Memories of patients past...
I don't remember his name anymore. He'd had a massive stroke. Unable to speak. Came in completely comatose. He was in his late 70's.
He was there for a few days. Not a drop of sedation was given. He didn't wake up at all.
On day 2 of his stay, while the family was trying to make a decision, something went wrong with his foley (bladder) catheter. So the nurse had to change it. I was in the room looking at the chart when they started to pull it out.
He yelled, quite clearly, "SHIT!!! MY DICK!!!"
The nurse stopped. He was again completely comatose. I did every trick in the book to try and get him to speak again. Nothing worked. The nurse pulled out the foley, and put a new one in. No repeat performance.
He was there 3 more days before he died. He never said anything else. Every attempt by me and the nurses to try and find conciousness again failed.
To this day I have no idea how he did it. The MRI was awful looking. I can only assume it's some primordial part of the Y chromosome. No matter how badly damaged the upstairs is, you're still touchy about the downstairs.
Neuro patients are so touch and go. Recently I was inserting a nasogastric tube into a patient with a GCS that was fluctuating between 6 and 9, but had been sitting around 6 all morning. We were having difficulty even getting a reflex response from the patient. I hadn't gotten the tube past the the sinuses when the patient's eye opened and they began saying "ow, ow, ow." The patient then helped us to insert the tube by swallowing, and remained awake for the rest of the afternoon (GCS 14). The next day it had returned to a 9.
ReplyDeleteSad**, puzzling, fascinating and amusing at the same time. I don't consider going into neurology because I just don't grasp the brain's workings very well, but it sort of calms me that guys like you still have secrets to discover, too.
ReplyDelete[** although I can imagine that - for him - it was better to die than to survive with massive brain damage. Our neurology professor taught us that one big quality in doctors is that they must know when to let go; ironically, the most common reason for docs to hang on too much wasn't the overdose of god complex, but the fear of forensic consequences aka getting sued... apparently in one clinic they did a law consult with the docs and had a significant increase of patients who were allowed to die. Obviously I'm writing "allowed", since I'm not talking about patients who'd have had any life quality, had they been kept alive on the resp. etc.; I don't want to spike an OT discussion right now. ;P]
Survival of the species!
ReplyDeleteThat's pretty amazing.
ReplyDeleteOMG, talk about famous last words!
ReplyDeleteI think this is a new classification of coma level. "Patient is unresponsive except when touching junk".
ReplyDeleteHa! That was funny! How'd you like those to be your last words on this planet?
ReplyDeleteReminds me of a uroseptic old nursing home lady I looked after, was giving her a Tylenol supp. for fever, and she screeched out (in a squeaky, old lady voice), "Ollie! You've got the wrong hole!" The nurse helping me turn her and I nearly peed ourselves trying to hold in the laughter.
She died on the next shift, but never said another word.
I was a nurse aide in a skilled nursing facility where there were two or three patients that were seemingly 'out of it'. As geriatric aides we were taught to talk, comment, explain as if we were being understood. We turned them, propped them, bathed, etc., but no words or even routine grimaces. Fetal positions from muscle contractures doesn't help debase the impression that there's nothing going on. One woman, I recall, had to go to hospital for a short surgical procedure, maybe it was j-tube placement. When she returned after the surgery she surprised me completely when I commented on the weather and she replied. We carried on a short conversation and apparently that was it for the rest of her life. I don't remember whether it was 'yes or no-type' or insightful. I was so stunned.
ReplyDeleteSounds like you should have tried some tricks that weren't in the book...
ReplyDeleteAnother thing about the Y chromosome: As a nurse I've noticed no matter how old and demented they are, how nonverbal and oblivious they appear to their surroundings, I still catch them staring at my boobs.
ReplyDeleteOh, Grumpy, you should come work with the quads.
ReplyDeleteNo I can't feel you cathing me, they'll say, but I know it hurts.
Or my personal favorite (giving lovenox or heparin below their level of injury) and the patient screams, "Ow!" when they don't even feel the shot, just to see what you'll do.
Y oh y...
The ultimate noxious stimuli.
ReplyDeleteOn a lighter note, I realized that my husband, who had just had major abdominal surgery, was going to be just fine when his first words in PACU were "Get this damn thing outta my dick!"
ReplyDeleteIt was before I became a nurse and I was embarassed at the time, but I never insert a Foley on a Y-Chromosome-handicapped person without thinking of this and smiling!
Pattie, RN
Did you tell the family about it? I don't think I'd want to hear those were my fathers last words...
ReplyDeleteOn a palliative term at the moment. We have a patient with spinal compression due to mets who has only just regained 2/5 power in his lower limbs. Overnight however, while delirious, he was lying in bed with his legs going round like on a bicycle yelling at the nurses to call the Pope to report the miracle.
ReplyDeleteUnfortunately when we examined him again in the moring he was still at 2/5 power with no memory of the previous night. But complaining of sore abdominal muscles.
Hahaha, this story and Deodand's comment gave me a great laugh. That is all.
ReplyDeleteTotal guy thing. You all are freaks.
ReplyDeleteDid he have a tattoo above this area too???
ReplyDeleteactually this is awful interesting to me... seems like this would be worth study; ability of abrupt onset discomfort or unusual deep pain stimulus to cause apparent or brief consciousness in otherwise comatose or unresponsive pts.
ReplyDeleteBased on a single personal experience in nursing school I am very suspect of SNF pts who have been labeled non-verbal. A classmate had been assigned to one such pt and she asked me to finish feeding her so she could do her review with our instructor.
As I commenced feeding her I had no trouble understanding her at all, although she spoke very quietly. She didn't want the cream of wheat which was "too mushy" and wished for more peaches. It broke my heart.