Hope When It Exists

In my experience, taking time to talk with family members and to explain what we’re seeing and doing for their loved one is immensely helpful. Physicians should always acknowledge hope when it exists, and so, too, realism when not much more can be done. Even in the worst scenarios, it’s important for family to keep the lovely memories they have of their loved one. Let me try to explain where we, as health care providers, are coming from. Then I’ll describe the type of conversation and social interaction we want to have with a patient’s family to achieve the most satisfactory outcome. Neurointensivists are doctors trained to deal with acute disorders of the brain and spine. They understand the deterioration that occurs after a major catastrophe. Neurointensivists also consult on other illnesses with neurologic concerns and possess core skills in interpreting neuroimaging and other brainwave activity studies. For example, a patient with a traumatic brain injury who undergoes surgery to remove a clot will be cared for by neurosurgeons and neurointensivists. Generally, the major task of a neurointensivist is to orchestrate a cohesive plan for assessing and managing a patient and preventing gaps in the patient’s care. They may probe a patient’s body or superficially stick needles into the patient’s skin. They may turn the person’s head sideways to detect eye movement, shine a light into the eyes, touch a cornea with a tissue or a piece of cotton, or squirt water in an eye.

Light Inside

Neurologists may move the patient’s limbs back and forth to feel muscle tone. In individuals who’ve recovered from a coma, neurologists look for actions that suggest unusual thought processes, such as repetition of a word, a changed mood, or an inability to concentrate on tasks or make simple decisions. Neurologists also may evaluate the stability of a person’s stance and walk and use provocative tests, such as walking heel to toe and standing with the eyes closed. They work on the balance of probability and carefully weigh all the data about a patient and, when necessary, review the data with another neurologist. Because findings on a neurological exam may fluctuate, another opinion can be helpful. Neurosurgeons are another primary contact. They make recommendations about whether the patient is an appropriate candidate for brain surgery. As I’ve discussed previously, surgery might involve removing a large portion of the skull to create more room for swelling, removing a tumor or a blood clot, or placing a drain. Many neurosurgeons also practice what’s known as interventional neuroradiology. This involves using a catheter instead of traditional surgery to remove clots from large brain arteries or injecting drugs into spasming arteries following a ruptured brain aneurysm. Trauma surgeons specialize in management of major trauma. They treat patients with head injuries but also individuals who have major injuries to the liver or spleen and bone fractures.

Keep On Going

Trauma surgeons often are called when a person has bleeding in the chest or belly. In situations in which a patient’s life is in danger and there’s trauma to the brain, a trauma surgeon typically consults with neurosurgeons and neurointensivists, assuming they’re available at the hospital. Hospitals without a neurologist on call or a neurosurgeon at hand often will transfer a patient who’s comatose to another hospital that can provide a higher level of care. They administer drugs, monitor and alter infusions according to directives, maintain access to veins, closely monitor vital signs, and closely participate in resuscitation of patients in the event of a respiratory or cardiac arrest. This helps family members to understand their loved one’s condition and the complexity of care. Nurses are trained in techniques for communicating with family members during times of significant stress who may not be familiar with medical terminology. They focus on maximizing the role of a patient’s family rather than attempting to exert power and control over them. When a nurse forms a special connection with a patient, that can be comforting to the family. Social workers and chaplains also are part of the health care team. They’re available soon after a patient is admitted. The American College of Critical Care Medicine recommends that spiritual care be provided to patients and their families. In the United States, a clergy member’s first encounter with a patient often is triggered by referral from health care staff or because it’s hospital protocol.

Speak To Me

These professionals visit patients and provide them with moral support. If requested, they can offer anointing, blessings and prayer. Clergy can be essential to families at the time of a loved one’s death and in the days that follow. Families, however, prefer not to have clergy present and even find it intrusive. Teaching hospitals also have residents and fellows who see patients. They may be the first on the scene when something goes wrong. It’s often residents who visit with family members following morning rounds to explain care plans for the patient. Medicine is very much a specialty of apprenticing. Multiple lines of communication can change plans, and that’s not usual in complex situations. Family members are part of the health care staff’s social organization. Spouses and significant others are welcome as friends and confidants. The family members are to the patient, the more effective our discussions and conferences with them can be. If family members can’t be present physically, we encourage them to participate by phone or online. Many are in our family room, waiting to speak with a member of the health care team or for their loved one to return from a test or procedure. We get to know each other well over a period of days and weeks. How much families know about coma and where they go to seek information varies. When studied, more Google searches are carried out on the topic of brain death than on coma in general or coma recovery. One could argue this suggests a general unfamiliarity with the significance of brain death. Not all, are reliable sources. We don’t want our loved one to suffer when dying.