Vigil

“The healing process of the brain is more like running a marathon than a short sprint. It has a longer time frame.” ~ ICU doctor

There are three things that influence your perception of a patient’s recovery: 1) The placebo effect – or the expectations of both patient and observer. 2) The variability of the mind – mental activity follows a natural cycle. It’s wave-like; waxing and waning on it’s own. 3) The observer effect – the tendency to focus on one phase of the cycle more than the other. Expanding wanted periods and minimizing unwanted periods or vis versa.

Day fourteen: Laura had endoscopic surgery this morning to create an opening between ventricles that will allow one to drain into another. They left the external drain in place but clamped it in hopes the ventricles will take over. Now all we can do is wait and see. Like watching anything in nature, I’m reminded of the ‘observer effect’. After the anesthetic wears off ..Laura sees me, Vanessa, doctors and nurses hovering anxiously over her asking the same questions as before. I don’t place much stock in the answers and don’t remember them. She nods back to sleep. Periodically throughout the afternoon I grasp her hand ..wake her up ..and guide her through some deep breathing exercises ..squeezing her hand while inhaling and relaxing it while exhaling. I go “Breathe in ..hold your breath ..breath out ..relax yourself.” I use dramatic gestures to indicate my own breaths. Whether or not she can follow is almost beside the point. I figure just observing can effect the mind and simulate the action (Dr. Ramachandran). I know I look silly but I don’t care. Her intracranial pressure (ICP) is running high right now due to the procedure and it is my intent to do anything I can think of that may help bring it down. Her ICP is an indication of how well the ventricles are doing on their own. After half an hour it has gone from 18 to 13 (it’s normal range is between  - 6 and 20). During the next half hour it has remained at 10-13. I’m aware I’m observing a fluctuating system that changes on it’s own. How much of it is due to the healing process, my efforts or just the passage of time ..I have no clue. When the nurse comes in I mention what I’m doing. He shows me another line on the monitor that measures her respiration. It has been elevated for the last half an hour. He says there’s a loose relationship between it and her ICP. Sure enough, when her respiration was high ..her ICP was lower. He explains that high respiration means a higher rate of CO2 exchange between blood and cells, which leads to enhanced drainage. Now I don’t know if he’s telling me this just to make me feel like I have a better handle than I do on what’s going on. I’m aware that the observer effect extends to everyone in the system. The CAT scan tomorrow morning will be more telling. 

I feed Laura lasagna and salad. She’s ravenous but insists I finish it. I take a couple of bites then she nods off to sleep. I go to the cafeteria for BBQ chicken and rice.