The Beginning of an Inspired Recovery

March 19, 2012 by  
Filed under Acute Hospital Care

Most people find this website when looking up information on stroke, traumatic brain injury, or some other major health issue.  If you found the website as a result of one of these traumas, then this article is a great place to start.

When a person’s life is in doubt, everything changes.  Traumatic injury is a terrible reality of our world.  When a parent, spouse, or child falls victim to an unexpected trauma, the world can be a very dark place.  Traumatic injury is something that no one wants to deal with first hand.  Thoughts that run through your head can be sinister.  Hoping they will survive and wondering about anything you could have done to make their life better is a natural consequence of your unfortunate situation.  Adjusting to the role of decision maker means stepping through the doorway to the most stressful experience of your life.  Each decision seems magnified as the minutes turn to hours and the hours turn to days.  The waiting becomes your enemy and you come to despise everything about the experience.

Many families are not equipped to handle massive trauma.  It requires huge doses of patience, hope, and faith to encourage a patient to come out of a coma.   The road ahead will contain many bumps and detours.  Some days will be based around sorrow and depression.  The purpose of this website is twofold:

  • to inform you of the realities of your situation
  • to encourage you to do everything in your power to support and promote the recovery of your loved one

There is no guarantee that you’ll get the result you want.  However, there is much to be gained by giving it everything you’ve got.  Besides providing your loved one with the best possible chance of positive recovery, putting everything into their improvement will liberate you from regret.  It will free you from the worry, doubt, and frustration of wondering what might have been.

Living without regret is a wonderful thing.  Inspired living is possible even after the terrifying thoughts and feelings that confront you during these first days.  You may not be able to control everything about the outcome, but you can always control your own actions.  It is my hope that you will develop the skills necessary to help your patient improve… my hope that you will experience an inspired recovery.


Your First Placement:  The ICU

You have been waiting outside the trauma room in a tiny waiting room for hours.  You have made phone calls, sent texts, and discussed your hopes and fears with family and close friends.  Time slowed down as you hoped and prayed for God to grant you just this one wish.  Every stone has been unturned as you have reasoned and made promises to God.  You have promised perfect behavior for the rest of your earthly days if only he could help your loved one.  The time spent with your thoughts has led to some serious soul searching.  What is left is a feeling of regret for being so imperfect.  Suddenly, your memory becomes crystal clear.  You remember every rotten thing you have ever said or done to your loved one.  This journey through your soul has revealed your imperfections and resulted in a huge dose of guilt.

The trauma has been controlled and the patient stabilized.  News of the patient’s condition has been locked up in the trauma room with them.  Medical staff scurry in and out of the room, doing their best to avoid talking to you until there is something to talk about.  After what seems like an eternity, there is finally some news.  Your patient is going to be moved to the critical care unit.  The situation remains uncertain and life is now minute-to-minute.  None of that matters right now… the only word registers is the word “alive.”

The contact you have yearned for is reduced to a quick glance of the hospital bed rolling past.  Unconscious and unaware of their surroundings, at least you loved one looks like they have a chance to make it.  You figure that if they are given a chance, then surely they will come back to life.  The fact that you want them to make it is such a compelling reason for them to do so.  Surely their trip down to the ICU will be the beginning of a great story.

An ICU is a place of separation.  It is a place of walls.  The doctor in charge here is called the “intensivist,” and his job is to manage all of the body’s mechanisms to allow it a chance to heal itself.  Of all the specialties in the world, none deal with patients who have more drastic fluctuations in health conditions than the intensivist.  He is an expert at observation who must be able to quickly and effectively process information in order to make lifesaving decisions.  The intensivist and the ICU nurse provide a blanket of protection that is always within a few steps of the patient.  Their job is simply to assess the patient and provide the best possible environment for the body to begin repairing itself.

After a few days of adjusting to life in the ICU, the realization sets in that this is just a temporary stop.  Choosing the next placement is a decision that requires some independent research.  It is the first decision you will make that may have a major effect on patient recovery.  The hospital may recommend one or more step-down units that would be a good fit for the situation.  It makes sense to consider and research all available options.  Use the internet and personal testimony to decide on one or two to visit.  Plan a list of questions to ask the new placement’s intake coordinator, and see if it is possible to meet the charge nurse and the attending physician.  You will sleep better if you do your homework and are comfortable with your decision.

Once core systems begin to improve, the patient is transferred out of the ICU.  After dealing with the rigors of intensive care for just a few days, the idea of transporting the patient to a new location is quite scary.  Your mind conjures up visions of an emergency inside an ambulance or knocking into something while rounding a tight hospital corner.  The world is a scary place when looking at it through the eyes of an ICU patient.  The possibility of accident or infection lies around every corner.


Welcome to the Step-Down-Unit

The step-down unit (or long term acute care (LTAC) unit) is quite a change from the ICU.  There are fewer machines, a downsized care team, and a more segmental approach to patient care.  The comforting feeling of having a personal nurse available 24/7 has been replaced by the reality of nurses whose caseload includes 6 or more patients.  Heartbeats are now assumed to be stable, and the safety net of a heartbeat monitor is cast aside.

