Episode 21

The Heartbeat of Compassion: A Nurse's Account of Open-Heart Surgery Care -21

Welcome back to another episode of The Heart Chamber Podcast, where we delve into the intricate world of cardiac care and the experiences of those who work tirelessly in this field. In today's special episode, we have the privilege of sitting down with Christine Boev, a healthcare provider, mother, sister, daughter, and ICU nurse with a wealth of experience. As we embark on this insightful conversation, Christine shares her journey through the realms of nursing, from her early days as a novice nurse to her current role as the chair of an undergraduate nursing program. We'll also delve into the intense and emotional world of pediatric ICU nursing and the ethical dilemmas that arise when making life or death decisions. Get ready to expand your knowledge and gain a deeper appreciation for the dedicated professionals who navigate the complexities of the heart. So sit back, relax, and join us as we enter The Heart Chamber.

If you are looking for something specific - here's where you'll find it:

[04:01] Healthcare provider and mom shares nursing knowledge.

[06:28] What is the role of an ICU nurse?

[15:42] Why do you have so many wires after surgery?

[21:55] Multiple potential complications can occur during surgery.

[25:34] Care for babies to adulthood, including surgeries.

[26:52] Nursing children and supporting terrified parents.

[31:11] Transplant patients depend on worst days.

[39:17] ICU needs frequent monitoring for patient safety.

[41:44] Saving everyone, including those with no quality of life, is an ethical dilemma for care providers

A Little More About Today's Guest

Dr. Christine Boev is an ICU nurse and professor of nursing with extensive training and research in anti-aging, health, fitness, and wellness. She is a health coach who works with clients to become the best version of themselves. By precisely calculating macro-nutrients related to their overall goals, Dr. Boev works one-on-one with clients to achieve optimal health outcomes. She has particular expertise in nutrition, supplementation strategies, and strength training. In addition, Dr. Boev is a devout Yogi who believes that mobility is the key to health, especially as we age.

How to connect with Dr. Boev

Instagram: @drchristineboev

How to connect with Boots

The Heart Chamber - A podcast for heart patients (theheartchamberpodcast.com)

Email: Boots@theheartchamberpodcast.com

Instagram: @theheartchamberpodcast or @boots.knighton

LinkedIn: linkedin.com/in/boots-knighton

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The Heart Chamber - A podcast for heart patients (theheartchamberpodcast.com)

Transcript

We feel it is important to make our podcast transcripts available for accessibility. We use quality artificial intelligence tools to make it possible for us to provide this resource to our audience. We do have human eyes reviewing this, but they will rarely be 100% accurate. We appreciate your patience with the occasional errors you will find in our transcriptions. If you find an error in our transcription, or if you would like to use a quote, or verify what was said, please feel free to reach out to us at connect@37by27.com.

Boots Knighton [:

Hi. This is episode 21, the first episode of season two. I am your host, Boots Knighton. Welcome back to The Heart Chamber podcast. It was an amazing break, but I am so glad to be back with you every Tuesday. And we are starting this season off with the episode I needed when I was facing open-heart surgery. I feel like I've said that a lot, especially in season one when I interviewed my healthcare providers, but this one was what I really needed. I interview a nurse with a PhD in nursing, Dr. Christine Boev. And she gives such an incredible education around the ICU. Why systems are set in place or put in place the way they are supposed to be, what each of the different wires coming out of our bodies are for. When we come out of open-heart surgery, all the different milestones we have to reach before we can get out of the ICU to then go to a step-down unit, it's just such necessary education that I was simply not provided when I went through my open-heart surgery.

Boots Knighton [:

We also touch a little bit on pediatrics, and I ask her some really hard questions about what it's like to be an ICU nurse in the cardiac pediatric unit. And I get really pointed with one of my questions, which is, what does she wish she could scream from the mountaintops? She gives us some sage advice at the end. I'm just so excited to bring this episode to you. And in fact, I'd already interviewed several others for season two, and I decided to move Christine's interview to the very beginning because it was just such important information. So, I hope you find this valuable and without further delay, let's get right to it. I'm just so glad to be back and so happy to be back with you.

Boots Knighton [:

Welcome to The Heart Chamber. Hope, inspiration and healing. Conversations on open heart surgery. I am your host, Boots Knighton. If you are a heart patient, a caregiver, a healthcare provider, a healer, or are just looking for open hearted living, this podcast is for you. To make sure you are in rhythm with The Heart Chamber, be sure to subscribe or follow wherever you are listening to this episode. While you are listening today, think of someone who may appreciate this information. The number 1 way people learn about a podcast is through a friend. Don't you want to be the reason someone you know gained this heartfelt information? And if you haven't already, follow me on Instagram, two different places, @boots.knighton or @theheartchamberpodcast. You can also find me on LinkedIn as well as Facebook. But enough with the directions. Without further delay, let's get to this week's episode.

