17 March 2007

Acute Liver Success

Got a page late in the day from the PI, "The fellow admitted an ALF patient yesterday (Sunday)." That's code for some poor patient is in the ICU with acute liver failure and I want you to go sign them up for our study. Honestly, I enjoy being the research nurse/coordinator, but it doesn't mean it gets any easier to go and sign up potential participants. This poor guy in particular....

"Hey, AZ! Whatcha doin' up here in the unit," asked MH, the charge nurse? "I came to screen the ALF patient. Do you know who's taking care of him, right now?" "Sure do, he's in 7 with Linda. Let me give ya her number...."* "Hi, Linda, it's AZ. Is there any family in the room with ya? Great, I'll be in after I check the chart."

I start flipping pages looking for the EMT report. The paramedics and EMTs have the best record of what happened at the scene as well as documenting the time when this all started. This is really important as I have 24 hours from incident in which to enroll participants. I start looking for the things that will disqualify the patient from my study. So far, so good. I grab a chair and pull myself up to the computer to check his current lab results. Okie doakie, looks like we're good. I grab my consent form, take a deep breath, and walk into room 7 to see the family.

It always amazes me how different people look when they're in the unit lying in bed intubated. This poor guy must have taken a tumble from the bruising on his face and arms. His wife is sitting quietly watching him from across the room as I enter. She is slightly older than me and reminds me of my neighbors. I introduce myself to her and tell her who I am. I explain that we are participating in an international study trying to figure out more about ALF. She gives me permission to discuss the consent form with her and I do...page by page. I explain everything and answer her questions. "Can I keep this and think about it a little more," she asks me. "Of course, you can. I need to let you know that we have to enroll everyone within 24 hours of coming to the hospital and we only have 4 hours left. I'll come back in a little while."

I finish reading the dictated history and find Linda to fill in the blanks for me. "Well, let's see...around 0200 he came into the bedroom and his wife told him to go downstairs as she was trying to sleep," Linda said. "Around 0600, she heard a 'thump' in the bathroom and found him down on the ground. It looked like he had vomitted up a plastic bag with some crystals in it," Linda shook her head as she said this. "We think it's meth, but we're not sure," Linda finished. I was at a loss for words. That guy looked like the guy down the street who mows his lawn with strategic precision. I couldn't believe my ears...meth?! I mean all my other ALF patients (so far) looked a lot more worldly than Mr. 7. I was floored. This man was the father of two small children 10 and 7. How do you explain this to them?

I went back to get the consent form and see if Mrs. 7 wanted to enroll her husband. She said, "I sure do." She handed me the consent form and everywhere it read 'acute liver failure' she had crossed out failure and written in the word 'success.' I asked her about the changes, and she responded, "I believe we need to be positive that what the doctors are doing here will be a success." "Well," I started, "this is a legal document and we can't sign one where it's been changed like this." "I'm sorry," she said, "I won't sign one that says 'acute liver failure.' I just feel like that's giving up on my husband." I thanked her and headed for my office. I called the PI and let him know what happened. You know, folks have to cope the best way they can.

I do know that the intensivists and nurses did their magic and brought this guy back from the edge of the drain. Last I heard, the patient had been discharged to a skilled nursing facility of some sort. I don't know what happened to him after that, but I do know I'll never forget him. I hope he has more than just acute liver success.

*Our hospital is extremely communication friendly; so, the staff nurses all wear portable phones as do most the inpatient staff. The others, like myself, wear pagers; so, we're obtainable at all times (during working hours).