Difficult Conversations - With time running out, a nurse makes sure a family answers a crucial question

摘要

On a Monday morning, Mr. P, a bilateral lung transplant recipient, was admitted directly to the medical intensive care unit (MICU) from the lung transplant clinic for shortness of breath and higl fevers. His differential diagnoses were pneumonia versus acute lung rejection. We see many pneumonia admissions in the MICU, and I knew his symptoms didn't match that diagnosis. As his condition quickly deteriorated, Mr. P began panicking and calling out for his wife, who was on her way to the hospital. After three bedside bron-choscopies and an hour of me holding Mr. P's hand, we were able to get some samples to send to the lab. When Mr. P's tests showed a critically high donor-specific antibody level, the physicians quickly realized he was going through an acute lung rejection. Shortly after his wife arrived, I was informed that Mr. P needed to be intubated because he was not oxygenating properly. Two hours later, the patient I had been comforting and conversing with was laced with drains, lines, and tubes. I calmly explained to his wife what every line was for and promised to do my best to keep Mr. P comfortable on the ventilator.