We were taking care of a patient who had multiple medical issues. He was a bilateral leg amputee, diabetic, hypertensive patient with an acute exacerbation of congestive heart failure which brought upon him new onset renal failure. When he was initially admitted, we were running him on aquaphoresis (pulling fluid out from his blood without actually dialyzing). Then, his kidneys were looking a little worse, so we did run him on dialysis for a few days. Everything was looking better and be left the ICU for a room on the medical telemetry floor.

Later that evening, he respiratory arrested, was intubated and returned to the ICU. His son came in the next morning with the legal paperwork showing that he was his father’s medical power of attorney and wanted to “pull the plug” and let his father go peacefully. This is a very hard situation to be in for us as well as the family member. Even though his father is laying in the bed, very still, it is only because we have sedatives going through his IV to keep him asleep. We cannot legally take out the breathing tube with the sedatives going (Dr Kevorkian, much?) and if we turn off the sedatives, he will wake up and breathe on his own… not well, but he will breathe enough to keep himself alive for awhile. We understand that his dad has a lot of medical issues and has been through a lot in his life, especially the last few years after his amputations, but he is not in a state in which we can withdraw care and let him pass on peacefully. Just another difficult day in the ICU trying to explain situations like these to families who are losing hope.

I had never heard of dentists checking blood pressures and heart rates… who would have thought?? Well, apparently many dentist offices realize the impact that they can have on the health of their patients. I recently asked my personal dentist if this was something that they did at their office and he replied that if a patient had a relevant medical history or had advanced age without regular medical checkups, he would check a blood pressure before performing any procedure on the patient. Interesting.

This all came to light after we had a patient present to our hospital for a diagnostic cardiac catheterization. He had originally gone to his dentist where they had checked his blood pressure and found that it was very high. They referred him to a cardiologist who started a work-up to find if there were any other medical conditions and found that he had a positive stress test and a CT scan showed that he had a large aneurism in his abdominal aorta. So, he was referred to a vascular surgeon to fix his aneurism, but since he had a positive stress test, the surgeon insisted that he get cardiac clearance from a cardiologist before surgery. His cardiologist then brings him to the hospital for a cardiac catheterization, which showed severe disease in multiple coronary arteries and a need for a coronary bypass (open heart surgery). So, he was placed in the ICU for a few days while the vascular surgeon and the cardiac surgeon ran tests and discussed which was better for the patient: to fix the aneurism or fix his blocked coronary arteries first. And this is where the patient sits at this point, it’s been two days and we’re waiting for a set of test results.

If the patient’s dentist didn’t find the high blood pressure and recommend that the patient get it checked out, then the aneurism could have very easily ruptured, probably causing sudden death, or he could have had a massive heart attack from the blockage in his coronary arteries. The more that we can do to make patients fully aware of medical conditions they have, or might have, the more informed decisions they are able to make about their health. We see patients all the time who come in as smokers, drinkers, and/or children of people who died of heart disease saying “I was totally healthy before this heart attack” only because they hadn’t seen a physician in 15 years. If they had known that their cholesterol level was over 300, they could have been placed on a daily pill to help decrease their risk of this huge heart attack they just had.

Today I had an extremely satisfying day at work. I wouldn’t say that it’s rare for me, but it’s nice to come home after 12 hours and not have a single thing to complain about.

Today I had the pleasure of taking care of a 37 year old man immediately after 5-vessel coronary bypass surgery. Upon getting report from the nurse in the operating room and hearing his age, the fact that he was overweight, and an uncontrolled diabetic, I have to admit that I was nervous. Generally, these patients are a pain in the butt. Judging by the facts that I had laid out on paper, I was imaging a rough day.

But, it was just the opposite – the guy woke up from anesthesia very calmly, required absolutely no vasoactive medications, was extubated quickly, and worked on his breathing exercises and got out of bed without complaint. He asked me lots of questions, which is not something many people have interest in within 6 hours of open heart surgery  - how long have i been at the hospital, am i married, how far do i have to drive home after work, etc. I had plenty of time through the afternoon to talk to his wife and his 14 year old daughter, and really enjoyed my day with them and being able to get a glimpse into their life together as a family. At the end of the day, the patient’s wife teared up, gave me a hug and thanked me for taking good care of her husband.

My perception of my day was totally wrong and I was pleasantly surprised. I went home with a smile on my face and I felt like I made a difference in someone’s life and really… isn’t that why we all wanted to become a nurse?

We had a 50-something year old man who was admitted to the ICU after a vascular bypass surgery in his left leg. When reading through his history, we found that he was in our hospital just 2 weeks prior and had a stent placed in that same artery. He was a heavy smoker at 2 packs per day and made the decision that purchasing his cigarettes was more important than purchasing his Plavix (a medication that reduces the effect of platelets, thereby reducing the chance of a clot forming in the newly placed stent, which would re-occlude the artery causing a lack of blood flow to the leg and foot).

This guy was a little rough around the edges… he was not the kind to say thank you to the nurses or doctors (but he looked appreciative after his massive, hourly dose of dilauded). When we helped him get in or out of the bed, he would scream and swear, and even reach to pull out his IVs or EKG leads out of aggression/pain. Its tough for many nurses (myself included) to have a lot of empathy for a person like this. When someone doesn’t take care of themselves, or have concern about their own health, it makes it difficult for the healthcare providers to have as much compassion, but we do take care of them. We do make sure that they get the attention that they need no matter how much energy it takes, but it is definitely easier mentally when you do have that connection.