Try Again Tomorrow

“Courage doesn’t always roar. Sometimes courage is the quiet voice at the end of the day saying; ‘I will try again tomorrow.'” Mary Anne Rademacher

A friend posted this quote on her facebook page recently.  The same night I was seeking this inspiration in my personal life I helped a patient face this reality during the biggest tragedy in his life.

Joe’s accident had left him with spinal fractures and a loss of movement and sensation below his bellybutton.  I met him and his wife in the ER at midnight and brought him to his room in the ICU.  He was only in my care for a few hours before he went to surgery.  Though the time was short; it was packed with emotion, struggle, tears, talking, and consent forms.  I could tell that in those first few short hours he didn’t get to express nearly all of his concerns and the next night when I was back he would be someone that would need a great deal of encouragement to see the sliver of opportunity that presented itself in his situation.

I was right.  The first night he talked about his immediate realization when he couldn’t feel his legs, the fear he had about being paralyzed, how he had no idea what he was going to do, how he and his wife were weeks from losing their home,  and about his anger towards the driver that cut him off on the highway. He came into the ER talking; having never lost consciousness in the field.  He was able to describe everything that happened.  I came to work dealing with frustrations, failures, and fears in my personal life and that night I was given the immediate gift of perspective.

The second night I took care of him he had just gotten out of surgery and had returned to his room.  He was doing well, hadn’t lost too much blood during the case and so the first priority was to get him extubated and off the ventilator.  We worked on breathing trials and gave him a few hours to wake up after surgery and at 11 pm he looked great. We removed the breathing tube, put him on a few liters of oxygen via nasal cannula.  That’s when my night really began.

Sometimes, keeping someone off the ventilator is harder than trying to get them off.  Spinal cord injury patients are predisposed to shallow breathing because of their loss of sensation much of the time and just like most patients he was exhausted and wanted to sleep.  After a couple hours of me waking him up on the hour to have him do his coughing and deep breathing exercises and completing a full neuro exam to ensure everything was stable after surgery he began to get very cranky with me.  We hadn’t talked very much about his injury or his recovery since we extubated him and I could tell now was the time.

We talked about all the things patients want to talk about in these circumstances.  How long will they be in the hospital, do you think I’ll be able to work again, will I be able to go home after the hospital, what will I need help with, and what makes most people most angry in this situation: their loss of control. In an accident like this, immediately control over everything in your world is gone and you are at the mercy of another human being for almost everything.  I would have a hard time with this as well.  The key word though is almost.  His arms still worked fine and after much education to both him and his wife I was able to get him to see the importance of hardwork and why doing for yourself whatever you can is so vital.  If he didn’t take control over the things he could still do he would lose them and much of his arm strength very quickly.  His rehab is going to be dependent on his arm strength, he needs it to get his independence back.  While we were talking I saw a lightbulb go on for him and saw him realize what we work so hard to get all patients to understand, getting better is now out of the hands of the doctors and nurses, it was falling squarely on his shoulders.  He was one of the only people responsible for his well-being. He needed to keep working hard to get stronger, to work with physical and occupational therapy to get accepted into a rigorous rehab program and avoid going to a nursing home.  As much as he hated his new life situation, he realized that he was the only person that could determine his fate at that moment and he wanted out of here.

I was off for 2 nights and on my way through the building and into my unit for the night I passed them in the hallway as he was being transfered to rehab.  My heart swelled with pride and they both thanked me.  Five total days in the ICU without a medical complication and he had been able to demonstrate in that time that he was ready to work hard in rehab.  To this day I have never been as proud of a patient.  Seeing him accept the work that was ahead of him and plow through it; inspiring.  I hope near independence for him.  I think he will get there. If anyone can, he can.

It wouldn’t be the first time I was thought to be tough on my patient.  I do expect a lot out of them. I would hope that my nurse would expect a lot out of me if the roles were reversed.  Having sympathy for people suffering through terrible life altering struggles, we just want them to be comfortable, to help them, and not hurt them further.  That’s not realistic however.  When we have empathy for them instead, we can understand their challenges and fears,  we can see the life that waits for them at the end of their hospitalization, and we can encourage them towards success.  He was a strong independent man and I would assume no less than he wants to get back to that point. I consider it part of my responsibility to show him the path to take to get there.

Seeing him work hard to get out of the ICU so fast were motivating to me. It’s so rare that we see patients embrace the inevitable and come to terms with the new path they are on so quickly.  No doubt that he will face very difficult times ahead and many struggles where he will want to quit, but seeing how he turned his anger and frustration into motivation was enough to keep me looking towards tomorrow as well.

Life is not about how fast you run or how high you climb but how well you bounce. ~Vivian Komori

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