I was serving as a sub-intern on my rotation in the general medicine service. Brittany and I were sharing a patient suffering from RIME (reactive infectious mucocutaneous eruption), a rare rash that mimics Steven-Johnson syndrome and is extremely painful/pruritic. This patient was speaking and had a significant language barrier with no English-speaking family members. During my time as the primary physician taking care of this patient, in both the MICU and on the general floor, I noticed that this patient's symptoms were not ideally controlled. She had pain that was relatively refractory to her current therapy at the time, as well as significant pruritis.

Brittany reached out to me while taking care of the patient on 4JPP with concerns regarding her symptom control. She also astutely tracked the patient's vitals, beyond that which was required, to discover a low-grade fever that the team and I were unaware of. She also took time to reconcile the patient's lab values, pointing out the patient was thrombocytopenic and appropriately questioned whether her DVT prophylaxis was medically indicated. Perhaps the most impressive part of Brittany's extraordinary care pertained to her dedication to patient communication, especially in the setting of a significant language barrier. Brittany took a surmountable amount of time out of her already busy schedule to thoroughly communicate with the patient and her family via the interpreter. Ultimately, she discovered that the patient's pain was poorly controlled, but even better, she honed in on the specific areas, a question the team had assumed was already answered. Prior, we had thought that most of her pain was well controlled, though we had focused on the abdomen. Brittany was able to discover that the patient's oral mucositis (related to her rash) was the largest source of uncontrolled pain and that her current therapy was inadequate, and possibly irritating the patient's oral mucosa further. Brittany suggested switching to a specific therapy, which provided significant symptomatic relief. Another impressive aspect of Brittany's care and, quite frankly, her thoughtfulness was her creativity regarding her clinical problem-solving. For example, the patient was getting daily Chlorhexidine baths which were extremely irritating to her painful sloughing and pruritic rash. Brittany suggested placing a temporary CHG-allergy on the patient's chart in order to avoid causing additional unnecessary pain.

Perhaps the most encouraging and impressive part of Brittany's care is that this was simply normal for her. I could tell she was no stranger to advocating for her patient's care and that she had a great heart for them. While I have been impressed with the care that UIHC nursing staff have provided for our patients, Brittany stood out above the rest with her commitment to excellence. If any patient on my entire service needed a nurse like Brittany, it was this one, and I am so grateful for her compassion for her patients. She truly changed the patient's care, perhaps in ways that our team of physicians could not. She clearly is talented, thoughtful, and outstanding at her job.