents

A Nurse Narrative

Nurses are compelling story tellers with compelling stories to tell. Nurses’ most memorable stories include situations where they have made a difference, where breakdown has occurred or where there was important learning. Public story telling among nurses helps make distinctions in clinical practice visible and creates opportunities for ongoing discussion and learning. Even the story teller learns from telling the story.

BWH Nurse periodically features clinical nurse narratives for the purpose of stimulating ongoing discussion and advancing our learning as a professional community. This narrative is told by Roger Blanza, BSN, RN, of the Cardiac Surgery ICU.


Roger Blanza

By Roger Blanza, BSN, RN, Cardiac Surgery Intensive Care Unit

I came to the Brigham and Women’s Hospital more than a decade ago after having the experience of working in most of the adult cardiac ICU settings. The experience I have gained throughout the years sustained my belief that “yes,” there are miracles in life, and that maybe somehow I might have been a part of some of them.

Mr. A’s journey to a successful ventricular assist device implantation is one of those stories I considered a miracle. Mr. A is a 63-year-old man with a complicated and sad cardiac history. His school-age granddaughter who was visiting him with her parents found him unresponsive at his home. The granddaughter called for “Nana” and her parents initiated CPR. He was brought to the BWH ED in full cardiac arrest and was eventually resuscitated and transferred to the CCU. He woke up in the CCU and was told that he suffered from end-stage heart failure and that his only chance of survival at that time was to have an implanted left ventricular assist (LVAD) device. He was also told that if he survived the complicated VAD operation, he would need to have a complete recovery before he could be listed for a heart transplant. He was told that his journey to his new heart would be long and could sometimes be bumpy.

After discussing his options with his family, Mr. A decided to begin his long journey to a new heart. No one was more nervous and anxious than Mrs. A. She had been through a roller coaster ride since she saw her husband’s lifeless body that night. She just wanted her husband to have a new lease on life and spend another 10 years or so with him.

Mr. A went to the operating room and underwent a 10-hour left ventricular assist device implantation. This device would support his failing heart until a new heart was found for him. This was the longest day for Mrs. A and her family. Mr. A came up from the operating room bleeding, open chest with multiple vasopressors to support his low blood pressure. He was very sick. Mrs. A was very shocked to see Mr. A in this condition. No amount of preoperative teaching could prepare her for this scene. She was devastated and extremely frightened. All the nurses attending to her husband were very busy stabilizing him. She was told that her husband had a complicated OR course and would stay in the ICU for a while.

Mr. A had a set of nurses caring for him, and Mrs. A was already familiar with them and wanted to keep the same nurses. She became her husband’s strongest advocate. She would stay 24/7 in the room and not leave her husband’s side. She would do everything to make sure that her husband recovered.

One day, all his primary nurses were not on schedule, and I was assigned to care for Mr. A. I could tell immediately upon entering Mr. A’s room that Mrs. A did not like me there because she did not know me. I introduced myself to Mr. and Mrs. A. I explained to them the situation, and that I would be Mr. A’s nurse for 12 hours. As I was going through my assessment of Mr. A, I could sense that Mrs. A was sizing me up and paying attention to every move I made and questioned what I was doing. I had the feeling that she was trying to gauge my capabilities and if I was competent enough to take care of her husband. I knew this feeling, having experienced this with other patients before.

My Filipino accent can sometimes signal something “foreign” to some patients and their families. I don’t take this personally, since I have noticed it can be a learning experience for some people. I patiently explained to her all the details of my actions in a slow and clear voice, for if I talk very fast, my accent can be difficult to understand. I encouraged her to ask questions and tell me if I was talking too fast. I promised her that I would not take it personally if she did not understand me. This statement made her smile. I also told her that I had been a nurse for more than 25 years, and that I had been caring for patients like Mr. A for 11 years.

Our conversations were interrupted occasionally by nurses asking me for help and troubleshooting advice, and doctors asking me how Mr. A was progressing. As the hours went by, our conversations became longer, and she started telling me about her family, her grandchildren and how much she would dread losing her husband. I listened to her and encouraged her to also take care of herself by making sure that she could sleep and eat. She finally agreed to leave her husband’s room and have breakfast in the cafeteria.

While she was in the cafeteria, I continued my assessment on Mr. A, who was very weak. He was extubated already and still on oxygen, but the stress of surgery and long ICU stay made him a little depressed and confused. All he wanted to do was sleep. I told him that he should only sleep during the night so he would be ready for his physical therapy and other activities during the day. I bathed and shaved him. I then asked him if I could cut his hair. He said no at first. I then told him that I was going to sit him up in the chair. It would be his first time to sit in the chair. He said he was too weak. I explained to him that it would be hard at first, but it would be good for him. He agreed to sit up in the chair.

