The Labyrinth Beckons - Part four

Continues...

We had almost lost Carolie and now confronted a bleak landscape of possible death or severe disability and brain damage.  We moved to a waiting room adjacent to the intensive care facility.  It was a subdued, impersonal space with soft chairs, computer facility and tea and coffee – the notion of waiting in a surreal transport hub returned, only this time we had some idea of the destination.   

An ICU nurse informed us of what was happening and how the ICU operated.  She was from the same ‘school of excellence’ that had produced the other intensive care nurses we encountered during that dreadful night and the many ahead.

Around 3am, Carolie was wheeled into the ICU.  We saw her soon after.  The machines had multiplied and she had lines emerging from many parts of her body, including two nose tubes and another emerging from the top of her skull that led to a bag mechanism that both captured bloodied fluid and monitored intra-cranial pressure (hereinafter ICP).  Others administered drugs intravenously via small dispensing machines that manage volumes and flows.  A rectangular ‘lunch box’ was dispensing a nutritious thick shake through her nose.  A saline water feed, doubling as an oral drug dispenser, came via another nose tube.  

Yet another tube channeled urine into a bag.   An arterial line emerged from her lower arm to monitor blood pressure.  She was on full life support.   The protocol in an ICU is one nurse per patient and these nurses are special.  They have obviously attained a high level of proficiency to qualify for this work.  As the name implies, it is intense.  Shifts are twelve hours long, with various short breaks and a ‘lunch’ break.  The lights are always burning, although it is possible to dim lights around patients during the night hours. 

Mesmerizing machines track patients’ vital signs – BP, pulse, ICP, breath dimensions, stimuli responses, cranial fluid drain rates and blood content, and a raft of other survival minutiae.  Integrated monitors like the one displayed on the banner of the blog became a looking glass.  I peered into them for hours together – they were both a window on Carolie’s inner workings and an outward signal of danger, distress, recovery and hope. It is difficult to convey the extraordinary impact these machines had on my consciousness and sub-consciousness.  Periods spent away from them were angst-ridden.  I only tore my eyes from them reluctantly while I was in the ICU.

ICUs are a twenty four hours operation with teams of allied professionals on duty at all times.  They have graded alarm protocols, calibrated to reflect the level of need and urgency. I will return to this later as they are pivotal to a patient’s survival in such life threatening circumstances.   

One of the Registrars on duty came up to me and said he knew my wife.  He was clearly a little shocked, as she had spent the morning settling his ‘kindy’ child into a new school year the previous Monday.  The first days at school for a little one are full of wonder and apprehension. It is another labyrinth of sorts and not always benign. Carolie has a rich history of guiding kids through the early years and on to graduation.  Many of her student cohorts reached out to Carolie during our journey.

Carolie spent less than 12 hours (the length of a nursing shift) in the Canberra Hospital ICU.  A helicopter was to transfer her to Royal Prince Alfred Hospital (hereinafter RPA) in Sydney, just over half a day since the first brain drain had been inserted.  Her time in this ICU was relatively uneventful, with her various pressures monitored closely, especially intra-cranial fluid pressure, as it is a critical indicator in SAH treatment regimes* - my obsession with the monitors increased.   

Apart from the occasional interaction between Carolie and a nurse, these ‘looking glasses’ were the only external signal of her metabolic processes at work.  Managed by computers linked to a centralized monitoring system, they have calibrated alarms that beep and wail according to the severity of the anomaly.  The slightest variations would get my immediate attention.  

Most alarms are just an alert that a particular drug has ceased or needs replacing, but if something is seriously amiss, ‘all hell breaks loose’.  On one occasion in Sydney, at a point deeper in the labyrinth, a junior nurse accidentally hit the ‘scramble’ button for a neighbouring patient, which set overhead lights flashing and a loud wail.  ICU staff came running from all directions to manage the crisis.  It was mortifying for the poor woman, shaken by her mistake, but for me it was a riveting demonstration of rapid response procedures in an emergency.  

I must have driven nurses to distraction at times with endless questions and curiosity but I needed to know how it all worked and what to worry about.  They answered all questions precisely with good humour.  Apprehension over a spike in numbers or indicator lines was usually pointless, but occasionally I spotted something a millisecond ahead of rostered staff.  This did not happen on the first night, as I did not know what to look for or to fear.  We were at the opening of the labyrinth; preparing for a dangerous, sloping tunnel with awkward twists.

Lou and I wandered off around 4am.  We went back to the school to pick up Carolie’s vehicle and made it home by 4.30am.  One of the worst nights of my life was winding down.  I tried to sleep, but was visited by night trolls and other terrors.  I kept reminding myself that it was not a bad dream, it was real and our lives had changed forever.  I kept calling out for Carolie, worrying our cat, who instinctively knew something was desperately wrong - why was I crying and railing after being out all night?  Cats notice subtle changes in their family environment and this was emotional tumult.  He was loving and comforting.   

At some point, I convinced myself to calm down and face the new day with some degree of fortitude.   My first email to one of Carolie’s closest friends was short and to the point:

          I have some sad news.  Carolie had a brain aneurysm last evening and is in a critical condition in the Canberra Hospital ICU.  It seems she will be transferred by air to Sydney for a procedure today.  The prognosis is not good as she experienced a lot of bleeding.  Life can be so cruel.

I had to let our son know.  He lived separately from us in shared student digs. I explained what had happened as best I could and that he had to be prepared that his mum would never be the same again.  At this stage, her chances of recovery were grim.  A young man in his early 20s, he coped remarkably well, with just an occasional bubbling up of raw emotion. It was going to be hard, whatever happened, and the signs were all bad.