When I relocated to Pittsburgh in the 1970s I was unable to find a position open in the OR so I accepted a position at Montefiore Hospital that offered a month-long critical care course if I agreed to work for a year in their neurosurgical ICU. My home in the OR was the neuro room so it seemed like a good fit. One of my first patient experiences fossilized itself onto my heart and with my low emotional IQ, that's really saying something! I have never seen a patient with so much neurotrauma make a recovery like hers.
Before she received a depression generating "C" grade in thermodynamics, before her suicidal drive shifted into high gear, before she blasted down Bates Street with pedals pumping and a chainring spinning like a top, before the deliberate impact with her road bike impacting a brick wall fronting a moving and storage building, before a 4-hour session in the OR to tease and release a huge subdural hematoma, Jenna had been an outstanding mechanical engineering student at the University of Pittsburgh with a spoiled little Shi Tzu as a pampered pet..
The Neuro ICU at Montefiore hospital was a huge room with 10 beds separated by curtains, but there was an alcove like area hugging bed "1" and that offered a modicum of privacy for staff interactions with comatose patients and Jenna was going to need all the stimuli she could get. She was transported directly from the OR to neuro ICU and her entrance was memorable. Jenna was a young looking 21-year-old who could have easily passed for a teenager. She looked so tiny and helpless in her ICU bed with her thick blond hair cascading below the cranial dressing on the unshaved side of her head.
It didn't take an assessment via the Glassgow Coma Scale to see that she was well beyond obtunded and her consciousness had exited the time/space continuum long ago. Her pain was captured in the coarse weave of the gauze carefully wrapped around her fractured skull. The number of surgeons, nurses and anesthetists accompanying her foretold a grave prognosis. Prodigious pumping was always a bad sign and the anesthetist was squeezing the Ambu bag like a sailor squeezing a sponge to bail out a sinking boat. A harried nurse was pumping away on the syphgmo to tease out a blood pressure and one of the critical care medicine fellows was maintaining pump pressure on the infuser for her arterial line. A trio of pumpers was not a good omen.
We connected her endo tube to one of the newfangled Puritan-Bennet MA-1 ventilators which had just recently replaced our old Engstroms. Those old ventilators had a nice soothing swish/whisper sound to them while the new Bennets had disturbing bark-like noise when the inspiratory cycle was initiated. I didn't like them. Untangling her mannitol, pressor, arterial and blood lines made me wonder if anesthesia folks were macrame aficionados! What a mess.
We did not have dedicated gizmos to secure endotracheal tubes and the heavy adhesive tape applied in the OR was snagged in what little hair that was hanging like a stalactite from her cranial dressing. After she was settled in, I explained to her, "I'm going to free your hair from the tape and comb it out so you can be styling." I always liked to plaster two pieces of tape together sticky side to sticky side where there was contact with hair. Sometimes it's the little things that matter the most.
Neurotrauma is a beast that maliciously extends its tentacles to outlying organ systems inducing problems like diabetes insipidus, hypotension, thermal dysregulation, and in women, disordered menstrual cycles. On the second day of Jenna's coma her menstrual period began with the intensity of a Mount Vesuvius eruption. I didn't know if it was her time, but the intensity suggested a jump start secondary to her neurotrauma.
Her Mom brought in a box of tampons for her, but ICU policy restricted their use, so I explained to Jenna what we were going to do. I said, "Jenna, I really hope you can hear me (I was hoping that despite her comma I could communicate with her on some level.) We really need to monitor your flow so I'm so sorry we can't use tampons. You have so many internal devices that pads are really a better option. I'll change them every couple of hours and tidy you up. I really hope this is OK with you." I rolled up a chucks blue pad like a burrito with the absorbent side facing out and used it to prop an ABD pad into position.
Slowly Jenna began to show signs of the coma lifting and on the fourth day we were able to extubate her. Her eyes were open and beginning to sluggishly follow moment.
I had a couple of days off and upon return to the unit the nurses were excited because Jennna was awake and verbalizing. One of the first requests she made was to meet the male nurse who apologized for the pad substitution for the tampons. I strolled over to her bedside and told her how happy I was to see her awake and she began crying. "When I heard that masculine voice apologizing for the tampon ban, I just knew that I had to meet you. I think that gave me a reason to wake up. I will never forget you."
I certainly never forgot Jenna!
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