This past October our hospital has become certified as a Cardiac Arrest Center. They rolled out a new standard for patients who have suffered from a cardiac arrest in a non hospital setting. We were all trained about two months ago on a hypothermia treatment. Our first patient that came to the Cardiac Cath Lab was just last week. Here is the scenario: A 60 ish man was playing sports with friends when he collapsed. One of his friends immediately started CPR and called 911. When EMS arrived they shocked him and his rhythm and his breathing returned but he did not wake up. EMS covered his body with ice and transported him to the hospital. Immediately upon arrival they put a Velcro vest and pants on the man and moved him to the cath lab. We were ready with the machine that hooks up to the vest and pants and started the cooling of his body to around 32C. We proceeded with a heart cath and found that he had small vessel disease. (Essentially, this means that there is nothing in his arteries we can fix). His left ventricle was a different story. It was pumping at only around 5-10%. (This is called Cardiomyopathy) So, we figured that he may need an AICD (automatic internal cardiac defibrillator) to shock his heart out of any future rhythms that can cause sudden death. We sent him to the ICU and kept him cool for around 24 hours. Then they will slowly start re-warming him over the next 24 hours. When the procedure was over I went to the waiting room to get the family. There I met his beautiful young daughter and by the grace of timing was allowed to meet the man who did the CPR, along with his wife. I spent a few moments with them hearing the story and telling them how truly inspiring they were to me. I took the daughter back to meet the Doctor and they talked about the hard things. She asked if he would wake up, he told her he did not know. She told the Doc that she had had this conversation with her dad and if he was not going to wake up she could not keep him on life support, per his request. He explained our protocol and assured her that he was on the same page as they were. She agreed to the protocol.
After a day off, I found out that he did well and is on the schedule for an AICD. Yesterday I went up to meet the man. Wow, what an incredible person this guy is. He is fully alive in every sense of the word. He is a very funny man, and again by the grace of timing the friend who saved his life and his wife were there. I sat for a moment to hear their stories. The man told me that his whole life has been this way; he is always in the right place at the right time. I loved his zest for life and his sense of humor. He lives life to the fullest every day. Makes homemade Western movies with his friends and plays sports. I told him that I had been calling him "The Iceman", he loved it. I am sure that I could listen to this man talk about his life for hours and I feel very proud to work some place where this work is being done. On my way out of his room I asked him "what will you do differently now with the second chance at life?" He said, "live life with less inhibition."
With the old protocol these patients have a 16% chance of survival. The new protocol increases survival to 74%.
Tuesday, November 18, 2008
Sunday, November 2, 2008
Imagine
I hope the following story will help to guide you on a journey of self-discovery and growth; that it awakens your ability to see our patient’s perspectives and help you to notice an old way of speaking and the power of body language that can add to our patients already traumatic experiences. Imagine how it could be different. Ask yourself “what can I do to push the bar ever further?” Although this story is fictional, the events and attitudes are based in truth from things that I have witnessed and been a part of in my 21 years in the Cardiac Cath Lab.
