DrOrrange's Journal

Journal Entry for November 5, 2007 Mood

Monday, November 5, 2007

There are several experiences I have imprinted in my memory and have thought "I should write these down" and never have. Well here goes

I had a patient last week who has nightmares about her last days with her father...she never got to say the things she wanted to say until he was basically unconscious. How much did he hear? I know some of you in the Alzheimers community have asked me the same thing..how much does he/she understand or hear? Awareness, consciousness.....honestly we in the medical profession guess at it.....but I have a story

It was 2001 and I was in San Diego for the last year of my residency. I was the resident in charge of the Medical Intensive Care Unit (MICU) at UCSD for the night. I got a call from the ER that there was a patient who was coming in with decompression sickness...a near drowning. You see at UCSD we had a decompression chamber (A hyperbaric chamber) so we got all of the diving accidents. His name i still remember and will call him J.B. He worked scraping algae off the side of boats and had a surface air supply (a hose connected to the back of his scuba suit with a surface air supply). The hose became detached and he obviously tried for a rapid ascent. We didnt know this at the time and all we knew was his friend who was back ON the boat heard a "gurgling" sound and looked over to see him floating on the surface. He pulled him up....did CPR......called for help.....paramedics did CPR.....got him breathing after no respirations or heart rate for over 5-10 MINUTES.....then we got him.

When he came in the ER immediately put him on a ventilator (did the breathing for him) and put him in the chamber to recompress him (you usually dive them in the chamber to at least if not more than the depth they were diving....at least 75-100 feet) and called me. Here is the first weird thing to imagine. The other 2 people in the chamber are the nurse trained to do this....AND an ER doctor also trained....and all the medications, etc that J.B. needed were passed by me via this strange rubber sleeve in to the chamber. I was ordering meds and monitoring his vital signs over a microphone to the 2 people inside. This takes hours because they rapidly dive him down and slowly ascend him. It was at least 1 AM. 2nd strange thing to imagine: the ER doctor in the chamber starts to get LOOPY which can happen from the pressure and basically lies down USELESS. The nurse in there and I manage this whole thing over a microphone...she handles his ventilator, his meds, and remains steady for those hours we "dove" him in the chamber.....nurses....the UNSUNG heroes in medicine for sure. I will never forget her.

I brought him to the ICU after this and we had him for days. His brain on the CT scan was just swollen....all of those indents (sulci) you see at the edge of the brain GONE. Puffy, swollen brain from lack of oxygen. He was a young guy so everything else worked well..his lungs obviously had suffered from the near drowning but we were doing the breathing for him. With these puffy swollen anoxic (no oxygen) brain injuries you never know what youre going to get. His family was asking about organ donation. The local news was calling us. As the resident in the MICU you carry about 2-5 patients...and they take up ALL your time. I spent many hours in his room...managing the ventilator with the respiratory therapists...monitoring his vital signs constantly...follwing his labwork...continuing with supportive care. After 4-5 days we didnt see much.....and one morning I went in to gather vitals for morning rounds...7 AM. His eyes had been open at times (with no response) but this morning they were tracking me....like your 4 month old starts to do. Purposefully tracking me....I could tell....I told the nurses but nobody else had noticed. I tried to ask him to follow basic commands but he could not.

Over the next 24-48 hrs he started to follow commands, take some breaths over the ventilator and tried to mouth words. We were thrilled...the ER docs, his family, the MICU team...all were thrilled.

I handed him a pen after he kept trying to mouth words over the ventilator (and I had explained to his sort of blank eyes what had happened to him). Remember this is at least 4-5 days after the incident. We were talking organ donation with his family. I will never forget this. I said "Im Dr Orrange one of the medicine residents that have been taking care of you"

He wrote (shakey on the pad but clear) : " I know. I watched you come in here every morning. Thank you for taking care of me"

3 months later I received a page from the downstairs cafeteria. J.B. wanted to see me. I brought my whole team down to see him....he had been in rehab and still walked with a cane and had slightly slurred speech but looked great. He brought me a shell....which I still have....I cried when I saw him....and I had 2 medical students with me at the time who chose to pursue internal medicine because of his story and what we were able to do for him. My message to you: assume they hear, see and feel you....because they most likely do.

