Life-and-death decisions

Julie Thomas-Beckett is a family nurse practitioner with the McLaren Medical Group’s Primary Care Partners in East Lansing.

“I don’t want a pacemaker,” 78-year-old Harold said as he sat with his wife and three daughters in the family nurse practitioner’s office discussing his recent tests and the implications of the results.

Harold lived with multiple chronic health issues. He had been brought to the office a few weeks earlier by his wife and daughter, who noticed symptoms of episodic “slumping.” Every now and then, he would slump down in his chair and seem tired; he would then perk up and be back to normal.

Concerned about his heart rate, the Spartan nurse, who had been caring for Harold and his family for more than 20 years, ordered a Holter monitor. Results showed episodes of Harold’s heart rhythm going into an ominously low junctional rate of 32 beats per minute — compared with the normal 60–100 times a minute. His “slumping” episodes were likely due to a very low heart rate.

The cardiologist suggested Harold get a pacemaker. The Spartan nurse helped navigate the family through this life-and-death decision.

Thomas-Beckett called a meeting with the family to explain the Holter monitor and share images from the electrocardiogram. She informed them that this could happen again — and that Harold could die from this condition. The first step to remedy this would be to change some of his medications in an attempt to help the heart work optimally. She informed them that these types of heart rhythms were often corrected with the surgical insertion of an electrical pacemaker that “tells” the heart muscle to beat a minimum of 60 beats a minute. 

With compassion, Thomas-Beckett’s humanistic approach led Harold and his family through this heavy moment — educating them, providing counsel and listening to what they wanted. At the conclusion of the meeting, she encouraged the family to talk about Harold’s options. A few days later, the decision was confirmed — Harold did not want an electronic pacemaker surgically inserted.

“I have been a nurse practitioner for 25 years, so I have families that I have cared for across multiple generations. Nurses are prepared to teach, listen, counsel and to really, really hear people — to develop a plan with patients, not for them,” Thomas-Beckett says. “Patients need the truth. Being honest is an act of respect, and it gives patients the tools they need to make the best decision for their lives and their healthcare. 

“As I think of Harold, I believe he is the ‘pacemaker.’ He is setting the pace for his life according to what he wants and needs,” Thomas-Beckett adds. “We all have choices in how we live. Some of us get choices in how we die. We could all be so lucky, if we get the chance to decide." 

It was more than three years ago that Harold decided not to have a pacemaker put in and he still enjoys putting together jigsaw puzzles and attending his grandchildren’s sporting events.

“That, to me, is the pinnacle of patient-focused care. This is why I’m a nurse practitioner.”