Friday, May 08, 2009

Sometimes, those prayers aren't answered.

The best we could've hoped for was for the patient to end up with persistent weakness on one side and some word-finding difficulty, followed by a long decline and eventual demise. The worst we all feared was that he'd end up hemiplegic, mute, gorked out, and unable to provide for his wife and kids.

It was one of those cases. There was a nasty looking widget deep in his brain in a very bad spot that had been found incidentally. We'd scanned and done angiograms and generally worked him up eight ways from Sunday, and the general consensus was that something was going to kill him sooner or later, but it would be better not to die with whatever it was that was in his brain.

So off he went to surgery. About five hours in, my pager went off: did I have the patient's wife's contact information?

I called the OR floater: No, it's all there in the chart. Well, nobody's answering that number; did I have another? No? It's kind of important that the surgeon finds the family stat. Okay, okay, I'll hunt around for more contact information.

After a frantic half-hour of calling various numbers, I heard the overhead pager go off. Overhead pages at Sunnydale General are reserved for the most dire of emergencies, and here was my patient's name on the OHP, with the request that his family return to the first-floor consulting area immediately.

I started to pray for our best possible outcome. Moderate hemiplegia and aphasia seemed like a really good thing.

My prayers did not get answered.

When I finally found his family, about an hour and a half later, they were already in the ICU waiting room. I stepped off the elevator, met his wife's eyes, and was unsurprised when she burst into tears. I had already been leaking a bit myself, and started up again at the sight of her.

What I wasn't expecting was what happened when I finally got across the room to her and her parents and friends: they were all laughing and crying and hugging me and each other, all at once. Turns out that nasty mass in my patient's brain was totally benign. The surgeon had tried to get hold of the family to tell them that and ask if they wanted the mass in or out; he ended up making a decision on his own and simply leaving it in. It's not going to hurt anything or cause any more problems than the occasional headache, if that. Now that it's deflated and dealt with, he'll be perfectly fine.

People crying in the ICU waiting room is not unusual. What is unusual is a nurse whooping and laughing and dancing around, while tears run down her cheeks and she hugs and high-fives everybody in one corner.

I saw him a couple of hours after that, once he'd settled in and had a nap. He recognized me immediately, spoke clearly and fluently, and moved all his extremities well. 

"I am so totally gonna kick your ass for scaring me that way," I said.

"Yeah, I know," he replied, "but it all went okay, right?"

"Yep." I said. "It's perfect. You're perfect. You're fine."

He smiled and went back to sleep.


alex said...

wow....just, wow. that post made ME cry, and i'm a micu nurse who thought she'd seen just about everything. wow.

Penny Mitchell said...

You know I'm crying. Again.

And again and again.

Praise God.

bek said...

You sure know how to make a girl cry! What a great post!

Deanna Bland Hiott PhD, MSN, RN said...

I love happy endings!!!