Guiding lights to gift of life
May 10, 2008
Peter Krivel
STAFF REPORTER
It's a family's worst nightmare: a loved one is involved in an accident and lies brain-dead in hospital.
It happened to a Niagara Region family last year when their 18-year-old son and brother was admitted to Hamilton Health Sciences with auto-accident injuries he could not survive.
When the tragic ordeal was over, the teen's mother wrote a letter to the hospital praising nurse Nancy Hemrica for her caring and compassion.
"I don't recall the exact moment that Nancy walked into our lives but I know it was either during surgery or shortly thereafter, just before noon," wrote the mother, who asked that her name not be used in this story. "She remained with us until we left the hospital, which was late that evening."
The letter was read out at a ceremony last month when Hemrica received the hospital's Cornerstone Award, which honours individuals whose work has enhanced medical care.
As organ and tissue donation co-ordinator at the hospital, Hemrica's job is to explain the importance of transplants to families of loved ones with no chance of surviving. She must diplomatically explain the need for organs and tissues, while balancing that with end-of-life concerns and people's values and beliefs.
"Very often, the patient looks like they're sleeping and you have to get the family to understand that their loved one is truly dead," Hemrica says. "What words do you use, what do you say, how do you say it, how do you support the family in such a time of grief?"
She always pauses for thought before she approaches a family, because she has only one chance to do it right. "If they say `no,' you can't reapproach. That's not respectful care."
The Niagara teen's family donated his heart, lungs, liver, kidneys and pancreas.
Hemrica can't recall if the young man signed an organ donor card, but she knows the mother was confident this was his wish.
"He was a very generous, kind and thoughtful boy," she says. "The mother knew he would be happy with the donation."
In her letter, the mother continues: "Even though much of that day remains shrouded in a haze of shock and grief, what I do remember are the feelings of caring, the empathy, the holding of hands, the soft-spoken words of assurance and explanations, the permission to let myself cry, the quiet time sitting together while I processed the beginnings of this journey, the touching of my arm or my back, the unbelievable patience while completing the forms, the lending of emotional strength to just get me through another few minutes – all this from a person I had never met and who did not know our family nor my son. In my opinion, this takes both character and professionalism."
Hemrica has been doing this type of work for the entire 23 years she's been an intensive care nurse. But when the Trillium Gift of Life (giftoflife.on.ca) was formed in 2002 to promote organ and tissue transplants in Ontario, she applied for the job of Hamilton co-ordinator and was hired.
"I really like caring for that particular type of patient," she says. "My work was very satisfying (before Trillium) but it was also difficult because there wasn't a lot of support for us. We didn't understand a lot of the process. I really had a passion for doing this at the bedside."
Hemrica's job is easier now with the help of Trillium, which handles the acquisition, distribution and delivery of organs and tissue across Ontario.
According to Hemrica, Hamilton Health Sciences last year dealt with 32 multiple organ donors, a record for any one centre in Ontario. In addition, there were 149 cornea and 10 multiple-tissue transplants.
Hemrica and the other nurses who work with her helped develop a protocol for dealing with what are known as cardiac after-death patients. Unlike severely brain-injured patients, they are not neurologically dead but there is no hope for them, other than to continue in a vegetative state.
The protocol involves taking the patient from intensive care to an operating room, where life support is withdrawn. The family can be there if they wish, as well as a chaplain.
In the case of the Niagara teen, Hemrica's relationship with the family didn't end with the signing of a consent form.
"Nancy had asked me if there was something special that would make my son more comfortable. Remember now, he is officially brain-dead, and she was concerned enough about him and us to ask what would make him more comfortable, even though he would not really know.
"As a little boy, he liked his feet rubbed and kept warm. She called me the next evening, when the organ retrieval or harvesting had been completed, to let me know how great my son was and that the staff had made certain to keep his feet warm and rub them during the surgeries. Such a thoughtful thing, a small thing ... but to a mother, this meant the world."
Toronto Star