The patient had atypical carcinoid tumor of the lung status post chemoradiation and pneumonectomy with metastasis to her femur, liver, adrenals, pancreas, abdominal wall and brain. She was diagnosed in 2013. She presented to the emergency room with hypoxemic respiratory failure so she was intubated and admitted to Tower 7 MSICU Blue. She was eventually extubated to a facemask when she expressed her desire to transition to comfort care. She told her husband that she had lived way past her life expectancy and she was tired. Palliative care was consulted to discuss goals of care. Her husband agreed that she had been suffering for too long and her wishes were clear, she no longer wanted to suffer. He respected and supported her decision to transition to comfort-focused care. He stated that the patient's family was very supportive of her decision to not pursue any further aggressive treatment. They did not plan for things to turn out the way they did and that added to their distress. They always expected her to be at home or get better and to be out in nature but things did not work out that way and he wanted to respect her wishes.
Iris Barnaja was their nurse on the day they decided to transition to hospice. The patient’s decision was emotionally difficult for everyone on the unit. She was only 47 years old and they had two young children. In her usual style, Iris stepped up to take care of this family. She leaned into their distress and sadness and provided extraordinary care. Iris was instrumental in providing the right amount of medicine to control her pain. She maintained a quiet and peaceful environment for the husband and children so that they could spend the last few treasured moments together as a family. She coordinated all the teams of physicians, social workers, palliative care team, lift team and child life so that the care was seamless. Iris worked to provide an environment that was as compassionate and tender as her nursing care. She wanted the care to be so flawless so the family could forget they were in an ICU. And she succeeded.
I cannot imagine the sadness and pain of losing a life partner and the mother of young children. Nor could I imagine the sadness of a child losing a parent. Iris was able to provide more than a calm peaceful experience – she was able to provide a lasting loving memory of a wife and mother. All the family knew was that they were together as a family and the patient was able to spend her last precious moments with her children.
It is an honor and great privilege to work with Iris who role models extraordinary compassion every day. If you ask her, she would say, “it’s nothing”, that she was “called” to be a nurse.