Looking Forward to the Visit? Humor in the Cath Lab

After twenty-plus years as an RN and four-plus years as a CRNP, it still amazes me how perceptions of the same situation can differ so greatly. I’ve found that seeing a situation from different sides has multiple benefits and life’s lessons often come at unexpected moments. We were taught in nursing classes that nursing is part art and part science. We learned the “science” in lectures and in clinical throughout the course of our education. The “art” would come with time and experience, along with our own reflection and learning from experiences. Incorporating new experiences into the repertoire of nursing practice enables us to learn and grow. Throughout the years, I have worked in both critical care and trauma while providing bedside nursing care to patients. I always try to see the situation from the patient’s point of view. I imagine how I would feel in their position and to see the circumstances from their perspective — to be lying in bed, not feeling well, overwhelmed, exhausted, tubes from all angles, machines making loud noises, depending on someone else for assistance, not being able to do for myself, in pain, away from home and not in control of my surroundings. With this in mind, I always attempt to treat the patients in the manner that I would like to be treated, with genuine concern and their best interests at the core of the nursing care I deliver. Most times, even if I do not fully understand what patients are experiencing, I find I can still be empathetic. While in graduate school, I worked in a combination cardiac catheterization lab (cath lab) and electrophysiology lab (EP lab) in a large, urban hospital setting. The patient population was diverse. Patients were referred from all over the local area, as well as across the eastern region, for the services offered at this institution. A hefty portion of the patients came from a large, well-respected heart failure and cardiac transplantation program. The program encompassed all stages of heart failure patients, ranging in status from New York Heart Association Class I to Class IV. Many of the listed patients (those waiting for a heart transplant) were so sick that they required prolonged hospitalizations with multiple drips, oral medications, surgeries, left ventricular assist devices (LVAD), pulmonary artery catheters (PA catheters), etc., as well as being involved in clinical research trials. Each adjustment to their regimen usually required a trip to the cath lab for a right heart catheterization to evaluate if the current treatment was proving effective, or trips to the cath lab at pre-determined times, as defined by various research trial protocols. As a result of many patients’ multiple trips to the cath lab, we (the staff in the cath lab) became very familiar and friendly with both the patients and their families. Often we were on a first-name basis with the patients as well as their family members. I can remember cheering and rejoicing as treatments worked and as patients improved and were able to be discharged to home. I remember feeling thrilled at successful orthotropic heart transplants (OHT) and celebrating as the patients, post OHT, left the hospital with their new hearts and a second chance at life. The relationships fostered in the hospital continued long after OHT and discharge. After becoming a transplant recipient, the patients’ schedule of trips to the cath lab became more frequent, because right heart catheterizations, along with right ventricular biopsies, were needed to evaluate the new heart and to assess for post-transplant rejection. Call cases and emergency trips to the cath lab during suspected transplant rejections always proved to be anxiety-provoking for the patients, families and staff involved. With timely interventions, most episodes can be treated effectively and the patient can continue to go about their new life. At the other end of the spectrum, I can also recall feeling distressed and crying on more than one occasion as I watched the patient begin to lose his or her battle. They became weaker and weaker as the medications started failing to control the disease. As these patients would continue their downward spiral, I felt helpless, realizing I was powerless to prevent the inevitable. All I could do was provide some measure of comfort and to show the concern I felt as I did my job. I tried to never forget the reason why I came to work every day — to help people and to have a positive impact on someone’s life. As a young nurse, I thought that this was accomplished by “curing” the patient and resolving whatever the medical issue might be. As I grew up and gained more life knowledge, I realized that “cure” is not always the answer and the patient’s perception of their outcome is really what matters to them. Often the moment is what is important, not necessarily the ending. Humor has long been recognized as a valuable tool in a nurse’s arsenal to alleviate patient anxiety and to help relieve fears. The use of this tool is part of the art of nursing, a part that cannot be taught, but must be both innate and gained through experience. The staff of our cath lab, as a whole, was a friendly set of people. Like most work environments, we attempted to enjoy our long days by infusing humor into the workday. We enjoyed laughing and joking with each other, and did so frequently. Our manager often used humor during staff meetings and had fun events for us to help lighten the atmosphere. When dealing with life-and-death situations on a daily basis, the tone of the work environment can weigh heavily on the staff and this can be felt by the patients and their families. Often, during long wait times in the holding area, while the staff of the cath lab worked through upwards of twenty to thirty cases a day, we utilized humor to defuse the tension the exhausted, frazzled patients and their families felt. The opportunity for learning, insight and professional growth often occurs at the most unexpected moments, with the power to leave one amazed. I can remember one such opportunity as if it were yesterday. What seemed a normal day in the cath lab turned me on my heel when a heart failure physician casually remarked that the heart failure patients enjoyed their trips to the cath lab to “see all those funny people and to have a laugh.” Whoa! I was stunned and speechless! Could it really be that what I took for granted as a routine day at work, some patients actually looked forward to?! What was work for me was entertaining for someone else? My reality was turned upside down and my perceptions along with it. Only then did I fully place myself in the patients’ shoes and realize the struggle of what their daily lives must be like. Stuck in the hospital for months on end, away from home, missing family functions, celebrations and important events. Missing family and friends. Not being able to work or feel productive. The daily drudgery of the same routine such as the same blood draws, the same food, the same walls, not being able to go outside or to enjoy a beautiful day, being dependent on others, all the while feeling physically lousy. Watching as those around you become sicker and sicker. Your friends dying before a heart can be found and wondering if that will be you soon. Additionally, the building anxiety, staring down death while waiting for another to die and a heart to be made available — this dichotomy alone must be mind-boggling and confusing. For some patients, just to leave the unit required a coordinated undertaking: ventilators to be transported, beds to be moved, multiple IV poles with pumps and drips, LVADS, PA catheters, staff to transport, along with staff manually ventilating the patient during the move. The receiving cath suite open, with the personnel to take over and manage the patient. Then, when finished, repeat the process to return the patient to the unit. Is it such a stretch to think that a trip to the cath lab could prove to be a high point of the day for the patient? Interacting with another group of people, sharing a joke, having a laugh? Even just to see a different set of walls? I could not conceive of such a life until the physician’s casual remark jolted me into examining the experience from the other side of the bed. I am glad I did. Same situation, different perspectives, vastly different perceptions. This was a moment that opened my eyes to how I truly could make a positive impact on someone’s life, just by doing my job and having a sense of humor about it. It taught me to see my role as an RN/CRNP as more than just routine, but as a caring, worthwhile endeavor that does help people, regardless of the ending. I can make a difference in a moment of a patient’s life and that is another part of the art of nursing. It is a lesson I have never forgotten and try to pay it forward. The physician who made this remark may not even remember what she said, but I do, and I carry the lesson with me always. Theresa Eiser-Brown can be contacted at teb1108@aol.com

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