Boots Knighton [:

I am so grateful to have you on the show. Welcome Christine Boev to The Heart Chamber. So, Christine, I want you to brag about yourself. You have a laundry list of qualifications and certifications and just ninja-like medical training. So, please tell us all that you bring to your work on a daily basis.

Christine Boev [:

Well, Boots, thanks so much for having me. This is such a great opportunity to connect with your audience from the perspective of a healthcare provider and a mom and a sister and a daughter and all of the things that we are as women. I have a PhD in health practice research, and I've been an ICU nurse since 1999 in various capacities. I've done adults, and then my most recent stint is, I work in the pediatric cardiac intensive care unit. I also am the chair of an undergraduate nursing program at St. John Fisher University here in Rochester, New York. So, I've got a lot going on my plate, but I feel like it's really important to take everything I've learned as a bedside nurse and share it with the next generation of nursing students who are going to take care of you and I as we age and deal with health-related issues. So, it's an awesome responsibility to take care of vulnerable patients, but then also share my stories, my knowledge, my expertise with my students and now with your audience.

Boots Knighton [:

That's incredible. And so, thank you even more for taking the time out of your busy schedule. My goodness. How do you sleep? Do you sleep? That's an amazing schedule.

Christine Boev [:

I definitely do. And I encourage everybody listening to put on a really good sleep schedule because I wouldn't be able to do what I do if I didn't.

Boots Knighton [:

That's right. And I've talked about the importance of sleep in many of my episodes, and I know that's one of the many things that you focus on in your work. Let's just start with the basics of nursing. Okay. So, as a recovered heart patient myself and now thriving, which is why I started this podcast, because I wanted to bring folks like you on to educate all of us, no matter where we are listening around the world. And this is now a global podcast. And downloaded in every state in the United States, which is just beyond my wildest dreams. I want you to educate us on, when we're in the hospital, and this seems like almost like too basic of a question, but I was curious when I was in the hospital. Like, what is the role of an ICU nurse when someone has come out of open-heart surgery?

Christine Boev [:

Yeah, so, great question. The role of the ICU nurse, and I teach my students this. We are really the conductors of the orchestra because we have touch points with all of the different subspecialties, right? You've got respiratory that's managing the ventilator. You've got your surgeon who did the putting back together. You've got the ICU physicians who are managing your hemodynamics and your airway and your general well-being. But the nurse is the person that's there 24/7 that can give everybody that is in contact with you the latest, right? What is going on? How do we work together with dietary, with social work, with the chaplain, with all of the people that you're going to come in contact with? And the one thing that I really enjoyed listening to your story was the notion of advocacy and how deep down you knew the intuitive mind that there was something going on and that you really had to self-advocate. That's another piece that you can't teach your students how to be intuitive, right? But you can learn to receive those signals from the universe.

Christine Boev [:

And if I'm taking care of somebody, in my 6th sense, like, something doesn't feel right, that's when I go into advocacy mode. And I've been doing this for a long time, almost 25 years. So, I'm very comfortable speaking and saying, like, you guys need to come to the bedside. Something is wrong. But again, that notion of conductor of the orchestra, you are the person that's boots on the ground right there the whole time, and you're the best source of information for the patient and their family.

Boots Knighton [:

That's so cool. I've never heard it put that way. And how long did it take you to develop that intuitive sense? And then from that point when you knew you could trust your instincts, how long did it take for you to start speaking up? Do you remember?

Christine Boev [:

I do. The first year after nursing school, you were very much a novice. You have no idea what you're doing, even if you were the best student in the best nursing school. It's really that hands on training and then having good mentors that taught me the things that I should be paying attention to. So, the first year was really just honing in like, okay, how can I be safe? How can I do the basics? And then you really start to advance your repertoire of skills. And that advocacy piece is something that takes some time because you're going to get negative feedback from people. There's still this hierarchy in medicine where you don't challenge the surgeon, you don't challenge the physician. Well, yes, you do, because oftentimes in my experience, it's the difference between life and death, where you're picking up the phone and saying, no, you need to come to the bedside right now.

Christine Boev [:

You need to come right now, and you might get yelled at the other end. I don't care, right? Because I know that I'm doing the right thing by our patients.

Boots Knighton [:

That's incredible. And I'm just thinking back to my time in the ICU, and I was wondering if they truly understood my situation, because I threw up 25 times post open-heart surgery. I mean, my memory is in and out about that time. I remember they immediately got me up out of the bed as soon as they had taken the breathing tube out, and I had all these wires. And Jason, my husband, got pictures of my first time standing up and then, of course, I threw up all over the floor. But walk me through the decisions of when, you know, it's time to extubate, when it's time to have the patient stand, when it's time to walk, and the importance of all those steps, because I know there's a lot of data involved, right? And, I mean, it's really an exact science of when those steps can happen.

