"I NEED TO have you come back to the hospital. I can't breathe."
That was the phone message my mother-in-law, whom I'll call Laura,* sent to us one day while we were at lunch. She had been hospitalized for atrial fibrillation (AF) and had been in the step-down unit for the past 2 days on a diltiazem infusion.
It was an ominous message that my wife Dianne and I had never received from Laura before. We immediately rushed back to the hospital to find out what was going on.
Laura was in trouble. Although her BP was normal, she was tachypneic and dyspneic, in rapid AF, and complaining of not being able to catch her breath. We called in her nurse and told her what Laura had told us. She assured us that she had called the cardiologist and was waiting to hear back from him. After 10 minutes, things stayed about the same and no rapid response was called. Then Laura said something that caught our attention.
"Dianne, I haven't seen Bill in over 20 years," she said. "Do you remember that blue dress I wore at your wedding? That's the dress I want you to put me in."
Those words were a giant red flag. Bill was Laura's late husband. In my years as an RN, I had learned to take note when a patient starts talking the way Laura was talking. I took her hand. "What are you talking about?" I said. "You're not going anywhere."
I looked at my wife and then called the nurse to ask if she had heard anything from the cardiologist.
"No, he hasn't called me back yet," she replied.
"We need to talk," I said, motioning to the hallway.
At this point, I felt the cardiologist needed to be doing more to try to stabilize Laura's condition.
Once outside, I relayed my concerns. "She's talking about dying. She's never talked that way before. It's a very bad sign. We need to do something now, or we'll lose her."
The nurse, who had been in the profession a long time, agreed with me.
I was blunt. "Look, this cardiologist isn't going to do anything for her. Let's get another doc in on her case who's going to do something."
I named another cardiologist. "I know this doctor. I've seen him in the CCU at all hours of the night. He's smart, he's sharp, and he cares."
Laura's nurse agreed with me. She went back to the desk and got things rolling. Shortly afterward, the cardiologist's physician's assistant came to Laura's bedside. She listened to our concerns after reviewing her medical record and prescribed a chest X-ray, furosemide, and an additional dose of diltiazem.
Laura's condition improved, and she was discharged the following day with new medications and a new cardiologist to care for her.
She never would have made it to another day without prompt, decisive intervention. If we had ignored her statements, failed to listen to her, and not acted promptly, Laura may have died that day.
Although Laura's BP was stable, she was not fine. We listened to her with our ears and our hearts, and that is how her life was saved.
Listen to your patients. Because you are the voice for your patients, and they will not be heard if you do not speak for them. If they are not heard, their voices may be silent forever.
* The patient's name has been changed to protect privacy. [Context Link]