Thanks for letting me share

Dr O.

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Comments

"WOW" It amazeses I can feel your Heart & Soul when you write. Just because I dont write to you alot doesnt mean that I dont read your shit. "WOW" The way you write means just what I said sister. I needed an uplifting expierence today after my last week or so. You getan "THATTA GIRL" From me!!! Thanks sister!!!!!!!!!!

tattman
TY for sharing & yes i say nurses are overworked & underpaid & i dont kno what they make.
Peace to your house
chip

chipchip
Thank you soooooo much for sharing this. I have no proof, I just always knew that my loved ones have heard me. Dr O, you are such an angel. ^_^ SG

soberSG
Thanks for your story, you have helped others with it. I used to work in a hospital before I got PD and loved it. My dad had PD and at the end could not speak because of a stroke but I knew that he heard everything we said because the tears would come at times. Hugs, Jan

parkiejan
you always inspire me Sharon.
I know have the calm assurance THAT I REALLY ALREADY FELT........the last day my Dad was in a coma and I was talking to him.......and a tear would fall at the times it would have b/c of the conversation.............HE DID HEAR ME.
BLESS YOU ONCE AGAIN.
JUDYL

JudyL
Wow that was amazing.So many would have just gave up right off but you didn't that was great.Do you know how he is going now?Just wondering.Thanks for sharing keep sharing your amazing stories.

Arvey
Thanks!This reassures me that I did the right thing for my mother. She had brain bleed and was left not able to talk,walk, eat anything but baby food for 3 years. Her brain slowly deteriated. I always spoke to her like before. This helps me know she understood. Thanks again!

omastoy
you are truely an angle. thanks for your wonderful storey.
Lisa

MSinPA
I had a Grama that had been through ALOT. She went into the hospital after collasping in her kitchen during a coughing spell. They had to put her in a drug enduced coma as they found an anyerism in her brain. After several months, she had endured 2 brain surgeries, a massive stroke, 4 heart attacks and of course all her internal argans had shut down. No brain waves,,,, NONE on three different scans. So on a Monday my mother signed to have the machines turned off. They gave my Grama 72 hours max. The next day we (My mom and my 3 sisters) were all visiting of course and we were just wracked with grief. Sobbing how are we going to go on. She was more a mother to my sisters and I. We assumed that God had put her through all this to teach US how to go on without her. After we settled down some, our sobs ending, tears totally gone, Grama woke up!!! She was watching us walk around the bed. Trying to talk to us. Crying at us, shaking her head. She wrote I will not leave you! It took us over 24 hours to get her to stop crying. We had to convince her that we were going to be ok without her. Lonely, missing her terribly but that she needed to let go. She finally did 67 hours after the machines were turned off. It was very peaceful in the room and we could tell when she just stopped breathing. Bittersweet. I just wanted to share my experience of someone being able to hear even when you think they can't. I am crying now, but because we were selfish, and because I still miss her so much. This was in 1981. Thanks again.

aNewNae
Thank you for telling us of that moving experience. I have been tended to by numerous nurses throughout my lifetime. Without their concern and compassion, along with motivation, I doubt if I would be alive today. You are in the ranks of the unsung heroes! We need many more caring nurses like you who willingly go the extra miles. Jim

JimK
Crying here . . . awesome story. Keep them coming!

Annabeth
WOW!! This story brought me to tears.

I have metabolic stroke-like episodes due to a mitochondrial disorder. I am unable to walk, talk, or move for 5 minutes or longer. The weird thing is I can hear everything going on and tell you every detail once I wake up. I have told my kids, if I ever end up in the hospital like this, please tell them I can hear everything. I just can't communicate back.

What a wonderful blessing you were to this young man. My Dr. is at UCSD studying to be a Dr. someday. I will tell her of this story.

