1. Aponesto, Sol BSN, RN, CCRN

Article Content

AS A NURSE for almost 20 years, I've found working in the ICU to be challenging because of the unique patients we care for everyday. I always prepare myself physically and emotionally before work, but no amount of experience can prepare you for a life-changing situation. One unforgettable experience touched me in a special way.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

Holiday shift

I was working a 12-hour night shift on Christmas Eve. The shift started slowly and because of the holiday, I thought we'd have a quiet night. But it was not to be.


At around 0300, our unit received a call from Admitting asking for a bed for a patient to be transferred from the telemetry unit. Anticipating an unstable patient, I quickly made sure my other patients were comfortable. Within 5 minutes I received report from the telemetry nurse regarding the incoming patient.


Mr. H was a 75-year-old Hispanic male admitted to the hospital 24 hours earlier with a diagnosis of cirrhosis. He'd suddenly become hypotensive and was desaturating, even on a 100% non-rebreather mask. Mr. H was in respiratory distress, tachycardic, pale, and diaphoretic.


When Mr. H arrived in the ICU, I introduced myself while attaching him to the cardiac monitor and performing a focused assessment. I readied myself for what might be a long night ahead.


Last request

Although Mr. H's respirations were labored, he was awake, alert, and oriented. I explained to him in simple terms the plan of his care, including the fact that he'd need a tube and a machine to help him breathe, and he nodded his head in agreement.


In a weak voice he said, "Please do whatever you need to do. I know you're all trying to help me, but please do me one favor: Let me speak to my son JR before you put that tube in my mouth. I want to see and talk to him before you put me to sleep."


I reassured Mr. H that his request would be followed. I asked the chief medical resident and the respiratory therapist to wait until JR could talk with his father before proceeding with endotracheal intubation.


Our unit assistant made a call to the patient's family. Within minutes, JR arrived and was escorted to his father's room. They were together for only a moment. I overheard JR telling his father he loved him. He then kissed his father on the forehead, embraced him, and said, "Merry Christmas, Dad. Thank you for all the wonderful things you've done for us."


After JR left the room, Mr. H turned to me and said, "Thank you for waiting. Thank you for letting me see my son. I'm happy, and I'm ready." He then smiled and added, "If I'm not able to get out of this, I'm wishing you a Merry Christmas." I told him we'd do our best to help him.


Although Mr. H was immediately intubated and placed on mechanical ventilation, he deteriorated quickly. At 0500 he had a cardiac arrest, and at exactly 0600 on Christmas Day, he was pronounced dead. JR was at his side.


JR approached me. He expressed his thanks and appreciation for the team's efforts to save his father's life. "Thank you for waiting for me," he said. "I was able to tell my Dad how much I loved him."


Being an advocate

At first I felt terrible that the family would now think of Christmas Day as the anniversary of the death of their father. But upon further reflection, my experience with Mr. H and his family that Christmas made me realize that advocating truly is the heart and soul of nursing practice. It's all about looking out for our patients' well-being, including their dying wishes. Just taking time to listen to our patients' simple requests is an important part of what we do. Nurses are the frontliners. If we don't advocate for our patients, who will?


Christmases now are even more special for me. They remind me that on that particular day, I was a patient's advocate-and I always will be.