Initial impressions include the fear of your loved one lying there dying while the staff busily attends to everyone else.  Those fears may push you to ensure that your loved one has visitors for as much of the day as possible.  These fears eventually subside once your patient shows they hearty enough to thrive in this new location.

It is easy to continue living day-to-day, assuming that the step-down unit is a long term proposition.  However, it’s not a marriage.  It’s not even a courtship.  It’s more like a fling.  Once the unit starts to become comfortable, the countdown clock starts again.

Time spent in the step-down unit is slow time.  It is time spent just watching the patient lie there.  It is time when the caretaker needs to begin delegating the visiting process.  It is time to address the practical needs of managing finances and the emotional well-being of children, parents, and close friends.  Getting a handle on life means spending some time at home, but right now the main priority remains providing the patient with as many experiences as possible.  Each interaction could be the trigger that unlocks part of their brain, body, or personality.


Trading Places:  Caretakers Become More Important Than Medical Staff

An inspired recovery begins with motivating the recovering.  A familiar voice, song, or item might trigger a memory and give them the desire to strive for more.  In many ways, this time isn’t so much about medical recovery… it is about providing the impetus to get the patient to wake up.  The idea is to stimulate them in as many ways as possible in order to get the ball rolling.  It is a time to come up with as many ideas as you possibly can to remind them of their life and all the things that made it enjoyable.

The step-down unit is the place where the caretaker supplants the medical staff as the most important factor for securing a positive recovery.  Each day should be treated as an opportunity to introduce stimuli and attempt to elicit a response.  Visitors should be encouraged to interact with patients as much as possible during visits.  Talking and touching are the best ways to communicate.  As a caretaker, you may be surprised by the voices, memories, or types of physical contact that may help the brain make these connections.  The best strategy here is simply trial and error.  Be creative and come up with a variety of way to attempt to get to your loved one.  Just try everything and see what sticks.

Many medical professionals strive to treat sleeping and comatose patients as if they are completely conscious.  They talk directly to the person and treat them as if they can hear everything.  When discussing unpleasant or irrelevant information, medical professionals often talk to family outside the patients’ room.  Treating a patient in this way adjusts everyone’s mindset.  Treating them as if they were conscious adds just a little bit of anticipation and expectation to each visit.  If everyone feels the patient can come out of the coma, then everyone involved does a better job of creating opportunities to interact with them.

There is one more reason to treat a patient with the utmost respect.  There have been cases where patients have come out of an unresponsive state and remember being able to hear, see, and feel what was going on around them.  In many cases, the patient did not appreciate some of what they unwittingly heard and saw.

Patients who have regained consciousness often need to have sleep patterns reset.  Having visitors cover various shifts each day is a way to remind the patient to stay awake, drawing a contrast between daytime and nighttime.  If the patient is unconscious, they should be adjusted and stretched regularly.  Moving the patient prevents sores and infection.  Stretching them out sends their brain and body the message that the limbs are theirs to control.  It also pays dividends later as they rehabilitate the affected areas.  Medical staff will stretch limbs and perform range of motion activities during a patient’s bath.   Caretakers who desire an inspired recovery should see to it that range of motion is performed several additional times each day.  Limbs that have been stretched out three or more times each day have a distinct advantage over those that were not.


Your Final Step-Down Days

The first two weeks at the step down-unit should be devoted entirely to the patient.  It makes sense to understand the big picture from day 1, but there is no need to think about the exit strategy until the patient gets closer to the end of their time here.  A typical stay is approximately 30 days.  At the halfway point, it is time to consider the next placement.  Ask for the input of the nurses, social worker, and attending physician.  They will generally guide you to one of three places:

  • Nursing home:  Although generally thought of as a permanent situation, the nursing home can also serve to give the patient more time to heal and strengthen before moving to rehabilitation or home.
  • Inpatient Rehab:  An intensive program to jumpstart the body and regain function.  Insurance may block this option if the patient cannot meet physical requirements
  • Home:  Under the right circumstances, a patient may also move home.  Rehabilitation can be performed in the home by traveling therapists a few days per week.  If the patient is strong enough, they can opt to travel outpatient rehabilitation center for therapy.

Once you have experienced an ICU and a step-down unit, you are well on your way to recovery.  You have likely seen people who put a lot of effort into their family members as well as those who manage the situation like an absentee landlord.  As in all things in life, you will get out of it what you put into it.  In the months ahead there will be much frustration between moments of joy.

Investing is a philosophy where you put in time and effort now in the hopes of reaping rewards later.  If you subscribe to the philosophy today’s investment will lead to tomorrow’s dividend, then you are well on your way to an inspired recovery.  Set your goals high and shoot for the stars.  Never doubt the power of the human body to heal and never take anything for granted.  Reevaluate often and be willing to make adjustments and try new things.

You have survived the infancy of your major recovery.  Although complete and full recovery is rare, investing fully in the possibility is a key to your future happiness.  You’ll sleep at night and live without regret.


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