Kaylynn was caring for one of our patients, who was young, but had terminal cancer.
Over her 3-day shift, she noticed that the patient was deteriorating. She called me to discuss this, but as palliative care was short staffed, we are not present on the weekends.
Kaylynn was able to have an appropriate end of life conversation with the patient and family - a conversation most doctors are not able to have. She continued to seek help and got a CRNP involved from a palliative perspective. Kaylynn goes on to tell her story in an email, which I will share:
I just wanted to share with you an amazing patient story:
I was scheduled to work the weekend (Friday-Sunday). I had a patient who had been diagnosed with reoccurring cancer with metastasis, and he had been slowly declining over the previous few days. He and the family still had expectations that he would eventually get stronger and be able to return home in the coming days, with a plan to pursue hospice in the outpatient setting should he continue to deteriorate.
By Saturday afternoon the patient continued to decline, the family was present, and you could tell that they were very concerned by how rapidly he had declined in the past 24 hours. Palliative Care was not in the hospital at this time due to it being a weekend, and I had concerns about the patient's decline as well the code status of the patient (full code). I reached out to Dr. K, who was very helpful in guiding me in a conversation to gently discuss what I was seeing going on with the patient and get a feel of the direction the family wanted to go. At this point, there was a family meeting scheduled for Monday afternoon to discuss a plan, but I had concerns that this patient would not make it that long.
Dr. K sensed my fears and reached out to a CRNP who was in the hospital at the time to see if she had time to come up and speak with my patient's family. She quickly made herself available and came to the floor to talk with the family. She was awesome in helping them to understand what was going on and helped to formulate a plan to keep the patient's best interests in mind as well as keeping the patient comfortable throughout the entire process. The family chose to pursue comfort measures. Many family members came to see the patient, and most of all of them chose to stay through the entire process of this man's passing. His fiancé, his brother, his sister, and his mother stayed near the bedside the entire time.
I was privileged to be with this family for 3 days and got to know them and know their story.
Little did I know something amazing was also going on next door with one of my other patients.
My patient who was in the room next door was admitted for a small bowel obstruction, so he was up walking almost continuously in order to try to avoid surgery. After getting to know him I learned that he was a retired pastor who had helped many people throughout his career.
Early one morning (around 0400) this patient got up to go for a walk in the hallway. While walking around he found the family member (the brother) of my dying patient sitting in the waiting area. He approached this family member stating, "It can't be a good thing if you are sitting here by yourself at this time, do you want someone to talk to?"
They continued to have a conversation and my patient's brother found great comfort in this conversation, so much so that he asked this patient to come back to his brother's room to pray with them and talk with them.
This patient agreed to do so, and the family found great peace that they asked this pastor to do the funeral services for them. I was privileged to be present throughout each of these transitions that this family went through as well as be present with the other patient who was able to help this family find comfort in such a hard time.
This was an amazing experience, one that I will remember for the rest of my life. I am so lucky to have had all this fall into place and be involved in all of this throughout each of my shifts. This is just a great example of how absolutely rewarding this career can be, even in difficult times.
Dr. K's response to the email:
Kaylynn - Thank you for sharing. I see several positive things about this (besides the obvious)
You had the clinical sense to know what was going on.
You had the courage to continue to seek resources to get what you needed for your patient.
You took responsibility to go ABOVE your level of training, and outside of your comfort zone to have a conversation that most of our physicians shy away from.
I am proud of you for stepping up. I'm proud of you for taking the time to reflect and share your growth during your career.
It makes me happy to know that we as a team really are working toward the best interest of our patients.
I am happy to see that the spirit of palliative is still being followed and that it is providing the opportunity for growth in our nurses and other colleagues.