Nursing Compassion

Her Last Wish

Chrissy and mom at her wedding at hospitalChrissy McAlduff’s wedding on July 29, 2011 was everything she hoped it would be… and more. It’s hard to believe when a month earlier her mother, Arlene Almeidea, had been told she had very little time left to live. The 58-year-old adoring mother and proud grandmother’s stage 3 gastric cancer had taken a turn for the worse and all hope of remission vanished. However, something far more powerful emerged when severe pain brought Arlene to Milford Regional’s fifth floor, for their care would transcend anything they could ever imagine.

When Arlene was asked by family members what she wanted to do in the time she had left, having Chrissy’s wedding topped the list. “She said, ‘Let’s do it in a month,’” Chrissy recalls.

Susan Primeau, RN, nurse manager of MRMC’s fifth floor, was determined to make that happen. “She told me my mom would be at my wedding,” Chrissy says. “That they would get her pain under control.”

So, when Arlene’s worsening condition prevented her from going home that week, Sue told Chrissy she could make arrangements to have the wedding at the hospital. This was nothing new for Sue, or for that matter, the entire fifth floor. They had made a collective decision over ten years ago to improve end-of-life care. “I have previous experience with close friends dying in the hospital,” Sue explains. “One was great; the other was awful. There are always big plans when you come into the world, and no plan for when you leave. I knew there had to be a better way to do it.”

Sue knew she would have vast support from a floor that was already taking extra measures on their own to provide comfort and compassion with patients close to death. “A nurse would clock out for the day and come back to sit with a dying patient,” Sue says. “Another nurse started knitting afghans as an alternative to the hospital blanket. We give it as a gift and tell them they are wrapped in our love.” Sue says the afghans also provide comfort to those left behind. “Many treasure them as symbolic of their loved one’s last moments.”

Others on the floor started bringing in rosary beads, music, reading materials, hand lotion. There was respect for every religion and cultural belief. “At first it wasn’t formulized,” Sue notes. “It came from their hearts.”

Eventually, all of these items would become part of the “comfort cart” which is also available for use by family and friends to help them better cope and bring comfort to their dying loved one. Once word got out to the community, groups and individuals began to donate items to ensure the comfort cart was always well supplied. Interestingly, the fifth floor’s instinct to provide these items to dying patients has proven science behind it. According to Donna Saul, RN, director of inpatient services, music blocks out the clinical sounds of the hospital and reduces the heart rate to make people feel more relaxed. Scented lotions instill a fragrance that diffuses hospital smells, and while human touch usually diminishes when a patient is dying, rubbing lotion on the patient encourages human caring and interaction. Reading poetry also provides a beautiful, spiritual connection.

The fifth floor’s reputation for exceptional end-of-life care precedes them inside the Medical Center. “The fifth floor is the leader in this,” Donna acknowledges. “Sometimes, people don’t know how to help someone who is going to die. The fifth floor is expert at it.”

If you ask Sue, it’s not complicated. It’s all about the patient’s life. “We want to know their story,” Sue emphasizes. “Their stories make them real. It’s not just a patient… the person doesn’t end with a diagnosis. Their value to us is immeasurable.”

When Sue and her staff learned that a young dying patient longed to visit the tropics, they transformed her room into a tropical paradise with decorations and photographs of islands and beaches. It was topped off with an order of pizza and a movie. This extraordinary level of compassion and respect are continuously recognized by those who have benefitted from it. A surviving daughter once said to Sue, “I want to make my reservation here now, because when I die, I want it to be like this.”

Several years ago, a Comfort Care Committee was established to expand the fifth floor’s initiatives throughout the hospital and continue developing new measures that improve end-of-life care. The multi-disciplinary group includes nursing, physicians, social workers, case managers, rehabilitation, pharmacy, hospice and VNA. Similar to the fifth floor’s grassroots efforts, Donna points out that this committee came together on their own because “they care passionately about the care we give at end of life.” During this time, four nurses and a social worker completed the End of Life Nursing Education Consortium (ELNEC) training program, which qualifies them to teach Milford Regional nurses how to care for dying patients.

In less than 24 hours, Sue worked with administration, care management, housekeeping, food and nutrition and her staff to prepare for Chrissy’s wedding. While some arranged the conference room, decorated it with festive purple and white balloons, and situated a wedding cake and drinks on a table draped with Chrissy’s organza, others helped assist Arlene with her hair, make-up and beautiful purple dress.

Chrissy entered the room to wedding music from Sue’s smartphone and a line of smiling, clapping nurses. All of Chrissy’s immediate family was there as well as some hospital personnel including the CEO and president. Chrissy’s mother greeted her, crying.

“It was all for my mother,” Chrissy chokes up as she remembers. “The hospital went above and beyond to give my mother her last wish. Because of them, she was there for that moment in my life I always dreamed about. I wouldn’t change one thing about it.”

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