Tuesday, November 16, 2010

I'm back at work, so be afraid. But not as afraid as if you'd seen that one doctor.

Just a tip from Auntie Jo to the nameless millions of future hospital patients out there: if you sustain a subdural hematoma in a fall at home, and you need that subdural hematoma evacuated, make sure it's a neurosurgeon doing the evacuating.

Because if you let just any Fred Friendly into your brainbox, it's possible things could go very wrong indeed. This goes double if you're from Teenyville, that tiny town just south of Wherezat and east of Whadyasay.

Grandma took a fall a couple of weeks ago at home and conked herself on the head. It wasn't a very big conk, or a very painful one, but Grandma, being the careful sort (and being on coumadin and aspirin), took herself to the emergency room just to be on the safe side. The folks there checked her over, did a scan, and kept her overnight for observation. This was a very good thing, because Grandma developed a subdural hematoma during the night, and her level of consciousness dropped.

Subdural hematomas are interesting creatures. They're called the "walk, talk, die" injury because of the way they present: you're fine for some amount of time, and then you're very suddenly not at all fine. You become not at all fine because of bleeding below your dura, the covering of your brain, that puts pressure on the brain itself. A brain can stand quite a lot of abuse (that's the "walk, talk" part of the equation) before it finally starts being squished beyond tolerance or repair (that's the "die" part).

Anyway, back to Grandma. She started getting wonky, so the folks at Teenyville Memorial did a series of CT scans that showed an expanding subdural hematoma.

The correct thing to do at this point would've been to ship Grandma to a larger hospital, like Sunnydale or County General or even Our Lady Of Questionable Mercies. Instead, one of the general surgeons at Teenyville Memorial decided to take matters into his own hands and evacuate that subdural hematoma himself.

Evacuations are done with suction. Careful, gentle, less-is-more suction. By qualified neurosurgeons. In a neurosurgical suite, with nurses and assistants and anesthesiologists who know what they're doing. Because, if they're not, you end up with a cowboy with a suction catheter who suctions out part of Grandma's brain.

I'll just let that sit there for a minute while we all look at it in silence.

Yeah. It made me sick to my stomach, too, and I don't quease easily.

So Grandma came to us, because of course we work miracles, including inducing our patients to regrow large portions of their frontal lobes. (Yeah, right.)

Grandma is off the ventilator now, but she'll never write another thank-you note. She doesn't recognize her kids, near as we can tell, or even follow any commands. It's an even bet what did this to her: either it was the jacked-up surgery or the intense high fever she had afterwards (which is usually a sign that something has gone badly wrong in the brain) that wasn't treated correctly.

The general rule of thumb is that, if a patient has a temporal-thermometer temperature of 40 (that's...um...somewhere about 104 or thereabouts), and that patient is an adult, you say the hell with cooling blankets and start packing 'em in ice. You don't put them in a phenobarbital coma in an attempt to calm things down.

Sunnydale Hospital: For those times when even a Dustbuster won't pick up the pieces!

*** *** *** *** ***

So, yeah: the first day back at work was a runner of a day. There were more patients than I have fingers on one hand who were on multiple drips (note to self: three four-channel IV pumps on one pole will cause that pole to tip over), there were people with interesting breathing patterns, people with crazy-ass neuro changes, and folks who hovered on the edge of disaster all day long. Add to that the usual postop cases, and we had fun.

But you know what? I loved it. Getting back to work, while it was taxing, was the best thing I could've done. I spent the day as an extra set of hands, helping everybody without carrying any acutely ill patients on my own, and it was *great*. I took two very long breaks to stretch my jaw and rest my face, and ate lunch like a normal person, with conversation and everything.

It was also nice to hear from the most critical people in the world (CCU nurses and intensivist physicians) that I sound mostly normal and look really good.

Tomorrow is another day in the unit. It feels really good to type that, and to end the sentence with the word HOORAY!

33 comments:

clairesmum said...

Poor Grandma - hope that there is a successful suit on her behalf, so that this general surgeon doens't ever decide to 'practice' neurosurgery! Glad you are transitioning back to work as slowly as is feasible - I know it's all relative. You go, Jo!

Bardiac said...

Great to hear that your day went well :)

(And I LOVE your town and hospital names :)

Penny said...

H O O R A Y ! ! ! !

me said...

Congratulations on the return to work ~ I think that will help with the "I don't have cancer anymore" mind-set wigginess ~
And whatever else it's faults, YAY for your boss/hosp. letting to come back as an extra hand ~ bet your co's love it!!!
Hugs ~

Cr0w$c@lling said...

GooooooD..........God.
A non neurosurgeon sucking out brain.
-orightf

Celeste said...

Welcome back, Jo!!!!! I hope tomorrow is even better for you.

For that poor Grandma, Imma hafta go with a certain line from Stephen King's "Pet Semetary"...."Sometimes, dead is better.".

AM said...

Boo-yah! I'm so pleased for you I could just spit.

woolywoman said...

Yay! at least her heirs can sue for all the RTC care she will need. Nice that they let you have a break in day. Being busy is the best thing for me, too.
Also, set the pumps lower on the pole, and then use those little blue hanger thingy's that come with the piggyback tubing to extend the bags on the bottom pump to fit.Like 2 per bag.

