Not wearing a helmet when riding a motorcycle or any motorized ATV, is a personal decision, even if may be illegal in your state— it’s about your freedom. Same with riding a bike, a skate board, a scooter, skates—your decision, whatever you choose, I am down with it. Every time I see a helmet-less rider, I think, oh, a POD (Possible Organ Donor). I hope they signed the back of their license to become an organ donor. You folks leave the very best corpses, lots of intact organs to donate because it takes so little for any helmet-less rider to become a TBI.
I have been an NT CCU RN for last 7 out of 10 years BC (before COVID) and plan to return once the pandemic has ended. A TBI is a traumatic brain injury, these are the ones I have worked on the most in Neurotrauma (NT). A depressed skull fracture, part of your skull is crushed with the bones pushed inward to the brain. A compound fracture, a depressed skull fracture with large pieces of skin and flesh missing and the skull bone has splintered—many tiny little razor sharp fragments shredding your brain. I promise you won’t feel a thing, no pain at all, you have lost consciousness.
Your first stop will be the ER/ED where the doctors and nurses will try like mad to save your life. You will be intubated and ventilated by hand, until you can be hooked up to a ventilator. If you still have your scalp, one can actually feel the bones crunching under their fingers as they palpate your skull. The bleeding from your ears, nose and sometimes your mouth, gives them a pretty good idea—TBI . At the same time other team members will have cut off your clothing and be checking for other injuries. If you are still alive, next stop Neurosurgery.
A Neurosurgeon will shave the your head and reflect your scalp and saw a large portion of the skull away. The surgeon will begin the very tedious task of removing all those tiny bone shards, shredded brain tissue, blood, and clots. I have been told it’s much like trying to remove broken glass from a pan of soft scrambled eggs, covered with a bottle of lumpy catsup, using tweezers and suction. At the same time pressure monitors and drain tubes have been placed into your brain. Your open skull has been covered with a sterile dressing. Assuming you are still alive, there is 50% chance of living but only a 10% chance of ever being “you”. Each little bit of “scrambled egg” suctioned away was part of your brain, part of the very thing that makes you, the you that you were. That person is gone but don’t worry, you won’t feel a thing. If only the same could be said for your family and friends. On your way now to NT CCU.
This what your family and friends will see. The first thing your loved ones usually notice is your face which can become swollen and discolored sometimes to the point of being unrecognizable. Usually the second thing is the large bulge in your skull where the brain has swollen through the opening the surgeon made for just that purpose. You will be sitting up at about a 45% angle to reduce swelling and bleeding. There will be several devices inserted into the your brain, we refer to them as bolts. They monitor what’s happening in your skull, to your brain. You will be connected to all kinds of machines with leads and tubes every where. No matter how much I try to prepare your loved ones—it just not possible. Their pain is so intense, it is palpable, gut wrenching, rip your soul pain. You, fortunately, will not have to witness this because you are unconscious but they will—every soul sucking second.
The next several days will determine your outcome. During this time, you will have a myriad of tests—MRI, CT, brain waves, pupil dilation, pain reflex, etc. At some point, usually with in week or so, the neurologists know the outcome, 50% of the time—not a happy ending. If your brain swelling continues unabated into the brain stem, heart stops—no amount of medical care can change that, you are dead. Sometimes the brain is dead but the body can be kept functioning for a time with life support. Sometimes, a body will actually show signs of death while on life support. I won’t go into details except to say it is horrible. Sometimes there is flicker of brain activity. Just enough so you can be kept “alive”, in a minimally conscious state. You can spend the rest of your days, hooked to a breathing machine, fed through a tube in your nose, laying in a bed with a giant diaper under your bottom. You will require 24 hour a day care everyday for the rest of your days, everything will have to done for you. While you are on life support, the families see a warm body, the chest rising and falling, monitors with lines that have peaks and valleys. It’s so hard for your family to accept that you are actually dead. I usually try to explain it in a much simpler way than the doctors. “The owner of this house has left, never to return, but they left the furnace on so the pipes won’t freeze. When the fuel runs out, the pipes freeze.” Don’t worry, you won’t feel a thing but those that love you most certainly will.
Within a very few weeks, your family will have to make what will probably be the hardest decision of their lives. Move you to a long term care situation or let you go. If the patient has not made a decision to become an organ donor, the family must make that call too. There are organ donation teams to explain the process from decision through honor walk to organ recovery. One patient’s death can give another 5-7 patients a second chance at life. How amazing is that, one person is able to save that many lives. The criteria for organ donation have changed too. It’s not just for the young anymore. A 50 year old recipient would be thrilled to get 50 year old heart, lung, kidney or part of liver. Please sign that card become an organ donor. It actually helps the ones left behind gain some sense of peace from a tragic death. Just do it.
My story ends here, but not for the loved ones left behind. Their grief will go on but so will I, onto another patient, another family, another story. I look around me at the CCU nurses I work with, they are amazing. Strong, courageous, resilient but we, too, are human. CCU RNs have a 86% burnout rate, 48% of nurses in a CCU meet the criteria for PTSD. If you are the praying type, please say a prayer for every CCU/ICU nurse, in every state, in every city. I have always found the 23rd Psalm comforting.