I asked him again if I could cut his hair. He asked me why I insisted on cutting his hair. I asked him if he would leave his house looking like this, pointing to his long hair. Mr. A said no, and that he would usually go to his barber before it could grow that long. I told him that I would be his barber now, and that I also cut other patients’ hair. Sensing that I was the type of nurse who would not take no for an answer, he agreed, so I started cutting his hair carefully. When the haircut was done, I gave him the mirror to look at himself. He must have thought that he looked so good because, even with a nasogastric tube in his nose, he gave me a big smile and said, “Thanks Roger. I look good.”

Then Mrs. A arrived. She almost dropped her cup of coffee when she saw him sitting in the chair, clean-cut and smiling. Mrs. A was so overjoyed, she hugged her husband and started crying and said, “You look so good, honey.” She turned to me and hugged me and said thank you! Mrs. A took pictures of her husband on her cell phone and sent them to her kids.

That was the beginning of my relationship with Mr. and Mrs. A.

The next day, I took care of him again. He was still confused and pulled out his NGT. I felt frustrated because I knew this situation could turn ugly. Mr. A was malnourished and failed the speech and swallow study two days before. He would give us a fight if we put the NGT back. As Mr. A gave me the NGT, I calmly told him that the tube was giving him food so he could get better and go home. He said he was sorry, but the tube was very uncomfortable. Mrs. A was afraid that if we forced the NGT on him, he would get more confused and we would have to restrain him and this could tip him over the edge. After much discussion with the ICU team, I suggested to do another speech and swallow study. If he passed, we would feed him.

The team said that it would not be enough nutrition to meet his caloric needs, and that we needed to insert the NGT again. I argued that we might lose the little gain we had made if he became combative and more confused. I explained that Mr. A could aspirate from trying to pull out his NGT again. They finally agreed with me. Mr. A passed the speech and swallow, and we started feeding him. I encouraged Mr. A to eat even if he did not have an appetite. I explained the importance of good nourishment; otherwise, the NGT might be inserted again. He forced himself to eat, and in time, became less confused and more participatory with his care.

The next day, Mr. A was able to take a few steps with much encouragement from his family. Every milestone was celebrated by picture-taking and sharing with the rest of his family. Mr. A transferred to the step-down unit at the end of his third week in the ICU. When I transferred him to the intermediate floor, I reminded him to always walk and eat, even if he did not feel good. I also reminded Mrs. A to rest and try to get out of the hospital from time to time so she could “recharge” and be Mr. A’s greatest cheerleader.

I would visit Mr. and Mrs. A in the step-down unit. As things were heading in the right direction for Mr. A, Mrs. A was now relaxed and happy. On the day before he was to be discharged, Mr. A’s LVAD began to alarm. Further tests revealed that he had developed a clot in his pump. He needed to go back to the OR to have the clot removed. I was working the day Mr. A was rushed back to the ICU, but I was caring for another patient. When Mrs. A saw me, she rushed over to hug me. She was shaking and in tears and did not know what to do. She was afraid her husband would not make it.

I reassured her that things would turn out well. I told her that he was lucky that this happened while he was still in the hospital and not at home. She asked me if I could take care of her husband again. I assured her that any nurse in the unit was capable of caring for her husband, and that I would care for him as well.

The second ICU stay was unbearable for Mrs. A. She was near breakdown, as she refused to leave her husband’s side. She was not getting any rest and became very critical of other nurses caring for her husband. Unfortunately, when Mr. A woke up from anesthesia and got extubated, he was a different patient this time. He was very withdrawn and became depressed. He refused to talk and participate with his care. It was back to square one, and he was tired of it!

I could see that Mr. and Mrs. A were getting impatient and stressed out with this setback. I sat down with both of them and listened to their frustrations. Although Mr. A was quiet, I knew something was bothering him. I asked Mrs. A to take a break and get herself something to eat. As I continued to explore Mr. A’s feelings, he said he did not think he would make it and he was tired of fighting. I listened to him and gave him every word of encouragement I knew.

I told him that I would give him a shave and cut his hair again so he would feel better. Mr. A refused and did not want to be bothered. I told him that it would “stain” my reputation as a barber if the staff saw him with long hair and an unshaved face! He smiled and agreed. It was like déjà vu, as Mr. A looked in the mirror and smiled. Mrs. A walked into the room and almost dropped her coffee in amazement. She could not believe her husband was smiling again. Mrs. A hugged and kissed him and then took pictures to share with their family.

After much encouragement, Mr. A eventually got better. With peace of mind, Mrs. A was able to leave him and occasionally go home.

The big day had arrived, when he was finally going home! Mr. A would be placed on the heart transplant list while waiting at home. Before they were discharged, they returned to the ICU and thanked the staff and his primary nurses. They gave me a personally made “thank you” card, for which I was deeply touched. With tears in their eyes, they told me, “We will never forget your Roger. You advocated for us, and you will always be our friend.”