Sunday, April 25, 2010

The Darkest Secret of Nursing Revealed

So last night I was absconded. Shocked actually. And it takes a lot to shock me.

“What is this terrible scandal to which you were exposed and subsequently shocked by?” you ask? It is this:

I work on the Neuro ICU. We get all the brain injuries. Strokes, head injuries, spinal surgery, nerve damage... that sort of thing. Last night we had a patient with a traumatic brain injury who was pronounced brain-dead. The rest of his body didn’t get the memo so his lungs, heart and all his other organs were functioning just fine ( fine, that is, in an intensive care unit sort of way). The family of the patient (God bless them) had seen fit to authorize the patient to be an organ donor. (By the way, when I die, please donate my organs too.) The Organ Procurement nurse was working on our unit doing her thing - prepping the patient for organ harvesting, contacting all the people that would be involved, and so on.

As I was working nearby, I overheard her conversation. She was working out the details of the organ procurement surgery. At one point in her telephone conversation, she asked about what time anesthesia would be available.

This struck me as odd. “Anesthesia?” I thought. “Why would a brain-dead person need anesthesia?” The purpose of anesthesia is to make sure the patient is so unconscious that no pain is felt as the surgeon cuts into them and does whatever he has to do. But why would someone with no brain function require such a service?

I asked one of the other nurses. “Why do they need anesthesia for someone who’s brain-dead”

The answer was stunning. “It’s to prevent cruelty and to maintain dignity. Just in case the patient can actually still feel pain.”

What? In all my years of medical experience I had always been taught, and told others, that someone who is brain-dead feels no pain. “Don’t worry, he’s not feeling any pain right now.” “If you’re worried about it, she felt no pain in her condition.” “No, it was a painless way to die.” Such were my responses to concerned family members and friends on many, many scenes of trauma, disease and death.

But now another medical professional had stirred those subtle doubts. “In case” they still feel pain? You might as well drill air holes into the coffin “in case” they might actually still be alive! All at once, the state of medicine in our modern day came to the front of my brain. With all our tests, amid all our technology, after thousands of years of medical observation and knowledge, we still don’t know if a brain-dead person feels pain? Seriously?

I have often said that as I learn more about medicine, alternative medical practices appeal to me more and more. But here was hard, concrete evidence that our medical world simply has no clue about what REALLY goes on in the mind! “In case” they still feel pain? Holy shit! What other senses might still be lingering? Hearing? Will they report to Saint Peter the snide remarks about the embarrassing mechanism of their death (that porn on the TV we found them “stiff” in front of?) Will they detail the smells surrounding their demise (it’s okay if I fart; they’re dead - they won’t mind)? How long does the sense of touch linger? (Hey cops! Look how far I can put my finger into this bullet hole!)

The implications are staggering! I want to be an organ donor, but if we’re so uncertain about what is and isn’t sensed by the dead brain... well, I dunno! I mean, little girl with the bad heart, I know it sucks having to live most of your childhood in a hospital. Grandma, it must be really painful to wonder if you’ll survive to see your new grandchild born before you get a new kidney. I’m sorry you have to worry about your baby, new mom, wondering if you’ll see him off for his first day of school if you get your new corneas. But jeez- will it hurt if you take that stuff outta me?

I totally intended to make this a sarcastic, ironic, doubt-inducing post. But after having written it and thought about it, I can still say - “Please, if I won’t need them, take my organs and give them to someone who will.” Even if it hurts some.

1 comment:

medic999 said...

I used to be a theatre nurse (OR Nurse) in a previous career and one of the jobs I worked was in the Cardio Thoracic theatres where I worked as part of the retrieval and transplant team.

I have some stories to tell also, however, maybe this isnt the best forum for them - Maybe if we meet up one day at a conference!

What I will say though is that I was always told that the reason for the anaesthetic was indeed to do with dignity for the patient, some suggested that it was a 'just in case' measure but the other reason given was to ensure adequate muscle relaxation for entry to the abdomen to gain the abdominal organs for transplant.

That sat better with me!!