You wake up with a busy day planned, work, meetings, kids, and family. You are going about your day and suddenly you start experiencing some discomfort in your chest. It catches you by surprise; you do not give it much thought. It comes and goes for about 20 minutes. Then suddenly, it will not stop; in fact, it is getting worse. A million things start going through your mind, my husband, my kids, (where is my insurance card?), my job, and my parents. Surely, I cannot be having a heart attack; I am too young for that. Then you think should I go to the hospital. By now, the pain is getting worse. You call 911. The next thing you know the fire department is rushing through your door. It is all happening so fast, you are frightened, and your heart is racing. They start an IV; all the while, they are asking you 50 million questions about your medical and family history. “Are you a smoker?” they ask. You say “yes,” they tell you, “not anymore.” You are being rushed now to the Emergency Department at your local hospital via ambulance. On arrival your care and treatment is turned over to the Emergency Department staff. They, ask, “Are you a smoker?’ you say “yes,” they tell you, “not anymore.” Things are getting a bit fuzzy and you know that something is not right as you fearfully fall asleep. As you awake you are told that, “your heart went into a funny rhythm and we had to shock you out of it, don’t worry we’ll take care of you.” Now another team from the Cardiac Cath Lab enters the scene and you are taken by this team to the Cath Lab for a “procedure.” You notice that they are running down the hall, which increases your fear. They ask you, “are you a smoker?” you say “yes,” they tell you, “not anymore.” You are put into a room that is extremely cold, several people are around you and moving furiously to get your clothes off and hook you up to all sorts of things. You are embarrassed about the fact that you are a smoker, (you have tried to quit several times). You apologize for your weight as they remove your underwear to shave your groin for the procedure. You barely meet the doctor who is now going to put a tube into your groin, which travels to your heart to see which one of your coronary arteries is blocked. (This feels very uncomfortable to you because you look everything up on the internet before making any decisions). This feels like a nightmare. The Doctor first question is, “are you a smoker?” You say, “Yes” he continues asking you so many questions and you can hardly remember your name at this point. Someone tells you that your husband and kids are here in the waiting room, now your mind shifts to them, and the thought that you could have just died, and better yet, you still might. So many things are swirling around in your head. You start to cry and the doctor insists that he gave you enough numbing medication and he is not hurting you. Why are you crying? They sedate you and when you are almost awake, The doctor tells you that you have a blockage in your right coronary artery. You have the choice to put a stent in or go for bypass surgery. You have no idea what either of these things entails. You are frightened beyond imagination. The staff is telling you not to worry and that it will not be so bad. More sedation comes as you tell the Doctor that they are the experts and to do what is best. You have never let someone take total control of your life before now. You feel helpless. When the procedure is over you hear the Doctor say, “I will go out, and talk to her family.” It makes you wonder what happened, you cannot remember everything and you are worried about what the Doctor did, and if you are okay. The nurse brings you a pill and tells you that you will be taking one everyday for the next year or so. Do not stop taking this no matter who tells you to except for the Cardiologist. Asking questions to the staff is futile at this point; you know they are not at liberty to tell you. When the procedure is over you are transferred back to a cart where you await transport to a room to recover. Someone says to you, “that wasn’t too bad now was it?” (Are you kidding me?) Your family all meets you there and the staff asks them to wait for a minute while they get you settled. You can see the tears in your family’s eyes and it adds to your sadness and confusion. The Cath Lab hands your care over to the Nurse that will take care of you for the next few hours. She says, “Hi, I am your nurse for the day, are you a smoker?” your guilt is starting to mount as your family starts filing in to see you. They assure you that you will stop smoking and lose some weight. All you want is to scream! “Okay already!” “When did I lose control of my life?” You leave the hospital with this set of new rules and a bag full of despair. At some point, real depression sets in as the guilt of smoking and being overweight becomes a constant reminder. You have tried it, but you do not have the tools or the right state of mind to make positive changes.
If this were hard to imagine, maybe it would be easier to imagine being the husband, daughter, son, or parent of this patient. What these patients mostly desire is nonjudgmental care. They already know what they need to change. We all know what is healthy for us, right? People generally do until that “little voice” in your head chimes in, like when you are eating a double cheeseburger combo meal. It tells you, “Just this once will be okay.”
When our patients receive a diagnosis of heart disease, they not only get a diagnosis that disappoints them, but a dictated set of “new rules” from medical staff on how to live their lives. (Lose weight, quit drinking, quit smoking, take all these medications, and get more exercise, etc.). This is where their inner critic rears its ugly head, the patient feels guilty, depressed and hopeless. That critic convinces us that we cannot change, and that we are nuts for even entertaining the idea. It points out our past blunders and our current shortcomings. In most cases this is a negative place to be for passionate change, we remain where we are and hope by some “medical miracle” that we get better.
This scenario could happen at any moment to you or someone you love. How would you want them to be treated with all of their imperfections? What you do and say as a medical professional can give these people the best chance for “true resuscitation.” My wish is that you will see how small changes can benefit our patients for a lifetime. How can you empower your patient for change?
