Critical Care Essay

The patient I am choosing to write about is Robert; a patient who on a routine radiology treatment, is called for Condition A. The reason Robert’s Condition A, or cardiac arrest stood out to me, is due to how unexpected it was. Robert was not admitted to the hospital for cardiac-related complaints, nor did he have a cardiac history. He was in the hospital to receive radiation treatment for his cancer, when he experienced a sudden cardiac arrest. These unexpected arrests account for nearly 50% of deaths stemming from a cardiovascular cause (Juntunen 2024). As healthcare professionals, we are expected to not only deal with death but to also comfort those who are not expecting it: wives, daughters, fathers, and mothers. Although we are taught how to handle death, we are not taught how to handle the aftereffects.

In Critical Care, Theresa talks about how she was tasked with waiting for Robert’s wife, Marianne, and escorting her to the floor where a code is currently being run on her husband of thirty years (Brown 2010). Even though Theresa was not part of the team that worked the code, I believe that she had one of the most important jobs. It was her responsibility to wait for Marianne and explain an impossible situation to her. Earlier on in the chapter, Theresa mentions how many nurses find some family members to be “annoying” and “demanding”. When a single nurse is charged with multiple patients who all have family members demanding specific foods and treatments, it can be easy to forget that although this is our every day, this is likely their worst day.

Theresa writes about “chances” and “odds” early on in explaining Condition A. In this situation, Robert’s radiology treatment provided Marianne with a rare chance to take a moment away from her husband’s side and go somewhere for herself. What are the chances that in the brief period that Marianne is not present, Robert codes? What are the odds that Theresa has two patients unexpectedly code in as many months? What is the likelihood that while Robert is waiting in the hallway to return to his room, he arrests? All of these scenarios are incredibly unlikely; however, they still happen. As Theresa puts it: “sudden death has no regard for probability” (Brown 2010).

Condition A is not common medical terminology, rather it is how the hospital Theresa practiced in referred to cardiac arrests. The first two patients of Theresas that experienced Condition A, died from sudden cardiac arrests (SCA). The cardiac activity in their body suddenly ceased without indication or understood reasoning (Juntunen 2024). The risk of an SCA increases with age and is not uncommon in patients with cancer. There can be multiple reasons for the SCA: ventricular fibrillation, ventricular tachycardia, or even pulseless electrical activity (Juntunen 2024). An autopsy must be done to determine the exact cause.

When Marianne was brought to the radiology floor where the condition team was working on her husband, the nurses immediately wanted to know how long she expected them to run the code. Hospital and regional protocols dictate how long CPR must be continued on a pulseless patient who does not have a valid DNR. To be considered valid, a do not resuscitate order must be signed by a physician and presented to the code team (Brown 2010). Since Robert did not have a DNR, it was Marianne’s decision on when to cease resuscitation efforts. After that decision, she also had to choose whether an autopsy would be performed on her husband. Although an autopsy would reveal the true cause of Robert’s death, she told the staff that she did not “want him being cut up” (Brown 2010). I truly cannot imagine how stressful and terrifying this situation must have been for Marianne; she had to decide to terminate CPR, decide if she wanted an autopsy to be performed, inform the nurses of which funeral home to make arrangements with, and call her daughter to explain that her father was gone, all before getting a chance to truly grieve.

Although I am only in my first year of nursing school, I know that delivering my first death notification is inevitable. However much I dread this situation, I hope I will be able to find solace in the comfort that I wish to provide the grieving loved ones with. Condition A’s are a possibility and a grim reality for nurses working any floor. It does not matter if you are in the ICU, Labor and Delivery, Home Health, Med Surg, or Radiology. Whatever specialty you choose, as a nurse you will face “death, life, and everything in between” (Brown 2010).

References

Brown, T. (2010). Critical Care: A New Nurse Faces Death, Life, and Everything in Between. Harper

Collins.

Juntunen, S., Holmström, L., Vähätalo, J., Mäntyniemi, L., Tikkanen, J., Pakanen, L., Kaikkonen, K.,

Perkiömäki, J., Huikuri, H., & Junttila, J. (2024). The burden of sudden cardiac arrest in the setting of

acute coronary syndrome. Resuscitation, 202, 110297. https://doi.org/10.1016/j.resuscitation.

2024.110297