Just Raven

Andy is a patient I work with quite often. Six days before Christmas of last year he and some friends smoked some pot laced with heroin. They promptly fell asleep and Andy never woke up.

He was found 12 hours later, face down on the floor, in cardiac arrest. The EMT’s resurrected him and on the way to the ER he coded out again; once in the ER he arrested yet again. They saved him and he was admitted to a large MA hospital’s Intensive Care Unit. Here he suffered two more cardiac events and then had a massive stroke. He is in a Level 3 coma and has been since the day he was found. He is 23 years old. He is severly brain injured.

Like so many of my other patients, Andy is hooked up to and connected to many devices and machines and tubes. Along with the usual GTubes and PIC lines and urinary caths, ventilator/trachs, Andy’s heart is attached to a special monitoring device; he has a special blood collection port in his forearm that allows us to check his 02 status in real time- we cannot depend on a machine to tell us these numbers with Andy. The doctors has to surgically break his arms in order to keep them relatively straight, for the IV ports and other lines. His arms are casted with windows to the ports.

His body is a nursing nightmare. Covered with stage 3 and 4 (very deep) decubiti from his hospital stay- wounds on every surface, some that require a vacuum device machine to help them heal. The dressings take hours to clean, change, and hook up to the machine. Andy has what we call compartment syndrome- which affects his limbs and is life threatening. He also endures what is known as autonomic hyperreflexia- a neuro condition in which the involuntary nervous system goes crazy. His temp will often over climb to 105 degrees, his heart rate will scream at 230 BPM, B/P will go up to 240/180. He has to be maintained in a calm environment or he goes into this state. This means as little noise as possible- which is difficult with all the machines and alarms that go with them. In other patients we would place headphones on them with their favorite music- to soften some of this noise. But with Andy we cannot do this because it’s too stimulating.

Basic nursing care for a patient like Andy requires a lot of skill and a very gentle touch. Moving him can kill him. It takes three of us to do this. It takes three hours to do his am and pm cares; he never gets out of bed. He must be repositioned every 1 1/2 to 2 hours. We use specially designed wedges, rolls, neck pillows and foot cradles to keep his body in alignment. He rests on a mattress that has chambers that constantly change pressure- all done by a machine of course. Every instance of care must be given with the upmost skill and compassion- just cleaning his mouth takes 20 minutes. Shaving him is an art. A bed bath is out of the question. We do that bit by bit all day long. We have dry waterless shampoos we use to keep his hair clean.

As if all that weren’t enough for this man to have, he also has MRSA, VRE and MRSE. His bloodstream is septic and there are no antibiotics to heal this. He is in a constant state of infection. Most brain injured people develop seizure disorders within a few months of the initial event. Andy is no exception; he has seizures that are difficult to control because, we suspect, his bloodstream is not able to deliver the meds in the manner desired. Andy’s seizures are life threatening in that they last a long time and he has to placed into a deeper coma in order to end them. This means we sometimes have to control his heart function for him. Andy stays in one of our Isolation rooms to protect him from catching the everyday germs we encounter in a semi acute care setting.

Andy’s prognosis is poor. I have never seen a patient with SO many things going against him. I have worked in with this stuff for years and Andy pulls at my heart. Because he was just an average young guy who had a lot going for him. Until one day he decided to try smoking heroin. His friends told him it was cool and it would make him “feel good”…one of his friends died. The other had no reaction other than the pass out phase so typical of this drug.

When they tested the joint the boys smoked from, it was laced with a mild form of heroin- plain and simple with no additives. The worst stuff actually. Everyone reacts differently to heroin- some pass out, some get violently sick, others just doze off…and some die. Some experience something worse than death- they live like Andy is living. I don’t know if this is living. I am extrememly pro life, so I support every chance for this kid. He is a full code- if he goes out, we do everything we can to bring him back. This probably will kill him all over again though…moving this kid is deadly for him. 6 months of Level 3 coma, with no signs yet that he even is aware of himself. Usually by now these patients make some gesture that they have an awareness of sorts: To pain or to a familar voice. Not Andy. Nothing. Even his eyes never move.

Is this living? I don’t know. Sometimes this work I do really makes me wonder.