"Good luck, dude, you're gonna love this one," the charge nurse told me as he handed out the patient assignments for the day. "You win the lottery this morning - dude needs a guy cause he's really inappropriate with the female staff. Really." Oh, wonderful, I thought to myself. A frontal type TBI patient who is also a quad - this ought to be fun. As I took report from the off going nurse, and she told me that the kid's mother was also going to be around - a LOT - I started seriously questioning my choice of career. And as I heard the continuous fecal refrain from the room, I knew I should have studied computer science instead.
"@#$!, @#$!, @#$!, @#$!!" "You're a dumb@#$." "@#$! off." He couldn't vocalize, but he spoke loud and clear. It took me about half the shift to realize that his anger was neither triggered by nor directed towards me - though I was the nearest available object with ears. It took a little less time than that for me to recognize that he could not control the repetitive speech - it was like a nervous tic. The more stressed he got, the worse it became.
So I stopped responding to him with dismissal or anger - I took my feelings out of the equation - and listened to him. What I began to hear was a spirit in agony - and a person who not only had been robbed of all power in his own mind; his caregivers had robbed him of all power as well. We were not listening to him, we were not giving him any say in his own treatment, and we certainly were not willing to entertain the idea that behind the repetition of the curse words there might just be a devastated, emotionally shattered, kid - who was terrified.
I spent a week working with this young man - and I learned a lot about myself in the process. I learned that I needed to discard my ingrained thought processes with him, and do some real thinking outside the box. I learned that sometimes life changes occur quickly, and dramatically, in the tinkling of shattered glass and the groaning of twisted steel - and sometimes much more slowly, in the gradual transition from total dependence to having a voice in one's care, from bedfast to chair trips downstairs and outside - from constant infusions of sedatives and antipsychotics to vent weaning and Passy-Muir valve.
On the day he finally could fully vocalize, I put the Passy-Muir cap on his trache tube and braced myself for the now familiar refrain. Instead, I heard "Thank. You. Thanks." I knew then that computer science would never bring that kind of lump to my throat, or ever feel that fulfilling.
