CHAPTER 33
Dr. Jensen greeted Dr. Freenold, when he arrived at George Bennett Baxter Trauma Center at 7:25am. “I’m so glad to see you Doctor. We have the patient set up in Room 333”
“I got here as quickly as I could. The traffic was unbearable. I’d like to take a look at the patient and his charts.”
“Of course, this way Doctor. Your patient is Thomas Mortinson. He was in bad shape when he arrived. We cleaned him up as best we could. He wasn’t conscious when he arrived. We saw some early signs of recovery and felt it best to induce a coma to prevent any further damage to his head.”
As Freenold approached the bed, his face became drawn and he shook his head slightly. He hastily reviewed the results of an MRI and CT scans, then spent several minutes inspecting Thomas’s head wound and ordered that Thomas be moved to the operating room and prepped for immediate surgery to repair his crushed skull and reverse the buildup of cranial fluids. The next three hours would be crucial.
Dr. Freenold wasted no time in removing the portion of scalp that had been pushed down into the brain; a procedure that was performed over the course of an hour to allow for a gradual restoration of the brains natural formation. The broken skull bone was in three pieces making it improbable that they could be fit back in the skull after the surgical procedure was complete. He ordered that a temporary plastic implant be molded to ultimately replace the skull pieces.
During the procedure Thomas’s vital signs were being monitored to assure proper oxygenation, blood pressure and intracranial pressure. Several times corrective actions were needed to restore the patient to the support range required to continue the procedure.
The next hour and one-half was dedicated to stimulating the soft brain tissue; a course of action that called upon the expertise acquired from close to three dozen Craniectomies. Using his fingers and specially designed instruments Freenold massaged the tissue, attempting section by section, to restore it to its original shape and size, something that could only be attained over time. He could only do so much; nature would have to do the rest. Freenold was one of forty-six neurosurgeons in the world able to perform the reshaping procedure.
Once satisfied that the he could go no further with the reshaping, he placed a soft surgical cushion into the space left by the broken skull parts. The cushion would allow cranial fluids to return to the top of the brain. It would remain there until he was satisfied that his patient had stabilized or recovered sufficiently that the molded plastic implant he ordered could be inserted into Thomas’s skull.
Lastly, he and a neurotrauma specialist placed a protective helmet on Thomas’s head. The model he selected had a clear top section so that the surgical cushion could be observed without disturbing the patient with constant removal.
Freenold ordered that Thomas be transferred back to Room 333, where a team of nurses and technicians waited to connect him to machines that would measure his vital signs 24/7. Surgical supplies, catheters, anti-embolic stockings and special dressings were required to support the monitoring process and prevent further damage to the patient’s body.
The doctor finished his notes then returned to the top of the page to enter the new diagnosis codes that had become effective several weeks earlier. These codes, known as ICD-10 (International Classification of Diseases) were designed to help health officials track the quality of care given to patients (and Health Care Policy holders). He shook his head, as he often did, at the amount of paperwork required. Usually paperwork would be handled by his office staff but being miles away and without this support it became his responsibility. After one-half hour he was finally ready to join Dr. Jensen in the section of the hospital known as the “Family Room”. Here he would meet with the assembly of people that had waited for hours to find out anything they could about Thomas’s condition. It was another part of the “job” that he loathed. He was a highly trained and skilled medical professional accustomed to concentrating on minute, sometimes unseen, parts of the human brain. Trying to explain to parents and love-ones, what he was going to do or had done, was not an activity he relished.
CHAPTER 34
Walter and Mike went up to the reception desk, while Emily and Louise sat down on the last two seats in the waiting area.
Louise turned to Emily and asked, “Who is that man?”
“Oh, I’m so sorry. I should have introduced you, but we were in such a hurry to get over here. His name is Mike Tolliver and he is an attorney. He’s here because his client, a woman by the name of Miriam Walton hired him to locate the son she gave up at birth. They believe that Thomas is her son. Apparently, she was at the dance last night, wanting to get a closer look at him. She saw when the stage collapsed on Thomas. Then she was knocked to the ground herself and suffered a serious concussion. She’s in a ward over at Owensburg
General.”
Louise was stunned. “Oh my God, you’re not going to believe this, but Thomas and I were talking about his birth mother before we left for the dance. How certain are they that Thomas is the son that they are searching for?”
“Pretty certain from what Mike says. I haven’t seen any of the paperwork, but he was able to see records that had been previously sealed. It must be heartbreaking for Miriam to come all this way to meet Thomas, only to see him injured like that.”
Walt returned. “Thomas is definitely here. He has multiple injuries that they’re attending to right now. Mike’s getting whatever details they are able to give us. It looks as if it’s going to be a while before we’ll know anything for sure about his condition. From what they did tell us, Thomas was unconscious when he arrived at OG. Due to the seriousness of his injuries they moved him over here where he could get the specialized treatment he needs. Right now, they want us to move upstairs to a special room to wait for any additional information.
Mike joined them. He did a quick introduction to Louise. “They didn’t have anything else to share with us. Why don’t you folks go on upstairs while I go back to Miriam’s room and update her on what we know so far. You can give me a call when they are ready to talk with us.” He handed Walt a slip of paper, “This is the number of her room. Okay”
“Sure,” Walt said.
