Impatiently we watched for signs that Matt’s coma was lifting and for him to regain consciousness. If only Matt’s rebirth was as predictable as growing corn. Each spring, my dad had sown vegetable seeds and waited patiently for them to awaken from their state of hibernation, then germinate, and finally, produce new life. Now we waited with no such assurance, guarantee, or ability to hasten the process. It was hard for me to stand idly by, helpless. I turned to my experience as a PT and found a degree of comfort and purpose gently stretching Matt’s arms and legs—up and down, in and out; and talking about life—then and now; hoping to engage both his muscles and his mind. The nursing staff and the therapists willingly accepted my assistance as they cared for Matt. I firmly believed that a combination of everyone’s efforts to exercise, stimulate, and involve Matt gave him the best chance to recover.

While our family was in a holding pattern, the healthcare professionals were diligently working to reign in and control a multitude of medical issues. Matt had been admitted with pressure sores on both elbows-- the consequence of laying so long on the bedroom floor before help arrived. His arms and wounds needed to be cleaned, bandaged, and elevated; and the nurses frequently repositioned his body to prevent pressure sores from developing elsewhere. Unusual, involuntary movements, such as jumpy legs and a primitive withdrawal reflex in his right arm, were also observed.

Repeat CAT scans and MRI images tracked the fluid level in the ventricles and brain swelling; EEGs (electroencephalogram) his brain activity; and EKGs (electrocardiogram) his heart function. All four extremities were retaining fluid—so much so that he looked like the Stay-Puff Marshmallow Man. The nurses packed him in ice and used a fan to circulate cool air to combat this swelling, as well as to help lower a high fever. Matt had an unidentified infection, and pneumonia, and continued to experience wide swings in his vitals. Numerous tests monitored and guided appropriate interventions including the use of pulmonary drainage and suctioning to clear his lungs, and necessary adjustments to the ventilatory to help him breathe more comfortably.

When his medical condition stabilized, plans would be made to move him to a step-down unit and ultimately to a rehab facility. Before that could happen, several temporary forms of life-support had to be transitioned to safer and less cumbersome devices—specifically the ventilator, feeding tube, and ventriculostomy drain. Efforts to train Matt to breathe without ventilatory support were not successful—at best, he tolerated less than four hours. 

Although these surgeries were fairly straightforward, they fatigued and caused Matt to sleep more throughout the day, which indirectly slowed progress elsewhere, and impeded the already rare moments we had to connect and bond. One day, Mike and I waited until midafternoon to allow him adequate time to rest, only to have him promptly fall into a deep sleep five minutes after our arrival. In his defense, according to the nurse, Matt had been awake most of the morning and perhaps, hadn’t wanted to fall asleep until he knew we were there—a nice sentiment, but I couldn’t help but feel let down, hating that I had missed yet another opportunity to penetrate the void that obstructed our search for the Matt lost within. I left feeling dejected. 

Footnote: *The ventricles produce and secrete cerebrospinal fluid (CSF) to protect and maintain the central nervous system. The ventriculostomy drain, also known as an intraventricular catheter (IVC), works on the principle of a siphon. The lower the level of the external drainage bag, in relationship to the ventricles, the easier for excess CSF to flow out. Raising the bag level slows the flow. In Matt’s case, the amount being siphoned off had steadily decreased over the past week, from 300 to 90 to 60 cc’s, showing positive signs that his CSF level was no longer increasing and that perhaps his ventricles were beginning to drain on their own. The process of weening off the ventriculostomy required gradually raising the siphon level to slow the external flow and place more onus on the brain. Staff had to carefully monitor for any decline in his neurological signs or an increase in CSF volume viewed on a CAT scan. If the drainage bag could be raised high enough to stop the external flow without an internal buildup, then ICF could be removed.