I swear every word of this is true (as long as you believe it).

12-hour shifts are LONG, and sometimes you just have to find something to help you along. I was lucky enough to find that “something” in the form of a patient. For the past week, the majority of my patients have all been head traumas. This gave me the chance to learn more about Mannitol, ICP, the effects of CO2 on said ICP, and the exquisite pleasure of witnessing a neuro patient come out of sedation.

THAT last thing, good people, is something to behold.

My preceptor warned me that when a neuro patient wakes for the first time, he/she might say some odd things. “Those that don’t cuss, will cuss. Those that do cuss, will cuss some more. In any case, strange things are often said, so be ready for it,” I was told.

This particular young patient had struck his non-helmet-protected-head from a bike fall. Upon arrival to the unit, he attempted to crawl out of bed, pull at his lines, and tug at his Foley… bear in mind that this was all under the effects of Propofol. Soon the doctor ordered some Precedex as well.

I cared for him for 2 days, and on the 3rd day, well… this happened.

6:05am – He self-extubated. I wasn’t there to see it, but I heard that it was an unprecedented event.
7:45am-ish – He tried to climb out of bed and would have succeeded if he didn’t fall asleep halfway through the attempt. He ended up looking like this (imagine the bookcase is a bed):

9:00am – We repositioned him.
9:05am – I have no idea how this happened, but we found him like this:

9:10am – Restraints were applied to protect him from further injuries

10:45am – I had the following exchange with him…

Patient: “Hey, man… come here.”
Me: “Sure. Can I get you something?”
Patient: “Man, touch my NCLEX Book” (except he didn’t say “NCLEX Book”)
Me: “Dude, I don’t think I want to do that.”
Patient: “Come on, touch my NCLEX Book.”
Me: “That’s ok, I’m good.”
Patient: “Come on, just touch my NCLEX Book, ok?”
Me: “Thanks for the offer, but I’d rather not.”
Patient: “Ok… then give it a tug, ok?”
Me: “Then I’d have to touch it, wouldn’t I?”
Patient: “Yeah, you’re right… ok, so just touch my NCLEX Book, then.”

Saddest part is that this conversation went on for about 10 more minutes.

It was a strange, strange day. By the time I left, we had about 50 more deep conversations like the one above. The guy’s lucky… he was able to demonstrate purposeful movement in all four limbs, and his O2sat never dropped below 99% even after the self-extubation. Only time will tell if he regains his full memory of the events that brought him in, and only time will tell if there is any permanent brain damage. For now, he is the classic example of why we should always wear a helmet… whether it be for skateboarding, bike riding, or from the simple act of ordering off the Chinese take-out menu.

Now, you’re probably thinking that I’m making fun of this guy, but that’s the furthest from the truth. In my short time in the SICU, I’ve found that a good sense of humor will get you through the day. I won’t sugar coat it – I find the SICU incredibly depressing. Death is just a breath away and you’re constantly reminded of this, especially when you see a patient you transferred off to a lower acuity unit come back in worse shape than before. It’s disheartening, it’s disenchanting, and at times it’s downright despairing.

And if I don’t find a reason to laugh, then I’ll go crazy.

Even the patient’s parents had to chuckle when they were asked to “give his NCLEX Book a good slap.” It was the first time in 3 days I saw them smile, and they needed it.

Laughter bonds as it heals. A day without laughter is truly a day wasted.


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