revised coma description

Specialties Neuro


Thanks for all the tips and input regarding my text. Here is the revised version if anyone wants to critique it further. I so appreciate all who responded. My deadline is looming...............

""I am Doctor Fallon. I am in charge of your husband's care. Please sit down", he said as he motioned to the empty seats behind them. "I'm afraid your husband is in a coma" he continued, flipping through Daniel's chart. "Here is what we've deduced about his condition: He has suffered a traumatic brain injury from his car accident. The force of the impact from the left, the driver's side of his car, caused his brain to slam against the right side of his skull. The car spun around and slammed into a retaining wall which compounded the already violent back and forth motion of his brain. This is called coup-contrecoup."

Megan's face had a puzzled look that came up on the fear and worry already there.

"Let me explain further" the attentive doctor sustained. "Daniel has an epidural bleed which means he is bleeding between his brain and his skull. There is also severe swelling and that is why he is in surgery. You see, your brain is inside your skull. When trauma causes the brain to swell, the skull's confining space keeps it from being able to expand; so pressure builds up. Blood supply is then cut off and ischemia develops. This is a term that we use to define lack of blood flow or oxygenation to tissues. That could cause a stroke or even death. Unfortunately he has some internal injuries as well, and was in severe hypovolemic shock. These are the insults they are addressing in surgery right now. Though in critical condition, he is certainly lucky to be alive."

The word "lucky" jumped out at her like a snake. She reviled back from the doctor. "Lucky?"

"Quite frankly, he should have died in this crash-especially since he was not wearing a seat restraint. Now, Megan, let me explain the level of his coma. We use what is called the Glasgow Coma Scale. A three on this scale, is the lowest possible score of a person in a coma. A fifteen is of a normal appearing person. Your husband's evaluation revealed the score of...." Just then the doctor's pager beeped loudly, and it distracted him for a moment while he fumbled to turn it off. Their eyes reconnected. "Your husband's score was a five. I must be honest and tell you that his prognosis is not very good. We are doing everything we can for him, and he is in very good hands. Our team has tremendous expertise in traumatic brain injury but you should know that there is only so much we can do for him. This is not an exact science, and you need to prepare yourself for either outcome, Mrs. Tasselvan."

"What kind of damage will there be if he survives?" she asked him, never allowing her eyes to avert his, in case she would miss meaning that couldn't be expressed with just words.

"His neurological damage did not only occur at the moment of impact. It will evolve over the ensuing hours or days. Time will have to show us. These things are very unpredictable. If you are a praying woman, I would suggest that you pray for a miracle."


After signing in, they were escorted to Daniel's bedside. Megan was immediately overwhelmed with emotion, and grabbed the Pastor's arm to steady herself. She thought she would be sick as she got a closer look. She knew it was Daniel, but didn't recognize the person laying there. Daniel's face was so puffed-up and bloated looking. His skin was pitted, probably from the glass that had shattered onto his face. There were still tiny glistening bits she could see imbedded in his ears. His eyes were swollen tightly shut and welts of maroon and deep purple bruises surrounded them. Stitches tore through his forehead zigzagging in several different directions, leaving a path of dried blood behind. Down the front of his gown were remnants of a brown liquid of some sort, smeared in the mop up attempt. Why didn't they give him a fresh gown? But how would they get this one off him? Tubes and wires seemed to be coming out of everywhere, his mouth, nose, and stomach. Multiple IVs were pricking his skin. Bottles with indistinguishable labels hung at varying heights around his bed. Standing guard over him, too, were machines and monitors ticking and beeping and whooshing. Their colored lights blinked at intervals, keeping watch with the rhythm of the room. The sight of it all replicated the set of a television trauma show she and Daniel watched regularly. Only now they were living it!


244 Posts

That's great kloget! I can't wait to read more!


19 Posts

Specializes in General/Trauma/Neuro ICU.

Wow, I am sure I speak for many of us in saying I am impressed!

