VIEWPOINT Thoughts and reflections on issues of interest to perioperative practitioners KEYWORDS User’s perspective / Accident and emergency / Trauma / Perioperative preparation / Reflection Provenance and Peer review: Invited contribution; Not peer reviewed; Accepted for publication September 2012.
Deliverance:
a mother’s journey from the roadside to the operating room Abstract Sometimes I wonder why I wandered into the nursing profession, but in the past few years it has become clear – I became a nurse to look after my son. As we journey through life we try to predict and plan our future. Life twists and turns in so many ways just like my son’s life when one fateful day those plans and predictions were smashed. I recount, as a mother my son’s journey into your hands... the operating room. Some names have been changed. I decided to work a little late that day and received the dreaded phone call on a November evening. The shock of it made me scream to the extent that colleagues thought I was being attacked. I drove home, I don’t know how, to collect my younger son. His words were “Mum they are still working on him”. At the crash site Noel was lying on a spinal board, sandbags either side of his head, neck collar in place and stabilising bandage across his head. I screamed “what have you done to yourself? Can you feel your legs?” His reply, “No mum”. I lost my senses completely whilst my younger son pressed my face into his chest and said “Mum don’t look”. Noel kept shouting “I’m okay I’m okay.” This was the darkest moment of my life. This is the moment that every mother fears, at that instant all I felt was “not me, not my son, not now!” The paramedics lifted their casualty into the ambulance which the police escort to A&E. Brian and I followed behind. This was one of several desperate journeys to come in our life. At A&E we were shown to a bleak waiting room with two small sofas, nothing on the wall, no window, the paint a dim blue. All I wanted was to see was Noel. I hoped, prayed, fretted and panicked.
Seeing our distress the accident and emergency manager arranged for the Senior Registrar to speak with us. His words were, “There is a step in his spinal column which indicates spinal fracture. The picture is not a good one”. At that moment we wept tears of pure despair. When I visited Noel in the resus room he was calm and strong, maybe due to the morphine. “Mum don’t cry I’m alive.” He was lying flat on his back, O2 on, IVs running, neck brace on, sandbags at either side and a bandage across his head to steady it. This was his position for the next 18 hours. He went to X-ray then the CAT scanner and had an orthopaedic and spinal consultant visit. The whole situation was frenetic. I soon received my son’s belongings in a black bag: his cycle jacket, jeans and his green lucky T-shirt which was cut to pieces. I could smell him: his sweat, his smell coming from the T-shirt and boots. It was lovely. I covered my head with his T-shirt and wept. After all the X- rays and scans the awful news was finally confirmed: Noel was a complete spinal injury between L2 and T12. The doctor broke the news to us bluntly to say the least. “He will not walk again and will not be able to use his bladder or bowels”. The professionals kept using this cliché ‘worst case scenario’ and it turned out to be true. The bad news was something I thought I would never receive. Vibeke Lohne’s (2009) narrative research concludes that spinal cord injury is one of the most devastating incidents that can occur to an individual, it is ‘incomprehensible’. It results in life being suddenly, dramatically, radically and long lastingly changed. When we saw Noel again in the resuscitation room, he was shocked to see his brother weeping and saying softly “This is so unfair”. Noel’s Dad turned away and wept. The only one who did not cry was Noel. My best friend Cath arrived (we
July/August 2013 / Volume 23 / Issue 7 & 8 / ISSN 1750-4589
had planned to meet after work). I went to pieces she said “Cry it out girl, cry it all out of you and give it to me”; I sobbed like a child in her arms. The orthopaedic registrar visited and he explained that the surgery was merely to “stabilise his spine. He will not walk again and will have to medicate his bowels and self-catheterise”. This was too much to take in three hours. Noel was transferred to the trauma unit. I was not going to leave him. His dad went home to his house and my younger son spent his first night alone in our apartment with the dog where he cried himself to sleep. At arrival in the trauma ward the night duty nurse was shocked at how ill Noel was. I could discern this from her non-verbal reaction. She attended to his needs, pain relief, vital signs and pressure care, with great diligence. When he was log rolled by at least three people, he cried out in pain, his spine must have been like a piece of porcelain very unstable and with multiple nerve spasms stretching down his back and radiating out to his sides. During these moments he would squeeze my hand and his whole body would shake and shudder. During the night his O2 was changed to humidified because his saturation levels were changing, his BP dropping maybe due to the huge haematoma pressing on his spine and he was sweating profusely. During this long first night he said “Mum I am having awful thoughts. I thought I was going to die on that road with no one in my family with me, not you, not Brian, not Dad. I am afraid of this surgery; will I ever wake up from it or waken during the surgery?” I wept and gave him reassurance. He told me throughout the night to stop crying but even when I breathed I was sobbing. The shock and grief was overwhelming. I still watched his feet for any glimmer of
