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Seeing Smarter
Fall 2008  
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“You’re scared you’ll hurt somebody for what you don’t know,” Evans says. “You can draw up the wrong dose of insulin and kill a patient in seconds. It’s a big job.”

  He was their patient. Now he’s one of them.
By Rhonda Mullen

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Randy Evans has come full circle. Eight years ago he lay in a patient bed in Unit 21 at Emory Crawford Long Hospital, recovering from quadruple bypass surgery, lucky to be alive. Recently he started working in Unit 21 as one of the registered nurses who care for people, like himself, who have just come through a life-changing operation.
How does that feel? “Absolutely frightening,” Evans says.
     He’s only two weeks into the job, still working under the supervision of a preceptor nurse but with increasing responsibility for patients. Unit 21 is a 41-bed, step-down surgical nursing unit for patients who are preparing for or coming out of major open heart or lung surgery. The busiest at Emory Crawford Long, the unit is a challenging place to learn to be a nurse.
     Just the day before, for example, Evans and his preceptor were in charge of a 40-year-old patient admitted for open heart surgery. The man was diabetic and obese and needed four drip bags including ones for insulin and heparin—both of which require complicated protocols. Between finger sticks to check blood glucose every hour and the math calculations to determine correct dosages, this one patient could keep even an experienced nurse like his 25-year veteran preceptor busy for an entire shift, Evans says. But the two nurses had others to attend to as well, including taking a complete history on a newly admitted patient.
     Evans is used to such challenges. Getting this far—from patient to nurse—has involved selling a house and downsizing, reorganizing a business, going back to school to get a nursing degree, even changing his self-image. “It has been a long journey,” he says, “the hardest thing I’ve ever done.”
     That journey began when he told his wife, Maria, and teenage daughter Marra that he wanted to switch careers. He and Maria had built an editorial services company together for the past 20 years, and her support in taking charge of the business allowed him to go after the prerequisites he needed to apply to nursing school.
     “As an editor, I had always thought of myself as a word person,” Evans says. “I had never taken a science course that I wasn’t forced to take.”
     Yet there he was at age 55, enrolled at Georgia Perimeter College in microbiology and organic chemistry courses that were “way out of my comfort zone,” he says. He wanted to continue nursing studies at Emory, so he buckled down to get the grades it took to be admitted. The first day of nursing school at Emory’s Nell Hodgson Woodruff School of Nursing was Evans’ birthday, his 57th, an age when many people are starting to think about retirement.
     “I felt like the aged mascot for a class of mostly women,” Evans says. “I was older than most of my professors.”
     Still, he had the motivation to overcome his hesitations. He had a second chance at life, and he wanted to do for others what he had seen nurses do for him. After the surgery, as he watched his nurses monitor medications, keep a close watch on vital signs, and be there for his family, his admiration for their dedication grew.
At one point, Evans remembers, “I just decided I’d like to be one of them.”

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Seeing the heart smarter
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  Cracking open a chest, a life