Pray2day
Wow, amazing a great story.....my mother has Pick's
disease, so talking with her is not really possible anymore. I've always thought or wondered if she knows what's going on in her mind & just can't control or get the words out...if that is the case, I feel so sad & scared for her. There have been times when I am with her, & I look at her
all of a sudden I see in her eyes that she is "back" that she's there, several times when that
has happened she will all of a sudden just say "HI"
then it is gone. Those are the most precious moments.
I have been an eye enucleator for over 17 yrs now, & also work in surgery, & have helped w/corneal transplants, so I see what good organ donation is.
But I pray for the people every time I get called
in, that I'm doing the right thing.
thank you so much for your story!!

scipher
Wow. Your story gave me chills.... and gives me hope that my mom, in her later stages of Alzheimer's, was aware of everything going on. Actually gives me hope that she knew how much we loved her and did for her and makes me sad that she really was aware and suffered from the indignities she faced with the illness and the hospitalization preceding her death.

cath
Was fascinated by your writing! Would like to see you write more!

Kazmin
thanks for sharing. that story really helps me....hugs marie...

penny59
Thank you so much for sharing your story. As a volunteer hospital chaplain I believe with all of my heart that people hear what you are saying.

When my dad who had alheimzers and a massive stroke lay in bed not able to communicate with anyone gave his heart to the Lord when my friend shared with him the plan of salvation. She asked him to blink his eyes twice for yes and once for no. She was sure he understood her. I knew for sure when I saw that he had a radiance of peace all about him. For 18 months he could not ever talk or walk. Two weeks before he passed away I heard a voice in my heart to go tell my dad that God was going to take him home in two weeks. I shook from fear that if I did that my family would blame me if he died so I went home. Two weeks later I was in church and the same voice in my heart said I am taking your dad home today and you must tell him that I am the one taking him home and that I have forgiven him. I slowly went to the nursing home unaware that he had had a massive stroke that morning and unable to breath good. My oldest sister stood on one side of his bed and I on the other. I gently shared with my dad that God was going to take him home and that God had forgiven him of all that he had done in his life. That he would see his Mom and Dad and his brothers and sisters that had gone on before him. I watched as tears fell gently down his cheeks. Four hours later a nurse was on one side of the bed and I on the other. She quietly said your dad is dying. We both looked in amazemnt as my Dad lifted his right arm up as if he were taking God's hand. His right arm that had been paralyzed for 18 months was now moving as he was gently taken home to heaven. I am so thankful I finally was able to share with my Dad the message so his home going would be one of peace. God is so good to let our loved ones hear us.

angelunaware
Hey Dr. O!
Whatta inspiring journal. Thanks sooo much for sharing it. My mama is an RN and has seen many people take therir last breath. It can be a bautiful sight. When my grandaddy passed he said he saw angels and told my grandma to join him. She did three years later, but I can imagine that it was an awesome sight to see. I believe that God IS sooo good to let our loved ones hear us during that time. Again thanks for sharing this!!!

niecy619
Great story...Thanks for giving the shout out for Nurses!! We get over-shadowed at times. I've had a few grand moments that I am super proud of...and these are the moments that make this job all worth it.

TLCDaisy
Thanks for sharing this awesome life experience. God was with this man. Just like he was with me for a 30 day stay in the hospital. It's good to know that they can understand and respond internally while going through this. I conclude that you are a very good Dr. and very proud. Again, thanks for the story.

beautifulsis
Dr. O you just have to write a book!!! You just have to. Thoughts and Prayers, Sky

Skytek
That is an amazing story....I'm sure that would be one that you would never forget. Thank you so much for sharing, it is nice to see things from a doctors perspective. Keep up all of your good work for your patients and for us....we really appreciate you. I agree with the last comment...you should write a book sometime. Thank you again for sharing. Take care.

wami
Thanks for sharing. I tell my patients families that all the time. I believe they can hear and know we are there.

WyattEarp
Thank you so much for this story. I'm glad you put it down in writing for you and I am so very thankful to have read it.
Hugs and gratitude...

