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Case Studies

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Case Studies

Language: English
Context: Emergency Room
Title of document: back pain
Name of compiler: Sabrina Grigolo
Actors involved: Nurse and patient
Description of the experience:
It is the first day of work after the rest, the colleague with the morning shift has just finished her shift. I am told that on the bed no. 2 there is a new person, a young man of 40 years old. He has suffered from back pain for a month, he has already been to the doctor and to other hospitals, where they have prescribed him anti-inflammatories that have had little effect.
Yesterday, Mr. X began to breathe heavily, so he decided to be accompanied by his wife to the Emergency Room where he found out that his back pain is due to a tumor and that he has difficulty in breathing because of a pericardial effusion; he undergoes drainage to evacuate the liquid obstructing the heart.
This afternoon, Mr. X is going to be transferred to CCU.
Mr. X sent for me: he would like us to set the bed so that he could rest a while before being transferred. While my colleague and I were lowering the headboard of the bed and setting pillows and draw sheets, Mr. X tells us what happened to him, he talks about his children and his job; his eyes are sad and scared but, nevertheless, he tries to smile as much as possible and jokes about the many "tubes" by which we "have drilled" him. For a moment, he becomes serious and asks anxiously about the transfer: I explain what we will do, that his wife will not come with us but we will talk to her before leaving and that she will be waiting for us at the new hospital.
Mr. X looks at us and says that it does not matter if his wife can not come because he is quiet since we stand by him.
I do not know what to say, I am puzzled, after all we have known each other for only 20 minutes and all I did was to turn his pillow!
After about half an hour, together with the doctor we go to Mr. X and visit him before leaving. He is again dyspnoeic. We decided to drain some more pericardial fluid and his breathing improves.
While I am filling out forms to transfer the patient, the doctor sends for me. Mr. X is in cardiac arrest. We begin resuscitation. The patient recovers. We send for his wife, we explain what happened and that the effusion is getting serious in an increasingly more rapid pace and that Mr. X’s heart is very likely to stop beating again.
The woman approaches her husband’s bed, reassures him and promises to wait for him at the other hospital. After a while Mr. X is back into cardiac arrest. We proceed with resuscitation but the heart rate is not recovered. He is declared dead.
The Emergency Room is filled with a silence full of pain, anger, frustration, fear and compassion for his wife and his two children.

This experience affected me more than others due to the difficulty I had in having to "freeze" my emotions in order to take care of the other three patients who, despite themselves, had heard what had happened (our department is made up of an open space).
It was not my first emergency case, but this time I could not put away the frustration, the sense of powerlessness and inadequacy that I was feeling because I could still hear Mr. X saying he was quiet because he trusted us. I knew we had done everything that was possible, but it was difficult to accept.
Objectives:
This experience affected me more than others due to the difficulty I had in having to "freeze" my emotions in order to take care of the other three patients who, despite themselves, had heard what had happened (our department is made up of an open space).
Means and Strategy:
It was not my first emergency case, but this time I could not put away the frustration, the sense of powerlessness and inadequacy that I was feeling because I could still hear Mr. X saying he was quiet because he trusted us.
Conclusions:
This experience affected me more than others due to the difficulty I had in having to "freeze" my emotions in order to take care of the other three patients who, despite themselves, had heard what had happened (our department is made up of an open space).
It was not my first emergency case, but this time I could not put away the frustration, the sense of powerlessness and inadequacy that I was feeling because I could still hear Mr. X saying he was quiet because he trusted us. I knew we had done everything that was possible, but it was difficult to accept.
Name of Institution: Gradenigo Hospital
Role: Project Manager

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