One day I was consulted on a patient in the surgical
ICU. It is uncommon for rehab physicians
to be called to the SICU, and so en route, I pondered what I might find. Maybe a multiple trauma patient who needs a
walker or chest PT?
As it happened, the patient was a 21 year old male who had
gotten into a fight in the West Village. He was hit on the head with a blunt object, resulting
in a subdural hematoma and severe brain injury.
He was intubated, sedated, and expressing decerebrate posturing (a
really bad sign).
The surgeons had called me because they were concerned about
pressure ulcers and contractures. They
wanted to initiate physical therapy and stretching exercises to make sure that
his Achilles tendons didn’t shorten irreparably as his feet were pointing
downward in the bed. Although I thought
it was great that the surgeons were planning ahead like that, truthfully I didn’t
think the patient would ever walk again, or perhaps even survive the SICU. The level of brain injury was just too
I wrote orders for daily physical therapy, got him some Multi Podus Boots, and recommended frequent turns in bed.
I figured I’d never see him again as I was scheduled to change rotations
and transfer follow up of this consult to another resident. It was a tragic case.
About 2 months later I began an inpatient rotation and was
listening to the story of several patients whose care was being transferred to
me. As the resident presented the final
one, I thought the story sounded familiar.
A young man out partying with his friends, got into a fight, sustained a
severe brain injury after being hit in the head…
“This isn’t the guy I saw in the SICU 2 months ago, is it?” I asked the resident.
“Yeah, that’s the one!
I remember seeing your note in the chart. The PTs did a great job with his ankles – he could
stand on them just fine when he got up.”
“Dude, no way! When I
saw him he was posturing in the SICU… this guy actually recovered?!”
“Yeah, I know… he’s the first one I’ve ever seen like this. Do you wanna see him?”
“Heck yeah,” I said, “I’ve got to see this with my own eyes.”
My colleague led me down the hallway to the occupational
therapy kitchen. As we got closer, a
wonderful chocolatey smell filled the air.
“What smells so good?” I asked.
“Oh, the patient is making cookies with the occupational
therapists. He’s learning how to cook
and take care of himself.”
I rounded the corner into the kitchen and there was a young
man, handsome and healthy, pulling a tray of cookies from an oven – I could barely believe it was the same
“Hey doc,” he said to me – not recognizing me of course, but
friendly nonetheless. “You want a
“I’d love a cookie,” I said, remembering the last time I had baked them.
“I believe that this is the best cookie I’ve ever tasted,” I
said, looking at the man with tears in my eyes.
He grinned from ear to ear.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.