Accountability in the Hospital

Introduction:

On April 13, 2013, I was found unconscious in the grass and my motorcycle helmet was found 20 feet away.  It is important that I note that even though I was wearing a helmet, it DID NOT prevent my brain injury!  I suffered a Diffuse Axonal Injury (DAI), which is “the shearing (tearing) of the brain’s long connecting nerve fibers (axons) that happens when the brain is injured as it shifts and rotates inside the bony skull.”  Do you know what that’s like??  Have you ever tried to shake a walnut and you heard the nut inside the shell?  That is the best example of DAI I can share but switch out my skull for the walnut and the nut for my brain.  I’m sure this explains why a helmet did not help me in this situation.  Also, if you could imagine the damage my brain experienced bouncing around in my skull, and why I was in a coma for a month.  

While at my second intensive care unit, I was told that while a tube was removed near my shoulder/chest area, I had a pulmonary embolism.  I had to be revived and my loved ones were escorted out of my room.  After this experience, my mother decided to leave a journal in my room so visitors could leave notes regarding their visit.  Also, when doctors or nurses asked questions that visitors could not answer, they could leave a note in the journal for someone in my family could see and follow up.

Pulmonary embolism is a blockage in one of the pulmonary arteries in your lungs. In most cases, pulmonary embolism is caused by blood clots that travel to the lungs from deep veins in the legs or, rarely, from veins in other parts of the body (deep vein thrombosis).

Because the clots block blood flow to the lungs, pulmonary embolism can be life-threatening. However, prompt treatment greatly reduces the risk of death. Taking measures to prevent blood clots in your legs will help protect you against pulmonary embolism.

Why did my mom leave a journal in my ICU hospital room?  I call it accountability!  For a number of ICUs in the US, visitation restrictions were based on five criteria: visiting hours, visit duration, number of visitors, age of visitors, and membership in the patient’s immediate family.  However, in my situation, my mother allowed anyone who wanted to come visit me in the ICU.

“I think it is all about checks and balances, especially when your loved one is not in you or someone else’s eyesight 24 hours a day.”  

Quote from Like a Snowflake, Rodrick Frazier.

Last week I talked about confabulation, but having a journal, with firsthand accounts of what visitors see is another reason why any confabulation stories did not go too far with me!!  Finding and reading the journal that was left in my hospital room gave me the jumpstart I needed to write a book of my experiences. This journal also provided accountability because I can see when I was taken from my room for a MRI, cerebral angiography, and for occupational or physical therapy.

Initially when I read through the journal, I was provided more details than I was prepared to see.   Not only did I get to read about the question’s doctors asked my family and friends, but I also got to see family and friends report when:

The Scale was described in 1974 by Graham Teasdale and Bryan Jennett (Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2:81-4.) as a way to communicate about the level of consciousness of patients with an acute brain injury.

The findings using the scale guide initial decision making and monitor trends in responsiveness that are important in signaling the need for new actions.

Conclusion:

It is easy to hope and pray your loved ones will be treated correctly while they are in your presence, but what do you do when you are not able to be at the hospital 24 hours a day?  I really appreciated my mom for providing a method for keeping an open dialogue with those close family and friends who came by the hospital to visit me.  Reading through the journal provided enough information that confirmed the stories family and friends were comfortable and uncomfortable sharing with me.  Unfortunately, I can only speak about what I remember, but seeing the words entered by family and friends provided insight on a portion of my experience in the ICU.  If you’re interested in reading all of the journal entries, you will have to wait to read them in my book, coming soon.

“Pulmonary Embolism – Symptoms and Causes – Mayo Clinic.” Mayo Clinic, 13 June 2020, https://www.mayoclinic.org/diseases-conditions/pulmonary-embolism/symptoms-causes/syc-20354647.

“Traumatic Brain Injury | Johns Hopkins Medicine.” Johns Hopkins Medicine, Based in Baltimore, Maryland, https://www.hopkinsmedicine.org/health/conditions-and-diseases/traumatic-brain-injury. Accessed 18 May 2021.

“Glasgow Coma Scale.” Glasgow Coma Scale, https://www.glasgowcomascale.org/. Accessed 18 May 2021.