About a year after starting in ICU, I was expected to take care of post-op open heart patients. I took a class, and I’d already been helping out with them after surgery, but had never been the primary RN. If I’d had my way, I never would have taken them. I was fairly comfortable with being in ICU by that point, but still not really mentally ready to take on the responsibility of recovering fresh open heart patients. The more experienced nurses did that kind of thing! I’d only been at this for a year! Didn’t matter, I had to do it anyway.
My first fresh open heart patient was one that I had admitted on a Saturday. He’d had an emergency cardiac cath and it was determined that he needed some bypass grafting. He was sent to my ICU for monitoring, but it was clear by Sunday that he could have gone to a stepdown unit. He was really very stable, walking around his room and such. But we didn’t need the bed for another patient, and figured he’d be back in a day or so after surgery anyway, so I took care of him all weekend. During that time, I’d say I developed a pretty good rapport with the patient and his wife.
The cardiac surgeon who saw the patient, Dr. A, was fairly new to this particular physician practice that had been established about 10 years prior. As he already had cases scheduled for Monday, he put the patient on the surgery schedule for one of his partners, Dr. Z, to do first thing Monday morning. All day Sunday I did pre-op teaching and answered questions.
Monday came, and I was very nervous about taking “my first heart.” I had a preceptor with me, of course, so at least I knew I wouldn’t do anything wrong. As I walked in at 7:30am, my patient was being wheeled off to surgery. The family was very emotional and it was a touching send-off. I had another patient at that time, so I busied myself with taking care of them, thinking that I had til about noon until “the heart” came back.
I was wrong. The heart came back at 8am.
Apparently, Dr. A didn’t inform Dr. Z that he had a surgery that morning. When Dr. Z found out, he was very angry. Dr. Z had had Monday morning office hours since the dawn of time, but no one thought that it was odd that there was a surgery scheduled for him. So the patient arrived to the OR that morning, had begun to be prepped, but no surgeon showed up. Dr. Z was the kind of doctor who, when consulting on a patient who needed open heart surgery, gave the patient a whole big informative speech on what that entailed, why the surgery was necessary, alternatives to the surgery, etc. Never have I come across another cardiac surgeon so involved in teaching and preparing patients.
To say that Dr. Z was angry with the situation wholly pales to the anger of the patient and family. Dr. A was able to come by and apologize for the mix-up, but that did very little to allay the family’s intense anger. I could understand their feelings – they were sending their husband/father/brother off to have his chest sawed open and his heart stopped – would it be too much to ask for a surgeon to show up at the appointed time?? It wasn’t like the surgeon was sick, or an emergency had come up… It’s just that no one showed up to do what could be the most stressful surgery in someone’s life. Questioning the competency of a hospital that could do such a thing would surely cross one’s mind….
And boy did it cross theirs. Although I had taken care of the patient all weekend, although I had a good rapport with them before surgery, even I was not immune to the many comments that were hurled at anyone who dared enter the room. That family made it VERY clear that they were mad at anyone and everyone who worked for that hospital, even down to glaring at the housekeeper. At one point, I had to go in the room to test my patient’s blood sugar, and I still count that as one of the hardest things I have ever had to do.
As soon as I walked into the room, 6 sets of eyes watched my every move. I meekly told the patient that I would be checking his blood sugar, and as soon as the words came out, I heard one of the family members tell another that he wondered if they could sue for such incompetence. Another wondered aloud if it was too late to change hospitals, since we “clearly did not have our act together here.” I know they were just expressing deep frustration, but it made me feel about 3 inches tall. Today I’m quite confident that I would be able to handle the situation and would certainly talk to the family and patient, but back then – I was pretty much still a new nurse, only having graduated a year and a half prior. I was quite easily cowed by confrontational family members. I didn’t want to make the situation worse, so I said nothing. At one point, I looked at my patient and he looked back at me with a mixture of sadness, anger, frustration and maybe even a little embarrassment for his family’s behavior in his eyes. They were definitely the ones raising hackles – the patient hadn’t said very much at all.
Lunchtime came and went and Dr. Z came to see the patient. The family had only somewhat calmed down, but after talking to the doctor decided to go ahead with the surgery that day. I don’t know what it was that Dr. Z said, but it seemed to go a long way. The tension in the room was cut in half and I was actually able to look some of them in the eye without being glared into a blubbering mass of shame.
The patient went to surgery and came back about 4 hours later. I was still incredibly nervous about this being my first open heart patient, and my nerves were also still a little extra-frayed by the morning’s events. Nevertheless, my preceptor was absolutely wonderful and we got the patient settled quickly. After that, it was time to call the family into the room to explain all of the various tubes, wires, and machines that were connected to the patient. I love teaching, so I knew this would be my favorite part under normal circumstances, but this time I was dreading it. My preceptor asked if I wanted her to do it, but I said I would go ahead and talk to them as long as she stayed in the room. I called for them and nervously waited for everyone to file into the room. I gave them a few minutes to look the patient over and then told them that his surgery went very well, he was very stable at that point, and everything was going as well as it could.
The remaining tension and anger almost visibly drained from their faces and I was able to get through my little teaching session not feeling as though I was standing in front of a firing squad. After all of their questions had been answered, everyone but the patient’s wife left the room. She came up to my preceptor and I and apologized for all of the harsh words and comments from earlier in the day. I was immensely relieved by this – I mean, who wants to go home feeling as though they were practically hated by their patient and family?
I had a few days off after that, so I never saw the patient again. And although I took several more hearts at that job, I have never had the desire to do them at my current job and have thus far been able to go about my career without having to do that particular task.
Oh yeah – and did I mention that Joint Commission was there that day, surveying the hospital? And that they were in our unit, witnessing the entire show? Could it have possibly been more stressful?