Narrative
By Karen J. Politano, BSN, RN Shapiro 6 West/Cardiac Surgery Intensive Care Unit
As a nurse for over 21 years, I have taken care of many patients. On any given day when you come into work, you just never know what kind of an assignment you will receive, or who you will meet. One night last October while sitting at the front desk doing paperwork, the supervisor came through the unit and told us of a patient going to the OR for a Tandem VAD (ventricular assist device), and that he would be coming to us after surgery. It was going to be a long procedure, and the patient wouldn’t come up from the OR until the day shift, but the nursing staff prepared the room just in case and printed out the paperwork.
As I was reading his medical history, it struck me that this patient who I’m going to call Marty (not his real name) was only 41 years old, married with two young children and worked as a contractor. Marty had no prior medical history and was basically healthy until two weeks earlier when he came down with what he thought was a cold that turned into the flu.
His wife Macy (not her real name) was away taking care of a sick relative, and when she spoke with him on the phone, she didn’t like the way he sounded. She called his parents to “just go check on him.” When his parents arrived at his house, they were shocked at how sick he was and insisted he go to the Emergency Room for treatment.
The timing of all this just happened to save his life, for as he arrived at the Emergency Room, he was having difficulty breathing with low blood pressure and was going into what appeared to be cardiogenic shock. He was intubated, put on vasopressors and fluid resuscitated. Diagnostic studies showed that his heart was failing quickly. He was taken up to Shapiro 9 East initially where he spent a few days getting treatment for cardiogenic shock.
His status was not improving, despite maximum medical management by the cardiology team. He was then taken to the OR for implantation of a Tandem VAD. This VAD was designed to temporarily assist his heart and be removed when he improved. His wife Macy called into Shapiro 6 West just to let us know she was in the waiting room and asked if we heard anything. I spoke with her on the phone briefly and told her I would let her know if we heard anything from the OR. I thought about her after hanging up the phone. She must feel alone and depressed. I decided to go out to the waiting room to see how she was doing. She was red-faced and tearful, clutching pictures of her two young children.
I sat down with her and explained that it would be a long time until we heard anything, but that he was in the best of hands with his surgeon and the OR team. I also told her that when he came up to the ICU, we would get her in as soon as possible to see him. Marty did not come in on my shift. I left that day thinking of Marty, Macy and their family and wishing for the best, although I knew it would be a long road for them.
I was assigned to be Marty’s nurse and grew to know the family very well. Taking care of Marty and his family over the next several weeks was like a ride on a roller coaster. They had many ups and downs, although he had more downs than ups.
When Marty didn’t wake up post-op, Neurology was called in, and the poor prognosis was passed on in a family meeting that Marty had a stroke and probably would never wake up. If he did, he would likely be severely impaired. While in the family meeting, withdrawing support and making him a DNR was being discussed. It was like Marty knew they were talking about him, and guess what? He started to wake up and move! Everyone was so happy and hopeful that he would recover.
That happy moment was short-lived. Marty started getting hemodynamically unstable again. This time he needed to return to the OR for removal of a pulmonary embolus, and it was clear that his only hope of survival was to get a new heart after he stabilized. The team decided that he would need a different VAD. This VAD, called Heartmate II, was designed to remain in place until a heart transplant becomes possible. Marty, if he survived this ordeal, could go home with this device and enjoy his family while waiting for a new heart. But first he needed to survive this trip to the OR. And of course, nothing came easy for Marty.
The night Marty went back to the OR for his new VAD is one that I won’t soon forget. We all have shifts where we “run non-stop,” and this was one of those nights for me. He was so unstable from bleeding, low blood pressure and difficulty ventilating, and everyone (me, the charge nurse, respiratory, the attending and CSS fellow) worked so hard to just get him stable. Marty’s lab work and blood gases were really not compatible with life that night. Eventually, with such a combined effort, we got him stable. This was the beginning of his long journey to his new heart.
The next several months, Marty continued to make slow progress. Macy was amazing during this time, working, raising the children and coming in to all the meetings to see how his progress was going and what the next steps were going to be. Marty’s parents were also incredible with their visits and helping with the children. I could set my watch by Marty’s mom’s morning phone calls. She was always so pleasant and upbeat, and the first few minutes of our conversations were always about the weather, what nights I was working, and that I should be careful driving home! I watched as Marty’s wife spent months making decisions for him that she could only hope and pray were the right ones. I have taken care of many patients that remind me of my parents and even grandparents, but I finally realized why Marty and Macy struck such a chord with me—this could be my husband…and me!
I took care of Marty almost every shift I worked over the next several months. We watched Halloween, Thanksgiving, Christmas, New Year’s and his children’s birthdays come and go. The nursing staff helped Macy plan a birthday dinner for Marty, white linen, formal dinnerware and all! I was happy to see some normalcy in Marty and his family’s lives. Unfortunately, even though he was making progress, Marty’s heart did not recover enough for him to ever be able to leave the ICU and go home to wait for his new heart. Also, as a result of the stroke, his medications and long hospital stay, Marty was getting depressed. In the spring, he was able to walk and go outside from time to time to get some fresh air. They even brought his dog in to visit him! Nothing was really working, and I watched as he took his frustrations out on his wife, his family and, on a few occasions, the staff. I reassured Macy and told her, “you always lash out at the ones closest to you,” and she understood. She knew it was not “really him,” but it hurt just the same. She knew Marty lost control of the situation.
Macy and I would spend many hours talking on the phone over those next several months while we “waited” to see what happened. Marty’s mom would try to celebrate every little milestone, and even said she would bring me some champagne when his hematocrit (which always was on the low side because of frequent bleeding) hit 30! I told her to save that champagne for the real celebration, when he got his new heart. I joked that I was going on vacation for a week in April and that after all these months of taking care of him, that he would probably get his heart when I was gone.
I was off by 10 days. Yes, 10 days! But before I went on vacation, I got a text at home that Marty was headed to the OR for his new heart! All went well this time, and I was able to take care of him for the few days before I went away. The first night I came back to work, Marty’s wife had tried to wait until 7 p.m. to see me, but she needed to get home to the kids. She left me a note thanking me for everything and telling me she just wished she could give me a hug and see my face knowing that he got his new heart. This is the note I still have at home and don’t ever plan on getting rid of. Marty was now in the stepdown unit. I went to visit him and was amazed to see him just looking like a regular guy sitting in a chair, wearing jeans and a sweatshirt, eating dinner and drinking a glass of wine!
Marty was able to go home shortly after that, and his family still sends emails and pictures of his progress and of their vacations in Maine. I have always felt that people come into your life for a reason, and this family came into mine for a reason that I may never know. Oh, and by the way, the other thing that was waiting for me when I got back from vacation in April was a bottle of champagne! I still have it in my refrigerator at home. I don’t know when I will open it, but I’m sure when the moment is right, I will know it. Marty’s mother and I always joked that this would make a great book or a Hallmark movie. Maybe I will have my champagne after the premiere.