153
VIEWPOINT
Deliverance: a mother’s journey from the roadside to the operating room Continued
movement. My tears fell on his legs, ankles and feet, I massaged them hoping that he would feel me touching his feet. I watched his toes all that night, there was not even a twitch. By dawn on that November morning my perspective had changed Noel was in so much pain that I desperately wanted the consultants to agree to operate. I was prepared to go down on my hands and knees to beg them to. The night duty nurse came to say goodbye as she finished her shift, we hugged. She reassured me that the day nurse was very special. He was highly respected and I could see why - he was patient, softly spoken, caring and kind, and paid strict attention to detail. Waiting in that side room for the doctors to call seemed like a lifetime. The hours since the accident slipped away, I lost all track of time, day or night. My mind was in fragments constantly thinking about our second floor apartment which is no longer accessible for a wheelchair. What of our future, my job? And what would my son’s life become? I felt lost. My colleagues from work were all very supportive; they brought a bag full of all sorts of toiletries. Sometimes the simple things mean so much, (Crunden 2009). An anaesthetist arrived to assess Noel, a very assertive matter of fact kind of man. With every question he asked I kept thinking, “Will they, won’t they?” It has to be said, that for nurses and doctors alike there is an inner torment of too much knowledge. I certainly felt that confusion as the roles of mother and nurse collided sending me into a blind panic. Fatalising, a counsellor would later call it. The anaesthetist’s assessment ended with Noel asking a question, “I am afraid, what if I wake up during the surgery?” The anaesthetist humoured him by retorting “Well I get paid a considerable amount of money to make sure that you don’t”! The anaesthetist prescribed a drug orally to reduce the acid in Noel’s stomach and he was given his first sip of water in over sixteen hours - it was heaven. As the anaesthetist left I knew that they would be operating, but the spinal surgeon had yet to visit.
154
The surgeon and his team arrived with the ward manager; he could not have been more gracious with Noel. He explained the spinal damage and the surgery to stabilise the vertebral column. He outlined the long slow process of rehabilitation and the profound change to Noel’s life as a result of the injury. He agreed to operate later that morning and at last Noel would be out of his ever increasing pain. At 11am that morning the staff, in their wisdom, decided to log roll Noel again. After this he was in more pain than ever, grunting and roaring in agony. Finally the time came when theatre was prepared for their patient. I asked the staff to give us some time private time with Noel. The uncertainty at this time was heart rending. A theatre assistant arrived at the ward to take a hand over report and escort Noel to theatre. I did not want Noel to go alone. He asked me not to leave so I went to the anaesthetic room with him. As we travelled along the hospital corridors I fretted like any mother would, wondering if I would ever see my son recover from this surgery. At the theatre reception Noel’s details were checked again, by this time his screams of pain were clearly audible in the anaesthetic room and the anaesthetist emerged and administered a very heavy sedative. Noel called out “Mum I love you” The staff wheeled him towards theatre but due to the sedative he was no longer aware of this. I was lost and alone. I took the longest walk of my life in trying to return to the ward we had been in overnight. After being led out of the theatre reception area by an uncommunicative person I felt alone, empty and numb. I proceeded along many corridors and walked into two wards, both the wrong ones. I could not remember anything familiar in the environment I had been in or the staff who had been present. At one point I broke down sobbing to a ward cleaner who asked a staff nurse “What’s wrong with this wee woman?” Throughout this ordeal I felt like my mother; I was developing Alzheimer’s disease I think I know a little of how she felt when her mind was slipping away. A nurse helped me to find my way back to Noel’s ward. I wrapped his green T-shirt around my neck and kept it on for days. The smell of his body was still present, even though it was torn to pieces I could not let
go of it, like a child with a comfort blanket. Six hours later Noel returned from theatre. The recovery was to become the second of many phases in a life changing journey.
