Friday, September 23, 2011

NEVER EVER give up hope! 1% chance at living

Ok so I will preface this post by saying that this is about an actual patient of mine but am following PHIPPA rules and will not disclose information that someone can accuse me of violating confidentiality rules.

So a couple of weeks back I was given my patient assignment and one of them had to do with a woman who had a stroke. Now I work on a neurology unit so this isn't anything new to me. What WAS new for me was this patient was in a coma. That's not normal! Even in a stroke patient, it's VERY rare to get a patient on MY unit who is comatosed.

I spoke with the neurologist to explain to me why my patient is comatose and what the chances were of this patient #1 surviving and #2 waking up.

His answer to my question was this:
#1 - he asked me what I defined as "surviving" - which I told him, was living - with or without deficits (which I told him I knew she was going to have)

#2 - he then showed me her CT scan....

HOLY SHIT BALLLS!!!!!!!!!!!! If you saw this woman's CT scan you would have to wonder how this woman was even alive at this point!!! The neurologist showed me the CT scan from when she was first seen in ER and then the most recent one that was 4 days after.

COMPLETE right sided necrosis - the right sided artery that feeds that side was 100% blocked - the swelling had caused a midline shift (which even I knew was BAAAAAAAAD) of almost 2cm - please remember that one's head is NOT very big and therefore this equals BAD!!!!! Also, any space that the brain had (pockets if you would cause I don't know the exact terms), were taken up by swelling.... her brain had herniated DOWNWARDS and was pushing on her brain stem... again NOT GOOD!!!

When I assessed this patient - she had NO gag reflex, was aspirating her saliva, had no pain reflex, left pupil was blown, was in a DEEP coma.... I explained to this family that if she didn't die from her heart stopping or her breathing stopping, that she would die from aspirating the saliva. Let's just say that the family took the news HARD!!!!

Now it doesn't seem to me that the family is necessarily religious but BOY did that family absolutely believe this woman would pull through and survive. They understood that even IF she did survive that there would be GLOBAL, CAATASTROPHIC deficits, they were OK with this!!! When this was all happening, they were asking if they could take her back to her hometown.... but that they would NOT make her a DNR.... something that did NOT sit well with MANY of the nurses - or neurologists/physicians that have been involved with this lady's care. But hey, we're not here to pass judgement, but to give INFORMED choices!!!

Now, I haven't been able to be her nurse much since I had her as my patient but have kept tabs on her - the family and I have really bonded... they love me!!! LOL
They felt like I was the only one who was supporting them without judgement - which is exactly what I was doing. The other day her daughter saw me in the hall and told me that her mom was moving.... I could hardly believe it. So I asked her to demonstrate it for me.... I followed her into the room and SURE ENOUGH... she friggin moved! Now mind you, she could ONLY wiggle her fingers and toes - but would only do it if the family was speaking her language - a specific dialect. But move that woman did!

Well ladies and gents - I had this patient again - and was able to see her most recent CT scan - and no wonder she has come out of the coma - her herniation has decreased, not completely but certainly dramatically. Also, the midline shift has decreased significantly - which explains why her coma has lifted. Now, that's not to say that it's completely lifted, she can still barely open her eyes, hardly move her unaffected side and certainly can't speak yet - but she's reacting.... which just goes to show that even when clinically the picture indicates that this patient is a hopeless cause - DON'T GIVE UP HOPE!!!!!!!!!!! And ALWAYS, ALWAYS, give support and love and care for your patients AND their families!!!!

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