1. Buckley, Elizabeth C. BSN, RN, CCRN-CMC


A nurse is reminded that quality of life is in the eye of the beholder.


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I walked onto the unit for my shift and saw MedFlight outside room 206 with five or six of my colleagues surrounding the stretcher. I checked the board and saw my name in the box next to this new admission's room. My colleague Michelle told me Philip was in his mid-50s and had been transferred with heart failure and low ejection fraction and a long list of comorbidities that were unmanageable at the previous hospital. The plan for my shift was to place a pulmonary artery catheter and tailor therapy based on his cardiac and pulmonary pressures. He would probably be intubated but, due to his body habitus and morbid obesity, was not a candidate for any mechanical devices or advanced therapies.

Figure. Illustration... - Click to enlarge in new window Illustration by Eric Collins

After he called me "Nurse Ratchet" during our first encounter, I had a feeling Philip and I weren't going to click. Philip was kept up all night that first night. We stuck him five times for an arterial line that subsequently fell out and needed to be replaced; he had a pulmonary artery line placed; there was lots of turning, repositioning, and bedpans, lab work, numbers, and switching meds in and out. He kept calling me "bossy" and telling bad jokes I didn't have time to laugh at. He tried to get other nurses walking by to bring him ice chips, but when they said, "Let me ask Elizabeth," he would scoff and say, "Don't bother."


He also kept telling me he was going to be going home in the morning. But according to his chart, he had progressive dyspnea and had been bedbound for over a year. When he told me he spent his days watching movies, visiting Facebook, and eating meals his sister cooked and brought to him in bed, I thought to myself, "What kind of life is that? That's not how I would want to live."


The night shift was nonstop. I left exhausted in the morning. In the car on the way home, I decided to sign up as his primary nurse. I knew he might get sicker and thought it would be a good learning opportunity. I texted my friend who worked the day shift to sign me up; she replied that I was crazy.


The next night Philip had gotten worse. Based on the doses of inotropes and vasopressors used to maintain his blood pressure, I was surprised he hadn't been intubated. The attending physician told him and his sister that he would probably not make it through the night, let alone an ambulance ride home. But Philip was tougher than he looked. He continued to tell me he had to get home to his own bed so he could go back to his life and routines.


Over the five nights I was assigned to Philip, there were ups and downs. For most of my shifts, he was told he was unlikely to make it out of the ICU. His bad jokes slowly grew on me, and when he told me how he had been attacked because he was gay and that this was why his nose was disfigured, I began to understand that his gruff joking manner was a coping mechanism. I saw how much he and his sister loved each other and made each other laugh. I saw his friends come to visit and talk about old times. I saw how much he loved watching black and white romance movies and reciting his favorite lines. I watched him play games and talk with friends on Facebook. By the time Philip was ready to leave the ICU, I was doing everything I could to get him to the step-down unit, to get him that much closer to home.


Sometimes we forget that even though we may not think a patient's usual quality of life is worth the suffering and hard work involved in keeping it going, this is not our decision. It is not our job to be liked by a patient, and even if they call us Nurse Ratchet, we shouldn't change our attitude. We cannot see the future. We are here for the patients and their families, to support them through illness and get them to where they hope to go.


I worked hard on my shifts with Philip. He left the ICU for the step-down unit, and a week or so later his sister came and found me on a day shift. She told me Philip was going home. She gave me a hug and told me how much everything I did for Philip meant to them and that he'd told her to come thank me. It is funny how things work out. I still think of Philip and hope he enjoyed his days at home in bed, watching old romance movies, playing on Facebook. He had a wonderful life!