HeartStrings
yes,your story about your paatient touched me.my grandmother had alzeimers and although we never knew if she understood or not quite wht we said to her ,we always spoke as if she did.then ,when my dad was in the itu in may and we were told he wouldnt make it ,there ,above his head ,was a sign saying,i may not respond,but i can hear.over here (in the uk),you are always taught that with a loved one who is under sedation ,or ventilation ,that you should always talk positively as their hearing is the last of the senses to go.I`m so glad you wrote this enspiring tale of your not to be forgotten patient down for us to read.I,think doctors do an amazing job ,and we need to remember that ,now and again,thankyou.sharon.xx

Rocky7
Wow... that really touched my heart. That's an amazing story and you are an amazing doctor! Thank you so much for sharing!

HelloChrissy
Amazing story. I could read your journals all day.

nicholas
NEVER GIVE UP HOPE...THANKS FOR THE STORY.. MOM IS SUFFERING BONE CANCER.. I HAVE BEEN HER CAREGIVER FOR THREE YEARS.THE ONCLOGEST GAVE HER 6 MONTHES SHE IS A FIGHTER..LOVE D

DianeLouise
gives me chills.

numbtomyself
that was beautiful

angelrv61
Dr. O. I am also a nurse and that is such a moving story. I sat with many a patient and my father and good friends at the end of their life. I am certain they heard and felt us. It is truly a toughing time.
Joan

jg07
It is a very moving story. I had goose gumps all over as I read. Thank you for sharing

Claire

star11
that was a very inspiring story you made me cry , but for a good reason

grama3
Hi,
Just found your profile, hope u dont mind my writing about your recent journal. I have a brief (I hope) story about the same subject.

My friend took a deliberate overdose, she was 21 and I was 25 years old. She called me, right before she passed out. i sent paramedics, but she remained unconcious, on a ventalater, for 5 days.

She recently told me that a doctor and her father were discussing organ donation, in front of her, while she lay unconcious. I did not know that then but am livid that even back then, 1978, they could be so callous.

I went every day, as much time as I could spare to the hospital,to speak to her, as I knew she could hear me, it never occured to me that she might not be able.

On the last day of her coma, I began to break down, right in the middle of the ICU room. I started screaming at my friend, crying, saying, "YOU CANNOT GO YET, YOU ARE SUPPOSED TO BE HERE"! A very efficient nurse ran to me, placed her arms under mine and put me in a "hold", to prevent accidental injury. I turned my head to look at the nurse behind me and she was looking over my shoulder, her eyes huge, at my friend.

Yes! Her eyes were open but she was also cognizent, she knew me, knew I had been yelling at her, came back because I had been yellng at he and was angry that I made her come back (she has since forgiven me).

The ventilater was removed that day and she could not speak easily, due to throat irritation but confirmed all of the above.

I was talking with her last night about this very thing. We dont speak often about it, maybe once every 5 to 10 years.

She is 50 and I am 54 years old. Our friendship was strong before the overdose but it remains strong and consistant for a total of 35 years. We both had two children, raised them a few blocks from each other and are ALWAYS there when we need each other.

I dont know if I could have gotten through the last two years if she had not been here.
Thanks, Nave

Nave
when my dad was in the icu and on a ventilator ,they had a big sign above his bed which read."i,may not see you ,i may not recognise you.but be sure i can hear you".the staff told us that the hearring is the last sense to go.I`m so glad we are made aware of this ,and can constantly tell our loved one how much we loved them ,and how well they are doing,even if there is no hope.It is so obviouss you are in the right profession.they need more like you that`s for sure.i,lost my dad last year ,but i know he passed knowing we were around hi and how much we loved him,and always will.thankyou for sharing your amazing stories.I,hope you will have a great day with your family tomorrow ,with love.sharon.xxxx

Rocky7
That really does not surprise me...I have seen so much in my lifetime, that I believe it to be true as well. I came across your site by accident...but am very glad I did. Thanks for sharing.

lori555