Caring to Make Sure Patient ‘Gets It’
The birth of her third child was supposed to be a happy time. Instead, here she was on the cardiac step down unit, on a monitor, IV running and so short of breath she had to sit bolt upright to breathe. Thirty-four-year-old Patricia had known all her life that she had an atrial septal defect and a cleft mitral valve, but, as she pointed out, “How come I didn’t have this problem with my other babies?” The Heart Failure Team had asked me to see Patricia to educate her about her heart problem and its treatment, and to make sure “she got it.”
Our first interactions were, frankly, awful. She was uncomfortable, frightened and most of all, distrustful. She never made eye contact and rarely spoke. She was very anxious to get home to her two young daughters and seemed to believe the whole problem would go away, if she could just get back home. Written materials were untouched and since she never spoke, I had no idea if she grasped any of the information I was giving her. I left Friday hoping things would improve early the next week and came back Monday only to find she had been discharged over the weekend at her insistence.
I was so concerned about her ability to manage her illness and her life that I called her from the floor before returning to my office. She answered the phone on the seventh ring and was short of breath from the effort. Having learned a little about her from our previous interactions, I decided to accentuate the positive and suppress my instinct to tell her she needed immediate readmission. I increased her diuretic; focused on things she could do herself to feel better and crossed my fingers. I called daily, even on the weekends, but she revealed little about how she felt and what she did. Patricia struggled along at home for two more weeks and then reluctantly consented to readmission.
Her second admission was complicated by arrhythmias that terrified her. We worried about the survival of both mother and baby but she talked only about how, “all this would pass” when she got home. Again, the team wondered, “does she get it?” Again, I tried to reach her with education and support, with little visible effect.
By her third admission, she was exhausted and depressed and there was growing concern that the baby was also struggling. I attempted to make conversation and asked Patricia if her husband or mother would be going with her to the fetal ultrasound later that day. She answered in a very small voice that they were both working so she’d be going alone, “as usual.”
“No you won’t,” I replied impulsively. “I’m going with you and we’re going to have a girls day out while we are at it – lunch in the cafeteria.” She looked absolutely startled and not only made eye contact but also smiled! When I returned in the afternoon to get her, she was a changed woman, wearing a pretty robe and make-up. As with all medical testing, there was lots of waiting time so we began to talk about her other pregnancies, her job, about motherhood and then she began to ask surprisingly hard questions about her heart and her prognosis. The next day the clinical nurses and medical staff on the team were astounded by the dramatic change and how she “suddenly got it.”
I was still baffled by what caused the abrupt turn around but rapid changes in her medical condition left little time to talk except about what was coming next. Much of the time I just did what nurses do best. I was there. There for the ultrasound, there to wheel her to the Delivery Room and there to take her to the NICU to visit her newborn.
Months later, during a follow-up clinic visit, Patricia educated me on what had changed. “You know,” she said, “the other nurses and doctors always kept saying to each other that I didn’t get it. But they didn’t get ME. They didn’t know where I was coming from and they never took the time to learn. You did. That’s why I could talk to you and learn.” I assured her that we clearly had something to teach each other.
Patricia is doing well three years later, juggling three children, a husband, home and job. On the second Friday in May, she calls and wishes me a happy Mother’s Day. We both still get it.