Friday, May 06, 2005

Well, that was interesting.

It's crunch time at the hospital. Every patient in the ICU is on a vent--no kidding--so we're getting a lot of really...er...marginal patients up on the floor and into our ICU overflow. Makes for an interesting day, as we discharge everybody that is ready for discharge, move people hither and yon to open up rooms, and then wonder what fresh hell is coming up from downstairs.

One of my guys this week was in after a major stroke to one of the big arteries in his brain (posterior basilar, if you're interested. Also, writing the word "basilar" over and over makes you wonder if you've spelled it right). He's lost all function except for voluntary eye movement, and that with a fairly significant delay. Ask him to open his eyes wide and he will, but only with what seems a lot of work and after a couple of seconds.

The report I got gave a diagnosis of "locked-in syndrome", a nightmarish situation in which a brain injury or other problem robs a person of all voluntary movement except those of the eyes. Given that that diagnosis was postulated by a pulmonology resident and not a neuroscience resident, I was a little weirded out. Anyhow, my poor patient had all the prerequisites for a rotten diagnosis: fulfilling life, happy family, loving friends, beautiful kids. At this rate, I'll live forever.

Another patient (beautiful children, loving family, loyal friends) came up to us after two weeks in a phenobarbital coma for status epilepticus.

In English, that means this:

You know when you have an epileptic seizure, and the electrical activity in your brain goes completely haywire? Imagine that without end. Status epilepticus equals completely wacked-out electrical signals. A phenobarbital coma is a fun little medical tool we use to calm peoples' brains and bodies down long enough to give them a rest and us some breathing room to figure out what the hell to do next. (By the way, we still have no clue as to what caused the problem, so please don't ask me.)

This poor patient had been in an almost-constant seizure state for *three weeks*. The seizures had calmed down to the point that facial twitching was her only symptom (well, probably also because she really couldn't move anything else, given the amount of damage she'd had), so they handed her off to me.

Nobody told me that the seizures would occasionally stop for a few minutes at a time, leaving my trached/g-tubed/paralyzed patient aware of what was going on. Unable to speak or move, but aware.

At which point she would sob silently, tears flooding down her cheeks.

Then, maybe mercifully, she'd start to seize again and would become unaware.

Makes you long for a tumor. At least those, you can get out of the hospital in a week or two.

2 comments:

d said...

Happy Nurse's Day!

K. MacDonald said...

Just a student nurse trying to find some information on what, exactly, a phenobarbital coma is (which is really hard to find for some reason). I stumbled across this blog though my google search and I'm hooked! I always love hearing about nursing outside of the "ivory tower" that is school. Thanks for sharing your stories. BTW, this story of the seizure patient... wow, just wow...