Most of us desire to make a difference in the patient’s experience. If we did not we would not be here. We only have a short time to touch their lives in a way that compliments their care. Focusing on what is happening now, and asking compassionate questions is the key. Not asking the old rhetorical questions out of habit like, “That wasn’t so bad now, was it?” Create barriers in communication between you and the patient. These questions tend to lead the patient away from their true experience and sets up possible defeating thoughts in their minds like “other patients must be tougher that me”, or “I must be weak because I was scared to death in there! “ This kind of questions also sets up a path for the caregivers responses, which shield them from having to be in the present. We are task oriented and life is at stake. It also keeps us from having to listen to the patient. I have found as a caregiver, by staying in the now and going through the experience with the patient, it allows me to have a deeper and more meaning experience. Here are some examples of questions to try.
“How was that for you?”
“ What would make this easier for you?”
“ How can I support you in this?”
“Can I do more for you? “
Most of all is to be willing to hear the answers. I assure you that it does not take any more time. It also allows you to take the patient a step beyond in their process. We have no idea what has went on in this patient’s life before they made it to us and minimizing their perception can be deflating. Their tolerance may be spent. When a patient cries, please do not stop them, do not tell them not to cry, and that it will be okay. Crying is a great stress relief, (and you really have no idea if it will be okay). A compassionate smile and a moment to listen will work wonders. Try to imagine where they are and choose to be in their experience with them. We take an amazing trust that they give us for granted. What they are looking for is a person who will witness their experience and see them as more than just the next patient. Call it an empowerment team if you will, believing that they can make it through and that they have the ability to make changes. Be assured that these people know all of the bad habits they need to change and that several people will be involved in reminding them along the way. Ask yourself if you will, "Do I really need to know if this person smokes to give them the best care, or is it a way to shame them into changing?" Notice when we have a patient that is one of the cath lab team’s family, we take care of them with a tender heart. Open your heart to all patients and notice how it changes your life.
Two years ago, I decided to become a Life Coach. The results were so astounding for me personally that I started introducing techniques in my professional work. My interaction with coaching clients as well as my patients has become more genuine and rewarding. The outcomes have opened my eyes to the need of coaching in our field. That is how The Cardiac Coach was born.
Here is what it looks like from a coaching standpoint. I ask “What have you noticed about your experience.” then I will ask them to go deeper in to that. (The feelings are the same as all other feelings of grief). If they are angry, I will go into the anger with them. Let them be angry. If they want to cry, I let them cry. I want my patients to honor all of their emotions, not just the good ones. They are all a part of who we are. After I notice a shift in their emotions, (which usually happens quickly when a person is allowed to experience what is reality for them), then we can deal with what is to come. So many people go right to the “be positive thing.” Do not get me wrong, it is a great thing to be positive, but literally impossible with underlying suppressed emotions. When you experience what is happening right now, you are free to move forward. The next step is eliciting the patient’s values, beliefs, fears, and support system. From here, you can plan your health goals in a way that is true for that individual.
What is coaching? Coaching gives patients your presence. I find that most patients have emotions that need to be expressed before they can even get to a place of change. Once they have really worked through what is going on inside of them, they can begin to see the different perspectives and find a way to achieve what they instinctively know is right for them. Coaching is a way of listening and asking questions that elicits the client’s true desires and values. The change then comes from their values, intensity, and aliveness. I assist them in processing emotions, visualizing what is possible, making realistic goals, setting up support systems, conquering obstacles and self-limiting behaviors as well as focus and accountability. Coaching improves clinical outcomes by less hospital admittance and more compliancy in self-management. Having a coach who is in your corner increases patient motivation and action.
A happy and healthy life is within reach.
