Sunday afternoon. I thought I'd have a few minutes to chart, having just opened my patient's lumbar drain. It takes thirty minutes to drain ten cc's on her, to I figured I'd just hop down to the station, enter a few orders, and hang out for twenty minutes or so.
Then the call bell rang.
"I have the worst headache ever" said the voice on the other end. "Worst headache ever" is a klaxon to a neuro nurse; it usually means something like a hemorrhage or herniation. And it was my patient who was complaining.
So off I trotted to see what the problem was. I found her sitting up in bed, at about a forty-five degree angle, with her hands pressed to her forehead.
Her lumbar drain was still open.
Now, then. A lumbar drain is a small, flexible, hollow catheter connected to a measuring device and a collection bag. You'd get one if you had a cerebrospinal fluid leak from somewhere in the whole brain/spinal cord complex. Basically, the premise is this: if you have a leak up high, we take some of the fluid off down low, so as to reduce the overall fluid pressure and allow the leak to close up.
Unfortunately, gravity is not your friend with these devices. The patient with a lumbar drain must remain flat and quiet while the drain is open, lest too much CSF drain out and remove the cushion that your brain depends on to stay in place.
My patient had gotten out of bed, walked to the bathroom and peed, then come back and sat up in bed. In ten minutes she'd drained five times what she normally would drain in a half-hour.
It was the first time she'd forgotten about the drain being open and I can guarantee that it'll be the last.
So I closed the drain, flattened out her bed, upped her IV fluids, and handed her the soda on the table. "Drink this," I said, "the caffeine will help." As soon as I had shot her up with some morphine I called the resident to let her know what had happened.
An hour later, when the headache had subsided, the patient asked me why it had been so bad. What could I say?
"Your brain was trying to migrate down into your chest" was the only reasonable way of putting it.