code blog: tales of a nurse

Recently, I took care of a 60ish man who had cardiac arrested at home, with no CPR done until the police showed up ~7 minutes later with an AED. That's a long time with no oxygen. When I had him, he was on a ventilator and was posturing. It didn't look good. His family kept talking about the future though (as in, "Dad didn't talk much about his doctor visits [he was being treated for borderline diabetes] but I guess we'll be going with him from now on!). I figured that there was no way in the world that this guy would wake up. He was taking breaths on his own, but wasn't responding.

Neurology was consulted, and we simply waited, doing as much supportifve care as we could. The next day, he was more responsive and was extubated. The day after, he was mostly coherent, conversant, and aware! I was completely amazed and VERY happy. The neurologist came in that night to examine him and sat out at the desk writing her progress note. She was talking about how gratifying it was to finally see a case end up positively.

Now flash back to about 3 years ago. I'd been at my current job only two months and had to admit a young woman that was my age. She had been up on the medical floor with some sort of viral thing, and just simply went unresponsive. No one knew what the heck was happening, only that she was not awake anymore. She ended up staying on our unit for about a month, and in that time got a tracheostomy and a PEG tube. She was eventually sent up to our Sub-Acute unit, which is like a nursing home within a hospital. Most every patient up there is trached on a ventilator and gets lots of rehab, which may or may not be working.

For the last 3 years, I have checked on the computer for this patient's orders to see if she has gotten any better. She had only been married for about a year; was her husband still with her? Visiting her every day as he had in ICU? 3 years can be a long time. Her prognosis wasn't the greatest; apparently she had developed some sort of nervous system thing where the myelin sheath of the nerves (the slippery coating that allows impulses to travel so quickly and effortlessly) deteriorated. From what I can tell, she has remained unresponsive and has been getting physical therapy consistently for the last 3 years.

So anyway, this neurologist was at the desk for this other patient, talking about how happy she was that this patient had turned around and said, "Hey, do you guys remember that young patient that was a hairdresser...?" and I immediately said the patient's name. I had been intending on asking this particular doctor about my young patient for a long time, but just never had. I was VERY eager to hear any news about how she was doing.

Well, this is how she's doing: She WOKE UP! She interacts with others, recognizes her husband, can move her arms around. She can't walk, but it's definitely looking more and more like a possibility that she may be able to in the future. I asked how that was possible and the doc theorized that since she was young, her myelin was able to regenerate itself. Or something. And her husband still visits religiously. I can't tell you how immensely happy this all makes me. I have no idea why I have thought so much of this particular patient over the years; maybe it's because it could have easily been me. Or someone I knew. All I know is that some weird thing happened to her, and her life was robbed from her, leaving only a shell, a body. It was so devastating to the family. I can still remember the desperation on their faces every time they'd walk onto the unit, hoping for some change in her condition.

I hope she continues to do well. I hope she can go home someday. But here's the explanation for the title of this post: This sort of situation isn't the norm. People who lack oxygen for more than a few minutes usually never "recover." So my patient who cardiac arrested may have just had barely-perfusing rhythm until the cops showed up. Who knows? All I know is that the typical patient who suffers brain damage from anoxia (lack of oxygen) ends up fairly vegetable-like or very disabled. I have no idea if these two stories will induce "false hope" into someone surfing around who happens to have a loved one who is comatose, but ya know... I have every right to be ecstatically happy that these two patients have at least partially recovered following extenuating circumstances. These two stories are what keep me going. They provide a point to my profession. A reason to keep going into work.

Sometimes we win.