Christine Boev [:

Right. So, ICUs, especially cardiovascular ICUs, are very protocol driven, and there are certain benchmarks that you need to meet, but there's a lot of emphasis on early extubation. So, getting that breathing tube out so you don't end up with a postoperative pneumonia and then early ambulation. So, we are getting patients out of bed whether they have a breathing tube or not, because we know that early mobility, oh, yeah. We get people up on the ventilator. It's wild.

Boots Knighton [:

I did not know that. Okay.

Christine Boev [:

Yeah. It comes with confidence, right? As a nurse, you need to be confident in making sure that you've got all the players next to you when you are ambulating somebody on a ventilator and that you're communicating really well. Unless you're very hemodynamically unstable, right, on a balloon pump, all the fancy equipment, then for the most part, like, sky's the limit in terms of mobility. Because if you don't get up and get moving, then your risk of pneumonia skyrockets. Your risk of getting a deep vein thrombosis, a blood clot in your leg that could go to your lungs, that could kill you, that goes up. You could get pressure related injuries. They call them pressure injuries instead of pressure ulcers now. So, we don't want skin breakdown and infection.

Christine Boev [:

So, we know that the right thing to do is get your patient out of bed. But you've got to be smart about it. You need to give them pain medication before you get them up. Because you talked about in your journey how discomforting that is. You've got sternal wires. You've had your sternum sawed open. You talked about your pasting, your sternal wires and having to get those taken out again, I can't imagine how traumatizing that was for you. But you've got to make sure that, as the nurse, again, conductor of the orchestra, you've got all the players in place so that when you do get your patient out of bed, number one, it's successful. If they are vomiting 25 times, okay, well, what tools are in your toolbox? Get some Zofran on board, right? And just really help to make that as smooth as possible.

Christine Boev [:

But you're also somebody that gives a lot of tough love. Because typically, when you first get somebody out of bed, they hate you. Right? They're like, I can't believe you're making me do this. You're so mean. And I'm just like, listen, trust me. This is in your best interest. So, you got to be a safety police. You've got to be a tough love person, and you've got to be the conductor of the orchestra. All at the same time.

Christine Boev [:

So, it's pretty miraculous what the bedside nurse does when you think about all the things that could go wrong.

Boots Knighton [:

And I'm also thinking about what nurses are paid, and it just does not equate to what you're laying out here. It's like the equivalent of a teacher, right? It's like what teachers and nurses do versus how they're compensated. But that's a whole another podcast in another day.

Christine Boev [:

Yeah, we'll have to do that one next time.

Boots Knighton [:

Yeah, exactly. Wow. Okay. So, hemodynamics. Can you just give us a brief understanding of that and what it means to be hemodynamically stable versus unstable? Now, I realize that's a very big topic, but can you give us enough that patients who are listening, who are about to go into heart surgery will understand so they can understand the other side?

Christine Boev [:

Yeah, absolutely. So, depending on what the problem is. So, yours was really interesting with the myocardial bridging. That's not something that we see a lot of. So, it was very interesting. I did a little bit of my own review of okay, remind me what the physiology is of that. But when, you know, typically, with your open-heart patients, there's either a problem with your valves, there's a problem with the muscle of your heart, it's not contracting well. If you're somebody who's had a lot of heart attacks, right? You think about that muscle around the ventricle. It’s weak.

Christine Boev [:

So, hemodynamics is the ability of your heart to pump and distribute blood throughout the body. And you will feel the effects of poor hemodynamics and Boots with your story of when you were climbing the mountain and you started to feel all the things. Your hands and feet were tingly, you were nauseous, you were pale. That's because you're not getting enough blood flow to the rest of your body. And so, the goal of open-heart surgery is to rewire the way that your heart pumps to bypass blockages. If you're somebody who has coronary artery disease and your coronary arteries are blocked, and then we provide a new passageway, we're restoring the hemodynamics so that we can achieve adequate blood flow to the rest of the body. Now, the way that we measure that is a couple of things.

Christine Boev [:

Number one is your blood pressure, okay? Everybody's going to end up with a little catheter in their artery, and that's called an arterial line. And that's a nice way to directly measure your blood pressure. And then most patients are going to have a large catheter in their neck vein that is called either a Swan-Ganz or a pulmonary artery catheter. And that's going to give us even better data about what's going on inside the chambers of the heart. So, the tip of that sits in your superior vena cava, and it kind of gives us a bird's eye view of what's happening inside the heart. So, inside your right atrium, it'll let us see what's going on with that tricuspid valve. How's your right ventricle doing? And then that leads to your pulmonary artery and how is that pumping. It can also give us indirect measures of what's happening in your lungs, so it can tell us if you're having good oxygen exchange in your lungs.

