Agraphia Medical Tragicomedy


The Moment I’ve Been Training For

He was a guy my age, in his mid-twenties, and his friend was driving drunk.  When they hit the tree at 50mph he was ejected out of the car, slamming his head into the tree on his way to the ground several meters away.  Initially he was walking and talking - a good prognostic sign for the severity of his underlying brain injury - but quickly decompensated when EMS arrived on scene.

By the time he came to me in the Trauma ICU he was comatose, intubated, and on very shaky ground.  The bleed in his brain was severe, and I wasn't sure if he was going to make it.  A petite asian girl sat in the corner of his room while I did my initial evaluation.  She didn't say anything, just sat there looking at the floor.  After my examination I went over and introduced myself.

"I'm Dr. Zac," I said, "How are the two of you related?"

She didn't look to be more than 23 years old, about his age, and she slowly looked up, a puzzled look on her face.  She looked like she was in shock.  It took her a moment to speak, but when she did, what she said knocked the wind right out of me.

"I'm Jen.  I'm... his wife.  We got married yesterday," she said simply, "I love him."

She twisted the ring on her finger as though it was unnatural, unfamiliar.  Her gaze was empty.  A single tear coursed down her cheek.

I don't normally get attached to patients, especially in the ICU.  I care for them deeply or else I wouldn't be in this job, but getting emotionally invested is dangerous.  I learned that early on.  Your responsibility as a physician is to all your patients, and decompensating from a bad outcome can have devastating consequences for everyone else.

But sometimes emotions take over no matter our intentions.  I didn't know what to say at first, and then it all came tumbling out.

"I'm... I'm so sorry.  I can't imagine what this is like for you.  You have my word that I will do everything within my power to save his life.  I will not sleep tonight."

That night, everything fell into place.  Everything that could go right, did.  I gave countless boluses of mannitol and hypertonic saline to drive his intracranial pressures down.  I drained fluid off his ventricles.  I sedated him into a medical coma and made him hypothermic to decrease brain metabolism, and paralyzed his body to decrease shivering.

For all my efforts, in the middle of the night I realized I was going to lose him. Intracranial pressures spiked, his heart rate dropped, and I had maximized every available option.  I went in and stood, arms crossed, watching the monitors.  Helpless. Just him and the universe, now.

Jen saw the look on my face.  I think she knew there was nothing left I could do.  She slowly walked over and took his hand in hers, kissed him gently on the forehead, and then whispered "I love you" in his ear.

And I watched, astonished, as his heart rate slowly picked up.  His intracranial pressure dropped to normal levels.  She sat next to his bed, a vigil for the rest of the night, but the turning point had been reached.   My treatments became less frequent and more effective.  By the morning his vital signs were as stable as a rock.

It'll be a long recovery, but he should be completely normal in a few months.  More than anything, I'm happy that I've been trained well enough to help him in his time of need.  It's a good feeling.

It was the best wedding present I could think of on short notice, Jen.  Congratulations, and many happy returns.

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  1. Hi Zac, ive been reading your blog for a couple of months, i must say your stories are inspiring. This is a beautiful one, thanks for sharing..Jen and her husband are real lucky to have you :)

  2. Great story. Thanks for sharing.

    Just wondering: was the patient in a post-operative stage when you took care of him? Did a haematoma develop and was it removed surgically?

  3. Strong work, Dr. Zac. Thanks for sharing an inspiring story of medicine making all the difference.

  4. Zac, Ariel shared your blog with me yesterday, and I’m hooked. Your posts are inspirational and very well written. Keep them coming!

  5. Reading you for the first time and all I can say is, impressed a lot. As I am far more interested in the medical field I liked this sharing of yours. Your approach to the patient and his dear ones seems lovely. It appears as if you don’t let down any way in order to acquire success; your higher energy levels boost you up to reach good results and that makes you indifferent.