From my experience in neuro, I would have expected an incision closed by a line of staples in addition to sutures, and probably more on the top/side of the head as opposed to the forehead, and usually pretty straight, not zigzagged. The path of dried blood, plus a little fresh blood, was RIGHT on. Does this seem more accurate in commonality to you guys? (Since you are paying SUCH close attention to accurate detail, kloget) :)


13 Posts

Really appreciate the critique! I will work on those things as well as the head dressing which I neglected.....not sure how it looks except I am thinking maybe turban-like...but I will try to research some photos unless anyone has specifics....AGAIN, I SO RESPECT YOUR PROFESSION AND JUST WANT TO HONOR IT BY DOING A GOOD J0B ON THIS SCENERIO. SO MANY NURSES HAVE TAKEN SUCH GOOD CARE OF ME THROUGH NINE SPINAL OPERATIONS, WELL, ITS THE LEAST I CAN DO SINCE THEY ARE SO UNAPPRECIATED SOMETIMES.


19 Posts

Specializes in General/Trauma/Neuro ICU.

It's strangely exciting - I must be weird - to have a non-nurse get so into these seemingly mundane details of our lives...

Picture a cross between a turban and a beanie - made of gauze. Basically they just wrap a long white gauze bandage around the head, yeah, just like a turban I guess. :) So fresh post - op of course the incision would be covered by the gauze (like I needed to say that, duh, sorry) and there is usually some blood bleeding through the gauze at the area where the incision is (again, usually on the side of the head, around 2 o'clock above the ear - just a common site, it could be several places depending on the area of the brain bleed/injury). Under the gauze, which is probably on a couple days before it's not needed anymore, will be a good-sized area of hair shaved to buzz cut length - and the surgery-team doesn't usually exhibit any care in what could ever be faked as a stylish 'do :eek: - and the incision has those train-track-looking staples. You can hardly see any sutures (stitches), they are mostly internal (under the skin). It's definitely a fearsome sight, especially when it's a female with long hair and suddenly she's got a lopsided quarter of her head shaved. Those that recover they must all do a Sinead and wear a wig in the meantime or something. Aside from the obvious, way more important, things to worry about, I'D BE CRUSHED after all my years of growing long hair.

Anyway, I'm happy to help out, keep throwing those revisions at us!


13 Posts

Stitches tore through his forehead zigzagging in several different directions, leaving a path of dried blood behind. Above that, his curly brown hair was replaced with white gauze bandages. They looked like a manufacturer's irregular-somewhere between a turban and a beanie. Blood had seeped through them in a couple different places. One particularly gross area was above his left ear. Beneath it the corner had lifted a bit and she could see train track looking staples sticking out from its edge. They looked like they were holding down swollen raw sausage. Getting just a glimpse of what was supposedly underneath there she was reminded of the upholstery staples that she had seen pulling free from the back of her couch at home. She had talked to Daniel about needing new furniture because of it, and now it was him that needed the fixing. Her thoughts seemed so bizarre, but maybe it was her way of coping with the disturbing images before her. She knew she couldn't be in her right mind if she was thinking about swamis, sausage, and sofas. Whatever was down the line for them couldn't be more frightening than this sight, could it?


84 Posts

Specializes in Neurology and Med Surg.

this is good, i want to read more!!!:D

also i know you mentioned that Daniel has some swelling, depending on the level of swellling, the Docs, remove the bone flap (like part of the skull) to allow the brain enough area to swell. and there is usally a sign above the patient's bed that says,

'no bone flap on the left side' our doctors place the bone flap in the abdomen.

the pt also has periods where they are sweating up a storm...

they have reflexes that the family think is voluntary by the pt, and it isn't... for example the family member will grab their hand, and think that the pt is trying to hold it, when really it is just their muscles probally relaxing.

the pt, can not follow you with their eyes, the body is so flaccid, this is all i can think of.. i am a new grad that works in neuro, and it sooooooooooooooooo interesting yet very complexed

write more please!!!

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