Christine Boev [:

So, when you see somebody initially come back from open heart surgery, there's a lot going on. They've got the arterial line, the neck catheter. They are going to have a tube that's draining out the fluid from inside of the heart that goes into a low plastid box. So, there's all sorts of things so that we can determine whether we're achieving optimal hemodynamics. So, is your heart pumping and beating the best it possibly can? And the other thing is your body getting used to, you know, the way that we have rewired things, because it's been working so hard to compensate for the problems, right. With your bridging, your other coronary arteries are really trying to pick up the flak for the fact that your LED was not where it was supposed to be. So, it's fascinating the way that our body adapts. It creates alternative pathways with our lungs and our vessels.

Christine Boev [:

And so, now we have to tell your body, like, okay, hey, guess what? You don't have to work so hard anymore. We've fixed the root problem.

Boots Knighton [:

That is the best explanation I've heard yet of why I had so many wires coming out of my body when I woke up. Thank you. And I know that all my listeners will benefit from that as well, and their caregivers, because that's something my husband Jason still talks about. He's like, you just had so many tubes and wires. And I looked like a giant science experiment. And I kind of was, like we say, practicing medicine, right? Not perfecting medicine, but practicing medicine. And I remember, and I'd love to talk about this real quick, I remember the morning of my surgery, they had me stay in the hospital the night before, and I had to start doing all the scrubbing down. What really sticks out was we watched, remember the painter, Bob Ross? Because there's, like, nothing on TV for me to watch.

Boots Knighton [:

There's just nothing that interests me anymore, really. But obviously I was a little stressed out, and so was Jason. And so, we both just watched Bob Ross painting the night before. And then the nurses got me up at five in the morning the day of, and I did my scrub down shower again. And then there was this surprise surgery before the surgery, which was at least it felt like a surgery to me, was this wonderful lady came in and put in the arterial line. And what really sticks with me was the amount of medical waste, because obviously she had to be careful about infection. But I'll never forget the long, help me with the wording of how you would describe this, but this medical grade drapery that she put along this tube, find the artery, and it was just like such this production, and I didn't know it was happening, and I didn't know it was coming. So, it was such a shock to me.

Boots Knighton [:

And then I rolled into the surgery from there. That really caught me off guard. And then just all of, like you said, the pulmonary. You said again, the one coming out of the neck was the Swan-Ganz and or the pulmonary.

Christine Boev [:

Yep. And it's always like the bigger one, and it's usually yellow and scary to brace your loved ones and your husband. Okay, this is what Boots is going to look like post operatively. You can't possibly give them enough information so that they're ready for that, and especially because I work in pediatrics now. When you see your infant with all of the wires and the tubes and the other thing that you'll see and your listeners may or may not experience but we'll have patients come back with an open chest so that they're not able because of the amount of swelling during the surgery, they're not able to close the sternum and the skin properly. So, they come back and they've got this yellow mesh, and you can basically almost see where their heart is inside of there. You can't possibly brace people for what they're about to experience when they see somebody they love in that condition. It is absolutely terrifying.

Boots Knighton [:

Wow. Yeah. Jason still took pictures of me, so he's quite the photographer, and I'm so glad he took the pictures because it just reminds me of where I came from. Right. So, I do encourage people like, it is worth the photography, it is worth your loved one using their smartphone and grabbing your progress. Because the difference between the day of surgery when I woke up versus the day I left the hospital, it is truly miraculous how quickly the body can heal. And I've posted pictures of me right after open heart surgery. And I'll probably post that again with this episode because I want not to be like, hey, look at me.

Boots Knighton [:

Look at me, all pale and terrifying looking. It's like, no, really, this is what you need to prepare for and it will be okay. That's the whole point. It's like I post these pictures to remind people that you can come back from really hard things and that it will absolutely be okay, but it is really not fun or comfortable in the middle of it all.

Christine Boev [:

And that's if everything goes according to plan. So, the other thing that your listeners should think about, too, are besides the straightforward repair, things that could go wrong, you could end up on ECMO, which is where they put a little cannula in your chest, and there's a whole machine that basically does the oxygenation for the heart. So, you'll see that in host bypass patients and often many different heart problems. The other thing that can happen is because when we talked about hemodynamics, your kidneys need a lot of blood flow. So, you'll have people that come back from surgery, and they're ending up on continuous dialysis. So, there's all sorts of other things that can go wrong besides the straightforward, what you would expect get out of bed day one, walk, day two, et cetera, that you need to just kind of be prepared for that. There's a lot of unknowns that are outside of our control, and you may have a couple of extra machines next to your bedside as we are trying to get you better.

