Brother Bruce's Big Bargain Brain Bleed Bazaar

Sunnydale General has turned into the place to be if you've had a brain bleed. No matter the type--subdural, epidural (what killed Natasha Richardson), subarachnoid--if your brain has bled, you're in like Flynn.

Which means, of course, that I've had an average of five patients a day for the last week, four of whom can walk, and all of whom are confused/delusional/generally disoriented.

Which means I've been running my rapidly-widening ass off, trying to keep my patients from (variously) finding a policeman to report some crime that they can't articulate, going downstairs alone in a bad neighborhood to smoke, getting on a bus that isn't there, delivering twins that don't exist, and going to the movies.

When blood gets somewhere it shouldn't inside your brainbox, weird things start to happen. The most obvious is that blood isn't supposed to leave its conduits, so your brain tissue gets really irritated. It's like meningitis, with the attendant pain and sensitivity to light and sound. Then you have the issue of what happened immediately after the bleed: some people end up with ischemic areas of the brain because their vessels clamped down right after the one vessel burst--it's the body's attempt to minimize the problem, but often it makes things worse. And, finally, all of that's compounded with ICU psychosis, because all of these folks have been in the ICU, with its constant noise, light, and disturbance, for a period of days to weeks.

To put it bluntly, you get very, very weird after a brain bleed. Initiative disappears (unless it's the initiative to do something like wander out of the hospital and into traffic), you get easily distracted, your balance suffers, and you hallucinate. 

All of that makes it fun for the nurse who's taking care of you. (I have no idea what it's like to be inside the braincase of somebody who's had a recent bleed, but it can't be a picnic.) I'd say that the distractability is the hardest thing to deal with: it's difficult to get a person to do something as simple as take a pill. Just the steps involved: grasp pill cup, bring to mouth, open mouth, etc. are too difficult for the post-bleed brain to handle. So the person sits there, meditating on God knows what, pill cup in hand, while the family tries to help by repeating the same instructions over and over. You can imagine what that does: sets up a feedback loop inside the injured brain, until the person in posession of the brain gets agitated, flipped out, and very worried.

I still like taking care of people who've had bleeds. It's fun. (No, really.) Something as simple as a two-hour nap can make a confused, agitated person into someone who's just a little stranger than baseline. It's also nice in that, unlike things like concentric sclerosis and optic neuritis, you can see people get better over the course of a week or so. There are drawbacks, naturally--the primary one being that, as people get better and stronger physically, the brain lags behind.

Which is why I've run my ass off. Sometimes the only thing you can do for someone who's delusional, agitated, and insomniac is exhaust them. I walked four people around in circles yesterday until I felt like my own feet would fall off. Three of them ended up napping heavily afterwards, while the fourth had to be restrained by Security and prevented from going out to buy some drugs. Three out of four isn't bad.

Oh, and that fifth patient? Once we figure out what's causing the encephalomalacia (brain softening; my new favorite term), we'll talk about that.