Miraculous Recovery of a Teenager From Head Injury

I must warn you before you read this article that some people don’t like graphic details of injuries, and there are technical terms in a couple of paragraphs that you might not understand, nor want to understand. I’ve explained them to the best of my ability. However, there is a story to be told.

During my nursing career I spent about nine years working in critical care including being a Nurse Manager of a Trauma Unit. During nursing school it was the only thing that I truly wanted to do, although I did work my first six month on a surgical floor.

I loved nursing and I was very good at my job, always getting solid reviews and ultimately being promoted after I completed my bachelor’s degree.

I thought I would write about one specific patient I started thinking about the other day. Following my critical care training I worked in a state of the art unit, shaped like a triangle. One leg of the triangle was kept for uninfected patients, like open heart surgical recovery, other types of complicated surgeries, and sometimes trauma patients.

I worked swing shifts, a week of days and a week of nights. It was hard to work those swing shifts but there never was enough staff at night. Anyway, one Monday morning I came in to work and was assigned just one patient, a 17 year old boy named John who was a trauma patient. It seems he was clowning around and sitting in an open passenger seat window talking with someone in another car while eating a donut. The car he was in ran into another car and John was thrown out of the window smashing his head on a palm tree, and those are pretty hard! There was no alcohol or drugs involved with anyone in this accident.

John was in a deep coma and connected to just about every piece of equipment we had available at that time in Critical Care.  I got report from night shift and went to work. He was very unstable and I spent many shifts working straight through with maybe one quick bathroom break because you couldn’t leave him alone in his room. Sometimes we were so busy there just wasn’t anyone to relieve you.

I put my hand on John as I always did with patients and said, “John, You are in the hospital and my name is Pam. I will be your nurse today.” When someone is non-responsive hearing is the last thing to go, so I always assumed my patients could hear me. Then I silently prayed that John would live through the day and that God would guide me in my care of John.

John didn’t have any broken bones, or any other injuries, just a closed head injury. The big danger with a head trauma is that the brain will swell and if it swells enough it will cause a herniation of the brain stem. Once the brain stem is squeezed through a notch in the tentorium cerebelli, there is no turning back. You are clinically brain dead. If you have ever seen an EEG, which is a test showing brainwaves we normally produce, they are squiggly lines, but after herniation they are rail road tracks. The brain stem controls cognitive thought and several other body functions. You will never be able to take another breath.

It is very tricky to care for a patient this unstable. John had a drain in his head and there was a read out on the monitor so I would know when to drain the spinal fluid. This must be a completely sterile procedure as an infection in the brain is almost always fatal because there are only a couple of antibiotics that cross what’s called the blood-brain barrier. John was on the ventilator which was doing all his breathing; he had an arterial line in his wrist so continually sticking him for lab blood and blood gases was unnecessary. He also had a Swan-Ganz catheter in his right jugular vein which put reading up on the monitor telling some things about the heart and the pulmonary artery. This was also great for IV fluid lines and you need several. He had EKG leads so we could read his heart rhythm on the monitor. Last but not least, he had a Foley catheter so we could keep track of his urine output. He had numerous medications, mostly being IV fluids which were a balancing act with a patient this unstable. I should mention that he had numerous doctors in and out continually with new orders. Now that should be enough technical information for you to either be bored, confused or overwhelmed, but now I that I have set the stage, I will tell the story.

Visiting hours were only 15 minutes long about every 4 hours. I didn’t look forward to them when a patient was this unstable. As a critical care nurse you have to stay emotionally unattached to the patient for the most part or you can’t be effective in a crisis. However, it was tougher for me to stay unemotional where grieving family is concerned. When visiting time came only the boy’s mother came in. She looked exhausted, scared and barely in control of her emotions. I think she had been sleeping in the waiting room that entire weekend. Her name was Mary. I had nothing new to tell her as he hadn't changed, for the better or the worse. I talked about John and encouraged her to talk with John as he might recognize her voice. She stayed back at first as if afraid to touch him, but I asked her to come by the bed and touch his arm while talking. She told she loved him and she started to cry. Before she left she told me he was her only child and he his father was dead. She said she didn’t think she could possibly stand to loose him. I just listened knowing that John’s chances were slim.

Over the next few of weeks they keep me assigned to John to provide continuity of care. I got to know his mother much better and let her stay a little extra time when I could, plus I wanted this boy to live so badly I prayed for him a lot. I was raising 3 sons by myself at this time and I knew sons weren’t supposed to die before their mother. John’s condition waxed and waned. He developed pneumonia because he had aspirated part of the donut. He had some very abnormal movements of his extremities which indicate severe head injury, but we just kept treating every problem aggressively. Some of the doctors held out no hope for this young man and I was kind of his cheer leader I guess, because I always believed he would live.

In this particular critical care unit we had “critical care fellows”, which are doctors that have completed their residency but specializing in critical care medicine. Most of them are very dedicated and smart. One day I got so angry when one of the Fellows walked in and loudly said, “We are beating a dead horse here. We need to stop being aggressive with the treatments.” I was not ready to give up on John and told him so. John hadn’t really improved, but the mere fact that he was still alive 3 weeks after the accident gave me hope. I knew he would probably never be his old self, but his mother didn’t care. Mary wanted John home and she accepted the fact that he might need special care. I was definitely more emotionally involved in this case than I should have been, but I couldn’t help myself.

Very gradually John started to improve. He moved into a lighter coma but didn’t wake. His mother brought in a radio with some of his favorite music. The brain swelling was no longer a threat and we pulled that line. He could feel pain in his feet if pricked with a pin which was a good sign. The abnormal body movements stopped and he needed less medication. By now we had done a tracheotomy because you can’t leave someone on the ventilator long term with a tube in their throat for an extended period of time. He also had a tube in his stomach feeding him nourishing supplements. Gradually we weaned him off the ventilator, removed most of the lines, and he was left with just the Foley catheter, the stomach tube and an IV line. He had been in critical care for about two months. It was time to move John upstairs to a private room. I believe God may have preformed a miracle.

I periodically went up to visit John and Mary and he continued to make progress. The last time I saw them John was sitting up in bed, talking although not very clearly, and his mother was feeding him. I wonder about him now. How far did the recovery go? I know an older person would never have survived. The regenerative power of a young body is amazing and personally I would like to have some of my power back! I very much regret not getting Mary's phone number so I could have checked in from time to time. I like to think he continued to recover and was able to walk again.

Interestingly, we had a 13 year old patient about the same time who had been hit by a school bus and wasn’t expected to live. Almost exactly a year later she walked into our unit with her mother and swore she remembered us. I don’t know if she really did but it made us feel great. Nurses work hard and often don’t receive enough thanks, so you treasure the great saves of patients where your input might have possibly affected that wonderful outcome.

The copyright to this article is owned by Pamela Oglesby. Permission to republish this article in print or online must be granted by the author in writing.