Boots Knighton [:

Wow. Yes. And I had tubes for my catheter and the chest tube, but I guess I take my surgery for granted. I mean, yes, I had the complication of the extreme vomiting, and they did give me Zofran, by the way, but that was my complication, if you could call it that. Is that call a complication?

Christine Boev [:

Hmmm. Maybe a side effect.

Boots Knighton [:

Side effect, okay. Yeah, side effect. And wording is important because side effect sounds a lot less severe than complication. That's another thing. It's like, how are you talking about the surgery, right? Like, how are you talking about your situation that truly matters. But I definitely don't want to paint a rosy picture unfairly because everyone's road is different. So, let's take a side trip to pediatrics since that is your most recent experience. Tell us about that.

Boots Knighton [:

I mean, I immediately just thought the human in me is like, oh, my gosh, how do you even cope when you are working with little people? That's just the human side of me. But walk us through that job and what you experience on a day-to-day basis.

Christine Boev [:

Yeah. So, pediatric cardiac intensive care units and pediatric cardiac heart surgeons. This is a field of medicine that has evolved very quickly. So, early as like, the early to mid-90s, we would have babies born with certain congenital heart defects that there was nothing we could do. They would not survive post-delivery. And the advances that have been made in the amount of time are incredible. Even in my career, the advances that have been made are incredible. And part of that is from 4D ultrasonography.

Christine Boev [:

So, we're really able to see early on if you've got appropriate prenatal care, what's going on, and then get multiple ultrasounds throughout the pregnancy and then be ready, right? You get induced at a certain age, you've got the whole team there ready to go, and we know what the problem is. It's interesting because I've talked to parents who know, and then I've talked to parents who they just never caught anything on ultrasound, and they had no idea, and they were blindsided. And they'll tell you both ways. Like, the people that knew, over-Googled everything and were really like, worst case scenario. And the ones that didn't know were kind of like, I'm kind of glad I didn't know because that would be really scary. Either way, it's absolutely terrifying.

Christine Boev [:

So, we take care of babies from birth, and then our ceiling age range really depends because we've got kids that were born with congenital heart defects who we've seen. So, they're in early adulthood, and they still come to our unit just based on familiarity and continuity of care. And typically, congenital heart defects range from, you know, you have a hole in between your left and right ventricle or something, what I would say, straightforward to kids where their entire left ventricle is just not present. And there are some cases where the teen will meet beforehand and be like, there really is nothing we can do. Like, this is too far gone. And that gets into the ethical dilemma, too, of, you know, trying to play God, of who lives, who doesn't live, what can we do, what we can't do? And then the parents making the decision like, is this what I want for my child knowing that their life is going to include multiple open-heart surgeries? There's this huge ethical component to this field as well. But I'll tell you what, kids are super resilient. We'll get, you know, babies that are born multiple issues.

Christine Boev [:

They have their repair, they're in the ICU for several weeks, and then they come back and visit us, and they're two and they're running around. So, it's the most satisfying way to work because kids are so resilient. But when you're a nurse in this setting, you're not just taking care of the child. You're taking care of those parents who are absolutely terrified. And I'm a mom myself, and so, before I had kids, I really couldn't relate to what they were feeling. And now that I have my own children, you really can appreciate how the struggle and how much they love their child and just how tormenting it really is to sit there and not really be able to do anything at all. You're pretty powerless. But just keeping the family in mind, keeping them involved in all of the care decisions. We do daily rounds with the whole team, making sure that the family is in the rounds, participating, giving their feedback because they know their child well.

Christine Boev [:

I want their input involved as we are making that plan of care. That's really important.

Boots Knighton [:

Wow, that's a lot. I'm just trying to put myself in your shoes. And I know there's HIPAA involved, but can you walk us through a scenario and like, what questions are asked, what has to be considered in a little more detail?

Christine Boev [:

Yeah, so if we've got all of the information before the delivery, then it gives you some time, right, to meet with cardiology, to work with them. Then there's also this arm of pediatric interventional cardiology, where they talked about your catheterizations. Well, they'll do catheterizations on infants. And what's really interesting is they've been able to do via catheterization repairs that normally would have required an open-heart sternotomy. So that's an advancement that has been made. So, it's really a multidisciplinary meeting that takes place. They'll look at the films, whatever data that they have and based on experience, right? The surgeon's experience of what they know that they can do.