For more information go to call Terri @480-821-0013 or
www.thecardiaccoach.com
Terri L. Wolf
RCIS, Cardiac Cath Lab
Professional Co-Active Coach
Banner Heart Hospital
Mesa, AZ 85206
You wake up with a busy day planned, work, meetings, kids, and family. You are going about your day and suddenly you start experiencing some discomfort in your chest. It catches you by surprise; you do not give it much thought. It comes and goes for about 20 minutes. Then suddenly, it will not stop; in fact, it is getting worse. A million things start going through your mind, my husband, my kids, (where is my insurance card?), my job, and my parents. Surely, I cannot be having a heart attack; I am too young for that. Then you think should I go to the hospital. By now, the pain is getting worse. You call 911. The next thing you know the fire department is rushing through your door. It is all happening so fast, you are frightened, and your heart is racing. They start an IV; all the while, they are asking you 50 million questions about your medical and family history. “Are you a smoker?” they ask. You say “yes,” they tell you, “not anymore.” You are being rushed now to the Emergency Department at your local hospital via ambulance. On arrival your care and treatment is turned over to the Emergency Department staff. They, ask, “Are you a smoker?’ you say “yes,” they tell you, “not anymore.” Things are getting a bit fuzzy and you know that something is not right as you fearfully fall asleep. As you awake you are told that, “your heart went into a funny rhythm and we had to shock you out of it, don’t worry we’ll take care of you.” Now another team from the Cardiac Cath Lab enters the scene and you are taken by this team to the Cath Lab for a “procedure.” You notice that they are running down the hall, which increases your fear. They ask you, “are you a smoker?” you say “yes,” they tell you, “not anymore.” You are put into a room that is extremely cold, several people are around you and moving furiously to get your clothes off and hook you up to all sorts of things. You are embarrassed about the fact that you are a smoker, (you have tried to quit several times). You apologize for your weight as they remove your underwear to shave your groin for the procedure. You barely meet the doctor who is now going to put a tube into your groin, which travels to your heart to see which one of your coronary arteries is blocked. (This feels very uncomfortable to you because you look everything up on the internet before making any decisions). This feels like a nightmare. The Doctor first question is, “are you a smoker?” You say, “Yes” he continues asking you so many questions and you can hardly remember your name at this point. Someone tells you that your husband and kids are here in the waiting room, now your mind shifts to them, and the thought that you could have just died, and better yet, you still might. So many things are swirling around in your head. You start to cry and the doctor insists that he gave you enough numbing medication and he is not hurting you. Why are you crying? They sedate you and when you are almost awake, The doctor tells you that you have a blockage in your right coronary artery. You have the choice to put a stent in or go for bypass surgery. You have no idea what either of these things entails. You are frightened beyond imagination. The staff is telling you not to worry and that it will not be so bad. More sedation comes as you tell the Doctor that they are the experts and to do what is best. You have never let someone take total control of your life before now. You feel helpless. When the procedure is over you hear the Doctor say, “I will go out, and talk to her family.” It makes you wonder what happened, you cannot remember everything and you are worried about what the Doctor did, and if you are okay. The nurse brings you a pill and tells you that you will be taking one everyday for the next year or so. Do not stop taking this no matter who tells you to except for the Cardiologist. Asking questions to the staff is futile at this point; you know they are not at liberty to tell you. When the procedure is over you are transferred back to a cart where you await transport to a room to recover. Someone says to you, “that wasn’t too bad now was it?” (Are you kidding me?) Your family all meets you there and the staff asks them to wait for a minute while they get you settled. You can see the tears in your family’s eyes and it adds to your sadness and confusion. The Cath Lab hands your care over to the Nurse that will take care of you for the next few hours. She says, “Hi, I am your nurse for the day, are you a smoker?” your guilt is starting to mount as your family starts filing in to see you. They assure you that you will stop smoking and lose some weight. All you want is to scream! “Okay already!” “When did I lose control of my life?” You leave the hospital with this set of new rules and a bag full of despair. At some point, real depression sets in as the guilt of smoking and being overweight becomes a constant reminder. You have tried it, but you do not have the tools or the right state of mind to make positive changes.
If this were hard to imagine, maybe it would be easier to imagine being the husband, daughter, son, or parent of this patient. What these patients mostly desire is nonjudgmental care. They already know what they need to change. We all know what is healthy for us, right? People generally do until that “little voice” in your head chimes in, like when you are eating a double cheeseburger combo meal. It tells you, “Just this once will be okay.”
When our patients receive a diagnosis of heart disease, they not only get a diagnosis that disappoints them, but a dictated set of “new rules” from medical staff on how to live their lives. (Lose weight, quit drinking, quit smoking, take all these medications, and get more exercise, etc.). This is where their inner critic rears its ugly head, the patient feels guilty, depressed and hopeless. That critic convinces us that we cannot change, and that we are nuts for even entertaining the idea. It points out our past blunders and our current shortcomings. In most cases this is a negative place to be for passionate change, we remain where we are and hope by some “medical miracle” that we get better.
