It became a very delightful relationship.
Geriatric Care and a Special Relationship Help a Man Care For His Wife and Himself.
An emergency call had gone out to staff at Monmouth Medical Center Southern Campus (MMCSC): A patient was having trouble breathing. “All these people descended on the room,” says Gerry Byrnes, 87, of Brick. “I’d never seen so many people crowded in the hallway.”
Gerry was visiting his wife of 44 years, Joan, who was in the hospital in late 2021 for pneumonia complicated by ongoing health issues including heart failure and chronic obstructive pulmonary disease (COPD). She began having respiratory distress that lowered her oxygen intake.
Among the providers who rushed to Joan’s room was Melanie Vernacchia, MSN, APN, OCN. A nurse practitioner specializing in geriatrics and palliative care, Vernacchia is Clinical Director of MMCSC’s James and Sharon Maida Geriatrics Institute. “Melanie knew Joan better than any provider in that room,” Gerry says.
Familiarity is typical for Vernacchia when working with older patients. “My general approach is to address the patient as an individual and provide individualized care based on the person’s goals, wishes and wants,” she says. “I try to look at the whole person and not just their diagnoses.”
That entails getting to know not only patients but also patients’ families. “Joan’s favorite thing to drink was root beer,” Vernacchia says. “I don’t know if any doctor would know that.”
Joan’s respiratory emergency quickly passed. “As a primary caregiver, I was able to assist in creating a care plan for her that day,” Vernacchia says. “But I think my presence also helped her relax and overcome this hiccup during her hospital stay.”
Compassion and Understanding
Gerry and his wife first met Vernacchia when they moved to Brick from the Cape May area in 2017. They came to the James and Sharon Maida Geriatrics Institute to find medical care geared to older adults. “It became a very delightful relationship,” Gerry says.
In addition to heart and lung issues, Joan, then 88, also had battled arthritis since her 50s. Over the years, she’d had joint replacements in both hips and both shoulders. “I helped her manage various issues,” Vernacchia says. “Over time, her orthopedic problems continued to worsen, but with COPD and her overall age, she wasn’t a candidate for any further surgeries.”
“Melanie is very compassionate and understanding,” Gerry says. “She never would express her own feelings about care until she heard the whole story of how we felt and what we thought. She’d listen, take notes and then make her recommendations.”
At one point, Vernacchia spoke up about something Gerry hadn’t seemed to consider. “Joan had so many ailments that Gerry put himself on the back burner all the time,” she says. “I said to him, ‘You need to take care of yourself as well—otherwise, how are you going to take care of her?’” It was a persuasive argument: Gerry also became Vernacchia’s patient at the institute and began coming in at least annually for a checkup.
But the focus for both Gerry and Vernacchia remained on Joan, who steadily declined and eventually required the use of a wheelchair. Mishaps around the house led to injuries to Joan’s lower legs that proved difficult to heal. “I started making house calls so that she didn’t have to come all the way in to the hospital,” Vernacchia says.
“Melanie was always available,” Gerry marvels. “She gave me her personal number and wanted me to know I could call. She’s one of a kind.”
Difficult Conversations
Gerry felt the COVID-19 pandemic accelerated Joan’s decline. “Not being able to go anywhere or do anything caused a slow loss of muscle and ability to maneuver,” he says.
When lockdowns eased, Vernacchia encouraged Joan to attend a Thanksgiving family reunion in New York’s Catskills region. “She had been hemming and hawing about going due to her health,” Vernacchia says. “But she went and thanked me afterward. She held on to those moments with her children, grandchildren and two great-grandsons.”
Vernacchia is experienced in end-of-life care and recognized the family could benefit from some healthy but difficult decisions. “She mentioned hospice a few times, but we obviously weren’t wanting to think about it,” says Joan’s daughter Sheila Rothschild. “She explained it in a beautiful way—that it wasn’t like Mom would pass away the next day, but we should do our best to prepare ourselves. Melanie always had a calm and thoughtful way about her, and she made some very good points.”
With Vernacchia’s help, Joan and the family decided not to seek hospital care that might not significantly prolong or improve her life but to remain at home surrounded by familiar comforts and the love of family. Joan passed away at age 93 in January 2022.
“She had a good life,” Gerry says, recalling how together they saw all 50 states—many of them during a six-week road trip in 2000.
In the spring, he went to the James and Sharon Maida Geriatrics Institute for his annual physical. “When I showed up, the staff said they were so sorry about Joan and gave me a hug,” he says. “When you lose someone, a wife of 44 years, just a meaningful hug brings tears to your eyes. The whole staff is considerate and caring in that way.”
To learn more about the James and Sharon Maida Geriatrics Institute at Monmouth Medical Center Southern Campus, call 732.886.4700 or visit www.rwjbh.org/monmouthgeriatrics.