Today I met a patient who was 34 years old. She was studying to be a nurse and was going to take her board exam on a Thursday. She finished her waitressing shift on the SUnday before. She was reaching for her cell phone in her truck and the next thing she remembers was teetering on the edge of the cement guardrail. She doesn't remember anything else.
According to her mother, she lost consciousness and was intubated and on a ventilator. She had a subarachnoid bleed in her caudate lobe in her brain and generalized damage to the temporal and parietal lobe. She was in a coma for 3 weeks and the last week she was agitated and confused. She attempted to pull out her tubes unsafely and was restrained. After 4 weeks, she was accepted into the Traumatic Brain Injury unit at Santa Clara Valley Hospital. She underwent intensive therapy. She does not remember much of the therapy. But her mother reported that she made rapid recovery.
Speaking with her tearful mother revealed that emotionally and mentally she was not the same person. She used to be very active and talkative. But in the office, she was polite, quite, and had a blunted affect. Her three kids were having a difficult time with their own mother because they didn't fully accept her as their mom. There were times when she wouldn't recognized her own mother. So it was not a surprise that her children felt uncomfortable around her. In short, she was not the same mentally and socially. Seeing her in the office was remarkable. Physically she appeared normal from the outside. She had minor problems with coordination and displayed typical reflexes that a brain injured person would. But her face was so blunted. Her laugh seemed fake and her smile was very contrived. It was sad. It was like she had seen the worst of the worst and survived. Her face looked like she saw the devil in Hell and was forced to come back to this stupid reality. She was almost to the point of denial. She would say "Thank you" when someone made the comment that she showed a lot of improvement.
I couldn't help but feel that her mother, with her questions, was just trying to get reassurance from us that her daughter's anger or sad face was a result of the TBI and not her. And we did reassure her that it was not uncommon for patients who had TBI's to have that expressionless face and may suffer from the cognitive deficits. But there was an unfortable feeling that she was going to treat her daughter like a child from now on. She would tell us how she would feel uncomfortable letting her go out again with her previous boyfriend and friends. She spoke in front of her daughter the entire time. And I kept getting the feeling that this mother was going to hinder the patient's improvement to be independent.
But the patrient was determined to continue to finish her exam for nursing school. And I couldn't say anything but encourage her. I didn't want to dash her hopes. But I still felt that the mother and daughter were in denial. That's the worse. Denial. You can never know if you'r doing it. You never want to force someone to face reality. But you don't want to condone it.
It's true though. After a person undergoes a traumatic brain injury, they can never be the same person. She will never reach the same functional level. But she will be very close. It will be something that requires a lot of patience. And it takes a strong person to lower their expectations. Man, what a tough case. I really wanted the mother to stop "baby-ing" her daughter. She almost treated her like a leper or a child. But I guess that's to be expected as a mother. What can you do but what you know? She only knew how to mother. And that's what she is doing.
I think a patient like that reminds me how lucky I am and that life's turns are just that. Turns, not stops. Life goes on, with or without me.
According to her mother, she lost consciousness and was intubated and on a ventilator. She had a subarachnoid bleed in her caudate lobe in her brain and generalized damage to the temporal and parietal lobe. She was in a coma for 3 weeks and the last week she was agitated and confused. She attempted to pull out her tubes unsafely and was restrained. After 4 weeks, she was accepted into the Traumatic Brain Injury unit at Santa Clara Valley Hospital. She underwent intensive therapy. She does not remember much of the therapy. But her mother reported that she made rapid recovery.
Speaking with her tearful mother revealed that emotionally and mentally she was not the same person. She used to be very active and talkative. But in the office, she was polite, quite, and had a blunted affect. Her three kids were having a difficult time with their own mother because they didn't fully accept her as their mom. There were times when she wouldn't recognized her own mother. So it was not a surprise that her children felt uncomfortable around her. In short, she was not the same mentally and socially. Seeing her in the office was remarkable. Physically she appeared normal from the outside. She had minor problems with coordination and displayed typical reflexes that a brain injured person would. But her face was so blunted. Her laugh seemed fake and her smile was very contrived. It was sad. It was like she had seen the worst of the worst and survived. Her face looked like she saw the devil in Hell and was forced to come back to this stupid reality. She was almost to the point of denial. She would say "Thank you" when someone made the comment that she showed a lot of improvement.
I couldn't help but feel that her mother, with her questions, was just trying to get reassurance from us that her daughter's anger or sad face was a result of the TBI and not her. And we did reassure her that it was not uncommon for patients who had TBI's to have that expressionless face and may suffer from the cognitive deficits. But there was an unfortable feeling that she was going to treat her daughter like a child from now on. She would tell us how she would feel uncomfortable letting her go out again with her previous boyfriend and friends. She spoke in front of her daughter the entire time. And I kept getting the feeling that this mother was going to hinder the patient's improvement to be independent.
But the patrient was determined to continue to finish her exam for nursing school. And I couldn't say anything but encourage her. I didn't want to dash her hopes. But I still felt that the mother and daughter were in denial. That's the worse. Denial. You can never know if you'r doing it. You never want to force someone to face reality. But you don't want to condone it.
It's true though. After a person undergoes a traumatic brain injury, they can never be the same person. She will never reach the same functional level. But she will be very close. It will be something that requires a lot of patience. And it takes a strong person to lower their expectations. Man, what a tough case. I really wanted the mother to stop "baby-ing" her daughter. She almost treated her like a leper or a child. But I guess that's to be expected as a mother. What can you do but what you know? She only knew how to mother. And that's what she is doing.
I think a patient like that reminds me how lucky I am and that life's turns are just that. Turns, not stops. Life goes on, with or without me.