After years as an RN and clinical nurse specialist (CNS), I continue to be enlightened every day by amazing encounters between nurses and their patients. A few years ago, I began clinical instruction in addition to my CNS role and I've found it to be remarkably rewarding working with nursing students.
With the continued pressures of the nursing shortage, multiple initiatives set forth by regulatory agencies and other organizations, and the pressures of financial constraints, it can be easy to let those unique, beautiful moments of patient/nurse interaction slip by without contemplating the underlying meaning of each of those events.
On a routine Wednesday, while performing my CNS duties, I was thinking about the upcoming evening clinical where my eight students would count on me for learning, leadership, support, and direction when one student truly amazed me. She had prepared a paper to share with me and her fellow students about her observational experience completed the week before. The following is a description of Antoinette's touching story.
From the eyes of a nursing student
As a nursing student, I would say that with each rotation comes at least one remarkable experience that you cherish throughout your journey from student to professional nurse. For me, that moment came on the day I observed a 6-hour mitral valve replacement and coronary artery bypass to the left anterior descending (LAD) artery. This was my chosen "dream day" experience set up by my clinical instructor. It had such an impact on me that I went home and immediately wrote a reflection of my experience to my family, friends, and nursing student colleagues.
My day in OR 17 started promptly at 7 a.m. as the surgical team prepared the room for the procedure. Surgical technicians readied equipment that would be used for the surgery: a plethora of scalpels, sutures, saline solutions, ice, gauze, saws, retractors/clamps, and many more instruments. The anesthesiologist prepared multiple medications and set up her workstation to put the patient to sleep and then to awaken her again. A perfusionist set up his equipment to essentially take the patient's blood and cycle it through a system thereby acting as the heart during the surgery.
The patient was a 74-year-old woman, 108 pounds, 5 feet 2 inches, with mitral valve prolapse, mitral regurgitation, and a blocked LAD. When the patient entered the OR, she was anesthetized, intubated, and a urinary catheter was inserted. A cardiologist came in shortly after the patient was sedated and performed a transesophageal echocardiography (TEE) to obtain an image of her heart from her esophagus. The image clearly showed a blocked area called the "widow's notch" near the circumflex artery and the blocked LAD. We were also able to see the defective mitral valve. At that point the surgeon and cardiologist discussed repairing the mitral valve, but replacing it would also be an option if repair wasn't possible. In our patient's case, the "trap door" of her mitral valve was so weak that when it was finally removed, it was nothing more than shreds. Our patient was a good candidate for a coronary artery bypass graft (CABG) through the internal mammary artery (IMA) because her ejection fraction was still at 40% to 50%, which would be enough for that final push of blood from the left ventricle into the aorta and out into the systemic circulation of her body.
The patient was completely cloaked during surgery. I was so transfixed by the monumental procedure that I hardly paid attention to the person underneath. It wasn't until one of the surgical sheets came off her leg a bit that I remembered there was life under there. I thought about the way she looked when she was rolled into the OR, her face frightened, as she kissed her son who was my age and seeing the stoicism of her husband who broke down as soon as he could no longer see her from the doorway. I said a prayer for her then, that she enjoy a better life once her surgery was complete, and I said a prayer for the success of the surgical team.
The mood was lively and talkative until the surgeon entered the OR, and then it became serious, focused, and intense. I watched as the initial cut into the mediastinum of the chest was made. Then, expansion of the chest with retractors was performed. I was able to see the lungs and the pericardial sac covering the heart. The team went in further to move back the lungs, which still curled outward and inward as the patient breathed. The surgeon pulled up the heart slightly to inspect it. The IMA was painstakingly removed because it would be used last in the procedure for the bypass. After the IMA was free, the team began hooking up the cardiopulmonary bypass machine to the heart so that the surgeon could replace the mitral valve and perform the CABG. At this point, the perfusionist came in and through a maze of tubes attached to different entries into the heart, the blood was pumped out, filtered, and put back into the body so the surgeons could work on a heart with no blood for a short amount of time.
At that time, I witnessed an incredibly laborious, suturing process. Imagine an excavation site of a new sky scraper being built and think of that as the patient's chest, lying open like a large rectangle. Around the perimeter of the opening were white plastic strips with numbered blue markings. Each number coordinated to a specific string that was first sewed into the heart valve, then back out and attached to the numbered strip. Then the strings went in and around every part of the new valve and finally the valve was pulled down into the heart. Once the valve fit, the surgeon and surgical assistants (SAs) sewed the valve into the heart and counted the strings. Behind one of the SAs, there were rows of tiny square boxes with sizing numbers. The surgeon shouted a number to the SA who opened the box and removed a replacement mitral valve. It was a porcine valve and fit the patient perfectly. More than 4 hours passed, and after the CABG was performed, the patient's chest was closed and she was closely monitored.
I am truly in awe of the surgical team, that the patient, family, and I were honored to spend time with. What a gift this patient was given and how blessed she and her family must have felt when they were reunited. This experience led me to pursue cardiac nursing after graduation. I saw what my patients go through before I care for them in the coronary care unit and I'm excited about the possibilities that await me as a nurse.
The gift of nursing
Antoinette and I talked about her experience after I read the narrative she provided. We talked about the acts of kindness, genuine thoughts of concern, and the caring that all nurses provide to their patients every day.
Just as Antoinette was able to see a vision of herself as a caring nursing professional, she reminded me of the true gift of nursing: the act of opening our hearts, and unselfishly giving ourselves to our patients, their families, and our colleagues.