Christine Boev [:

But it's really interesting, Boots. You've got kids that are born and they're missing huge pieces of their anatomy with their heart. Now, the most, I don't want to say crazy, but we've had kids that were born with their heart outside of their body. That one, now, I'm sure there have been and I haven't done a lit review lately, but that one is typically not going to be successful in terms of the two-year-old running around. But we do try to do everything we can to have some sort of resolution. Oftentimes, though, it's not necessarily repair, but maybe palliation. And what do I mean? Well, we're not going to get you back to normal per se, but is there a way to reroute blood flow? So, in the interim, however long that is, that there's some quality of life, right, that you have a couple of good years with your child. And again, all of these conversations are made with the family.

Christine Boev [:

Is this what you want? But again, you can't possibly understand what that trajectory is going to look like as a parent if you've never seen it. Some of my more naive colleagues who've been in pediatric cardiac ICU are like, oh, I would never do that for my child. If that was my child, I would never do that surgery. And I'm like, you have no idea what you would do if that was your child. So, that's really irresponsible to say. But you'll see all sorts of things and then you've got kids who are immediately going to require a heart transplant and that's a whole another field, right? And then, you know, do you have the expertise? And then where do you get that transplanted organ from? It's usually a trauma of another child. There are all sorts of different arms of medicine when it comes to this field.

Boots Knighton [:

I had a couple of transplant patients, three actually, in my first season. And each of the stories was just so hard because they were so grateful to be alive. And all three of them recognized that they had to wait for someone else's worst day, for them to have a new chance at life. For them to have a best day, right? And that is the tug of being a human and having a conscience. And I want to applaud you and your medical team for being willing to be in the roles that you're in, where you are seeing people, families in the hardest days that they'll ever have in their life and being willing to hold space and help make the decisions that you're right. I mean, you'd never really know until you're going to be in that moment. And I would imagine in your role now, as now, training nurses that will come after you, the ethics of what's appropriate to say and what's not appropriate to say. And yeah, there's just so much that goes into your roles.

Christine Boev [:

Right. That ethical piece, therapeutic communication, is it okay to cry with the patients? Absolutely. It's okay to cry with your patients. You're human. But back to the organ donation, one of the things that we do in our hospital is we will do organ procurement. And sometimes it's just the silver lining that gives us all hope in the midst of tragedy, because they'll get a lot of traumas. Really unfortunate when I say child abuse cases and when the family is willing to donate, we do everything that we can to make that memorable.

Christine Boev [:

So, we do an honor walk where when the patient is being rolled down to the OR to do the harvesting, they ring a bell in the hospital. Everyone lines up. It's like, I'm getting kind of choked up. It's absolutely beautiful. We do a lot of bereavement practices where we do photos, handprints, footprints, hair, just as much as we can to support the family through just the most difficult times.

Boots Knighton [:

So, when you say procurement, that means you're harvesting the organs.

Christine Boev [:

Correct.

Boots Knighton [:

Okay.

Christine Boev [:

With children especially, you can harvest so many. You've got heart, lungs, eyes. There's a lot there. So, it's such a gift if you're in that situation. And a lot of families do. They want to make something good out of their tragedy.

Boots Knighton [:

I so appreciate your willingness to share all of this, because, again, it gives us a backstage, if you will, backstage view of each of your roles and understandably as heart patients, when we've come out of open-heart surgery, it is all about us. And we can only think about us and getting through the first few days post open-heart surgery so we can go home. Right. The way I approached it with my nurses was I thought of us as a team, and I thought about trying to make their job easier, like, help them help me. And I don't know if that's a rational way of being, but that's just how I approach my life. And I would almost over communicate how I was doing. And this helps support my theory of just really approaching the nurses as we're all in this together. And I remember I said that to them because there was one unfortunate night where I definitely needed to use the CNAs due to not making it to the bathroom.

Boots Knighton [:

And this was not the vomiting. I really utilized the CNAs the entire time I was there. But anyway, I just remember I was feeling so terrible about it, but that's their role. And so, I was just, like, thanking them, and I was like, well, how else can I help? Because it was four in the morning, and I don't know, I just feel like if you can make that connection with the nurses, it just improves their ability. Like you were saying at the beginning of our conversation. It improves nurses’ ability to be able to be more in tune with you and to help just, I don't know, you're just more in sync with each other.

Christine Boev [:

Yeah. I mean, that relationship, that nurse-client relationship, it's everything. And it's interesting to hear you say that you were interested in trying to help the nurses, because we don't hear that very often, so, thank you. That's amazing. We don't really get to ever hear that, but if anybody's listening to this who is in the process of going to have surgery, any kind of surgery, you can't possibly over communicate. And so, don't ever feel like you're bothering people or you're any sort of burden. It is our job, it is our privilege to take care of you, but you've got to let your needs be known. And a lot of times, too, we're very computerized now.

