As if straight out of a movie, the words both stunned and chilled me: "Peter has been in an accident," cried my sister-in-law. From the tone of her voice, I could tell this was serious. "I had to give consent for emergency surgery and blood transfusions. They don't know what's wrong or if they can save him," she continued. However, I found myself entering a state of denial. My brother had been in a similar accident 10 years before, so these procedures were not new to us; however, the injuries this time were much more severe.
Peter had been directly hit by a drunk driver while riding his motorcycle home from work. He was traveling at 45 miles per hour-the speed limit in the area-and did not have time to slow down or turn.
By the time my brother arrived at the ED, he was in cardiac arrest. He appeared to be hemorrhaging, but the source was not apparent. During emergency surgery, they found that his femoral arteries had been lacerated by a crushed pelvis. He received all 100 units of the hospital's blood bank. He was somewhat stabilized, placed on mechanical ventilation, and transferred to the ICU. Shortly thereafter, the list of his injuries and complications started to grow. I had been a nurse for 11 years and I knew that his chances of survival were slim. Early the next morning, we began the long drive to South Carolina from Florida to see him.
Like most RNs, I have seen my fair share of horrible scenes. I have sat at the bedside of patients while they take their final breaths. Despite these experiences, I was not prepared for what I saw when I walked into his room that December afternoon.
My brother was nearly unrecognizable. I had to move close to his face to see if it was really him. I was in utter disbelief; he had been fine at this time the day before. How had this happened?
In the following hours, days, weeks, months, and years, I have learned many lessons that I never would have had I not been in this situation. I now have first-hand knowledge of the obstacles patients and families face because of severe traumatic injuries and long stays in the ICU. Perhaps the most surprising of these lessons is the deep emotional bond that develops between patients, families, and caregivers in the ICU and the lasting impact this has on them. For the most part, this relationship produces positive memories. However, being transferred from the ICU to another unit can be traumatizing.
When a patient is transferred directly from an ICU to a medical or surgical floor (not progressive care or "step-down"), the change in the level of care may be difficult for patients and their families. In the ICU, where the nurse-to-patient ratio is low, certain levels of attention and family interaction are expected. Healthcare providers (HCPs) make frequent rounds and spend time explaining things and answering questions; sometimes they just listen. It was not uncommon for us to receive phone calls from various nurses and HCPs to share new results and touch base about my brother's condition. We heard from them so often that we recognized their voices on the phone. The patient and family take comfort in this attention such that a sudden transition of care-from a nurse-to-patient ratio of 1:2 to 1:5 or even 1:8-can increase anxiety and concern among patients and their families. They may notice that no one comes to the room every few minutes and that HCPs don't check in as often throughout the day. They may perceive a lack of care from the staff.
In the case of my brother's hospitalization, the bond that developed between my family and the ICU staff presented another difficulty of leaving the unit. This staff journeyed with us through the crisis. They were often the only other people who truly understood what we went through. We think of these nurses each time we think about how my brother thankfully survived. Indeed, the role of nurses in helping patients and families cope with dire situations cannot be underestimated.
To all the incredible ICU nurses everywhere: Thank you for saving lives, instilling hope with empathy and compassion, and excelling at what you do every day.