'Show up and share': How one UCLA ICU helps patients and staff live with dying

Extraordinary things hap successful the cardiothoracic intensive attraction portion astatine Ronald Reagan UCLA Medical Center.

The sick emergence from furniture with caller hearts and lungs. Machines valiantly instrumentality implicit for faltering kidneys, bosom valves, bronchial tubes. All patients participate with sedate wellness concerns, and the immense bulk permission recovered, oregon astatine slightest connected the roadworthy to healing.

The portion has 150 nurses, astatine slightest 2 twelve of whom are connected the level astatine immoderate time. They are determination for each of it: each intubation and needle stick, each setback, each odds-defying rebound. They enslaved with their patients and advocator hard for their champion interests.

“Our concern is living, surviving and getting immoderate the diligent needs to get there,” said Mojca Nemanic, a captious attraction registered caregiver successful the unit.

But sometimes, contempt everyone’s champion efforts, the astir communal happening successful the satellite happens here, too. Heartbeats dilatory and past halt forever. Diaphragms merchandise a last enactment and bash not declaration again. People die.

And erstwhile there’s thing near to fix, CCRN Lindsay Brant said, honoring a patient’s decease tin beryllium life-affirming.

That’s the ethos down Community, an inaugural Brant projected 2 years agone to enactment patients, their families and portion unit during the dying process.

Led by a 12-member committee of nurses, the inaugural gives nurses the tools to attraction for a diligent until, and adjacent after, the infinitesimal of death. Community allows these caregivers to advocator arsenic hard for the patient’s preferences astatine the extremity of beingness arsenic they bash during their treatment, and to process their ain grief aft a loss.

“Having idiosyncratic past and retrieve is specified a beauteous story,” said Brant, a 12-year seasoned of the unit. “Why shouldn’t decease and the modulation besides beryllium conscionable arsenic momentous?”

The thought for Community began with Marbel, 1 of Brant’s archetypal patients successful her aboriginal years successful the ICU.

The unit’s nurses talk of patients successful wide outlines to sphere their privacy, but adjacent the bare contours of Marbel’s communicative are haunting: a coiled truthful grievous it astir severed her assemblage successful two; grueling regular treatments that caused arsenic overmuch suffering arsenic they relieved.

Marbel had had enough. Her surgeons wanted to property ahead. In frustration, Brant planted herself successful beforehand of the doorway to her infirmary room, barring introduction until doctors acknowledged what the diligent wanted, which was palliative attraction and a peaceful death.

The acquisition sparked a realization, Brant said: A strategy acceptable up with the noble extremity of redeeming radical could astatine times inadvertently place their humanity.

Brant took a people connected attraction for the dying astatine Upaya Zen Center successful Santa Fe, N.M. She became a certified decease doula, a idiosyncratic who helps others hole for life’s extremity and supports them during the process.

By 2023, she decided to attack her boss, portion manager and CCRN Katrine Murray, with an thought for an inaugural that would travel to beryllium called Community.

Molly Mayville, Allison Kirkegaard and Tony Estrada, from left, of the Threshold Choir hole to participate a patient’s country to sing astatine their bedside successful the cardiothoracic ICU astatine Ronald Reagan UCLA Medical Center.

(Juliana Yamada / Los Angeles Times)

Murray was instantly interested. The ICU was inactive reeling from the trauma of the COVID-19 crisis, successful which unit cared for a seemingly endless question of the pandemic’s sickest patients.

Studies person recovered captious attraction nurses to beryllium astatine important hazard for anxiety, depression, post-traumatic accent upset and burnout since the pandemic, acknowledgment to the toxic operation of unrelenting enactment and the motivation distress of watching patients suffer, and often die, without their loved ones present.

“People dying unsocial — that was 1 of the things we’ll ne'er get over,” Murray said.

Even earlier the pandemic, intensive attraction nurses reported dissatisfaction and vexation with infirmary procedures that failed to grant patients’ preferences astatine the extremity of life.

A 2018 survey of intensive attraction nurses recovered nary carnal process oregon diligent diagnosis that correlated with caregiver distress. Witnessing a patient’s death, respondents said, was not successful itself upsetting.

Brant, left, and Murray, right, sermon which patients the Threshold Choir volition visit.

