Crisis Phase The ER
The Emergency Room
The main focus for the staff in the ER is to stabilize the patient. The doctors and nurses work under intense pressure and stress to try to identify the injuries and then stabilize the patient so they can go on to other treatment if necessary. They worry about assuring a clear airway, stopping any bleeding, and identifying any internal injuries. With all of the stress and emotion, the ER experience may be just a blur when you look back on this tragic event.
What to Expect
You are probably overwhelmed just by being called to the ER and facing the uncertainty of your loved one being injured. Then, most ERs do not let you have much access to the patient immediately which is even more unsettling. Be prepared to wait without much information.
The staff is busy doing their best to help your loved one but you may not hear from them until they feel they have your loved one stabilized. Keep checking in and let the staff know you want to go back with your loved one as soon as possible.
Be prepared. If you see the ER team come together to work on a critical patient it looks like a swarm of bees. There are doctors and nurses everywhere and everyone seems to be talking all at once. There is however a method to the chaos you may see in the ER. Each person has a task and they work together to take the best possible care of the patient. Then, just as quickly, the swarm of doctors and nurses disperses and moves on to the next person.
Tips From One Family to the Other
When the Chaplain Meets You
When our daughter was injured it happened that my wife was out shopping with some other family members and she and the others arrived at the ER at the same time as I did. Our group was met by a chaplain and escorted to a room away from the general waiting area. There we were told we could call any other family members. At the time, we thought it was a nice gesture and just happenstance that the chaplain had met us.
Now we know that it was actually part of the plan the hospital had in place. It seems that the seriousness of our daughter’s injuries had set their plan in motion. The chaplain provided comfort, an interface with the medical staff and along with the extra privacy and some extra care and attention. It was very welcome and very helpful.
Call Your Family
If you are fortunate enough to have family nearby, take advantage of the waiting period and call your family to come join you. Besides the obvious care and support your family can provide they can also help you remember more of the details you hear or ask questions you may not think of. With all of the stress and worry you probably will not be thinking clearly and won’t be able to take it all in.
The doctors may ask just to speak with the parents or the spouse but we ended up just having the doctors address the whole family. This eliminated us trying to remember everything that was said and relaying it to the family.
Around the Clock Care
The ICU offers the highest level of care to the most critical patients. The nurses are very highly trained and have only a few patients to care for. Your loved one will receive constant attention 24 hours a day. The equipment and supplies the staff needs are readily available and should an emergency arise the response is swift and comprehensive.
Your loved one’s specific injuries will determine which doctors are involved in their care. In our daughter’s case, there was a Neurosurgeon who was managing the head injury and the Trauma Team who handled the rest of the person’s care while in the ICU. Both the Trauma Team and the Neurosurgeon will typically have coverage 24 hours a day in the major trauma centers. Other specialists will be called in as necessary.
A Frightening Sight
The sight of a seriously injured person in the ICU can be very terrifying as there may be wires and tubes everywhere. Your loved one looks so vulnerable and frail and the equipment so intimidating. Understanding what the equipment is and what it does is the best way to overcome the anxiety the appearance brings.
Below are descriptions of some of the possible treatments and equipment you may see as your family member tries to recover:
Secondary Insult – Brain Swelling
As if the initial brain injury was not bad enough, some of the real dangers can come from the secondary insult caused by brain swelling. A doctor explained it to us with the example of hitting your thumb with a hammer and the fact that your thumb is going to swell. He said the brain reacts the same way to its impact but the only problem is the skull severely restricts the space the brain has to swell.
A brain injury leaves a person open to a number of complications. Some area result of the person being immobile while others are due to the fact that the brain’s control of bodily functions has been compromised. Some of the complications may include:
Other Procedures/ Treatments
What to Expect
Coma — It's Not Like the Movies...
The word is so scary to families that some doctors do not even use it. The most important thing to know about a coma is that unlike the movies, a person is not going to just wake up from the coma and jump out of bed one day back to normal.
The medical experts can not even agree on the definition of a coma. Depending on the severity, the arousal process can be very slow. Waking up from a coma can be a long, slow process that can start with a twitch of a finger or a squeeze of a hand. If you are lucky, some of the steps will blend together in a matter of days. If you are not so lucky, the steps to arousal may take a long time, or not happen at all. (phases of recovery)
It's Just a Reflex
This is one phrase that you may learn to hate. When our daughter was in ICU we felt a squeeze of a hand or some other movement. Invariably, the response when we reported such movement was "It's just a reflex". That drove us nuts. We were with our daughter 24 hours a day and yet this resident, who was only with her a few minutes a day, was telling us what we felt strongly was volitional movement was just a reflex.
No one can ever prepare for the emotional turmoil a life-threatening injury can bring. The panic, the grief, the fear. It is truly overwhelming. But you can help ease the tension. First, no what-ifs. You can drive yourself crazy playing the what-if game when frankly it can do no good. In fact, it can only prove to be destructive.
Secondly, now is not the time to let the little things that drive you crazy come to the surface. I know your brother-in-law is a jerk and he drives you nuts, but just smile and let his unwanted advice roll-off.
Tips From One Family to Another
Easy to say, harder to do... Look, this is a terrible tragedy. Stop, break down, yell, cry, whatever. But, do it outside the room. And keep in mind that as tough as you think things are for you, your loved one is the one fighting for their life. So, suck it up. Your positive attitude, love, and compassion are the best medicine they can get right now.
Another reason to stay positive is we are convinced that the patients can hear you, even while in a coma. At least your loved one is still alive.
Set Ground Rules
Early on we set rules for the staff and the family. Only positives could be discussed in our daughter's room. We would stop a doctor in mid-sentence if we needed to and take the conversation to the hallway. Seeing someone with all the tubes and wires is crushing but the family and friends got the same message. Anyone that starts crying in the room, step in the hall until you get it under control.
What we found that helped, especially with our daughter's teenaged friends, was for them to look in at her through the window while we explained what the tubes and wires were for and that seemed to calm them before we went in the room.
Make sure everyone, staff and visitors, wash their hands when entering the room. If any visitors even think they are getting sick, ask the nurse and they can get them a mask to wear.
Know Every Med, Every Procedure, and Why
You need to be an active participant in your patient's plan of care. To do so you need know every medicine, every procedure, and most importantly, why. Write it down. Ask what alternatives are available, what are the side effects, are they being as aggressive as possible. Challenge the doctors and ask them to walk you through the alternatives.
Finally, with all of the staffing problems and shortages, keeping track of the medicines and schedules may allow you to catch a problem before it happens.
The Doctors Are Rushed, Make a List
Make sure you quickly find out your doctor's schedule for rounds. Both the trauma team and the neurosurgeon. Be there and be as forward as you need to be to make sure the doctor talks to you every day. This sounds like a dumb thing to have to mention but believe me it is not. Some people who we became friends with in the hospital went days before talking with their neurosurgeon while their daughter was in the ICU.