Conclusion There are, without doubt, positive and negative outcomes from this event. Noel lives with the consequences of his injury, disability and bodily functions. He feels robbed of a normal life and has an obsession with death, in that he was so close to it once that sometimes he can feel it coming for him again. Another perspective is that a £50 crash helmet saved him from a massive head injury and probably saved his life. He was injured close to a regional trauma centre; hence there was no delay in treatment, diagnosis and surgery. Staff in A&E, ICU, Trauma Care and Theatres should consider that their specialty is often an unpleasant and at times shocking necessity consequently there is much they can do to make the patient and family experience of these shocking events more bearable and a little less frightening. Indeed Crunden (2009) from his reflections ‘On the other side of the bed’ appreciates that there are numerous ways in which staff can positively improve the emotional and psychological care of patients and families. I believe that the way forward is for intensive specialities such as those mentioned above to continue patient centred care but they must not lose sight of the plight of close relatives. I suggest that nurses have a responsibility to the patient but also to the next of kin. Put simply the organisation as a whole has a duty of care to ensure that they are cared for as well as the patient.
n Leontia Hoy RGN, RNT, RCNT, PGCE, MSc Nurse Lecturer, Queens University Belfast
References Crunden E 2010 A reflections from the other side of the bed-An account of what it is like to be a patient and a relative in an intensive care unit Intensive and Critical Care Nursing 26 18-23 Lohne V 2009 The incomprehensible injuryinterpretations of patients’ narratives concerning experiences with acute and dramatic spinal cord injury Scandinavian Journal of Caring Science 23 67-75
July/August 2013 / Volume 23 / Issue 7 & 8 / ISSN 1750-4589
Disclaimer The views expressed in articles published by the Association for Perioperative Practice are those of the writers and do not necessarily reflect the policy, opinions or beliefs of AfPP. Manuscripts submitted to the editor for consideration must be the original work of the author(s). © 2013 The Association for Perioperative Practice All legal and moral rights reserved.
The Association for Perioperative Practice Daisy Ayris House 42 Freemans Way Harrogate HG3 1DH United Kingdom Email: [email protected] Telephone: 01423 881300 Fax: 01423 880997 www.afpp.org.uk
Deliverance:
a mother’s journey from the roadside to the operating room Abstract Sometimes I wonder why I wandered into the nursing profession, but in the past few years it has become clear – I became a nurse to look after my son. As we journey through life we try to predict and plan our future. Life twists and turns in so many ways just like my son’s life when one fateful day those plans and predictions were smashed. I recount, as a mother my son’s journey into your hands... the operating room. Some names have been changed. I decided to work a little late that day and received the dreaded phone call on a November evening. The shock of it made me scream to the extent that colleagues thought I was being attacked. I drove home, I don’t know how, to collect my younger son. His words were “Mum they are still working on him”. At the crash site Noel was lying on a spinal board, sandbags either side of his head, neck collar in place and stabilising bandage across his head. I screamed “what have you done to yourself? Can you feel your legs?” His reply, “No mum”. I lost my senses completely whilst my younger son pressed my face into his chest and said “Mum don’t look”. Noel kept shouting “I’m okay I’m okay.” This was the darkest moment of my life. This is the moment that every mother fears, at that instant all I felt was “not me, not my son, not now!” The paramedics lifted their casualty into the ambulance which the police escort to A&E. Brian and I followed behind. This was one of several desperate journeys to come in our life. At A&E we were shown to a bleak waiting room with two small sofas, nothing on the wall, no window, the paint a dim blue. All I wanted was to see was Noel. I hoped, prayed, fretted and panicked.
