Debbie Ehrstin
Amid the daily paperwork and the sterile technological miracles that have become standard in health care, there are simple stories of compassion that occur but are barely recognized, other than by patients and their families.
At St. Joseph's/Candler Memorial Hospital in Savannah, the nurse exemplar program gives nurses the chance to write about an experience in patient care that affected them.
The following is an essay written by Debbie Ehrstin, RN, BSN, a resource coordinator in the coronary care unit at the hospital. It has been edited slightly for space.
He died." The disembodied voice floated into my sleep-fogged brain. "I didn't want to call this early in the morning, but I knew how important he was to you and thought you should know."
The voice, that of my friend and colleague from the critical care unit on which we both worked, forced me to full wakefulness.
"He" was a 48-year-old man, Joe, who had been admitted just six days before with shortness of breath and pleuritic pain.
I had provided bedside nursing care for five of those six days and had become intensely bonded with Joe's family: his wife, Bev, and their two children, ages 11 and 15.
Now he was gone and I felt numb with pain and sorrow, feelings that seemed odd and misplaced. This was a good man - a father, a son, a teacher, an elder in his church and a Scout leader. How could this have happened and why was I feeling this way?
Joe was first transferred to our unit from an outlying hospital; he was extremely short of breath and the admitting physician ordered Bipap support.
Joe tolerated this treatment overnight, but his saturation level never progressed; in fact, it began to worsen through the early morning. By the time I came on shift, the doctor had spoken with both the patient and his wife about the possibility of intubation later that day. He also suggested that the wife arrange transport of the children from school to the hospital, a distance of some 70 miles, so that they could speak with their dad before the intubation.
As the morning progressed, it became obvious that Joe was tiring rapidly and his oxygen saturation continued to decline. We were racing against the clock, waiting for his children to arrive.
Bev had been at his side intermittently through the night, and had just stepped off the unit for a brief break. As Joe's oxygen level continued to drop, the respiratory therapist who had been at the bedside for most of the morning, looked at me over Joe's head and mouthed, "Now's the time." I spoke words of comfort to Joe, then attempted to locate Bev.
Next, I gently explained to Joe that he was working too hard to breathe and that we needed to place a tube in his throat and connect him to a ventilator. He looked at me above the Bipap mask with fatigued, resigned eyes, motioned for a paper and pencil, and wrote three pages of notes for his wife, children and students.
I think Joe intuitively knew what was going to happen. In the meantime, his oxygen saturation was dropping into the low 70s and he was still writing! What an amazing, strong man. Even when he couldn't breathe to sustain his own life, he was more concerned about his family and those in his care than he was for himself.
The next six days were a nightmare of fighting oxygen saturations. Even with the oxygen level at 100 percent, we were unable to ventilate Joe. We paralyzed and sedated him; provided a quiet, comforting environment; and aided Bev and the children in coming to terms with what was happening.
But nobody was helping us - the doctors and nurses who were caring for Joe - come to terms with this situation. The admitting physician haunted our unit, coming in and out at odd times to stand at the bedside, review the chart and write new orders, even when he was not on call.
I felt helpless. I knew the right things to do to provide the physical care Joe needed; but I found myself foundering each time Bev, the children, family members and pastors approached the bedside.
What could I tell them about his progress? How could I tell them that in this age of advanced technology, a time in which we keep people alive well into their 90s, we were losing the battle for the life of this 48-year-old who had something as mundane as pneumonia?
This was supposed to happen to really sick people, not strong, healthy men who didn't smoke or drink and who dedicated their lives to others to try to make the world a better place. In nursing school, we spend a bit of time discussing end-of-life issues and ethics. But nowhere do we learn to deal with situations like this. I felt out of my element and wondered if my efforts to softly light the room, play Joe's favorite gospel music and assist his family to cope with their numbing grief really made a difference.
What I do know is that this man - whose life overlapped mine for a few short hours - made an astounding impact on me. More than all the talk in classrooms, Joe demonstrated that death really is part of the cycle of life. In looking back, I realized that we must take hold of each new day with which we are gifted and live it to its fullest.
Each moment in life is precious, and each is truly a gift from our Creator. I think we must also strive to incorporate the completion of the cycle - dying - into the care we provide. Sharing in the process of dying is a soul-changing event and we have the capacity to help those left behind to find acceptance of their loss in a healthy, healing way. For that epiphany, I will be forever grateful to Joe and his family.