This scenario could happen at any moment to you or someone you love. How would you want them to be treated with all of their imperfections? What you do and say as a medical professional can give these people the best chance for “true resuscitation.” My wish is that you will see how small changes can benefit our patients for a lifetime. How can you empower your patient for change?
Most of us desire to make a difference in the patient’s experience. If we did not we would not be here. We only have a short time to touch their lives in a way that compliments their care. Focusing on what is happening now, and asking compassionate questions is the key. Not asking the old rhetorical questions out of habit like, “That wasn’t so bad now, was it?” Create barriers in communication between you and the patient. These questions tend to lead the patient away from their true experience and sets up possible defeating thoughts in their minds like “other patients must be tougher that me”, or “I must be weak because I was scared to death in there! “ This kind of questions also sets up a path for the caregivers responses, which shield them from having to be in the present. We are task oriented and life is at stake. It also keeps us from having to listen to the patient. I have found as a caregiver, by staying in the now and going through the experience with the patient, it allows me to have a deeper and more meaning experience. Here are some examples of questions to try.
“How was that for you?”
“ What would make this easier for you?”
“ How can I support you in this?”
“Can I do more for you? “
Most of all is to be willing to hear the answers. I assure you that it does not take any more time. It also allows you to take the patient a step beyond in their process. We have no idea what has went on in this patient’s life before they made it to us and minimizing their perception can be deflating. Their tolerance may be spent. When a patient cries, please do not stop them, do not tell them not to cry, and that it will be okay. Crying is a great stress relief, (and you really have no idea if it will be okay). A compassionate smile and a moment to listen will work wonders. Try to imagine where they are and choose to be in their experience with them. We take an amazing trust that they give us for granted. What they are looking for is a person who will witness their experience and see them as more than just the next patient. Call it an empowerment team if you will, believing that they can make it through and that they have the ability to make changes. Be assured that these people know all of the bad habits they need to change and that several people will be involved in reminding them along the way. Ask yourself if you will, "Do I really need to know if this person smokes to give them the best care, or is it a way to shame them into changing?" Notice when we have a patient that is one of the cath lab team’s family, we take care of them with a tender heart. Open your heart to all patients and notice how it changes your life.
Two years ago, I decided to become a Life Coach. The results were so astounding for me personally that I started introducing techniques in my professional work. My interaction with coaching clients as well as my patients has become more genuine and rewarding. The outcomes have opened my eyes to the need of coaching in our field. That is how The Cardiac Coach was born.
Here is what it looks like from a coaching standpoint. I ask “What have you noticed about your experience.” then I will ask them to go deeper in to that. (The feelings are the same as all other feelings of grief). If they are angry, I will go into the anger with them. Let them be angry. If they want to cry, I let them cry. I want my patients to honor all of their emotions, not just the good ones. They are all a part of who we are. After I notice a shift in their emotions, (which usually happens quickly when a person is allowed to experience what is reality for them), then we can deal with what is to come. So many people go right to the “be positive thing.” Do not get me wrong, it is a great thing to be positive, but literally impossible with underlying suppressed emotions. When you experience what is happening right now, you are free to move forward. The next step is eliciting the patient’s values, beliefs, fears, and support system. From here, you can plan your health goals in a way that is true for that individual.
What is coaching? Coaching gives patients your presence. I find that most patients have emotions that need to be expressed before they can even get to a place of change. Once they have really worked through what is going on inside of them, they can begin to see the different perspectives and find a way to achieve what they instinctively know is right for them. Coaching is a way of listening and asking questions that elicits the client’s true desires and values. The change then comes from their values, intensity, and aliveness. I assist them in processing emotions, visualizing what is possible, making realistic goals, setting up support systems, conquering obstacles and self-limiting behaviors as well as focus and accountability. Coaching improves clinical outcomes by less hospital admittance and more compliancy in self-management. Having a coach who is in your corner increases patient motivation and action.
A happy and healthy life is within reach.