Seeing our distress the accident and emergency manager arranged for the Senior Registrar to speak with us. His words were, “There is a step in his spinal column which indicates spinal fracture. The picture is not a good one”. At that moment we wept tears of pure despair. When I visited Noel in the resus room he was calm and strong, maybe due to the morphine. “Mum don’t cry I’m alive.” He was lying flat on his back, O2 on, IVs running, neck brace on, sandbags at either side and a bandage across his head to steady it. This was his position for the next 18 hours. He went to X-ray then the CAT scanner and had an orthopaedic and spinal consultant visit. The whole situation was frenetic. I soon received my son’s belongings in a black bag: his cycle jacket, jeans and his green lucky T-shirt which was cut to pieces. I could smell him: his sweat, his smell coming from the T-shirt and boots. It was lovely. I covered my head with his T-shirt and wept. After all the X- rays and scans the awful news was finally confirmed: Noel was a complete spinal injury between L2 and T12. The doctor broke the news to us bluntly to say the least. “He will not walk again and will not be able to use his bladder or bowels”. The professionals kept using this cliché ‘worst case scenario’ and it turned out to be true. The bad news was something I thought I would never receive. Vibeke Lohne’s (2009) narrative research concludes that spinal cord injury is one of the most devastating incidents that can occur to an individual, it is ‘incomprehensible’. It results in life being suddenly, dramatically, radically and long lastingly changed. When we saw Noel again in the resuscitation room, he was shocked to see his brother weeping and saying softly “This is so unfair”. Noel’s Dad turned away and wept. The only one who did not cry was Noel. My best friend Cath arrived (we
July/August 2013 / Volume 23 / Issue 7 & 8 / ISSN 1750-4589
had planned to meet after work). I went to pieces she said “Cry it out girl, cry it all out of you and give it to me”; I sobbed like a child in her arms. The orthopaedic registrar visited and he explained that the surgery was merely to “stabilise his spine. He will not walk again and will have to medicate his bowels and self-catheterise”. This was too much to take in three hours. Noel was transferred to the trauma unit. I was not going to leave him. His dad went home to his house and my younger son spent his first night alone in our apartment with the dog where he cried himself to sleep. At arrival in the trauma ward the night duty nurse was shocked at how ill Noel was. I could discern this from her non-verbal reaction. She attended to his needs, pain relief, vital signs and pressure care, with great diligence. When he was log rolled by at least three people, he cried out in pain, his spine must have been like a piece of porcelain very unstable and with multiple nerve spasms stretching down his back and radiating out to his sides. During these moments he would squeeze my hand and his whole body would shake and shudder. During the night his O2 was changed to humidified because his saturation levels were changing, his BP dropping maybe due to the huge haematoma pressing on his spine and he was sweating profusely. During this long first night he said “Mum I am having awful thoughts. I thought I was going to die on that road with no one in my family with me, not you, not Brian, not Dad. I am afraid of this surgery; will I ever wake up from it or waken during the surgery?” I wept and gave him reassurance. He told me throughout the night to stop crying but even when I breathed I was sobbing. The shock and grief was overwhelming. I still watched his feet for any glimmer of
153
VIEWPOINT
Deliverance: a mother’s journey from the roadside to the operating room Continued
movement. My tears fell on his legs, ankles and feet, I massaged them hoping that he would feel me touching his feet. I watched his toes all that night, there was not even a twitch. By dawn on that November morning my perspective had changed Noel was in so much pain that I desperately wanted the consultants to agree to operate. I was prepared to go down on my hands and knees to beg them to. The night duty nurse came to say goodbye as she finished her shift, we hugged. She reassured me that the day nurse was very special. He was highly respected and I could see why - he was patient, softly spoken, caring and kind, and paid strict attention to detail. Waiting in that side room for the doctors to call seemed like a lifetime. The hours since the accident slipped away, I lost all track of time, day or night. My mind was in fragments constantly thinking about our second floor apartment which is no longer accessible for a wheelchair. What of our future, my job? And what would my son’s life become? I felt lost. My colleagues from work were all very supportive; they brought a bag full of all sorts of toiletries. Sometimes the simple things mean so much, (Crunden 2009). An anaesthetist arrived to assess Noel, a very assertive matter of fact kind of man. With every question he asked I kept thinking, “Will they, won’t they?” It has to be said, that for nurses and doctors alike there is an inner torment of too much knowledge. I certainly felt that confusion as the roles of mother and nurse collided sending me into a blind panic. Fatalising, a counsellor would later call it. The anaesthetist’s assessment ended with Noel asking a question, “I am afraid, what if I wake up during the surgery?” The anaesthetist humoured him by retorting “Well I get paid a considerable amount of money to make sure that you don’t”! The anaesthetist prescribed a drug orally to reduce the acid in Noel’s stomach and he was given his first sip of water in over sixteen hours - it was heaven. As the anaesthetist left I knew that they would be operating, but the spinal surgeon had yet to visit.
