We had a patient with prior history of breast and lung cancers, who was admitted to CCU after suffering massive hemoptysis leading to cardiopulmonary arrest. The patient was treated aggressively with cooling and with maximum medical management. The patient was initially comatose, but did much better than anticipated. She regained consciousness, then developed unexpected peripheral motor quadriplegia, likely due to a paraneoplastic syndrome. Full workup had excluded treatable problems like Guillain-Barre syndrome. The patient became fully awake, cognitive and coherent. Her husband was her only family support as she was estranged from her children. He was devoted to her and heartbroken because of her medical issues. After a number of days without improvement, it was clear that the patient would never fully recover, or be dependent for weeks or months. The patient had been very active and did not want the complete dependency that she would be looking forward to with continued maximum medical intervention and ventilation. She did not want a PEG or tracheostomy.
Dawn worked a number of days with the patient and her husband. She helped the patient and her husband understand palliative care and hospice care. She helped them come to grips with the patient's devastating medical problems. The patient and her husband made the decision for hospice care. The patient was extubated. Dawn made sure that the patient was moved to Dove House exactly at 4 hours extubation so that the patient could be in a comfortable environment as long as she had left with her beloved husband and with her 2 dogs that she had missed tremendously.
Dawn's professionalism and compassion were awesome. She exemplifies the qualities recognized in the DAISY Award.