Caring for Cassidy
By Karen J. Politano, BSN, RN
As nurses we can care for hundreds to thousands of patients during our career. Having been a nurse in the Cardiac Surgical ICU for more than 20 years, I have, like most nurses unfortunately lost count of all of the names, and faces.
Every once in a while a special patient comes through the doors of Shapiro 6West and touches everyone. Cassidy was one of those extremely special patients. I was first approached by Maria Bentain-Melanson, our nurse educator on Shapiro 6W, about a week before Cassidy had her surgery. I was asked if I would mind taking care of a young patient of Dr. Prem Shekar’s who was having bypass surgery the following Monday.
Of course I responded that I would. We take care of patients having cardiac bypass surgery every day so what was so different and special about Cassidy you ask? Cassidy is only 11 years old! Over the years we have had patients in their late teens and early twenties all the way up into their 90s, but 11 years old was the youngest patient I had ever heard of at BWH having heart surgery.
After accepting Maria’s offer I was honestly a little nervous, but Maria made sure that everyone involved in Cassidy’s upcoming surgery and recovery was well informed with information via e-mail. An inservice on how to take care of the pediatric heart surgery patient was also given to the staff. Honestly, the most important piece of information I walked away with from that lecture was that children weren’t just small adults and had to be treated differently than the adult population that we were use to caring for.
I came into work on Monday night nervous and excited to take on this challenge of taking care of Cassidy. How lucky was I (and Cassidy, too) that Lisa Comis, RN, was the nurse taking care of her in the OR on the day shift! I know that if I had a loved one having surgery, I’d take comfort in knowing he or she would wake up to Lisa’s kind and loving voice and wealth of knowledge. Lisa was a nurse in Cardiac Surgery at BWH back when I was a nursing student working on co-op on Tower 8C. Lisa gave me report and showed me that all around the room were charts with most of our usual cardiac and pain meds conveniently converted to the weight scale we would be using for Cassidy’s care.
I felt that I had the knowledge I needed to take care of Cassidy but was worried about interacting with her and her parents at such a scary time for all of them. That feeling was gone within two minutes after I met Cassidy and her parents. This family was so down to earth and just so grateful to have this surgery behind them that they actually put me at ease. Her parents explained that Cassidy was a normal healthy girl until she became sick with what they thought was a cold or flu a few years earlier. When her fevers would not go away and she developed a rash and very swollen glands she was taken to Floating Hospital for a work up.
Unfortunately, it took them a while to diagnose Cassidy, but eventually she was diagnosed with Kawasaki’s disease. They began treatment and she responded quickly. A very rare side effect of this disease is cardiac abnormalities. Cassidy was being followed over the years with echo’s and cardiac catherizations. She fell into a very small population that develops aneurysms and blockages as a result of the Kawasaki’s. Dr. Shekar was following her and agreed that she should have bypass surgery. Children’s Hospital does not do bypass surgery as it is such a rare procedure in children, and that is why she had her surgery at BWH.
I was impressed at the family’s composure and how well informed they were as they went over Cassidy’s history with me. And Cassidy, well what can I say? She was just a beautiful young girl who seemed older than her 11 years. She was brave and strong and did everything I asked of her over the next few days. I had to stop and remember that she was only 11 from time to time! Often she would be so brave but then begin to talk about her Webkins or joke that her brother and sister would be just getting up for school and she didn’t have to, and I would remember how young she truly was.
I’ll never forget when she looked up at the clock on the night of her surgery and I told her it was just after midnight and she said she was never allowed to stay up that late at home, and then she wished me a good morning because it was a new day! Cassidy was lucky enough to still be under the effects of anesthesia that first night and was very comfortable. That unfortunately was not the case for the day nurse, Nancy Minghella. Pain was probably the most difficult issue for her and her parents as well. No one wants to see their child in pain. Nancy did a fantastic job of getting Cassidy comfortable using the usual meds but in such smaller doses that we aren’t accustomed to giving. Cardiac anesthesia even came up to give her conscious sedation when her chest tubes were taken out, a protocol Children’s Hospital routinely follows but not one we are familiar with. Children’s Hospital had made sure we had all their contact numbers in case we had any questions, which was a great show of collaboration between the two hospitals proving that what is most important is the patient, no matter where they are being treated.
Cassidy was much more comfortable after her chest tubes came out and she was able to get out of bed. She transferred to the step-down unit the next day and was home by the weekend. Often, we take care of patients that remind us of our parents, brothers and sisters and even our husbands and wives, but I can say this is the first time I ever took care of a patient that reminded me so closely of my own 13 year old daughter. I truly believe that Cassidy’s surgery and recovery were so successful because of the wonderful support from her amazing parents, Dr. Shekar, the OR surgical staff, Anesthesiology and everyone on Shapiro 6W and 7W. This was one case that everyone was invested in whether or not they took direct care of her because she just hit home with so many of us. I know I went home after taking care of Cassidy feeling really good and gave my kids an extra hug!