154
The surgeon and his team arrived with the ward manager; he could not have been more gracious with Noel. He explained the spinal damage and the surgery to stabilise the vertebral column. He outlined the long slow process of rehabilitation and the profound change to Noel’s life as a result of the injury. He agreed to operate later that morning and at last Noel would be out of his ever increasing pain. At 11am that morning the staff, in their wisdom, decided to log roll Noel again. After this he was in more pain than ever, grunting and roaring in agony. Finally the time came when theatre was prepared for their patient. I asked the staff to give us some time private time with Noel. The uncertainty at this time was heart rending. A theatre assistant arrived at the ward to take a hand over report and escort Noel to theatre. I did not want Noel to go alone. He asked me not to leave so I went to the anaesthetic room with him. As we travelled along the hospital corridors I fretted like any mother would, wondering if I would ever see my son recover from this surgery. At the theatre reception Noel’s details were checked again, by this time his screams of pain were clearly audible in the anaesthetic room and the anaesthetist emerged and administered a very heavy sedative. Noel called out “Mum I love you” The staff wheeled him towards theatre but due to the sedative he was no longer aware of this. I was lost and alone. I took the longest walk of my life in trying to return to the ward we had been in overnight. After being led out of the theatre reception area by an uncommunicative person I felt alone, empty and numb. I proceeded along many corridors and walked into two wards, both the wrong ones. I could not remember anything familiar in the environment I had been in or the staff who had been present. At one point I broke down sobbing to a ward cleaner who asked a staff nurse “What’s wrong with this wee woman?” Throughout this ordeal I felt like my mother; I was developing Alzheimer’s disease I think I know a little of how she felt when her mind was slipping away. A nurse helped me to find my way back to Noel’s ward. I wrapped his green T-shirt around my neck and kept it on for days. The smell of his body was still present, even though it was torn to pieces I could not let
go of it, like a child with a comfort blanket. Six hours later Noel returned from theatre. The recovery was to become the second of many phases in a life changing journey.
Conclusion There are, without doubt, positive and negative outcomes from this event. Noel lives with the consequences of his injury, disability and bodily functions. He feels robbed of a normal life and has an obsession with death, in that he was so close to it once that sometimes he can feel it coming for him again. Another perspective is that a £50 crash helmet saved him from a massive head injury and probably saved his life. He was injured close to a regional trauma centre; hence there was no delay in treatment, diagnosis and surgery. Staff in A&E, ICU, Trauma Care and Theatres should consider that their specialty is often an unpleasant and at times shocking necessity consequently there is much they can do to make the patient and family experience of these shocking events more bearable and a little less frightening. Indeed Crunden (2009) from his reflections ‘On the other side of the bed’ appreciates that there are numerous ways in which staff can positively improve the emotional and psychological care of patients and families. I believe that the way forward is for intensive specialities such as those mentioned above to continue patient centred care but they must not lose sight of the plight of close relatives. I suggest that nurses have a responsibility to the patient but also to the next of kin. Put simply the organisation as a whole has a duty of care to ensure that they are cared for as well as the patient.
n Leontia Hoy RGN, RNT, RCNT, PGCE, MSc Nurse Lecturer, Queens University Belfast
References Crunden E 2010 A reflections from the other side of the bed-An account of what it is like to be a patient and a relative in an intensive care unit Intensive and Critical Care Nursing 26 18-23 Lohne V 2009 The incomprehensible injuryinterpretations of patients’ narratives concerning experiences with acute and dramatic spinal cord injury Scandinavian Journal of Caring Science 23 67-75
July/August 2013 / Volume 23 / Issue 7 & 8 / ISSN 1750-4589
Disclaimer The views expressed in articles published by the Association for Perioperative Practice are those of the writers and do not necessarily reflect the policy, opinions or beliefs of AfPP. Manuscripts submitted to the editor for consideration must be the original work of the author(s). © 2013 The Association for Perioperative Practice All legal and moral rights reserved.
The Association for Perioperative Practice Daisy Ayris House 42 Freemans Way Harrogate HG3 1DH United Kingdom Email: [email protected] Telephone: 01423 881300 Fax: 01423 880997 www.afpp.org.uk