* * *
Four “visitors” sat together in the center of the Family Room awaiting the arrival of the doctors; four Styrofoam coffee cups were on the table in front of them along with several wrappers from snack food.
The Family Room was tastefully decorated in an ultra-modern motif with comfortable reclining and lounging chairs, several cots with pillows and bed linens and a twenty-foot, three shelf, bookcase with books chosen to meet a variety of reading tastes. Complimentary coffee and other beverages, in addition to snacks and light meals were available along with a small laundry and shower facilities. These impressive amenities were the Trauma Centers attempt to make relatives of trauma patients comfortable while they endured the arduous wait for optimistic news about their loved one.
Twenty minutes earlier, after several hours of waiting, they had been informed that the doctors would meet with them soon to discuss Thomas’s condition. This would be the first solid information they would receive since they arrived four hours earlier. As soon as the staffer left, Walt called Miriam’s room to alert Mike and he rejoined the team minutes later, using the courtesy van that the hospitals provided to ferry visitors and staff between the buildings.
Walter and Emily Peyton, Louise O’Neill and Mike Tolliver sat looking at the French doors though which the doctors would probably enter.
Dr. Frederick Jensen was the first to arrive. He nodded to the occupants as he moved two chairs over in front of the table facing them. As he awaited Dr. Freenold’s arrival, he began to prepare the group for what to expect. “Good afternoon, I’m Dr. Frederick Jensen. As you can imagine, we’ve been through this procedure many times since we opened the Center. As a result, we’ve developed a set of protocols that we believe are in the best interests of the patient, th
eir loved-ones and the Center. I know that you are anxious to learn about Thomas’s condition and I can tell you that I just left his room and he is resting, comfortably.
“That being said, the details of the care we have administered, our future plans and all other details concerning Thomas’s condition will be covered by Dr. Freenold who is scheduled to join us shortly. He is the Neurosurgeon in charge of the team assigned to Thomas’s care and rehabilitation. He is in the best position to answer your questions and address your concerns. So just relax for a few more minutes.”
A feeling of relief was immediately apparent on the faces of the four, but it was slowly replaced by expressions that exhibited the need to ask questions. Jensen expected that and rather than get involved in a discussion on the rules, he asked them about their relationship to Thomas. Walt was the first to speak. Putting his arm on Emily’s shoulder, he said, “I’m Walter Peyton. My wife Emily and I raised Thomas as his foster parents until he graduated from college and went off on his own. He’s staying with us while he’s visiting here for the Town’s Anniversary celebration. He brought his girlfriend Louise O’Neill with him.” Louise half raised her hand at the mention of her name.
Mike Tolliver introduced himself as a proxy for Miriam Walton, who he described as a friend of the family who was in the main hospital suffering from a concussion received in the accident out at the park.
Jensen continued, “The reason I asked that question of you, is that in order to protect the patient’s privacy, you will need to determine who will be a spokesperson for the patient; someone who can receive medical information and share it with other family members or associates. That person will also have the authority to approve of any necessary surgery or medical procedures that require consent. I won’t ask you to decide on the spokesperson right now, but I will need to know by the time were finished here.”
Mike called Miriam’s room and set up his cell phone as a speaker-phone. He took a few minutes to bring Miriam up-to-date on their progress. “We’re going to be meeting with the doctor that will be in charge of Thomas’s recovery.”
“Thanks for including me, Mike. You can’t imagine being cooped up here without knowing what’s going on.”
They didn’t have to wait long. Dr. Freenold walked into the room, looked around at the furnishings and took the empty chair facing the group. “Good afternoon, I’m Dr. Arnold Freenold. I’ve been assigned by the Center to head up the team of specialists treating Thomas Mortinson, who sustained multiple injuries due to the collapse of a stage last night.” He held up his hand to quell any questions. “I’m going to ask you to hold all questions until I’m finished. I promise you that before I leave, all your questions will be answered. Would each of you please tell me your name and your relationship to Thomas?”
Once again each explained their relationship to Thomas. As this was being done, he looked at each person, nodded his head and made notes about each on a yellow pad. When they finished, he hesitated for a few minutes before addressing them. “First of all, I want to tell you about the extent of
Thomas’s injuries. When he was rescued from the rubble out at the park, he was unconscious, and his breathing was much labored. His vital signs indicated that he had injuries that were not apparent to the naked eye. He was ventilated, given fluids at the site and immediately transported to the emergency room at Owensburg General. Once there, he was given a battery of tests that showed that he had suffered a severe head injury, a broken left collarbone, facial abrasions and contusions, bruising to several ribs and lacerations on both arms. The attending doctors wisely transferred Thomas to the Center here and a team of specialists were immediately assigned to his case.”
Freenold took a moment to gather his thoughts. He looked out at the concerned faces before he continued. Louise had tears streaming down her face, Emily was wringing her hands and the men seemed to be hanging on every word hoping to hear something, anything, optimistic to latch onto. I hate this part.