For more information go to call Terri @480-821-0013 or
www.thecardiaccoach.com
Terri L. Wolf
RCIS, Cardiac Cath Lab
Professional Co-Active Coach
Banner Heart Hospital
Mesa, AZ 85206
Saturday, November 1, 2008
Watch out She's a Mean One
This story happened not too long ago, we went to a patients room to pick her up for a heart cath. The nurses told us, "watch out she is a mean one!" (A personal note here: I don't care for the pre notice on people's personality. I prefer to treat everyone with love and compassion. It is more difficult when you already have a preconceived notion). I immediately decided that I was going to treat her a good as anyone else. She was the sweetest little lady you ever saw. She was 86, was all of 4'10" and 90 lbs. Her family met us and we all walked to the cath lab together. I was feeling so sorry for her because I figured that the staff was all treating her like she was mean. Poor sweet little lady... Well, half way through the case, she got a little agitated and we gave her a little sedation, it worked the opposite on her. I have never seen such a change in anybody in my life. We all tried to calm her and ended up securing her to the table so that she would not fall off. I don't know if it was the sounds of the machine or what, but she started screaming that we were not doctors and nurses. She felt as though we were torturing her. She needed more work in the Cath lab, but we could not do it under these circumstances. The only way to calm her was to work our way into her crazy thought of torture, we told her we were there to protect her and to take her to safety. We got her out of the room and still had her secured on the bed. I was standing next to her waiting to transport, she was calm and nice again. Suddenly, she pulled herself to a sitting position and pulled so hard that her arm came unsecured, then she proceeded to slap me in the face. Oh, I was mad.........then again my heart sank to think that her life survival skills were telling her to fight. At this point all I could do is laugh, I have never been hit by a patient. I am wanting to care for her, but now I need my own survival skills. When we get her to her room, it took about 8 people at bedside to put her in bed and to secure her, again she got loose and slapped my face. OMG!!! Twice in one day. I am not sure what the moral of this story is, I guess that sometimes you need to watch your own back and believe when you are told that the patient is mean. It is amazing and sad what happens to our minds as we age, dementia is a very real and scary thing for these patients. "Emotions are a response to perception-what you think is true about a situation."I won't change my way of caring for them, because I know that they are in survival mode. It is not personal, and I have to decide who I want to be in these cases. It is still loving and compassionate.
Saturday, October 25, 2008
My favorite story!
Let me tell you the story about Barb, I met her about 14 years ago. We met in December in the Cardiac Cath Lab. She came in for a heart cath and her Dr. was very late. (it happens) We had a good long conversation (about 2 hours) she was the nicest lady. We talked about cooking and babies and marriage. I had just gotten married and she had been married to the same man for over 50 years. I asked her the same question I ask every long married person. "What is the secret to a long marriage". She told me that faith, forgiveness and friendship were the keys. We did her heart cath and she was scheduled to come back a few weeks later for an angioplasty (balloon procedure). When she came back, she had a gift basket for me, recipes, scriptures and homemade brownies. We brought her in to the lab where we performed her procedure and she did not do well. She coded and I did CPR on her for about 45 minutes while they were prepping the OR. I was so sad, I talked to her the whole time. Telling her to hang in there and not to give up. She went to the OR were she underwent bypass surgery.........she didn't do well there either. My good friend got her in the intensive care unit afterwards................she didn't do well there either. It was one of those days in the cath lab where I worked from 6am until about midnight. I went with the Supervisor to tell her husband that we had done all we could for her. Her husband was a minister and he was so very gracious (which really touched me). He gave us all a blessing and then I proceeded to go home. The next day was the beginning of my vacation and Mike and I went to Colorado. The following March I found out I was pregnant and was moved from the Cardiac Cath Lab to the Cardiac Rehab department. (radiation purposes). It was my first day there and I almost fainted. In walked Barb..........wow, it blew me away. She said, "Well, there you are, my little guardian angel" It was apparent to her that I didn't know that she had lived. She told me that she remembered me talking to her when I was doing CPR, she knew that I had cried and watched her the whole day. When it was time for my baby to come the department had a baby shower and she knitted this pink little outfit that was beautiful, but it did not compare to the note that was with it. It read, "what a lucky child you are. For your mother gave life to me too". I was amazed. Barb later moved to Texas and I get a Christmas card from her every year. She is almost 90 now.
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