Confronted for the first time with life support
procedures followed in emergencies, I expect most of us respond viscerally.
Those hardened souls that manage their reactions dispassionately are obviously
better suited to intensive care situations.
It is a shock for the unprepared and untrained eye, but daily fare for
the highly trained, 'hard-wired' personnel that populate these units. This was a dramatic initiation into the
amazing arenas of critical and intensive care. The
lead players ooze detachment from the raw emotions and stressful responses of
patients’ family and friends. Machines
take over, dispensing air and drugs, while monitoring blood pressure, pulse,
brain activity and the complex dimensions of breath.
Carolie’s next stop would be surgery to
determine the nature and extent of the damage wrought by the aneurysmal
bleed.
After surgery she would be moved to an
Intensive Care Unit (hereinafter ICU), where we could stay with her as long as
we liked. The mirror was melting and we
were entering the labyrinth proper.
Carolie’s eyes were closed and she was a terrible pallor, her blouse had been cut from her, lower clothes and jewellery removed, to be replaced with identity bracelet and a loose hospital gown; she appeared to be responding to commands such as “squeeze my hand”, “wiggle your toes”, “can you hear me”, but otherwise appeared out to it. As I left the Resuscitation Unit, the nurse gave me Carolie’s watch and jewellery in a paper bag. It was redolent with dire consequences.
Carolie’s eyes were closed and she was a terrible pallor, her blouse had been cut from her, lower clothes and jewellery removed, to be replaced with identity bracelet and a loose hospital gown; she appeared to be responding to commands such as “squeeze my hand”, “wiggle your toes”, “can you hear me”, but otherwise appeared out to it. As I left the Resuscitation Unit, the nurse gave me Carolie’s watch and jewellery in a paper bag. It was redolent with dire consequences.
Waiting was again our lot. Hours went by with no word. We remained in the small waiting room,
talking quietly, trying to keep anxiety at bay. Eventually a member of the neurosurgical team
appeared with an interim prognosis. In a
perfunctory manner - a trait I found typical of these accomplished brain
plumbers – he informed us of SAH survival statistics (see previous post) and that
Carolie’s prognosis was grim. She should have died from the bleed. I heard this many times along the journey as
a form of ‘encouragement’.
Some medical professionals would do well as boot camp instructors – no room for cloying emotions in their world. Aloof detachment seems a protective garb donned to project ‘professionalism’ and is perhaps honed to avoid psychological scarring from bearing witness to tragedy and grief; the matter of fact, ‘cut to the chase’ style of delivery an antidote to the raw emotions that can well up from recipients of their advice.
Some medical professionals would do well as boot camp instructors – no room for cloying emotions in their world. Aloof detachment seems a protective garb donned to project ‘professionalism’ and is perhaps honed to avoid psychological scarring from bearing witness to tragedy and grief; the matter of fact, ‘cut to the chase’ style of delivery an antidote to the raw emotions that can well up from recipients of their advice.
When a cerebral
aneurysm ruptures, blood fills the space surrounding the brain. CT scans* revealed she had
bled across seventy per cent of her brain, which in usual circumstances could
mean only thirty per cent brain functionality. Blood seepage into the brain is
terrible as the body perceives the blood as a foreign invasion and launches an all
out assault. The brain becomes a
veritable battlefield, which has devastating consequences for sensitive
tissue.
The surgeons inserted a cerebral fluid drain
and started a further suite of drugs.
The surgeon explained there are two ways to staunch an aneurysm. The first was the traditional method of a
titanium clip inserted using a microscope after a craniotomy to expose the
arterial bleed as illustrated below.
The second and more recent method was termed
‘coiling’ and involved ‘endovascular image guided procedures’, placing a ‘coil’
in situ to stop the bleed, as seen in
the next illustration.
In the mid 90s,
A revolutionary treatment was developed by Dr.
Guglielmi, an Italian neuro-radiologist, where a fine tube is inserted from a
needle puncture in the leg. This tube is navigated under advanced image
guidance into the aneurysm and the sac delicately packed with very fine soft
platinum wires shaped to look like coils that match the size of the aneurysm.
Several such coils may be required to close an aneurysm; this basically depends
on the size of the abnormal sac.+
The preference of the surgical team was coiling
but this was not available in Canberra.
I gave my permission for a helicopter transfer the next day to
Sydney. The surgeon advised that Carolie
was in post surgery recovery and would arrive in the ICU shortly.
To be continued...
*
X-ray computed tomography, also computed tomography (CT
scan) or computed axial tomography (CAT scan), is a medical imaging procedure
that utilizes computer-processed X-rays to produce tomographic images or
'slices' of specific areas of the body.
CT scanning of the head is typically used to detect infarction, tumors,
calcifications, haemorrhage and bone trauma.
+ http://www.irtreatment.org/procedures-and-treatments/brain-and-spinal-cord/coiling-aneurysmsah.html
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