Patients Age: 76
Admission Date: 3/13/18
Admitted From: Burke
Discharge Date: 6/23/18
Discharged To: Home
Length of Stay: 3 Months
Reason for Stay: Tracheostomy, Heart Failure, Presence of Heart Assistance Device – Left Ventricular Assist Device, End Stage Renal Disease (Acute Kidney Failure)
Details of Experience:
On March 7th, Diana arrived at The Grove for a tour. She was impressed with the new beautiful renovations, cheeriness of the staff, and the state-of-the-art gym with the most up-to-date equipment. But her primary questions revolved around the ability of our medical, nursing, and rehabilitation departments to address the complicated medical needs of her father, Charles, a left ventricular assist device (LVAD) patient.
At the young age of twenty, Charles immigrated from Europe to the United States. Within a surprising few short years, he built for himself a lucrative construction company. By the age of thirty, he was married with four children. Charles spoke one language – dedication and grit. Providing for his family and earning an honest living was his life and nothing could stop him. But he did have to slow down, at age sixty, he suffered a massive heart attack. His medical condition required him to change his lifestyle, but not his attitude. This was another challenge and obstacle life presented to him that he was determined to beat. If a failing heart is not challenging enough, Charles also required dialysis treatment three times a week as his kidneys failed him too.
When Charles arrived at The Grove, he was already fifteen years into his battle, a fight against a failing heart. In 2016, Charles had a left ventricular assist device inserted into his heart (LVAD); his heart cannot function on its own. It’s very common for patients with an LVAD to display feelings of depression and grief, the dependency on an electrical device to survive can feel demoralizing and hopeless. But Charles is different. His family is different.
Charles is well-known at Westchester Medical Center’s cardiac unit. He’s been receiving medical treatment there for over a dozen years. Despite the years of needing treatment, he made it clear from the first day, “I’m not a patient, I’m a father and business owner and I will return home.”
One can only admire his stubbornness and resilience. Charles has little pity for himself and does not need anyone else’s either. In his first month, Charles demonstrated great commitment in the gym and his therapists were pleased with the therapeutic progress he was making. His muscles and core were getting stronger, but his medical condition was beginning to decline. After one month, Charles had to be re-hospitalized. On top of a failing heart and kidney, Charles was having respiratory trouble. The attending physicians were worried, his lungs were failing, too. Charles was placed on a ventilator until he was stabilized, and his new tracheostomy would be left indefinitely.
Charles’s came back with a new set of challenges. He was our first patient to have an LVAD and a trach (and require dialysis). Having a successful therapeutic outcome with either, is astonishing, let along both. For the very first time, Charles asked himself, “Will I ever be able to return home?” Not accepting defeat, but reality. Both Charles and his family agreed that the question would have to be put on hold, the focus now was to get better as much as possible. The team of physical and occupational therapists along with the respiratory, nursing and medical team, revised his goals and care plans.
The initial goal was not whether he will be able to return home or not, but how long can he live? Will he ever be medically stable? Small goals are what we agreed to focus on. Physically, he was weak and couldn’t carry his own weight. He needed assistance with transfers and support while standing. Six days a week he received therapy and those were his happiest moments. Slowly, his strength and stability were increasing. For the following month, his therapists worked on his lower body strength and the medical team treated his respiratory needs and stabilizing his condition. As he was improving, he was slowly returning to himself and his commitment to “return home and live to see his first grandchild get married.”
Charles and his family revisited the conversation of the possibility of returning home. His children and wife couldn’t have been more supportive and understood, that returning home would require lifestyle changes on their end too. His wife would need to feel confident managing his care and assist with his tracheostomy care at home. In his final weeks, Charles was the happiest and hardest working man in the gym. His team of therapists tailored his exercises to functional and basic skills he’ll need to return home safely. The social worker coordinated the home care services, equipment and the additional nursing care he would require, while the medical and nursing team helped train his wife on tracheostomy care. It was the first time we succeeded in discharging a patient with a tracheostomy (either we succeed in weaning the patient off the trach or the patient ends up requiring long-term care).
Never have we seen a patient leave with such triumph and pride, “I told you I will return home.” That was the biggest “thank you” the staff could ever hear. We knew that his return home was truly the collective efforts of the entire team here at The Grove and the hospital along with his wife and family and his inner strength and commitment to live life at his own terms.