Caring Moments: BWH Nurse Clinical NarrativeBWH Nurse - For and about the Nursing Staff of Brigham and Women's HospitalCaring Moments: BWH Nurse Clinical NarrativeBWH Nurse - For and about the Nursing Staff of Brigham and Women's Hospital

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Caring Moments: BWH Nurse Clinical Narrative

Nurses are compelling storytellers 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 storytelling among nurses helps make distinctions in clinical practice visible and creates opportunities for ongoing discussion and learning. Even the storyteller learns from telling the story.

BWH Nurse periodically features clinical nurse narratives for the purpose of stimulating discussion and advancing our learning as a professional community. This narrative is told by Suzanne Fernandes, BSN, RN, ICU Float Pool, and is followed by comments from Ellen Liston, RN, MS, program director, Nursing Practice Development, and advisor to the BWH Nursing Practice Committee.

Suzanne Fernandes, BSN, RN

One day recently, I was assigned to the STAT nurse role.  Immediately a wave of anxiety drifts through my body. What will this day have in store for me?

My first call was from one of the thoracic floors with a request to travel with a gentleman who was admitted with Idiopathic Pulmonary Fibrosis/respiratory failure and was going to need a work up as a candidate for potential lung transplantation.  I was told he had several diagnostic tests and needed the STAT nurse to travel with him because he was on such a high concentration of oxygen and his overall respiratory status was fragile.  I immediately went up to the floor, obtained a more thorough report and went to meet and assess the patient. 

 Mr. A was a middle-aged man.  As I entered his room, I could see that he was working fairly hard with his breathing but by all accounts doing okay.  He was wearing both a nasal cannula and O2 mask, which meant I would travel with two oxygen tanks.  His oxygen saturation levels were good.  I introduced myself, and Mr. A was very upbeat and friendly. We started in the vascular lab, then went to CT scan and then had a PETC scan.  Despite Mr. A's shortness of breath, he was able to converse and hold a very meaningful conversation.  I asked him about his illness, and he told me it was a form of pulmonary fibrosis and that he lost three family members to the disease.  He spoke very openly and honestly to me about how his family members had succumbed to the same disease that he was now confronted with.  He was so brave and trusting in sharing all of that information with me.  He seemed sad about his family members, but he appeared to be optimistic about his own fate, perhaps because he had the chance of a lung transplant.   

His optimism was contagious; I could feel myself really pulling for him as we spent time together.  We talked about many personal things: our careers, family and children.  Mr. A was a lawyer and spent most of his career as a public defender. He spoke of his work and career with much pride and said that even though the work was very challenging and not very glamorous, his biggest fulfillment and reward was helping and defending those people who had very little means, but really needed someone in their corner.  Those sentiments resonated with me because so often in nursing, we care for the most vulnerable and sick people in this society. Like Mr. A said, they really need someone supporting them every step of the way.  I felt it was a privilege to care for Mr. A that day, being able to provide him the comfort and support he needed as he intermittently struggled with his breathing.  He talked to me about how fortunate he was to receive care at BWH and that if there was any place that could help him, it would be here.  Mr. A talked about his children and how they were facing their own challenges as young adults and how he tried to be there for them. I remember hearing and sensing the deep concern he had for them. As a parent, I could really understand how much you worry about your children, and I am sure being sick yourself can make your worries far worse.  I told him they were very lucky to have such a caring and concerned father.  

After several hours of testing, I was able to bring Mr. A back to his room on the thoracic floor.  He was tired, but he did well, and I was able to keep up with his oxygen requirements.  I was glad that Mr. A was able to tolerate and complete several hours of testing.  I helped get him settled back into his room and reported off to his nurse.  I can remember going to his bedside to say goodbye.  I told him it was a pleasure and hoped our paths would cross again.  

 I came to work the next day and was assigned to the Thoracic ICU, and Mr. A was my patient. I can remember feeling a mix of emotions-glad to have him back as my patient for continuity, but now he is in the ICU.  I smiled and waved at him, and he managed a smile back to me.  I received report and learned that his respiratory status had worsened overnight, and now he needed ICU level of care.  He was on the maximum amount of oxygen that could be delivered to him without being intubated.  His work at breathing was really difficult.  I hoped he would be a candidate for transplant and that it would be really soon. I spent most of my day inside Mr. A's room carrying out interventions that made him comfortable and would hopefully improve his breathing and slow the downward spiral he was facing.  

My day caring for Mr. A in the ICU was more somber than the day before.  I explained everything I was doing, offering words and acts of comfort.  I could tell Mr. A was scared, but he managed to smile.  By this point, he could not expend any energy or air speaking.  Over the next several hours, his condition became a little more stable with the use of steroids, diuretics and antibiotics.  Later that day, both Mr. A and I learned from the thoracic team that he would not be a candidate for a lung transplant.  Due to the nature of his disease and compromised condition, it would not be possible.  I could see the disappointment on Mr. A's face and feel the sadness he must have felt in his heart.  There were no words for me to offer, only my presence of being there beside him.  Mr. A did not say much.  The social worker and family members were at his bedside soon after he learned the news.  Mr. A greeted them with a smile and sense of optimism that seemed inherent within him.  I think he wanted to protect his family from this news, but the team, with his permission, explained the situation to his family.  I continued to care for him, maintaining his comfort, always letting him know that he was safe and cared for.  His respiratory status improved a little over the day.  I gave pass off report to the incoming nurse and explained the sad news that Mr. A had received that day.  I felt so sad for what Mr. A would have to face and endure.  As I said goodbye to him, I told him to keep up the fight and that I would see him again.  He smiled and thanked me. 

 When I returned to BWH several days later, I learned that Mr. A had been transferred out of the ICU to a medical unit.  I visited him briefly; he was actively dying and unconscious, surrounded by family.  I asked to come in, and his family greeted me.  I held his hand, smiled at him and said goodbye to him.  Later that day, I stopped by the floor one last time.  I learned he had just passed away.  Some of his family was sitting in the family room, and I had an opportunity to meet his children and offer my condolences.  I shared with them that he had been such a brave and selfless man as I cared for him.  I also told them that he spoke so fondly of them.  I hope Mr. A really felt like I was there for him in his corner, like all the people he touched and helped throughout his own life.