NIGHTINGALE WINNER: JANE MACIVER

Courage and compassion

May 9, 2009

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Janice Bradbeer

Michael Martin was a kind, happy man with a big heart — and a badly broken one. All the love in the world couldn’t heal it after he developed cardiomyopathy, a disease that would result in congestive heart failure. Martin was comforted during his final days by family and medical staff, who cared for him and gave him critical support when he made the decision to die.

Nurse practitioner Jane MacIver — this year’s Nightingale Award recipient — tended to Martin while he was treated at Toronto General Hospital. It was Jennifer Martin-Kepes, Martin’s younger sister, who nominated MacIver. “She’s an incredibly caring person — it emanates from her in waves. There’s a twinkle in her eye. Although she’s no-nonsense, she has a wonderfully irreverent sense of humour,” says Martin-Kepes.

MacIver calls Michael Martin “the real hero of this story.”

As a nurse practitioner for heart failure and heart transplant in TGH’s cardiac care unit, she learned how to fine-tune Martin’s left ventricular assist device (LVAD). The batterydriven machine was surgically implanted into his heart in May 2005 to help it pump, as a stop-gap measure while he waited for a heart transplant.

When it became evident a transplant wasn’t possible and the device could no longer effectively do its job, MacIver and Martin’s family comforted him while he turned off his machine. He died in March at age 54, after surviving as Canada’s longest-living LVAD patient.

“When I found out that I had been honoured with the Nightingale Award, it was bittersweet — I started to cry,” says MacIver, a mother of three who lives with her family in the Beach. “I’m honoured to be nominated, humbled to be selected. It’s Mike’s story — the story needs to be heard.”

Martin’s story is interwoven with MacIver’s, since she cared for him for seven of the 11 years he suffered from cardiomyopathy — a disease that causes the heart muscle to deteriorate, reducing its ability to pump blood to the rest of the body. Martin had the type known as dilated cardiomyopathy, resulting in an oversized heart. One theory was that he contracted the disease in his teens from a virus.

There were other health problems. Martin was diabetic prior to receiving his pump and, over the last six years, he developed neuropathy from the diabetes. Neuropathy causes nerve and blood vessel changes, which resulted in pain in his legs. It was relieved with medication, says MacIver.

“It was Jane who was phoned in the middle of the night when there was an emergency, Jane who learned how to fine-tune the computer adjustments that kept Michael’s heart pumping and Jane who had the thankless task of changing infected bandages and inserting ports and IVs and conveying grim news,” Martin- Kepes wrote in her Nightingale nomination.

MacIver has practised nursing for 20 years and has worked at TGH since 1994, first as a clinical nurse specialist in cardiology and then as a nurse practitioner in cardiovascular surgery in ’97. She helped develop the ventricular assist device (VAD) program in 2001. Her main duties involve the outpatient care of VAD patients, as well as prepping recipients for pre-op and then overseeing them in the ICU. The team sees 12 to 15 VAD patients a year. Originally inserted as “a bridge to transplant”, VADs are also in use as long-term therapy for patients who do not qualify for transplant.

MacIver says working with VADs is still an evolving field, with staff learning as they go.

“It changes not only how patients live but also how they die. These patients typically have an incredible will to live and, for many, it’s the last chance at life.

“With VADs, both the team and the patient/family need to commit to the relationship that is hopefully a long one. Some go into heart transplant; others, like Mike, remain on support until they die; some die after a short duration of support,” says MacIver, who works days but is committed to be on call 24/7.

Because Martin lived such a long time with his ticking LVAD, Martin- Kepes says the family had years to develop a relationship with MacIver.

MacIver is quick to give credit to the rest of the team involved with Martin’s care. “The nurses on the ward were awesome — it took courage to enter that room knowing that every time that LVAD alarmed, it might be the end.”

She also lauds the work of the program directors: Dr. Heather Ross, a cardiologist, and Dr. Vivek Rao, Martin’s cardiac surgeon.

Martin-Kepes says her brother — who lived with his parents and younger brother Andrew in Richmond Hill and taught computer graphics at George Brown College — was “never a great candidate for a transplant” and was terrified of the procedure. He was overweight and would continually come within 10 pounds of the weight needed to qualify. But if you met him, she adds, you would never have known he was sick. “It was a huge shock to me when I came to the realization that I would go in (to the hospital) one day and that the machine was going to have to be turned off.”

In January, Martin and his family were told the LVAD was failing. MacIver says Martin made the decision — because of health issues and his fear of surgery — not to have another device implanted. That left him with roughly three months to live.

On Feb. 25, the machine’s alarms went off and Martin was admitted to TGH for what would be his last time. Alast supper was thrown for him, attended by MacIver, Rao, and his brother and sister.

“He didn’t want this to be a sad event. He wanted to be surrounded by people who loved him. We laughed and told jokes,” recalls MacIver.

One week later, they were there when Martin pulled the plug on his life — dying when he chose to, rather than “alone at 4 a.m.,” says MacIver, her voice breaking.

“He didn’t want to die at home and he didn’t want it to hurt,” she says. “We accomplished both.”

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