Long Night's Journey - Part four

Continues...

A further CT scan would check the effects of the new drain.  On the day of this scan, I left the ICU early as I could not accompany her on these escapades.  I rang around 6pm to get the results.   

A junior ICU registrar took it upon himself to display his expertise in reading scan pictures.  His opening gambit was “the scan revealed major infarction of the frontal lobe from the original bleed”.  He next pointed out that between 20-40% of this part of the brain was “dead” – this is the area responsible for personality and decision-making.   

I was devastated on two fronts:  First, by the perfunctory prognosis of severe brain damage that contradicted previous advice from neurosurgeons; second, the fact that this ‘epic’ assessment came from a junior member of the hierarchy who was not a neurological specialist. I was alone in my friend’s apartment.  The shock could have sent someone with a weaker heart over the edge. 

My response was livid anger.  Somehow, I reached the hospital without killing anyone.  I confronted the registrar immediately; we removed ourselves some way down an unoccupied corridor for a ‘chat’.  This was the first of two occasions I lost my cool during the journey.   

I proceeded to give the young man a verbal scalding.  He started bravely with a defensive posture but gave way under my barrage, quickly resorting to plaintive apologies as the air surrounding his ears began to arc with white light.   

It took me over an hour to calm down, at which time one of the nurse managers wandered over to say the registrar had no right to say what he did over the phone and that my response was fully justified.  ‘Poor people skills’ were writ large yet again on this damaging exchange.  My patience with ‘plain talking’ specialists was running thin.

I sought clarification of the obtuse prognosis of the registrar.  ‘Mr Sensitive’ was on duty and came by to offer that clarity.  My anger rising again, I told him to go away in so many words as his ‘soothing’ manner was the last thing I needed.  Eventually, one of the senior neurosurgeons with a semblance of a decent bedside manner approached me.   

He explained the damage seen by the registrar was not from the initial bleeding and that the percentages he quoted were ambiguous at best.  Additional damage was due to the insertion of a new drain, which was inevitable as the tube engages sensitive tissue.   

As a prop, he showed me her CT scan series (not unlike these below) on his smart phone – the amazing plasticity of the brain was apparent as the recent pictures bore little resemblance to the older.

His technical interpretation of the pictures was beyond me.  I took his word that swollen brain ventricles – a combination of ventriculitis and hydrocephalus - were likely behind her not waking from coma. She was between a ‘rock and a hard place’ and I was despairing of it all.

The next step was the insertion of a ventriculoperitoneal shunt to control the draining of cerebrospinal fluid from the ventricles in the brain.  Carolie’s intracranial pressures had not responded to treatment, suggesting the life-threatening hydrocephalus condition would persist without this intervention.  

 A permanent shunt was the only solution.   

Apparently, “shunts can come in a variety of forms but all of them consist of a pump or drain connected to a long catheter, the end of which is usually placed in the peritoneal cavity” (Wikipedia).  My permission given, this last surgical procedure took place without a hitch, just over a month since the initial haemorrhage.  

 

A neurosurgeon proudly showed me the shunt, which is a miniaturized engineering marvel, calibrated by an external magnetic device.  Carolie would have a small horseshoe like indentation just backward of her right ear for the rest of life.  I learnt that children sometimes have these inserted for life. 

 The ongoing major risks are infections to the brain such as meningitis, which could seriously compromise shunt operation.  It had never occurred to me that a person might require a mechanical ventricle drain for life.  After the procedure, Carolie was still not showing any inclination to wake up.  

To be continued...