    Leading up to his heart surgery, Evans had ignored initial signs of trouble despite a strong family history of heart disease. He regularly had run 40 miles a week, and he ate a healthy diet. When he and Maria adopted their daughter, he stopped exercising for a year, but soon enough he got back to walking. Only then, as he crested some hills in the neighborhood around the Emory campus where he lived, he felt pain in his chest. It usually went away. Meanwhile, he was getting weaker and weaker. Eventually, he didn’t even have the energy to mow his lawn. The chest pains started coming on at night, growing until finally they didn’t go away at all.
     Evans finally submitted to his wife’s urging and went to the emergency room. When an EKG and blood test were normal, he was sent home. But his wife, who knew in her own heart that things were not normal, pushed for more testing. The next day he returned for a stress test. During the test, it was clear to Evans from the expression on the cardiologist’s face that there was a problem. He then was sent to the catheterization laboratory, where the findings of an arteriogram revealed many major blockages in four coronary arteries.
     “There was no reason I should have been alive,” Evans says.
Within days, he found himself in a place he didn’t want to be—facing surgery at age 51, just as his dad had at age 60. During that earlier surgery, the elder Evans had a stroke, and afterwards, his quality of life plummeted. “He was wheelchair bound,” Evans says of his dad, “and all the things he and Mom had talked about that they would do when he retired went undone.”
     With that history in his head, Evans clearly remembers the lead-up to surgery. In the early morning hours of a Tuesday, he awaited, with excruciating chest pain, his quadruple bypass surgery, scheduled for mid-afternoon at Emory Crawford Long. Nurses put nitro-
glycerine under his tongue. They asked him on a scale of one to 10 the number of his pain. They hung a nitro drip, and still the pain continued. (The actions are all the clearer now as Evans goes about Unit 21 doing those very same things for patients.) Finally, the surgeon was called in from home, and Evans was rushed into the OR for emergency surgery.
But Evans had a better outcome than his father. His surgeon, John Puskas, was conducting a clinical trial for off-pump cardiac artery bypass surgery, which is performed without a heart-lung machine to oxygenate blood and pump the heart during surgery. The off-pump technique today has become the standard at Emory hospitals. Because Evans’ heart was in such distress by the time he reached the OR, Puskas was unable to perform the surgery off-pump. However, during his last semester as a nursing student, Evans had the opportunity to observe the surgeon perform the off-pump procedure.
     Cracking open a chest is hard on a person, and the recovery is tough. But Evans did well. There were days when he didn’t feel like doing anything, even six weeks out. But slowly, life returned to normal. He even ran the Peachtree two years out in a race that was symbolic for him.
     He also started working with an organization for heart surgery survivors, Mended Hearts. Every Wednesday morning as a Mended Hearts visitor, he would talk with patients on the same Emory Crawford Long unit where he had been a patient. The patients were usually one or two days out of surgery, and Evans shared his story with them and encouraged them in their own recoveries. He saw how much good that did, and he felt like he was giving back.
That experience sent him back first to school and now to
Unit 21.
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  Do no harm

“You don’t come out of nursing school knowing how to be a nurse,” says Evans. “All nurses will tell you that the first year is very stressful, and they doubt themselves and their ability to be a competent nurse.”
New nurses realize the responsibility they have assumed, that they can do great harm without proper supervision, indoctrination, and on-the-job learning. And there is much to learn—how to keep pace, complete the necessary paperwork, follow the proper protocols, learn admit and discharge procedures, and manage medication schedules for multiple patients.
     Evans feels that the veteran nurses on Unit 21 want him to succeed. He says he learns something new every hour. He’s learning to remove chest tubes and central IV lines. He’s running hard to keep up, to pay meticulous attention to administering medications correctly.
“You’re scared you’ll hurt somebody for what you don’t know,” he says. “You can draw up the wrong dose of insulin and kill a patient in seconds. It’s a big job. I’ve had a couple of days where I’ve come home and told Maria, ‘Oh, my god, this is too hard.’ Then a couple of days, I’ve felt like I was on my game. Who knows? When I go back next on Saturday, I may get kicked in the teeth again.”
     On one of his good days, Evans came onto a shift to find a frightened patient surrounded by her husband and daughter. She was supine, stiff, and so wracked with pain, she almost didn’t breathe. As Evans entered the sickroom, the husband, exasperated by the number of staff people in and out, snarled, “Who are you?” Evans explained to the patient, “I’m going to be your nurse for the next four hours, and I know how you feel.” Then he shared that he had been right where she was. He had gone through what she was going through. He knew she thought she’d never be the same again. Yet he knew, like himself, she was going to be all right. The woman burst out crying in relief. Later, her husband came and found Evans in the hall. “You really helped her,” he said.
     Evans thought back eight years to one of his own nurses, who still works on Unit 21, to how helpful he’d been, how dedicated, how caring. He was like that nurse now. After a long journey, he was one of them.
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