Saturday, May 19, 2007

Dora, the Explorer

Have I mentioned how much I can’t do this job with my husband. Yesterday, I went to one hospital. Patient wasn’t brain dead but the nurse had brought up donation, so I spoke with the family. They said they were going to see how he did in the next 24 hrs before they made any decisions. I left there and triage told me to head up to another hospital, 40 minutes away. Half way there, triage calls me. How far away are you? She said that pt is medically ruled out, but I may have to go to one of 2 other hospitals, both in the other direction. “Just turn around and I’ll let you know where you’re going to in a few.” I stop at the office for supplies and she calls and tells me to go to the nearer hospital. I get there, pt is not even close to brain dead. I chart a few labs, etc. I help another nurse help a Jewish family figure out how they can be contacted about their father during Shavu’os next week. And then I leave. Now it’s rush hour. I slog through the traffic. Five miles from home, triage calls yet again. Can I go back to the very first hospital. Family decided NOT to wait 24 hrs, they want to extubate right now.

Confused? Me, too. It’s amazing I found my way home that night and didn’t just keep driving in circles until dawn. In the middle of all these trips, I'd call my husband and say, "Can't come home yet, I've got to go to...." He start to protest, "but, but," and then he'd just sigh and say, "Ok, I love you honey. See you later."

When I first speak with the family, I introduce myself like this:

“Hi, I’m Susan and I’m a nurse who works with families of patients with severe brain injury.” This is not lying. But it is a mental leap I had to make, and my preceptees had to make. Walking in first thing and saying, “Hi, I’m here from the organ procurement organization!” is likely to get an immediate NO from the family. They are thinking about how their loved one is going to survive and recover no matter how bad the doctors say it is. They want to know that the hospital is doing everything possible to save them. They need some time to let the bad news sink in. Sometimes, I just completely stay out of the picture until it’s time to ask, especially if the hospital has a good family support system in place. In other hospitals, they don’t have the resources, I step in and try to be that support, whether they donate or not.

So, back to my first family. There were a lot of them. When I returned, there had to be 30-40 people around. He wasn’t brain dead and they wanted to extubate now. They didn’t want to donate. And the hospital had no family support, pastoral care or social workers on a Friday night. So I told them I’d stay to help support the family and help with the crowd control. Someday I’ll go into the whole story but it’s a little too fresh right now. Suffice to say, they needed someone and our family support person was still en route. My coworker calls it “doing the Lord’s work”, when we stay and help the family after they’ve said no. I even offered to help with the post mortem care, because these nurses were swamped and overwhelmed by the number of family.

Because no matter how much I want that 7 organ donor or that next successful DCD, I really am concerned about more than just your organs.
**If I'm Dora, guess which one of youse is the monkey! Ha!


Robin said...

OK first thing, I thanked you back at my own blog for always being the dependable one to catch my double entendres. I'm glad to see that someone is paying attention.

Now, on to this post: it never occurred to me that you need to be, um, kind of subtle in expressing your position. I guess it's not quite like Monty Python's "Meaning of Life" where you show up at the door and say, "Hello. We're here to take your liver!!"

But what does any of this have to do with your husband?

TC said...

I am so tired. I see I am going to have to edit the post a wee bit, cause I left out the part about his greatness....oops.

Susan Palwick said...

I got the greatness! He didn't whine when you called to say you weren't coming home yet, just told you he loved you, which I'm sure you needed to hear at that point.

I've said this before, but thank you for doing what you do.