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Stories of Hope: Pamela

By Currents Editor posted 10-17-2017 23:00


Pamela.jpgI had always felt healthy and energetic, enjoying my life in every aspect. I was teaching my eighth grade English classes, attending graduate school part-time, reading for pleasure, going to yoga, petting my cat, and enjoying time with my family and friends. Around Christmastime in 2009, I started having headaches that kept getting worse over the course of 10 days. I visited my doctor, and an MRI of my brain was unremarkable shortly before the morning when I awoke in unbearable pain. I called my parents who lived close by. My father came to my house and called an ambulance immediately. The last thing I remember is waving to my father from the ambulance window, trying to reassure him that things would be alright.

The ambulance took me to a local hospital where, shortly after I arrived, I became unresponsive and my heart stopped beating. I went into cardiac arrest. I was successfully resuscitated and intubated. A CT scan of my brain showed massive and diffuse subarachnoid hemorrhage.

I was flown to the University of Massachusetts Medical Center, where on arrival I remained unresponsive and another CT scan of my brain showed the bleeding was getting worse. It also showed hydrocephalus, a buildup of the spinal fluid inside the brain caused by blood clots obstructing its outflow, causing dangerously increased pressure inside my brain. A neurosurgeon placed an EVD (extra-ventricular device) to drain the blood and the CSF and relieve the pressure. Right after that, I underwent a cerebral angiogram (similar to a heart cath except it images and intervenes on the brain arteries instead), where they found a 3.2 mm x 3.4 mm aneurysm out-pouching off an artery called the left posterior communicating artery (PComm.) on the left side of my brain. The aneurysm was successfully coiled and fixed, but while in the angiography suite, my blood pressure and oxygen levels dropped, too. They had to put me on IV medications to raise my blood pressure. I started having copious frothy secretions coming out of my airways. A central venous catheter had to be emergently placed in my right internal jugular vein and another catheter in my femoral artery to monitor my blood pressure. An ultrasound of my heart showed it had been severely weakened, pumping only 15 percent (normal is ≥ 55 percent). 

I was admitted to the Neurological Intensive Care Unit for three weeks. I was put on medications to prevent seizure and antibiotics to treat pneumonia. My blood pressure continued to be difficult to control and my heart ultrasounds continued to show stress-induced cardiomyopathy, or what is referred to as “broken heart syndrome,” so severe that the other organs in my body weren’t getting enough blood or oxygen. But my heart didn’t give up on me and neither did the doctors and the staff in the neuro ICU. They called a cardiac surgeon who placed an intra-aortic balloon pump to help augment blood supply to my organs. Although I was successfully weaned off the intra-aortic balloon pump within 48 hours, the pressure in my head kept rising, threatening to cause lethal herniation, but the neuro ICU team treated that successfully. I became unable to move my legs and ultrasounds of my brain vessels showed vasospasm (a diffuse constriction of my brain arteries), yet another complication of the subarachnoid hemorrhage. I again underwent cerebral angiogram where a medication was infused directly into my brain arteries to successfully treat the vasospasm. An MRI of my brain showed multiple areas of stroke, but none affecting my language or motor control areas. 

Pamela_2.jpgAfter all that, it was a matter of time for improvement to occur, with the extraordinary care and support from the team of doctors, nurses and other staff in the neuro ICU. I left after three weeks of a miraculous journey to continue recovering in a rehabilitation center. By September 2010, I was weaned off all but one or two medications. I was back to my school teaching part time. In September 2011, I was back teaching full time. By the fall of 2012, I was back in graduate school and finished my degree in two years. I have returned to yoga, continue my love of reading, and petting my, now, two cats. I do these things all in the beauty of life in the heart of New England. 

As my journey of recovery continues, I have been most affected in two ways. First, I have been impressed with the lack of awareness of brain injuries. It is an invisible disability. While sympathy is aplenty, knowledge about it is scarce in the community, and so I work to educate those around me as I best can. But, more significantly, I have found myself living my life with more gratitude than ever before. The list of people and things for which I am grateful is very long. I am especially thankful to the team of doctors, nurses and other staff at the University of Massachusetts neuro ICU for the wonderful care they provide, and all the doctors and other care providers who dedicate their lives to ensure success stories such as my own.

Coming back from a brain injury is possible. May this story I share give hope to those in need.

Michelle Schober, MD, MS Audrey Paulson, DNP, FNP-BC, CCRN, CNRN, SCRN Ethical principles common to the various health care professions include the concepts of justice, nonmaleficence, beneficence, and autonomy. The American Nurses Association (ANA) Code contains these concepts and cites three additional ...
New England Journal of Medicine (10/20/22) DOI: 10.1056/NEJMoa2208687 Kjaergaard, Jesper; Møller, Jacob E.; Schmidt, Henrik; et al. For patients who had been resuscitated from cardiac arrest, targeting a mean arterial blood pressure of 77 mm Hg ...
By Sarah Livesay, DNP, APRN Associate Dean, Rush University, President NCS Mary Kay Bader, RN, MSN, Neurocritical Care CNS, Mission Hospital Mission Viejo CA, Past President NCS Karen Hirsch MD, Associate Professor of Neurology, Division Chief Neurocriticial Care, Stanford University Romer Geocadin ...