MamaDoodle said...

Congrats on such a success as you go back to work! Nothing like doing what you do best to feel back to your normal self.

Anonymous said...

Oh Jo-
So psyched to see you in all your glorious, perverse, thrilling nursing humor again.

Better than any dustbuster ever!
C.

Anonymous said...

Hooray! for you.

W. O. W. I cannot believe the gramma story. How unbelievably sad.

Albinoblackbear said...

That is shockingly sad. Who in their right MIND would do such a thing? Mercy.

On another note--great that you are back at work!

Nursing needs you, your brains, your hands, and your heart.

Anonymous said...

Woohooooooo so happy for you, and your co-workers, and your patients! Just what the doctor ordered, methinks. (Ughhhh I just realized how problematic that phrase is....) Anyway, enjoy and congrats! xo

Rebekah said...

Glad to hear your first day back went well. So glad.

The Merry said...

Jeez that's a sad story.

Lioness said...

Oh my, that could have been my mum. That could have been me, or any of us! How criminal is that, do egos know no bounds?? It's the brain! The Brain! There's a reason there's a speciality and training takes years and years to complete, that's just... That poor woman, and those poor patients (most of us really) at the mercy of megalomania.

On a cheery note, delighted to know you're enjoying work again! I have just found an Urban Search and Rescue Unit outside Lisbon that needs volunteers to train their dogs, am very cheery myself, if still bloody unemployed. (Verif word is 'ponge' - Victorian fetor?)

Elsie said...

HOORAY!!!

Lurkette said...

Hurray for you! (And a nice thought for your nurse managers who are being thoughtful about the way you get back into things.)

Looking good and talking almost like normal - already. I am sooo impressed.

Said it before, will say it again: You rock, Jo!

Eileen said...

Great news!! For you at least - poor grandma, poor family. Somehow it's always worse when it didn't have to be that way.

WV - clonop - mmm, hope that surgeon wasn't cloned.

Just My 2¢ said...

Congrats on working! Nothing helps like getting back into the routine. Cowgirl up!

Polly said...

Ugghhhh...ralph. OMG. Poor Grandma. All the worse because she did exactly what she was supposed to do!

I'd guess that another benefit of going back to work, aside from feeling useful and capable and social, is that you can thank your lucky stars you aren't that lady.

Cr0w$c@lling said...

Sadly there is some talk in the trauma community about trauma surgeons being permitted to perform EDH/ SDH evacuations. This should give them pause
-thilmgor

Anonymous said...

Oh, my, your post gave me pause! Almost 10 years ago, after a snowboarding accident, my then 20-yr-old son had his subdural hematoma sucked out...luckily by a very competent brain surgeon. He went on to graduate with honors from CAL (and go on for a masters) and you just made me realize all over again how lucky and blessed we were!

Whew!

PS--so, so happy to hear you up and about in such a normal way. Continued good wishes to you, Jo.

Lori

messymimi said...

Doing Snoopy's happy dance for you. Hooray!

SadieSadieLady said...

Nice. Grandma doesn't really NEED that brain I guess...

just wanted to let you know I've been reading your blog here and there for the past few weeks? i think and I really like it. I'm a nurse (peds) and your posts definitely hit home. I am very glad you're doing better!!! I hope things keep on a gradual upward slope and glad work went so well!!

birdergirl said...

Ah....good news and bad news. So glad you had a good first day back at work, Jo. This is a big step towards normal. Bad news about Grandma...what an incompetant ass.

Jill said...

Oh lord. Poor grandma. That's very sad.

Hey Jo, what happened with your cyber friend who found the lump in her mouth???

Elyse said...

Glad for you Jo! The first day back from my real bad asthma was a psychological hurdle in that ol' Bessie may work just fine idling in the garage but can she still zoom down the highway? Phew! Got that one done with flying colors!

Grandma indeed makes me so sad. The little sweetie did everything right for herself and drew the short straw on surgeons that night. I hope she comes round enough to at least realize who loves her.

Adirondack Autumn said...

Oh my GOD what a sad story! As soon as you started talking neuro suites, general surgeons and small town hospitals I was thinking "This will end badly"

I'm glad you're back to work. You sound very happy with that,

C in Canada said...

Holy crap. Can doctors lose their license for such stupidity? One can only hope. That poor lady.

My day was pretty interesting too - 3 week old baby brought into Emerg who'd passed (SIDS at this point), an eclamptic mom with seizures who was stabilized then sectioned (baby is okay) but she had a brain bleed, but in happy news got to watch a very healthy normal delivery, mom intact baby beautiful just before I got to go home. Out to a car whose battery quit (of course on the first day of our really cold weather. -20. I love being Canadian.)

Dr. Alice said...

Just to add my voice to the chorus, I'm very happy that you are back in the saddle, but not happy for poor Grandma. I hope her family sandbags that surgeon like nobody's business.

SP said...

J-M,

I thought you might like this:
http://hyperboleandahalf.blogspot.com/2010/11/dogs-dont-understand-basic-concepts.html

SP

Bongi said...

entertaining. a friend of mine once had a go at a subdural, but that is after the 20th hospital refused to take the patient. there was no option. still extremely suboptimal. i'm not sure i would have done what he did, but he did save the patients life, for what it's worth.