Christine Boev [:

When I started nursing a million years ago, it was all on paper and that personal, there's a little bit more of a barrier, I feel, like, with the computer between the nurse and the patient, because we've got all these boxes to check and all these scales and all this stuff, but just speak your mind, let people know. Advocate for yourself so we can advocate on your behalf. It's a huge thing that nurses do, is advocating. And we do that during rounds, we do that especially, you know, your night shift nurses, God bless them, working 7P to 7A. I did that for many years. It's absolutely grueling.

Christine Boev [:

And you're the person at 2:30 in the morning that's picking up the phone saying, you need to come now. And on the other end, you hear grumbling and moaning and things like that. So, yeah, just let your needs be known. If there are certain things that you like or certain that you're particular about, let them know. Right. Because we're not mind readers, but we want you and your stay to be comfortable, successful and as short as possible, because the quicker you get out of there, the better you're going to be. The worst thing that could happen is complications and you end up lingering in the hospital where there's a lot of infectious diseases that you normally wouldn't encounter in the community.

Boots Knighton [:

Wow, that brings up something for me. It's a good segue. It's way more computerized than it's ever been. And something I noticed is every time the nurses came in, they scanned my bracelet, they scanned every pill that went in. I started to wonder if they were only coming in when they could make money. I'll be honest, I was really wondering. Okay, so not just coming in to say hello, but, no, I can't scan you. There's nothing to scan for.

Boots Knighton [:

You can't scan for the emotion. We can't monetize on that. And I kind of developed, like a little bit of especially once I had had my third surgery. I was really kind of starting to feel pretty raw towards the medical community. But my more generous point of view now is and more loving point of view is it's just easier. It helps you all chart in a more effective, more precise manner. That Boots got these medications and, on this hour, she was this blood pressure and this temperature. Does it just help with automation?

Christine Boev [:

Well, it's really standard of care that if you're in an ICU, you've got to have at least hourly touch points, right? Otherwise, you wouldn't need to be in an ICU. If you were on like a medical surgical floor, then we would not need to bother you every hour. So, the more acutely ill you are, the more you're going to be interacting with the staff and the physicians and everybody else. Some patients are so acutely ill that they have one nurse assigned to them, and it's one-on-one. And we get those a lot, like immediately post open heart, it's just the nurse and the patient. That nurse doesn't have any other patients that they're responsible for because there's so many things that could change within that immediate post operative window. In terms of the scanning and things like that, the whole notion behind that is patient safety, right? Are we making sure you're getting the right medication at the right time, in the right dose and for the right indication. A lot of times nurses don't know why they're giving something. Which drives me crazy because I always ask my student, okay, why are you giving that? Tell me in your own words and then what are the things that you're looking for? What potential adverse reactions could occur with this particular medication? But you're right. Like, it's very automated.

Christine Boev [:

The healthcare system in the United States is extremely broken because we're very inefficient in how we do things. And when you talked about medical waste, that's a whole another conversation, right? About medical waste and practices that we do that just cost the healthcare system billions of dollars. And so, it's all kind of wrapped into that. But when you talk about also, like, nurses’ salaries, nurses’ salaries aren't going to change until we change the way that we do medicine and become more efficient at it and stop wasting so much money.

Boots Knighton [:

Wow, yet another podcast. We have so many other podcasts bursting from this one. Yeah. So, two more questions for you. Yet another segue from what you were just saying. What is one thing that you're just dying to scream from the mountaintops about the healthcare industry? Or it could be about cardiac ICU. I don't want to put any more parameters on it than that. What is one thing you just want to scream from the mountaintops?

Christine Boev [:

We try to save everyone. We try to keep people alive even though they have zero quality of life. And ethically, I really struggle with it, especially in the pediatric world where you'll have a child born at 23 weeks, 24 weeks, extremely premature, and we do everything to keep that child alive, even though it's futile, where we're also aborting babies at 23 weeks. At the same time, it's a real ethical dilemma for care providers that you're doing all of these aggressive, aggressive interventions. When their brain doesn't work, they're never going to be able to walk, talk, speak, eat, anything. They're just going to lay there. And I think we've become too good at saving everybody that I don't know. I really struggle with that.

Boots Knighton [:

Well, I think about, you know, I've got an old aging dog and I've got a sick cat right now, and it could go either way with both of them, right? And I think about how we are more quick to put animals out of their misery than humans.

Christine Boev [:

Yeah, we really are. Right. Because we don't want them to suffer yet we prolong life to a point where the suffering is, it hurts and it's difficult.

Boots Knighton [:

Yeah. Like the moment a dog loses its ability to walk, oh, we've got to put it to sleep. Right? But yeah, I'd scream that from the mountaintops, too. And so, my last question, and I ask this of everyone, what is the burning piece of advice you want to give heart patients? What is maybe something you want them to know before they come in or even when they're leaving the hospital afterwards? What is that one nugget of wisdom? Because I'm sure you have many nuggets.

