This Patient Got to Me
Because I work on the neuro unit of a large acute-care hospital I see a variety of patients. Sometimes all I have to do is clear them for discharge. Other times I make discharge recommendations and initiate treatment. Often my decisions directly affect the outcome and eventual quality of life for my patients. I handle this by remaining professional. While I become close to my patients I'm usually able to keep myself separated from the process.
Naturally I come across some very sad situations. I've had elderly patients who were independent and productive become globally aphasic, dependent individuals. I've had middle-aged providers with small children become disabled and unable to work. Once I even had a VIP executive who refused to believe she'd had a stroke because it didn't fit into her schedule. None of those situations bothered me.
Two recent situations have bothered me. One was a 16-year-old who was struck by a car while crossing the street after school. I saw him post-op day 2 following a hemicraniectomy. His head was so swollen he couldn't be fitted with a helmet and though he wasn't sedated he was very difficult to arouse. I got minimal purposeful movement from him. I kept thinking how wrong it was. His kind of injuries don't happen to children.
I know what is ahead for this boy. Years of therapy. He will probably never play high school football or run track again. His employment opportunities are now limited. Even with all of my knowledge and skill I couldn't help him get better. I couldn't sit him up and give him back some normal movement. I couldn't facilitate motor activity. All I could do was assess and tell the family it was early in the process and there is always hope. That felt hopeless.
The second situation involved the wife of my patient. She'd been thrown from her horse two months earlier, sustaining a TBI. She is s/p decompression and waiting for the wound to heal for her bone flap to be replaced. She is going to have an excellent recovery. I'm very happy for them. It bothered me how easily it could have been me thrown from a horse. Her horse spooked. It was a life-altering accident.
I frequently joke with my coworkers when the topic of horse-related brain injuries comes up. I say I'll be back on the horse as soon as I can climb back up there, helmet and all. This was the first time I actually saw the reality of such an injury. I had to stop and think. I'm grateful that I've been so lucky to never have gotten hurt coming off a horse. I don't really like the vision of what could happen. For a few minutes I had a glimpse of my own mortality. I won't stop riding but now I have a deeper appreciation of it.