Waking up slowly
When I first saw her in the trauma ICU, she was posturing.
B was a college student who had been on a skiing vacation with her family when she lost control and broke her leg. She was taken to a hospital closer to the mountain, where her fracture was repaired. Unfortunately, she’d suffered from fat embolism during the operation. Fatty marrow from inside the bone had entered her bloodstream, eventually becoming lodged in her brain. When she wouldn’t wake up, her family asked for her to be transferred to our specialist trauma center.
For the first few days she was with us, B showed very few signs of improvement. Her parents were at her side every day, and during our rounds, they would insist that she was progressing. I didn’t see it though. When we examined her, she would grimace and extend her arms – decerebrate posturing, a sign that her brain was massively damaged. Patients with this type of response to stimulation typically don’t do well.
But our attending, Dr. D, remained optimistic. He said it was too soon to tell. Patients with fat embolism tended to do very well in the long-term, he insisted to a skeptical crowd of residents. He sent us articles to back up his claims, but I still couldn’t believe that B would ever wake up, let alone return to any kind of normal life.
After about a week of this, B was physically well enough to be sent to a regular hospital ward. She was still quite unresponsive, but Dr. D was unflappable – “Give her a little more time – you’ll see.”
Some weeks and many patients later, I was getting ready to move on to my next rotation. I was chatting with G, one of the trauma coordinators. She knows me quite well, so she knows which patients bother me the most.
“So, girlwithaknife, remember B? She’s going home soon!”
“Really? To rehab?” I assumed she’d be sent somewhere for traumatic brain injury.
“Nope, she woke up, she’s done her rehab, and she’ll be going home-home.”
“No way!” Just a few weeks ago, I was convinced that she’d remain in a permanent vegetative state.
Later that afternoon, I found some time to duck out of the ICU. I walked over to the rehab unit and found B’s room. I knocked and heard her voice for the first time, weeks after first meeting her.
The girl who I thought would never return to independent life was sitting up in a chair with her healing leg propped up. She was awake, alert and oriented – and serenely buttering a slice of toast.
I introduced myself and sat down. She apologized for not remembering me. I could only shake my head and chuckle at her words. I still couldn’t believe she was awake. We had a brief conversation before I had to leave her room and return to work.
I left feeling oddly settled. I was wrong, Dr. D was right. And I couldn’t have been happier about that.