Cardiovascular ICU Team
December 2020
Cardiovascular ICU
at University of Virginia Health
University of Virginia Health
Emily Schneiderman, NP;
Amanda Simmons, CNS;
Jena Smith, RN;
Kate Walker, RN;
Micah Smith, RN;
Gene Donovan, RN;
Erin Tennyson, RN;
Karen Forsman, Administrator;
Kevin Adams, Chaplain;
Ann Marie Smith, Chaplain;
Michele Maddox, RN;
Megan Keith, RT;
Liz Massey, PCT;
Marcia White, RN;
Arati Ghising Tamang, BSN, RN




Intensive care units rely on interprofessional teams to care for the severely ill. In the TCV ICU, we often celebrate the teamwork that goes into handling patient emergencies and complex procedures. Teamwork is demanded when multiple patient cases return from the OR all at once, or when we open a patient's chest right at the bedside. But this is not the type of teamwork I want to recognize today.
We recently took care of a patient who required ECMO and ultimately had a devastating stroke. As can be imagined, this was an incredibly distressing time for his wife and three children. When they received very difficult news about his poor prognosis, they made it clear that they would make decisions in accordance with the patient's documented wishes. They decided that they would transition their family member's care to focus on his comfort, but first, we needed to help them grant a very important wish for this man during his remaining days.
This coming November the patient was to attend the wedding of his youngest daughter. His family was overwhelmed with grief. How would they recover from his loss and celebrate the marriage without him there? His daughter decided she wanted her dad to be there no matter what. The patient's wife approached Emily Schneiderman, NP to ask permission to have a small gathering in the room later that day so that her daughter could get married. Emily assured them that of course, they could do this and that we would all support them. She was able to pull off being a great LIP to all of her patients and a LIP/wedding planner extraordinaire to the father-of-the-bride.
The incredibly orchestrated heartfelt response compelled me to nominate my colleagues for a DAISY Team Award. So many moving pieces needed to come together to help this family pull off a marriage ceremony and celebration in the hectic setting of the TCV ICU. From the bedside to the c-suite, it was evident that respect for the patient and family-centered care is not just a goal on paper, it is our culture. I will never succeed in sharing all of the incredible details and adequately thanking every individual who helped us pull off a beautiful wedding for this family, but I will try to paint the picture as best I can.
Emily approached Amanda Simmons, CNS about the wedding plans and Amanda contacted the chaplaincy department to get the ball rolling right away. Amanda would also go on to ensure the unit was free of any alarm cacophony during the actual ceremony - a very important detail! The father-of-the-bride's bedside nurse was Jena Smith. She is an incredibly compassionate, skilled, and detail-oriented clinician who the family already knew and trusted. Jena handles the complexities of critical care with poise and thoughtfulness matched by few. ICU rooms can get cluttered with supplies, but Jena's meticulous nursing care ensured that her patient's room was immaculate for the ceremony. Devices were draped with white sheets. She bathed and shaved the patient, and had him looking a bit more like himself in his own long-sleeved button-down shirt.
Kate Walker, another team-oriented bedside nurse, offered her support to the wedding preparation and to Jena by taking on Jena's second patient as an extra assignment. Kate also coordinated getting a beautiful wedding cake brought to the hospital in time for the ceremony and reception. Micah Smith was in charge. He is always calm under pressure and his energy trickles down to calm the rest of us. He made sure that everyone got the support they needed, and fielded many of the wedding-related phone calls in addition to coordinating the admission of patient cases. Gene Donovan came in to admit cases and keep the unit running smoothly.
Many nurses popped in and out to write heartfelt wedding cards to the soon to be newlyweds and offer a helping hand to Jena and the patient's oldest daughter as they decorated the room. To conceal the clunky monitors, the ventilator, the IV pumps, and other devices, Erin Tennyson used white bedlinens and re-fashioned them to create a space that glowed with tranquility. Beautiful calligraphy and drawings of eucalyptus and were strung up and offered an ethereal effect. The floors sparkled thanks to our incredible housekeeping team. Karen Forsman, the associate chief for UVA Heart and Vascular made sure that no one would go hungry during this celebration. She gifted the family a beautiful spread of hors d'oeuvres that completed the scene of the celebration.
Staff chaplain Kevin Adams came up to meet the family and would go on to perform a beautiful marriage ceremony. It was Ann Marie Smith's day off and she was the chaplain with whom the family had a very close relationship. She still managed to make it to the hospital in time to attend the ceremony and share her blessings with the family. It meant so much to them to have her there.
Michele Maddox, our assistant nurse manager, helped to coordinate a harpist for the ceremony. She and Marcy White, our nurse manager, worked together to make sure all of our nurses had the resources they need to provide patient care and pull of this wedding at the same time. Before the ceremony began, the respiratory therapist Megan Keith performed deep suctioning and endotracheal suctioning to help manage the patient's copious secretions. This was a compassionate proactive intervention to mitigate the risk of him gagging and drooling during the ceremony and the photography that would follow. Michele, Marcy, Amanda, and all of our PCTs ensured the patient's blood glucose levels were checked so that Glucommander would not start beeping about overdue sugars during the ceremony. Liz Massey, PCT circulated about to ensure all of our patients were rounded on and that call alarms would not be sounding.
The ceremony went off without a hitch. Relieved of having to coordinate all of these details themselves, the family had had time to leave the hospital and get dressed up. They returned looking refreshed and ready to make this a day of celebration that they could share with this very special man.
I was providing care for other patients and wasn't able to watch the delivery of vows or the exchange of rings, but I poked my head in right afterward. What I saw still brings tears to my eyes and a soft chill to my entire being. Both daughters were holding their bedridden father's hands. They twirled around still holding on to him, dancing to the Elvis tune I was told would have been their father-daughter dance this upcoming October. They were crying and smiling. The newlywed daughter kissed her father's forehead and told him "I love you so much, Dad. You are so strong. Thank you for hanging on to be here for the wedding."
The next day I had the honor of being the bedside nurse for this patient and his family. We helped them grant his second wish, that he would receive comfort care and pass peacefully when his time came. I stood by his side with his wife and three children. We were joined by their chaplain Ann Marie. Elvis sang on in the background. The family expressed great relief that he was no longer suffering, and that he was allowed a natural death. They made their gratitude to our team well known.
We helped to create space for joy amidst sorrow. We supported this family holistically. The work we did together to facilitate the bedside wedding of this patient's daughter demonstrates our collective engagement in UVA Health System's values, especially the values of professionalism, integrity, and respect. I am grateful that I work with a team that can tend not only to crashing hemodynamics but to the spiritual and emotional crises that our patients and their families experience.