Inhabiting the Labyrinth - Part two

The nurses are the cement that binds operations within high care facilities. Working one on one with a designated patient per shift ensures each nurse provides a continuum of inputs, monitoring and evaluation across twelve hours.  They work the bed space with ergonomic grace, which I found sorely lacking in some of the specialist class.   

On one occasion, an anaesthetist arrived with insufficient notice to the shift nurse.  Normally they receive adequate notice to re-calibrate the life support paraphernalia to transport mode in preparation for an anaesthetist.  I witnessed this many times.  Nurses manage  this process with a minimum of fuss – it is a precise choreography.  

The anaesthetist asserted his authority over the nurse caught on the hop, issuing instructions and ‘taking control’.  It became 'pythonesque' as this rather big man lacked the grace and coordination of the nurses.  At one stage, I imagined a ‘Houdini’ act for my entertainment, demonstrating how one can unwind oneself from life support tentacles without unplugging the patient.  For a brief moment panic set in as I pictured this unruly physical presence at work administering anaesthetic.  I gritted my teeth and realized he must be good at his job.  It made me ponder the unequal relationships between senior medical staff and nurses.  

Doctors and ancillary staff came and went, with responsibilities across a wider range of patients and duties during their shifts. A computer based progress report registered all interventions and assessments.  The legendary clipboard at the end of the bed had gone, superseded by computer systems backed up by generator security.  ICU nurses are gatekeepers of patient information as they hand over from shift to shift, but they are much more than that.  

All of her time in the ICU Carolie was in the best of hands.  The nurses and the nurse managers were of the highest calibre.  Over the next month and a half, I was constant witness to the skill and dedication of this cadre of carers.  It was a privilege to get so close to their daily grind.   

The honed expertise of neurosurgeons and ICU specialists provided invaluable technical interventions, but round the clock attention to detail by nurses left indelible memories.  They were beacons of the labyrinth, guiding me through the darkest stretches; they were worker bees underpinning everything that happened; they were front-line soldiers in a daily battle for survival.   

During the second day, several procedures were scheduled.  Carolie had another CT scan on the first night in RPA.  The next day began with an angiogram to determine her suitability for a coiling procedure.  The surgeons threaded a line that included a miniature lens through a major artery running from the groin to the brain.

It turned out that Carolie’s aneurysm was situated awkwardly, and precluded the coiling option.  The reason for coming to Sydney was invalid on day two, but we were in the right place for surgical expertise.  The clipping procedure would happen later that night.  It involved a right peritoneal craniotomy – cutting the skull open from the right side to the upper forehead to expose the frontal area of the brain, *inserting a titanium clip to staunch the bleed and stapling it all back together.  

Aneurysm clipping by Dandy (Artist: Dorcas Hager Padget)

public domain

This sounds simple when you say it quickly.  It took several hours.  The clips vary in size and their successful positioning can be problematic.   

Neurosurgeons are masters of understatement – I suppose so as not to frighten the horses and to stay cool at all times.  I was amazed that complex procedures occurred well into the night.  I assume daylight is for seeing new clients, following up patients and, presumably, having a semblance of a life.  The labyrinth keeps its own hours.

Towards midnight the senior surgeon, who happened to be the head of neurosurgery at RPA, rang me.  The operation had been a success.  The extent of bleeding identified by the CT scan in Canberra was accurate, but incredibly only a small amount of blood had seeped into her brain tissue. They removed blood that stayed on the surface.  

 Despite some blood seepage, the initial prognosis of dire damage to the brain was likely inaccurate.  Carolie might make a reasonable recovery in these circumstances.  The surgeon was quite upbeat in his prognosis and he wished me goodnight. 

My heart leapt with joy and excitement.  I contacted family members with the news and had my first restful sleep in three days.  I wrote in an email,

Carolie is stabilized and responding to commands.  The extent of damage is impossible to assess at this point.

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*              The neurosurgical report indicated "extensive SAH with sulcal effacement and effacement of basal cisterns.  These latter are fluid filled spaces around the back of the mid-brain whilst the sulci are the furrows on the surface of the brain.  The sulci, basal cisterns and ventricles are examined for subarachnoid haemorrhage".