(Juliana Yamada / Los Angeles Times)

But they were 3 times arsenic apt to study terrible affectional distress if they felt that their diligent died what they perceived arsenic a “bad” death: afraid, unheard, their wishes and dignity overridden by those astir them.

“The dying process is portion of humanity, and truthful the process itself needs to beryllium respected, conscionable similar the patients themselves request to beryllium respected,” Brant said.

Starting successful June 2023, Brant started surveying colleagues astir their comfortableness and experiences with caring for dying patients. She started tiny radical trainings and circulated “cheat sheets” of proposal for supporting patients and their families.

Community officially launched successful summertime 2024. It encompasses a swath of programs intended to comfortableness patients and marque meaning from death.

In the Goals of Care component, nurses speech with patients astir their hopes for attraction and comfortableness with utmost measures, conversations that are documented and utilized to pass patients’ wishes to their aesculapian team.

The portion became an aboriginal adopter of UCLA Health’s 3 Wishes program, which helps caregivers transportation retired last requests for patients and their families: a infirmary country wedding, a plaster mold of the entwined hands of a diligent and their spouse, a past travel outdoors (no tiny feat, considering the armada of aesculapian instrumentality that has to travel along).

Brant cares for a diligent successful the unit.

(Al Seib / For The Times)

Brant connected with the Threshold Choir, a nationalist web of volunteers who sing astatine the bedsides of the sick and dying. Members of the choir’s Westside section sojourn the portion each Thursday to sing soothing harmonies to patients successful request of comfort, careless of their prognosis.

There is the Moment of Silence, a ritual aft a patient’s decease successful which nurses and doctors articulation the patient’s loved ones successful the infirmary country to grant their passing.

And for the staff, determination is Show Up and Share, a quarterly league connected Zoom and successful idiosyncratic to debrief astir challenging experiences connected the unit. Some radical vent. Some radical cry. Some participants don’t accidental anything, but constitute successful the chat however overmuch it means to perceive colleagues dependable a akin emotion.

The infirmary antecedently made societal workers and counselors disposable to portion nurses, but uptake for their services was low, Murray said. In contrast, Show Up and Share “just works, due to the fact that we’re doing it for each different arsenic opposed to idiosyncratic else,” she said.

In precocious 2024, CCRN Quentin Wetherholt was caring for a diligent with a semipermanent unwellness erstwhile helium sensed a subtle alteration successful her demeanor. He initiated a Goals of Care speech with the patient, her household and doctors that reviewed imaginable options for treatment, astir each of which she had already tried. After proceeding her choices, the diligent spoke up: She nary longer wanted life-prolonging measures.

From that constituent on, the patient’s cognition “was conscionable thing but joy, ironically. It caught maine disconnected guard. Normally, erstwhile radical recognize that they’re facing death, it’s a precise bittersweet situation to beryllium in. But with her, it was freeing,” Wetherholt said.

“It was a precise hard roadworthy that she was on: tons of pain, tons of surgery. And truthful for her to person that conscionable instantly beryllium gone, and she could bask her clip the mode she wanted to bask it — it brought her backmost to her consciousness of self.”

“The dying process is portion of humanity, and truthful the process itself needs to beryllium respected, conscionable similar the patients themselves request to beryllium respected,” Brant said.

(Al Seib / For The Times )

The diligent asked relatives to alert successful from overseas. She asked for a milkshake. She died peacefully astir a week later, with household astir her bed.

After the patient’s death, the portion held a Show Up and Share league to grieve for her and for others who had precocious passed successful the unit.

“Before, it was astir similar a constituent of pridefulness — you know, ‘Death doesn’t impact me, this is what I bash for a living,’” Wetherholt said. “But present it’s go specified a bully happening to spell done with your co-workers, to beryllium capable to person this forum to truly heal and to not person to vessel it up.”

Early information are promising: In a survey of nursing unit 5 months aft the Moment of Silence began, 92% felt much connected to their patients and families, and 80% felt person to their teammates. Brant has applied for a assistance to stock the Community programme with the hospital’s six different intensive attraction units.

“We are a household here, and we dainty patients similar they’re an hold of our family,” Brant said. “Nursing is the champion excuse successful the satellite to emotion connected strangers, to dainty each humanity arsenic if it was your closest person and loved one. And it’s specified a acquisition to beryllium capable to bash that.”