ICU Teenage Patient
Joan walked into the intensive care unit at 6:40 AM as usual. She greeted Teresa while asking her how she was doing.
“For a Wednesday I am doing great. Only one more day this week, and I am off this weekend. Jan is over there complaining about her assignment as usual, and she is on the ‘code team’ today.”
“What else is new?” Joan said while laughing. “She is always complaining, and Pat is the charge nurse,” said Joan.
“Right, and you have a new 17-year-old head patient with a Traumatic Brain Injury (TBI), but it is a closed head injury.”
“Well, I had better go get the report,” replied Joan.
Joan listened to the taped report from John, the night RN. John was still in the patient’s room working. Apparently, Jeremy Anderson was sitting in the passenger window of a car while eating a donut. The car was being driven by a friend when there was an accident. Jeremy was thrown head first out of the car and hit his head on a palm tree He was unconscious when the first responders found him.
Joan would only care for this one patient today as he was too unstable for her to take a second patient.
“Wow, that is a horrible story,” Joan said to John.
“He has all the bells and whistles now, and I know you heard that when you listened to the report. The Glasgow Outcome Scale (GOS) score is not great, but not horrible either. He has been a little unstable, so it will be a busy day.”
When Joan went into the room to assess Jeremy as traumatic brain injury treatment is complex. She checked the ICP catheter that is used to measure the intracerebral pressure and drain off excess fluid when the pressure is too high. He had multiple IV lines, the ventilator, an arterial line and wires that seemed to go everywhere.
She talked to Jeremy even though he was in a coma. “Jeremy, you are in the hospital
You were hurt in a car accident last night. I am your nurse, and my name is Joan.” She knew hearing is the last sense to go. She was busy throughout the day, and she skipped lunch to be in the room with Jeremy.
Various doctors came in and asked questions. The neurosurgeon came in said, “We cannot fix this young man with surgery, unfortunately, but I hope he pulls through without brain damage.”
“Me too,” replied Joan. Joan proceeded to go through the routine of checking and recording all the vital signs and readings. She kept his blood pressure and ICP readings at the appropriate readings, draining cerebrospinal fluid as necessary.
Talking to the Mother
When visiting hours arrived, Joan watched Jeremy’s mother walked into the room.
“Hi. Are you Jeremy’s mother?”
“Yes, yes I am. He looks awful with all this equipment. Promise me that he will be okay. He is the only thing I have, and I can’t lose him,” she said as tears flowed down her cheeks.
“Mrs. Andersson. I can’t make that promise as this is a very serious injury, but I want you to know we are doing everything in our power to save him. So, he doesn't have any siblings?”
“No, it is just us. His father died while serving in the Air Force. I just cannot lose him too! He is a good boy who did something stupid, but he should not die,” Mrs. Anderson said with a weak voice.
Joan felt the grief of Jeremy's mother and wanted to help this young man recover. The shift continued, and Joan kept him stable as did the night nurses, but he was not showing signs of waking up over the next 3 days. Joan was assigned for those days to keep the continuity of care. Joan talked to him throughout each day as she turned him and cared for him.
Mrs. Anderson arrived at each visiting time with an anxious look on her face.
One of the ICU doctors, who was doing a fellowship, came in the room each day. On Thursday he walked in and said, “We are beating a dead horse here.”
Joan got riled up. She said, “He is only 17, and young people have more regenerative ability than older people.”
“I know, but I don’t think he is going to make it.”
“Well, I do,” replied Jennifer in a haughty manner. The doctor left without writing any new orders. Joan noted by Friday that Jeremy was making some improvement.
Joan met Teresa while walking out the door at the end of Friday’s shift. Teresa said, “It has been chaos today! We had 2 codes, but everyone lived, so I guess that is the upside.”
“You know you are an adrenal junky, right?” Joan teased.
“You could be right, but take your own inventory,” Teresa laughed.
“Do you want to grab something to eat?” Joan asked.
“I can’t tonight as I have to pick up Jordan from baseball practice.”
“I understand, the kids come first. Right?”
“You bet,” said Teresa. “Even when you are exhausted, but I am off tomorrow.”
“Enjoy your weekend. I have to work Saturday, but I am off on Sunday, thank goodness.”
By Saturday Joan felt the stress of 4 twelve hour shifts in a row. Usually she never worked more than 3 shifts in a row, but she had the next two days off.
The neurologist came in early on Saturday and said he was going to remove the ICP catheter. Jeremy was responding to touch, and his vital signs were stable.
When Mrs. Anderson came in during the visiting time, Joan said, “I have some good news for you. The ICP catheter has been removed, and Jeremy just might respond even more to your voice today.”
“The doctor came to the waiting room and explained Jeremy’s progress to me.”
“I am glad he did that. He is such a good doctor.”
“Yes he is, and I liked him from the beginning. He said we have a long road ahead as we don’t know how much brain damage could have occurred.”
Joan’s Saturday shift was uneventful, and she was happy she had the next two days off. Jeremy was taken off the ventilator, and he was breathing well on his own.
When she arrived back at work on Tuesday, Jeremy had been moved up to the step-down unit.
During Joan’s lunch break, she went up to Jeremy’s room. Much to her surprise, he was sitting up in bed, and his mother was helping him eat. Mrs. Anderson smiled at Joan when she walked in the room. She stood up and walked over to Joan, and hugged her while whispering “Thank you”
Joan had no way to gauge how long rehabilitation would be for Jeremy or how fully he would recover, but she was so happy that Mrs. Anderson had her son back.
Louis Armstrong - What a Wonderful World
This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.
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© 2019 Pamela Oglesby