Christine Boev [:

Yeah. So, again, depending on your age and where you are in your trajectory, just go in there like you're preparing for battle, right? You're preparing for battle. You know that your body's going to get assaulted and you're going to go through some serious trauma, but in the end, the resiliency and your determination to get the heck out of there and just meet those milestones to the best of your ability, you're going to have a better outcome. It's hard, it's painful, but it's necessary, right? Open heart surgery.

Christine Boev [:

And then the other part is, don't forget about all of the mental health implications of going through open heart surgery. And I know you talked about depression, anxiety. For men, loss of sexual function after open heart surgery. Those are all things that are on the table that we've got to talk about so that even though you could be 99% fixed on the outside, you've got to make sure your inside matches your outside. That's critical because you don't want to go through all of that and then just feel terrible about yourself and not deal with the mental health that is just as important as the physical health.

Boots Knighton [:

Okay. That's the first time I've heard about men losing sexual function.

Christine Boev [:

Loss of sexual function after open-heart surgery is real, and it can also be from the medications that they take. So, you've got to have those conversations. And people are uncomfortable talking about sex and sexual function and erections, but you've got to be comfortable with that if that's something that you value.

Boots Knighton [:

Yeah, well, it's part of human health. Is it permanent? Like, I'm, like, so naive.

Christine Boev [:

No, not always. But also, if you think about it, too, you've got this body image disturbance. You've changed your whole way that blood flows in your body, and then you're taking medications. And so, no, it's not permanent, but there's a lot of things that you can do if you're having trouble getting an erection. And then there's also the conversation of, well, should you take Viagra? Right? And can you take that with some of these other vasodilator medications? So, there's a safety component. So, having those conversations with your healthcare providers is really important so that you feel like you've got great quality of life.

Boots Knighton [:

Sage wisdom from Dr. Christine Boev. Now, as we bring this episode to a close, you also help people with their health journeys outside of nursing. So, can you just brag about yourself real quick on what else you do and how we can find you? And audience I will put how to find Christine in the show notes.

Christine Boev [:

Yeah. So, it's unbelievable, but in my spare time, I do health and fitness coaching, and it has become such a passion of mine. So, I work with men and women. I've got 18 all the way up to mid-70s for clients, and we come up with health and fitness and nutritional strategies. But what I'm finding the more that I get into this is I'm really doing a lot more like life coaching and problem solving, and I absolutely love it. And postoperatively, you absolutely have got to move your body, right? You've got to move your body. You've got to eat well, and if you're doing those things, then your mental health will improve because you're going to feel better about yourself.

Christine Boev [:

So, I love that someday when I retire from nursing, I will exclusively do health coaching. And it's definitely a passion of mine that stems naturally from my expertise in medicine and health and wellness. And I love working out. I work out every day. I eat well. And I think it's something that a lot of people just don't understand. So, helping people unpack what that looks like it's like a no brainer. You might as well.

Boots Knighton [:

Wow. Well, and I can tell you this is the second time we've visited, and I feel like I've made a new friend. You're just so approachable and so obviously knowledgeable. I mean, you have your PhD, for heaven's sakes, and there's a lot of well-meaning health coaches out there who are definitely helping people. But for me, it matters that you have the education and you have the experience and the healthcare industry trenches. You know so much more than the average health coach. And so, definitely get in touch with Dr. Christine Boev. She is a lovely human. And I just can't thank you enough for spending some time with us today onTthe Heart Chamber.

Christine Boev [:

Oh, you're welcome. It is my pleasure. And if any of your audience has questions or you want something, just shoot me a message on Instagram, and I'm happy to go back and forth and help you guys problem solve.

Boots Knighton [:

Awesome. Wow. Lucky us. Well, thanks again, and be sure to come back next week for another amazing episode on The Heart Chamber.

Boots Knighton [:

Thank you for sharing a few heartbeats of your day with me today. Please be sure to follow or subscribe to this podcast wherever you are listening. Share with a friend who will value what we discussed. Go to either Apple podcasts and write us a review or mark those stars on Spotify.

Boots Knighton [:

I read these and your feedback is so encouraging, and it also helps others find this podcast. Also, please feel free to drop me a note at boots@theheartchamberpodcast.com. I truly want to know how you're doing and if this podcast has been a source of hope, inspiration, and healing for you. Again, I am your host, Boots Knighton, and thanks for listening. Be sure to tune in next Tuesday for another episode of The Heart Chamber.

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Hope, Inspiration, and Healing. Conversations on Open Heart Surgery.

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