Attention to Detail Fosters Healing Relationships
Patient Richard Briggs joins his nurse practitioners, from left, Linda James, Deborah Page and Colleen Smith, before discharge.
How important is it for a patient to be home to celebrate his child’s fifth birthday? Or to be able to walk his dog everyday?
Knowing what’s important to each patient shapes the healing relationship between the patient and nurse—a relationship that can last years as in the case of heart transplant patients.
Nurse practitioners Linda James, who works with heart transplant patients, and Colleen Smith, who works with patients on devices like ventricular assist devices (VAD), are part of the cardiac transplant multidisciplinary team. Their everyday work is understanding the particular needs of patients and their families as they teach and attend to the highly complex technical care these patients require.
Often, as needs change, Smith’s patients become James’ patients, as in the case of Richard Briggs of Cape Elizabeth, Maine. Smith began caring for Briggs before his LVAD was implanted. “It’s very intense following patients on VADs,” she said. “Both the patient and family have to know how to maintain the device and what to do in case the pump stops working.”
Smith spent hours instructing Briggs and his wife on how to handle such a situation, and their engineering backgrounds helped them easily comprehend the mechanics of the device, she said. “But if the pump actually stops, engineering goes out the window because it’s your husband’s heart in your hand,” Smith said. “My job is to make them confident and comfortable handling that situation.”
Instructions in case of emergency were especially important for Briggs, who wanted most to be at home in Maine and able to walk his dog, Baxter. However, Briggs’ LVAD failed in November while he was in the hospital, and he was subsequently placed on the heart transplant waiting list. At that point, Briggs’ care was transitioned to James, who gathered details of his care from Smith and began to get to know Briggs and his family.
“It takes a lot of commitment on the patient and family’s part to make life after transplant work,” James said. “As nurses, we get to know the details about the patient that allow us to best help them concentrate on their health.”
James works with patients from the time they are placed on the heart transplant waiting list, through their transplant surgery and for the rest of their lives. In addition to keeping patients in the best physical health, nurses are also a social support system, helping patients and their families understand issues from insurance and transportation to solving problems with employers.
“With heart transplant patients, because the transplant is such a crucial event, it makes for a very bonded relationship between nurse and patient and family,” James said. “It’s also a very trusting relationship.”
Briggs underwent heart transplant surgery on Dec. 27. His surgery marked BWH’s 500th heart transplant—the most for any New England Hospital.
After the transplant, James prepared Briggs and his wife for discharge by making certain they were clear on his medications and instructions for care at home. “Patients are receiving a lot of new information and medications at a stressful time in their lives,” James said. “It’s important for them to have the support of the family.”
James, who continues to care for Briggs starting with weekly then monthly check-ups, reassures him and his family and encourages them to call whenever they need. “We don’t want them to feel like they’ve been let loose,” she said. “There’s still a support system for them here.”
While Smith’s role in caring for the patient eventually ends when the patient transitions to a transplant nurse, the relationships last. “We care for some of these patients for more than 10 years,” she said. “You see their children get married and see your patients become grandparents. You go through life with them, which is the best part this job.”
She added, “It’s wonderful to see them enjoy their lives and experience these events because of how our team has helped them. Not all the times are good. Helping families through the complications and problems that arise also deepens our relationships with them. It’s hard when they pass away because we’ve had this special relationship over the years.”
The relationships are so close that nurses often attend the funerals of former patients. “When families see us, they become emotional,” she said. “They remember us and know that we helped their family member enjoy a part of their life that they would not have otherwise had.”