Switched back to the mothership last week (that's what I call the main hospital). So I'm back to carrying my own caseload which I really missed by the end of four months. While it was a nice reprieve to not be so involved in patients' stories, I was reminded how much I gain out of investing myself in my patients. And ask and you shall receive... little did I know that a story was about to come along that would completely require all my attention and energy.
At 26 years old, Mark was on top of the world- living with friends in southie, working in boston, close with his family. Everything changed January 16th when he went skiing with his family and tested out some new skis. He went over a mogul, fell, skis popped off, and he just didn't get up. His dad and sister were immediately behind him and were able to get ski patrol and medics to the scene. He was medi-flighted to the nearest hospital, intubated, and CT showed an intercranial hemorrhage. Somehow his helmet was unable to protect him from sustaining this traumatic brain injury. He remained unconscious for 1 week and was unable to be extubated, so his parents had to decide- to let him go or continue with life saving measures placing a trach and feeding tube. The wild part of this story is that this family has been here before. In 2003, Mark acquired a TBI (traumatic brain injury) requiring bilateral craniotomies. He made a dramatic and full recovery. On one hand, his prognosis may not be good because it's the second time, how much can the brain/body handle? However, on the other hand, perhaps this means Mark is a very resilient person. He may have what it takes to recover, his body/mind may known how to heal itself.
"Unresponsive, but family feels he is responding to their voice and blinking on command." The neuro report did not offer much hope. I went into the room and took a deep breathe, seeing such a young handsome person attached to ventilator just didn't seem right. His eyes were slightly open, but staring blankly, right through you. Looking into his eyes felt like looking into the night sky- filling me with wonder of what lies beyond what my eyes can see. I spoke softly into his ear, introducing myself and my role. Then I said, "If you can hear me, I want you to blink once." And he did. To be sure it wasn't just a coincidence of timing I asked him to repeat, and he did, slowly but intentionally closing both eyes.
So now, I know he's in there. Now I know somebody's home. So I went a little further, explaining to him that he could relax and to let go of some of the tension he was holding onto. I told him not to try so hard. I told him he was in a good place with good doctors and nurses. I told him he didn't have to worry about his family. I told him to just "let go." And with those simple commands, the tension in his muscles began to relax and urine began to flow into his catheter. The nurse was concerned that he hadn't urinated all day! I laughed, "Good you're peeing, see you can let it go!"
This week we will trial sitting him up at the edge of the bed and check his positioning in a wheel chair to get him out of bed. I'm also going to attempt to do a relaxation session with Mark and his mother. See if they can both begin to relax and allow some healing. If it happened once already, why not again? Let's do it!
