“The greatest ally of the physician is time.”
Surgeon-Commander Harris
I first glimpsed Anita through the security-wired, biochemistry-class windows, that overlooked the girl’s school next door. She was a competitor in the world of school athletics. A pair of massive blue gym knickers, ‘scissoring’ over a high-jump bar.
We met officially long after the end of the gym-knicker season.
It was at a strictly U18s “drink-as-much-as-you-can-before-the-slow-dances-start”, Christmas Party. I had an attention-grabbing plaster cast on my latest rugby-fractured hand and was sat enviously watching the dance-floor high jinks. Anita came over and asked me if she could sign my plaster.
She had an intense sapphire glare, or was that the Blue Bols chasers? Either way, her gaze gave me the heebie-jeebies.
I had loved her ever since.
—
Anita and Josh, our younger son, flew to Melbourne together, the morning after the crash. My elder son stayed to feed the dog.
The future held its breath.
Taxi and bags hastily dumped in a local AirBnB, they came to the hospital.
Had I been the consultant, I’d have called Anita. It was always good to get a sense of the family dynamics.
“No need to hurry,” would have been my stock answer.
In translation, that meant,
“We aren’t certain of anything yet. He’s going nowhere.”
What else can you say?
“Bed 20? OMG he won’t survive!”
Relatives want to hear cast-iron reassurances when there aren’t any. In Intensive Care, the list of ‘possible’ problems is endless, and the shorter, ‘probables’ list, is no more reassuring.
—
Human brains are made up of billions of tiny fibres criss-crossing each other in a myriad of directions, like a fine silk cloth. If the brain is shaken brutally, the rapid movements result in the fibres cutting each other, like millions of cheese-wires. However, the fibres are so small and interwoven that the microscopic damage can’t be seen by our medical scanners unless large scale bleeding or swelling occurs.
I had a bit of both and it would take a long time to figure out what the consequences would be.
Would it be the old me or someone else who woke up?
—
“Will he be OK?”, depended largely on your view of what ‘OK’ meant.
In ICU-terms, “alive = OK” so I’d usually say “Oh Yes!”
“Will he walk again?”
Most people did, so again one could be optimistic.
No one had ever asked me,
“Will life ever be the same again?”
That would have necessitated me knowing what the patient’s life was like beforehand and I didn’t have time for that sort of intimacy. There were 20 other patients to care for.
For all the fancy machines and drugs, ICU was simple. We controlled every aspect of the patient’s lives. We kept them asleep, watered and fed them. We might sometimes have to let them go, watch them die. But not before we had fought night and day. Not before we decided it was OK to give up.
The complicated, unpredictable factors were families.
It’s natural to want to witness your loved one’s ICU-struggle. Not just file an image in your mind, but grip their hand, hear their heart beeping and pray for them. That’s why the 24-hour care, all the washing, poking and prodding, was timed to avoid family visits. Families don’t need to see delirious head injuries like me, thrashing with their bruised brains and nightmarish flashbacks. They have already been through so much, and have so much to face in the future. ICUs have to care for the relatives too. Keep things looking neat and tidy because that meant ‘hope’.
—
Anita sat quietly at my comatose bedside discussing the potential for brain damage and paralysis with the ICU team. She rang the unit 3 times each day for an update and walked the lonely walk back to the AirBnB each evening after another day of failed, arm-thrashing wake up attempts. I had returned to the operating theatre from my ICU room a couple of times for more pins and plates in my hands and had any number of specialist reviews.
—
I did once ask the plastic surgeon, in another of my socially inappropriate moments, why I was still so ugly? Given that the collision had rearranged my face, it occurred to me that a unique opportunity had arisen to right the wrongs of years of neglect and dodgy genetics.
“We had to match all the broken bits with all the crooked, sticky out stuff you already had on the other side” he replied professionally.
—
I was battered and unconscious. Most of the busted stuff couldn’t be hidden by sheets or dressings. My broken neck had been filled with bits of bone chiselled from my hips; metal plates bolted it all together and wires held my mouth together. To finish the look, my arms, were tied to the bed, protecting my chest drains and catheter from frequently flailing arms.
I don’t know what Anita and Joshua thought. They won’t talk about it.
—
As the boss of an ICU, I tried to be informal with relatives. Largely for my own sanity. I cared for the patients, not about them. You had to detach your emotions from those of a patient’s wife, father, or their kids. Otherwise it was hard to think straight.
I’d lead the tearful and the stunned into the patient’s room, and gently explain the tangle of pipes and pumps. I would make vaguely reassuring noises to the group; observe the family dynamics; try to understand how they might cope, while our patient, their loved one, decided whether to live or die.
Managing relatives expectations was crucial and it was best to be honest. ICUs don’t admit patients that they have absolutely no hope for. Each bed is precious and surviving is hard and even distressing for the patient. It would be wrong to sustain unpleasantries if death was inevitable.
If the relatives asked direct questions, I would answer them. Relatives didn’t blame you for their loved ones critical predicament, but they expected you to be honest.
“A bit poorly at the moment,” was my stock summary.
It sounded like a ridiculous British understatement, but the relatives had witnessed so much trauma in visiting at all, that some compassionate understatement seemed kindest.
“We shall see how we go overnight. In the meantime, you must try to get some sleep.”
—
Anita walked slowly back to the AirBnB and did as she was told.
Another sleepless night ensued.
Dr Bruce Powell 