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Authors: Dianne Emley
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at the bottom of the oval and on the back of the profile. “The jolt jostled the brain, causing concussion. A concussion is typically a mild form of traumatic brain injury and usually results in temporary neurological changes. In a small number of concussion patients, there are more serious effects, as we see with Rory. Her CT scan and MRI don’t indicate skull fracture or hemorrhage, which is very fortunate. However, there is some swelling.”
“That’s what Dr. Gaspar said,” Evelyn said. “Why does that happen?”
“The brain, for all its magnificence, is a stupid organ in many ways. The only thing it knows to do when injured is to swell. Swelling can cause parts of it to die. Our job is to do what we can to stop the swelling, thereby preventing additional damage.”
Jolt. Swell. Die. The doctor’s words were like chunks of ice that Tom swallowed one by one, making a frozen trail down his throat and dropping into a cold well in his stomach. He glanced at the patients who were visible at all times through each room’s sliding glass doors. The beds were surrounded by equipment, reducing each patient—someone’s beloved—to a biological organism.
“The next twenty-four to forty-eight hours are critical in terms of managing the swelling. I’m treating it with a drug called mannitol. If the swelling does not go down, we’ll surgically make a small hole in the skull and insert a catheter to remove fluid and monitor the pressure. The drugs will hopefully be sufficient. We’re monitoring for seizure activity, and I’m administering a low dose of Dilantin as a preventative. She’s also receiving morphine sulfate for pain. We’ll do another CT scan in twenty-four hours to see if there have been any changes in her condition. Her condition could worsen if we can’t get the swelling under control or if there’s a secondary neurological event, such as hemorrhage in her brain.”
Tom put his arm around his future mother-in-law and pulled her into the nook of his shoulder.
Evelyn’s anxiety got the best of her. “Dr. Gaspar said that Rory was in a light coma. What does that mean exactly? She’s not going to be a vegetable, is she?”
“Rory’s not in a deep coma, which is what most people think of when speaking of coma, but she’s not completely aware either. In a deep coma, the patient is in a prolonged state of profound unconsciousness and incapable of conscious behavior. Most patients in a deep coma do wake up and resume some functional level. Some regain full consciousness. However, about ten percent enter another stage of coma, which we call a persistent vegetative state. These patients may have their eyes open, but they are still incapable of conscious behavior. The shorter the amount of time a patient is in a coma, the better the chances of that person resuming a normal life. The window of hope is a month. The odds go down after that. After a patient has been in a coma for a year, there’s nearly a zero percent chance of the patient returning to any functional level.
“Obviously Rory’s level of consciousness is much higher than one finds with a deep coma, and hopefully it will improve. We use something called the Glasgow coma scale to assess brain injury and impairment. The GCS tests three areas: the patient’s eye response, meaning whether she opens her eyes in response to pain or verbal commands; her verbal response, whether she speaks and her responses to questions are coherent and appropriate; and motor or movement response, which assesses how she responds to pain stimuli and obeys commands. Rory’s GCS score is thirteen on a scale of fifteen, indicating a mild brain injury. Patients with a GCS of thirteen are generally able to resume normal life with perhaps occasional lapses in memory or coordination that only family or close friends might notice.”
“When would you expect her to start to come around?” Evelyn asked.
“We can’t predict when Rory will recover or whether
“That’s what Dr. Gaspar said,” Evelyn said. “Why does that happen?”
“The brain, for all its magnificence, is a stupid organ in many ways. The only thing it knows to do when injured is to swell. Swelling can cause parts of it to die. Our job is to do what we can to stop the swelling, thereby preventing additional damage.”
Jolt. Swell. Die. The doctor’s words were like chunks of ice that Tom swallowed one by one, making a frozen trail down his throat and dropping into a cold well in his stomach. He glanced at the patients who were visible at all times through each room’s sliding glass doors. The beds were surrounded by equipment, reducing each patient—someone’s beloved—to a biological organism.
“The next twenty-four to forty-eight hours are critical in terms of managing the swelling. I’m treating it with a drug called mannitol. If the swelling does not go down, we’ll surgically make a small hole in the skull and insert a catheter to remove fluid and monitor the pressure. The drugs will hopefully be sufficient. We’re monitoring for seizure activity, and I’m administering a low dose of Dilantin as a preventative. She’s also receiving morphine sulfate for pain. We’ll do another CT scan in twenty-four hours to see if there have been any changes in her condition. Her condition could worsen if we can’t get the swelling under control or if there’s a secondary neurological event, such as hemorrhage in her brain.”
Tom put his arm around his future mother-in-law and pulled her into the nook of his shoulder.
Evelyn’s anxiety got the best of her. “Dr. Gaspar said that Rory was in a light coma. What does that mean exactly? She’s not going to be a vegetable, is she?”
“Rory’s not in a deep coma, which is what most people think of when speaking of coma, but she’s not completely aware either. In a deep coma, the patient is in a prolonged state of profound unconsciousness and incapable of conscious behavior. Most patients in a deep coma do wake up and resume some functional level. Some regain full consciousness. However, about ten percent enter another stage of coma, which we call a persistent vegetative state. These patients may have their eyes open, but they are still incapable of conscious behavior. The shorter the amount of time a patient is in a coma, the better the chances of that person resuming a normal life. The window of hope is a month. The odds go down after that. After a patient has been in a coma for a year, there’s nearly a zero percent chance of the patient returning to any functional level.
“Obviously Rory’s level of consciousness is much higher than one finds with a deep coma, and hopefully it will improve. We use something called the Glasgow coma scale to assess brain injury and impairment. The GCS tests three areas: the patient’s eye response, meaning whether she opens her eyes in response to pain or verbal commands; her verbal response, whether she speaks and her responses to questions are coherent and appropriate; and motor or movement response, which assesses how she responds to pain stimuli and obeys commands. Rory’s GCS score is thirteen on a scale of fifteen, indicating a mild brain injury. Patients with a GCS of thirteen are generally able to resume normal life with perhaps occasional lapses in memory or coordination that only family or close friends might notice.”
“When would you expect her to start to come around?” Evelyn asked.
“We can’t predict when Rory will recover or whether
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