I recently had the pleasure of working with Lyndsey on a difficulty case in MICU. We had an 87 year old gentleman who was intubated and unresponsive. The prognosis given by a team of physicians was poor. The family met with Palliative Care on a Tuesday. The decision was made to consult hospice and get the gentleman's home ready for him to be discharged home Thursday, so that he may die in his home. Thursday morning we would extubate the gentleman and make him comfortable. Ambulance transport would pick him up a short time later and take him home (with his son riding with him in the ambulance). Hospice would meet the family at the home where they would continue to provide care and offer medications to make him comfortable and treat his symptoms. Our goal was that he would survive long enough to make the ride home to Northeast and pass away peacefully surrounded by family and friends. He wanted to die at home, the same home he lived in for 85 years, since he was two. I received some pushback from some of the staff members, who felt this was not a good discharge plan. Staff who felt the patient's symptoms could be managed more efficiently in the hospital. Despite some resistance from staff, I saw the families DC wishes as something I needed to make happen at any cost.

Wednesday, Lyndsey came to me with some concerns the family expressed to her about pain management on the trip home. Lindsey was not taking care of the patient this day, but had established a bond with the family and found this bit of information while offering emotional support to the family during one of their visits. We called EmergyCare and found out we could add a paramedic to the transport team who could administer IV pain meds during the trip home.

Thursday morning came and I was concerned that everything would work out as we had planned. I feared that despite some of the best laid plans, all our efforts may have been in vain. I was apprehensive the patient may not live long enough to make it out of the hospital. I was concerned that maybe all the naysayers were right and perhaps his symptoms may not be effectively managed at home. I was most troubled that one of the staff who did not support the discharge plan may be taking care of the gentleman and could easily put a stop to all of the momentum I felt we had gained over the last few days.

I arrived in MICU Thursday morning to find Lyndsey caring for this patient; I could have not been more relieved. I knew from talking to her on Wednesday she had a good handle on what the plan was and supported getting this patient home to die in familiar surroundings. She was very attentive to the patient and family. She made sure this patient was comfortable, anticipated symptom management discussing her concerns with the CCM team and getting the right cocktail of medications on board to optimize his care and comfort. Lyndsey remained calm yet supportive, so she could be compassionate and caring to her patient and his family's needs.

The DC plan went off without a hitch. The family came and thanked everyone involved in this discharge plan as they were leaving. This was a sorrowful but joyous honor to help make a family's dying wish come true. The family called once the patient made it home safe and sound. The gentleman passed the next day, Friday surrounded by family and comfortable in his own home. I know this was a truly team effort, it took several team members working together to make this happen. I honestly can say that Lyndsey's professionalism and expertise was fundamental in making everything come together as it did.