I had been called to the hospital because Bill was in an accident on a rainy February morning. I had been waiting in the waiting room to see him, when finally the nurse called me back to see him. I stood outside the bay in the ER, just outside the curtain, gathering myself and trying to prepare for what I was about to see. Based on what I was told, I was expecting a monstrously unrecognizable face. I was expecting to wonder who was lying in the bed. I thought there would be machines doing all the work of keeping Bill alive. I was wrong. I attempted to prepare myself for the worst. I stood tall and inhaled with a ragged breath and stepped into my new world.
The trauma fog had lifted from my thoughts as I entered into survival mode. At first sight, I was relieved to find that I could tell it was my husband there under the sheets. No fainting or dizziness. No nausea, either. (They had prepared me to get on the floor if I felt any of that so they could get me out before I fainted.) As I approached the bed however, he cried out and flailed around. No one was near him as he randomly yelled a string of incoherent words.
“Let me go! 60, 59,58,57,56…REWIND the tape!! Help me! Shell. Let me go!”
Each step closer brought me face to face with the fact that the husband I knew wasn’t currently present in the room. A male nurse was stationed in the cubicle like a bouncer guarding the door. Once he was assured I would not be passing out or throwing up, he stepped out of the area to give me some privacy. I wondered if I might need him for my safety, but then I saw the restraints. Bill was tied to the bed at the wrists and ankles. He would not be getting up anytime soon. The thrashing around was due to the fact he did not know he was tied up. He thought someone was holding him down. He would cry out and pull against the unknown bonds.
When that did not work, he would get very still and lower his voice and say, “You can let me go now. I will be good.”
Then random words that made no sense would come in a rush. Then more attempts to free himself. My heart was breaking as I stood helplessly watching the struggle. I stood a few steps back, not knowing how to approach him in this state of alarm.
I waited for a still moment and moved to his side, within range to get a close up of his face. In the middle of his forehead was a starburst where the skin had peeled back from the bone underneath. And while I am a usually squeamish person, seeing my husband’s exposed skull didn’t seem to faze me. I attribute that to the numbness of the day. The starburst was obviously the point of impact where his head had intersected with wood hanging out of a construction truck at 60 miles per hour. The rain made for a slick surface on an area street, and when the truck pulled out in front of him there was no stopping the van. He ran right into the back of the truck. He had no chance to escape injury in a Toyota van with no front, the wood smashed into his skull and then to punctuate the impact two cars, behind him slammed into the rear. Three cars totalled in seconds. I didn’t know all this until much later, but here in the ER I saw the results of a horrific accident.
There were air bubbles in a pool of blood above his left eye. The eyebrow was missing and the gash had evidently punctured his sinus cavity. His nose was crushed with another noticeable gash on the bottom right. It appeared they had tried to clean off the blood, but his constant movement had done very little to help stop the blood from flowing or his appearance. They had tried to run a tube down his nose to clear stuff out, but the nasal cavity was too crushed, so they went down his throat instead. The contents of his stomach were in a container on the wall.
One side of his face was concave and appeared to be completely caved in. His eyes were swollen shut, like he had been in a heavyweight title fight. They were beginning to blacken and bruise giving him the appearance of having lost the bout. It was horrible, I will not lie. But, even in the gruesome, bloody mess I could tell it was my honey. I could make out the line of his chin, and his cheekbones. His matted hair still had a bit of a wave, and his teeth were all intact. This was my husband, no doubt.
I spoke, “Hey honey. I’m here.”
He stopped moving and for a split second there was recognition as he turned his face towards my voice. Then the counting backwards from 60 again.
“Let me go! Rewind the tape!”
The nurse on the phone had told me on the phone he was non-responsive. It dawned on me then, non-responsive didn’t mean what I thought it did. Non-responsive means he does not respond appropriately to the stimulus around him. With all his screaming I had heard for the past couple of hours while waiting to go back to see him, I had thought they were working on him or having to do painful tests or something. Not true. All that time, he was just randomly yelling out. The fight or flight of a madman, operating on brain stem alone. I could talk to him and he would not acknowledge my presence, or that he even knew me. Yet, he called my name repeatedly.
Later, I learned that there are many stages to coma and that at the scene he had been unconscious, a 3 on the Glasgow Coma Scale, which was my picture of what a coma looks like. He had woken up while they were extracting him from the van and starting swinging. This did not mean he was out of the coma, but at a different level. The Glasgow Scale is used by health professionals to assess patients with brain issues. It measures 3 different areas: eye opening- scale of 1-4, verbal response scale of 1-5, and motor response scale of 1-6. If the patient is unconscious he/she will get a 1 on each of the 3 areas. As they begin to wake up the score changes based on their actions and how they move through the different scales. Bill went from a 3 to a 6 at the scene. This put him in the severe brain injury category. Here are the levels of brain injury using the Glasgow Coma Scale.
Severe: GCS 8 or less
Moderate: GCS 9-12
Mild: GCS 13-15
He continued to progress along the scale over the next months. I would learn more about the brain than I ever wanted to know, but on this day I was a young wife who didn’t have a clue about any of it.
I tried to find a place I could touch, without causing pain or thrashing. I stroked his hair, gently on the side of his head without damage. I simply wanted him to know I was there in a tangible way I thought maybe he could understand. His babble changed a bit. He threw in the word ‘home’ with his next reciting of the numbers 60-1. I took this as a sign he knew I was there, and somewhere deep inside he was trying to come home to me. I held onto that thought as I left the room. Mom, who was never more than a few steps away, held me up. It was the beginning of many days of constant putting one foot in front of the other. One step at a time. In the hallway, the neurosurgeon introduced himself. He told me they would be moving Bill to ICU and the next 24 hours would be critical. If he lived past that, his chances of survival would improve drastically.
He informed me the CT scan didn’t turn out because Bill could not be still long enough to be in the machine, even with four people holding him down. They would try again at a later time. However, he knew it was a frontal lobe injury and that his occipital lobe was also affected because of his behaviors/symptoms. The doctor’s main concern was making sure the intracranial pressure didn’t get too high. The first day was critical to watch and see if there would be a need to put him into a drug induced coma in order to avoid having to surgically reduce the pressure.
“For now, all we can do is watch, wait, and see.”
It was my first day to know that for a neurosurgeon, ‘I don’t know’ and ‘Wait and see’ are the two most common phrases. I decided later on, that I could be a neurosurgeon because all they do is say those two things over and over.