Aljade
Rosario
April 2013
Aljade
Al
Rosario
,
RN
ICU
Franciscan Health System-St. Joseph Medical Center
Tacoma
,
WA
United States
Over the years, as a physician, I have taken for granted that the patients I follow in the ICU will receive excellent nursing care at SJMC. There are days though, when a particular nurse does something very special that reminds me of the spirit of collaboration and compassion that we must uphold to retain the privilege of caring for our patients. On one of those remarkable days I had the opportunity to work together with Mr. Aljade "Al" Rosario, RN in the care of two special patients that were assigned to him:
In one room there was a very young mother challenged by several mishaps in her life that rendered her bedbound, with frequent hospitalizations and now on life support. She had made the decision that medical interventions were simply prolonging her dying process. Al took care of this young mother, a father in the room who was about to outlive his child, a soon to be motherless daughter, and siblings who were struggling to find that difficult balance between not wanting to lose a loved one and at the same not wanting to see the same person suffering any longer.
In the second room there was a patient with ALS who had willed himself to live for 8 years, on life support, at a nursing home, while only being able to communicate by spelling letter by letter with eye movements, interpreted by a willing family member or nurse. This process was time consuming for the staff and frustrating for the patient who was otherwise physically paralyzed, confined to a bed and mechanical ventilation. In the same room there is a grieving wife who is adamantly opposed to the patient's decision that after 8 years he no longer wanted to prolong his life by artificial means.
Because of the complexity of the situations of these patients and their families I spent several hours on that particular day in the unit and I had the opportunity to witness how Al went about caring for them. He would kindly accompany providers to assist with the laborious and time intensive process of spelling Mr. B's words so we could clarify how he wanted us to care for him. It was the patient's choice to hourly receive pain medications instead of a continuous infusion in order to minimize sedation so he could be available for his family for a few more days before coming off life support. This required Al to medicate him hourly. Al also spent a significant amount of time on that day listening to the patient's wife verbalize her frustration about how wrong the patient's decision was to "end his life" prematurely knowing that a miracle was just around the corner if he maintained his faith. This was a particularly difficult day for her because it was gently conveyed to her that it was the patient's call to maintain or discontinue life support. The patient's wife later that day expressed unsolicited gratitude towards Al.
In the second room, the young mother is now off life support and is also requiring frequent medications and when it is clear that she will not likely survive for more than a few hours, she requests to put in writing her desire to nominate her dad as the guardian for her 13 year old daughter. Al stayed with the patient and her family while the care manager and a notary helped her fulfill her last wish. A few hours later Al obtained and implemented the orders needed to provide her with the necessary physical comfort to experience natural death, surrounded by her family a few hours later.
It would be unfair not to recognize that there was amazing teamwork going on for these two patients and their families for several days and that many nurses, doctors and consulting services deserve recognition. It would also be equally unfair not to recognize that what Al was able to do on that day was special. Beyond the incredible amount of work required to care for these 2 patients was the challenge of maintaining a caring, compassionate and respectful attitude towards the patients and their families. At no point did Al display any signs of frustration and would go from one room to the other maintaining a unique quality of presence and providing outstanding compassionate care.
In one room there was a very young mother challenged by several mishaps in her life that rendered her bedbound, with frequent hospitalizations and now on life support. She had made the decision that medical interventions were simply prolonging her dying process. Al took care of this young mother, a father in the room who was about to outlive his child, a soon to be motherless daughter, and siblings who were struggling to find that difficult balance between not wanting to lose a loved one and at the same not wanting to see the same person suffering any longer.
In the second room there was a patient with ALS who had willed himself to live for 8 years, on life support, at a nursing home, while only being able to communicate by spelling letter by letter with eye movements, interpreted by a willing family member or nurse. This process was time consuming for the staff and frustrating for the patient who was otherwise physically paralyzed, confined to a bed and mechanical ventilation. In the same room there is a grieving wife who is adamantly opposed to the patient's decision that after 8 years he no longer wanted to prolong his life by artificial means.
Because of the complexity of the situations of these patients and their families I spent several hours on that particular day in the unit and I had the opportunity to witness how Al went about caring for them. He would kindly accompany providers to assist with the laborious and time intensive process of spelling Mr. B's words so we could clarify how he wanted us to care for him. It was the patient's choice to hourly receive pain medications instead of a continuous infusion in order to minimize sedation so he could be available for his family for a few more days before coming off life support. This required Al to medicate him hourly. Al also spent a significant amount of time on that day listening to the patient's wife verbalize her frustration about how wrong the patient's decision was to "end his life" prematurely knowing that a miracle was just around the corner if he maintained his faith. This was a particularly difficult day for her because it was gently conveyed to her that it was the patient's call to maintain or discontinue life support. The patient's wife later that day expressed unsolicited gratitude towards Al.
In the second room, the young mother is now off life support and is also requiring frequent medications and when it is clear that she will not likely survive for more than a few hours, she requests to put in writing her desire to nominate her dad as the guardian for her 13 year old daughter. Al stayed with the patient and her family while the care manager and a notary helped her fulfill her last wish. A few hours later Al obtained and implemented the orders needed to provide her with the necessary physical comfort to experience natural death, surrounded by her family a few hours later.
It would be unfair not to recognize that there was amazing teamwork going on for these two patients and their families for several days and that many nurses, doctors and consulting services deserve recognition. It would also be equally unfair not to recognize that what Al was able to do on that day was special. Beyond the incredible amount of work required to care for these 2 patients was the challenge of maintaining a caring, compassionate and respectful attitude towards the patients and their families. At no point did Al display any signs of frustration and would go from one room to the other maintaining a unique quality of presence and providing outstanding compassionate care.