“The diagnosis is that Thomas suffered a Traumatic Brain Injury as a result of the accident. When he arrived here, Thomas was placed in a medically-induced coma to prevent any additional harm, should he suddenly return to consciousness. In cases such as this, given the extent of his injuries, the calmer the patient, the better. As to the nature of his injuries, we measure the severity of brain injuries using the Glasgow Coma Scale. A level 3 being the most severe and 15 the least. Thomas was diagnosed at a level 5.”
It didn’t take long for them to do the math.
Emily gasped, and the others paled a shade or two.
Freenold continued, “Don’t let the number concern you. We are equipped here at the center to provide the very best care for every level of cranial damage.
“Now as for the care we are giving him, as soon as I got here, I examined Thomas and decided that a procedure was needed immediately to relieve the pressure on his brain. I performed an emergency Craniectomy earlier and my first assessment afterwards is that the operation stabilized Thomas’s vital signs. He was transported back to the ICU where specialists are addressing his other injuries. He will remain in a coma until we are satisfied that he is strong enough to maintain a certain level of stability on his own. It could be days, perhaps weeks; there is no way to tell at this point, but when that occurs, his secondary injuries will be addressed. Suffice it to say we will be constantly monitoring his condition. As a precaution, a Respiratory Specialist and an Emergency Care RN will be with him for the next twenty-four hours or for as long as needed.
“You must understand that for his sake and for us all, we want him to return to consciousness as quickly as possible so we can proceed in earnest with his rehabilitation. I ask you to remember one thing and that is that no two brain injuries are alike, so please don’t go running to your computers and trying to second-guess us. Trust me when I say that
Thomas is receiving the best care possible.”
Emily could no longer maintain silence, she blurted out, “I have to see my boy. When can I see him?” The others wanted to ask the same question but were too reticent to do so.
“I wish I could give you an answer to your question. As I said, Thomas is being treated for a number of injuries. Injuries as serious as his require that he be held in a very controlled, sterile environment. As for the injury to his left collarbone, it won’t be addressed until we feel that he is strong enough to undergo an additional operation. I cannot allow anyone to see him until all emergency care has been completed and he is resting satisfactorily. That means that no one will be allowed into his room for at least two more days. I’ll leave it to Dr. Jensen to make such arrangements. The initial visit and all subsequent visits must be strictly controlled for Thomas’s welfare.”
Louise asked, “Are you saying that we can’t visit Thomas or even see him?”
“Until personal visits are allowed, you will only be permitted to view him and only from behind a glass wall. That will be arranged by Dr. Jensen as soon as he gets the okay from the ICU staff. I understand your anxiety. I don’t think it will be that much longer, but you will have to be patient.” He looked at the group. “Are there any other questions?”
Walt half raised his hand. “Can you explain a little about the operation you performed?”
“Yes of course. A Craniectomy was necessary because the upper back side of Thomas’s skull was broken into three shards. They were pushed down onto his brain. I removed the pieces and manipulated his brain matter to as near normal as possible. You understand that I’m simplifying the complexity of the procedure but be assured that it is a standard protocol in cases such as these. The hole in his scull will eventually be sealed up with a synthetic skull piece because the damage to the pieces we removed was too extensive to re-use them. Right now there is a soft cushion sealing the skull to allow us to monitor brain activity. He’s wearing a protective helmet as well to assure that no further damage can occur. Once everything heals to our satisfaction and the synthet
ic skull piece is sealed in place, Thomas’s head should be as good as new.”
Walt wasn’t the only one taken aback by the grizzly details of the operation. Emily spoke up, “I mean no offense, Doctor, but shouldn’t you have discussed the details and secured our permission from one of us before undergoing such a serious operation?”
“I understand your concern, Mrs. Peyton.
Under normal circumstances we make every attempt to gain such approval, but as you can imagine, with conditions such as these, we must put the patient’s survival ahead of any protocol. Thomas’s vital signs were in the extreme range and any delay in performing the Craniectomy could have resulted in his death.”
Emily gave a reserved nod, indicating that she understood and that under the circumstances she approved of the decision.
Louise asked, “I understand that you will keep Thomas in a coma until you are sure that he will be able to deal with his injuries, but I need to know is if he is feeling any pain from his injuries?”
“That’s an excellent question and the answer is no. As long as he in a coma, induced or otherwise, he is not feeling any pain. That is one of the reasons for the decision to induce one. I’m sure that you can imagine how he would feel, given the extent of his injuries, if he were conscious. At this early stage, he would have great difficulty dealing with the extent of his injuries. We would need to administer heavy doses of pain medicine. By the time Thomas is conscious we will be able to control his pain to allow us to perform the secondary surgery and get him ready him rehabilitation.”
Mike asked, “Just how long does an average rehabilitation from something like this take?”
“Once again, Mr. Tolliver, there is no average rehabilitation. I can’t emphasize that enough. Much depends on the patient, family support and advances in medicine and technology. It could be as short as nine to twelve months or as long as three to four years. I refuse to speculate about Thomas’s case. Is there anything else you want to know?”
Tenderly Beats the Lonely Heart Page 10