A patient was seen in the Eye Clinic with severe eye pain, and he was ultimately told that he needed to have his eyeball removed (enucleation). This patient was brought around to Amy Dawson, RN for scheduling. Upon reviewing the patient's chart, she quickly noticed that his platelet level was chronically very low related to his liver disease, and this would need to be addressed in the pre-op period. The platelet level was not safe for surgery, and if not addressed would lead to other life-threating complications post-op. As she was talking with the patient and his fiancé, she noticed how anxious he was about having this surgery and discovered they had their wedding planned within the next couple of months. This made Amy think about the timing of his surgery in regard to being able to have his prosthetic eye in place for his wedding, rather than having to wear a patch. She was so keenly aware of the psychological impact of not just losing an eye but having wedding pictures to look at through his lifetime with a patch that would remind him of this difficult time.
Amy began working with her colleague, Sarah Byrd, APRN, to figure out a way to get this patient taken care of quickly. At that time, the occulo-plastics surgeon only did surgery on Monday morning, making platelet transfusion challenging because of preparation needed on a weekend. The Eye Clinic does not admit many patients, and certainly not over a weekend for "elective" surgery, so Amy and Sarah had to advocate for this patient to overcome these challenges. They essentially had a week to get this patient through pre-op in the Eye Clinic and Anesthesia, arrange an admission over the weekend for platelet transfusion, get the surgery complete, and get the prosthetic ordered. The eye prosthetics provided to our Veterans from Alloplastic Facial Reconstruction are AMAZING! They are matched perfectly with the patient's other eye and often it is not even noticeable that a prosthetic is in place. Amy and Sarah worked together to coordinate admission for the patient on Sunday, arranged for an Ophthalmology resident to come to the VA on Sunday afternoon to consent the patient and order the platelet transfusion, the patient had surgery on Monday morning and was fitted with his prosthetic in time for his wedding 8 weeks later.
The teamwork among the Eye Clinic for this patient was amazing! However, without the "nurses' hearts" of Amy and Sarah to identify this patient's physiological and psychological needs so quickly, taking the time to work through the challenges, and pushing the team to do what was best for this patient so timely, the outcome would have probably been different for this patient. Yes, he would have survived, but his lifelong memories of his wedding day would have been different, and that's caring for the whole patient.