I've just recently lost my son (17) after a freak accident where he was playing a pickup game of football during baseball practice (to get in their conditioning/running/exercise instead of just running laps, etc) and he went back to catch a pass, tripped in a rut, and fell, landing on the top/front of his head.
Initially, it appeared that he strictly had a severe spinal cord injury due to a C5 fracture. He was awake and alert, talking and breathing well, but had no movement from nipple line down and only some sensation and a slight Babinski reflex left foot only. We were hoping that it was just a stinger or spinal cord trauma, but quickly saw on CT what a horrible fracture it was. (I am a nurse of many years, fwiw)
I was able to be with him in the ER, thank GOD, and was talking with him when he suddenly became violently ill, vomiting without the diaphragmatic control or strength to do so, laying flat of his back in a high C collar. The neurosurgeon and I log rolled him and I suctioned him while he vomited and this continued to get worse. He was given 4mg of Zofran for the nausea, and became groggy, but within about 10 minutes, he was completely non-responsive and decompensating with his breathing terribly. This was all while we were wheeling him from ER to OR and by the time they got him intubated and vented, he was in traction with a beautifully reduced C spine fracture. Probably one of the most easily reduced and well aligned I've ever seen. He had surgery at that point to remove the shattered vertebrae, disc remnants and replace with cadaver bone and fuse to C4 and C6. The surgery went beautifully with very minimal bleeding and the aligment and hardware all looked great. The surgery was completed around 7:00 pm or a little bit later.
He was brought back to an ICU suite to begin to wake on his own. This is a healthy, strapping 17 year old athlete with absolutely NO health problems that we are talking about. We went in to see him as soon as he came back and of course, was still asleep.
However, as the night wore on, he was not awakening nor reacting to us at all. Neuro checks were "ok"....pupils reactive, responsive. At first we thought he was just extremely sensitive to the anesthesia, as he'd never had surgery or meds at all. The neurosurgeon called me and told me that he'd realized that there was not a CT of the head done, in all the excitement over the neck fracture, and he wanted to send him back to CT. Of course!
Well, later in the night, the neuro and I were at the desk, talking over this case (my beautiful son, but me trying to be clinical) and he tells me that the vertebral arteries looked great on the CT, but that there is some opacity of the basilar. However, there were no signs at all of any infarct or bleed, so he just wanted to "watch it". We looked at the imaging together and the brain looked great, I'll admit. I had a niggling concern about the basilar opacity and why we weren't pushing that, but this is a wonderful doc we're talking about and I figured he knew best.
He calls me sometime later and tells me that my son has developed hydrocephalus and he's taking him back to surgery to place a shunt and ICP monitor. And we wait.
By 6:00 the next morning, I knew something was different. His pupils were very sluggish and he was simply not responding at all to anything. Sternal stim, pin prick, light, girlfriend, nothing.
I went out to the car to rest a bit after visiting and was soon called back by the nurse, telling me that there was a change....BP was bottoming and pulse was racing. We came back in and body temp was rising. I immediately knew we were looking at a brain stem stroke.
Of course, it was worse than just that (if there is such a thing) and we were soon told that he was "locked in". I almost lost it, because after taking care of patients in this condition, I felt that this was the most horrible situation anyone could be in. Soon after, both pupils were blown and he failed apnea testing miserably.
I had already declined a feeding tube the day before, because of the ethical and legal issues involved and knowing my son's wishes. He had also made the decision a year ago to be an organ donor, so I went ahead and told the doctor to begin preparations for that. He was stunned by this whole ordeal.
This has only been 2 weeks ago for me, and I am so very lost without my son. This neurosurgeon has been in practice for 25 years and is a wonderful surgeon, with many awesome successes where none were expected. He told me that he had NEVER treated a case that progressed like this in his 25 years in practice.
I begged them to sedate him while waiting for the organ donation process, because I could not bare the thought of him possibly actually having locked in syndrome (mother's minds, you know) and being afraid or in pain with no way to let us know. They were gracious enough to comply with my request, but I still find myself scrounging for all the clinical information I can find to reassure myself that we made the right calls.
I need to reassure myself that my child was ok and not in pain or fear, and this article is a great one. Please excuse the wordiness as this is still a very fresh pain for me and I guess I'm trying to "talk it through". I've never hated being a nurse as much as I did through this ordeal, knowing what I was seeing and being so very helpless.
