During the last weeks of my orientation in a neurocritical care unit amid the COVID-19 pandemic, I had the privilege of caring for a complex patient who reminded me of the lifesaving gift of organ donation.
When I came to work one morning, I learned that my assignment would be "Nicholas," a patient in his 50s who had a ruptured cerebral aneurysm, which resulted in a devastating subarachnoid hemorrhage. This was especially sad because he was supposed to have the aneurysm repaired, but his surgery was repeatedly rescheduled due to the COVID-19 pandemic. Then one day, he was found unresponsive at his home by a friend. On this particular morning, he stopped responding to any stimuli. He was endotracheally intubated and on multiple I.V. infusions to keep his BP and heart rate stable.
When I first walked through the doors of the room, I remember feeling very nervous. This patient was critically ill, and I was worried about being able to care for him. I remember turning to my nurse preceptor and hearing her say, "I will be here, but I think you got this." Knowing her confidence in me and her availability if I had questions was empowering.
A few hours into a very busy shift and after an extensive clinical evaluation, Nicholas was pronounced brain dead. I remember feeling incredibly sad for Nicholas and his loved ones; during this pronouncement, he had no family at his bedside. The pandemic took a lot of things from our patients, including the devastating consequence of not having their family at their bedside.
Nicholas, who was an organ donor, was pronounced brain dead at around 1100 but his OR time for organ donation was not scheduled until 1730. Even though Nicholas was already pronounced brain dead, I continued to talk to him. I felt so proud to be taking care of someone who will help save other people's lives. I believe that being an organ donor is such a selfless gift to people you don't even know.
Nicholas made his decision to be an organ donor many years ago, even before his diagnosis of a cerebral aneurysm. According to his family, he became even more adamant about wanting to be an organ donor after his diagnosis. I was humbled by his decision, and I wanted to make sure that Nicholas did not spend his last few hours with us alone.
As the day progressed and as I watched his chest rise and fall with the mechanical ventilator and the monitor beeping with each heart beat, I felt close to what a family feels when faced with this tragic situation. I found myself holding his hand at times and even asking him questions. I wanted to be there for Nicholas when his family couldn't.
When the time came for the OR, I remember preparing for the honor guard walk with my colleagues and the respiratory therapist. Before the COVID-19 pandemic, I've participated in a few honor guard walks, which are solemn end-of-life processions to honor an organ donor. One thing I always remembered was how quiet it became when the patient was wheeled in the hallway, surrounded by those who came to pay their respects. The only sounds were from the ventilator and the hospital bed. All I could think of was how thankful I felt to this patient-who I didn't even know-who has decided to donate his organs to someone in need.
When we arrived in the OR with Nicholas, everyone became still. Before I left, I said a little prayer-for Nicholas, his family and loved ones, and the staff in the room. I felt privileged to have been able to participate in Nicholas' care. I also felt grateful to my nurse preceptor for encouraging me to take care of him on my own and being there as a silent supporter. I felt so grateful that I chose nursing as my career. In his last hours of life when his family wasn't able to be there, I became part of his family, and I will forever carry the memory of Nicholas and his gift with me.
A few weeks after this event, I received an email from the Gift of Life transplant coordinator who shared that Nicholas was able to donate his liver, both his kidneys, as well as his heart valves to other people who were desperately waiting for these organs to lead a healthy life. His lungs went to research. When I read that email, I was once again overtaken by the feeling of utmost gratitude for Nicholas and felt humbled by my experience of being able to participate in something as amazing as the Gift of Life donation. Being a part of the honor guard allowed me to take part in saying goodbye, which reminds me of the precious gift he gave to others.1 I was thankful I was able to participate in the care of such a complex patient so early in my nursing career, and I have learned so much from that experience that I will take into my future practice.
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