He was curled on his side, his back to me, obviously faking sleep. Mike (not his real name), age 38, had been scheduled for triple coronary artery bypass grafting (CABG) at 6 am. "He's edgy," the night nurse had said. His size alone seemed enough to heat the room. His wife sat in a corner chair. We glanced at the clock: 6:32 am. She mouthed, "Where are they?"
As I left the room I saw the resource nurse. "We had a fly-in," she said. "Your CABG will be Dr. Kent's second case. He was the only physician available to take it."
That meant that Mike wouldn't have surgery until at least 11:30. He had overheard the explanation and was sitting on the edge of his bed. "What's that supposed to mean?" he demanded. "Dr. Kent took an emergency case this morning," I answered. "You'll be his very next case." "That pisses me off!!" he blurted, throwing a pillow to the floor. I glanced at his heart rate. "I haven't eaten anything since last night. I haven't had a beer. I held up my end of the deal. I'm first!!" He was waving his arms and I thought I might be knocked unconscious if I came too close.
"I know this is disappointing," I said, "but I'm here to help you through this."
"Then get a doctor to do this surgery now," he said, leaning toward me from the bed. "I've been through enough of this crap. I'm not waiting any more."
I spoke more pointedly. "Sir, no doctors will be available until they are done with their cases. You need this operation and you're fortunate to have one of the best heart surgeons in the nation. Please sit back and try to rest. You'll need your energy."
His shoulders lost some of their tension. He allowed me to do a quick assessment.
"I'll look after him," his wife said, indicating that she was used to this.
But by 7:40 she was at the station.
"He's not going to wait any more," she said. "He told me to get him breakfast. I don't know what to do. His father died at 42 of a heart attack." Stomach churning, I headed back to his room. "Hi, Mike," I said. He was sitting up, arms crossed. "What's going on?" "I'm going to have breakfast," he said. "If I can wait for them, they can wait for me."
I took a chance and sat at the end of his bed. "It's not the doctors you're waiting for, Mike," I said. "You're waiting for a life to be saved so yours can be next. If you're not ready, they'll take the next patient. You can have ice chips to keep your lips moist. But you must not eat." He seemed to consider what I'd said. Hoping the surgeon would come soon, I gave ice chips to Mike's wife.
At 9 am I heard Mike's wife yell, "Damn you, Mike!!" She burst from the room, in tears. Mike charged out behind her, tearing off his heart monitor and swearing. He threw it, and the batteries popped out on the floor.
As Mike peeled the tape from his iv, I walked up to him and looked him in the eye. I put my hand over his at the iv site. I felt very vulnerable, and I hoped that I'd already gained his trust by responding calmly and doing my best to make him feel understood and in control. "Please wait," I said, and he didn't resist when I tugged him back into his room.
He began muttering about doctors playing games, about his "not caring anyways." I sat next to him on the bed. "I know you're hungry and uncomfortable," I said, "but you're just a couple of hours away from the rest of your life." As he ranted that he was going to "rip apart the guy" who'd made him wait, I put his monitor back on, retaped his iv, and squeezed his hand. His voice was still angry, but his gaze had softened. I sensed that he really did want the operation. He promised to wait.
The operating room team came at noon. He griped at them too. I told him I'd be eager to see him after the operation.
The next day he was ambulating laps around the stations, pushing his chest tube drains, catheter, and iv pole. When he saw me, he announced, "That nurse saved my life. You made me believe in this," he said, pointing to his heart.
Mike was discharged from the hospital within 48 hours. He sent me flowers a month later.