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Victoria Tilney McDonough, BrainLine (page 1 of 2) Page 1 of 2
On the walls of Anne Moessner’s office are Christmas and graduation cards. There are wedding and birth announcements and photographs sent from former patients and their families. These cards and photos make up a collage of lives — and Anne has stories about each of them. “In my experience, people with brain injury often exceed their early prognoses and expectations,” says Anne, a traumatic brain injury (TBI) clinical nurse specialist at Mayo Clinic. “People’s drive and resilience, as well as that of their families, never cease to amaze me.”
Embrace the chaos
Anne, who has been at Mayo for 24 years, coordinates the care of kids and adults with brain injury from the minute they arrive at Mayo Clinic until … forever. In essence, she is a sort of medically-trained case manager. “I am a person they can always call, even years later,” she says. A boy she took care of more than twenty years ago — now a man with a regular job and a good life, according to him — phoned her recently. His mother had died and he needed some support. He turned back to Anne for resources. “I remain a primary contact while they’re here, after they’re gone … and always,” she says. “Mayo is big … there are more than 30,000 staff members at the Rochester [Minnesota] campus alone. Who doesn’t want a medical contact who will always call back … especially for people with TBI who may be living with life-long issues?”
Anne didn’t set out thinking she’d devote her life to working with people with brain injury. In 1986, newly sprung from nursing school, she thought she wanted action — acute care with all the life-saving machines and code reds, the sprint of feet next to gurneys lifted from ambulance beds, the whoosh-whoosh of helicopters landing on the hospital roof. Instead she was assigned to the rehabilitation floor. She soon found that working with people with brain injury was the perfect fit for her personality. “Staff who gravitate toward working with people with TBI tend to think on their feet, go with the flow, and have a sense of humor,” she says. “We don’t necessarily like calm and predictable; we tend to embrace chaos.”
Celebrating the big — and small — steps
It can be a bit overwhelming at times to be the lone medical person in a waiting room with a distressed family … 20 family members and friends waiting to hear what’s happened to their hurt teenager. “I sit with the families. I prepare them for what happens during each stage of recovery, and I try to answer whatever questions they have,” says Anne.
Anne has learned that early intervention is crucial for people with TBI, from acute care through all phases of rehabilitation. “The minute the neurosurgeons think a patient can have any rehab, we’re in there … usually within 1-2 days of the patient’s arrival at Mayo,” she says. Physical therapists will work on range of motion and mobilization, which helps stave off lung and circulation problems. Occupational therapists will help the patient with swallowing and, when ready, fine motor skills and cognitive rehabilitation. Speech therapists will also come early on, when the patient starts to wake up. Anne works closely with this rehab team. “Although the earlier the intervention the better, people with TBI can almost always make some gains with the help of rehabilitation,” she says.
At Mayo, staff can see as many as 1,000 people with TBI a year injured by falls, car crashes, or sports concussions. Three quarters of those have milder injuries, the last quarter severe. “Fortunately, I have only a few patients a year who end up totally dependent, living in a nursing home or group home,” she says. “It’s really not that common of an outcome when you look at the numbers. We have learned a lot about how to improve outcomes, and most people do get better and live in the community.”
Anne says it upsets her when she hears staff members saying to families, Your son will never walk again …or speak again … “What’s the point of stripping people of hope, especially early on, when no one knows for certain how things will turn out? I don’t have a crystal ball. No one does. Why say if when saying when is so much more powerful? After all, we have seen time and time again patients exceeding the limitations put on them,” says Anne. “Families invariably remember the nay-saying staff, the ones who said Your daughter will never … or Put her in a nursing home. When that kid is better and walking and talking and holding down a job, I encourage them to visit the acute care staff so they can see that many patients make solid recoveries, that what they do early on makes a huge difference, that it’s okay to be hopeful.” Anne laughs and adds, “I mean, you never hear from a family, Damn you for being too hopeful!”
Anne emphasizes that it’s crucial to celebrate with the families every step of the way. Recovery can be a very long, arduous process. If a mother excitedly tells a nurse, I think I saw his eyes flutter … I think he squeezed my hand … I think he’s coming out of the coma … the nurse or doctor should say, People usually respond to their loved ones first so that makes sense. I can’t wait to see that, too! Why say I didn’t see that so I can’t document it or That was probably just a reflex? Encouragement and support from professionals as well as from family and friends play an enormous role in a patient’s recovery.
Reaching beyond the walls of Mayo
When Anne is not working with patients, she is reaching out to the community and learning more about the system of care that extends beyond the walls of Mayo Clinic. “The longer I am in this field, the more I realize that system change is what is going to make the biggest difference to people living with long-term residuals from TBI,” she says. Anne sits on several committees that look at state-wide issues in Minnesota, Iowa, and Wisconsin. “Outreach is another way for me to hook up with other passionate people and brainstorm ways to help those with TBI in the short- and long-term. Learning what others are doing that works keeps me fired up. Every time I go out into the community, I think … how can I expand what I know and do?”
BrainLine
Comments [3]
�Families invariably remember the nay-saying staff, the ones who said Your daughter will never � or Put her in a nursing home. When that kid is better and walking and talking and holding down a job, I encourage them to visit the acute care staff so they can see that many patients make solid recoveries, that what they do early on makes a huge difference, that it�s okay to be hopeful.� Anne laughs and adds, �I mean, you never hear from a family, Damn you for being too hopeful!� This is so very true Anne. Two years ago our son suffered a severe TBI. Most of the staff was kind and hopeful. Some felt compelled to explain that our son could possible end up in a nursing home. Another case manager was quite emphatic that we should begin the process to obtain Social Security Disability payments. Our son will be graduating in December with his BS Mechanical Engineering degree with better than a 3.2/4.0 GPA. It was a lot of work for him and us. In the early days we weren\'t sure how well he\'d do in school. But with a great deal of effort and fortitude on his part and our part his recovery was off the charts. I still keep his neuropysch up to date on how he\'s doing. I look forward to sending him a picture of our son in his cap and gown with his engineering degree in December. Always be hopeful... PS: We made many visits back to the hospital and rehab to thank everyone. Lot\'s of hugs and tears.
People recovering from a TBI need more people like Anne involved in their care. High five to you Anne for all that you do to help the families and patients in the long recovery process.
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Thanks for highlighting the superb role that Anne and other nurses have on the rehabilitation team. As a family caregiver for my husband who had a severe anoxic brain injury, and as a caregiver support group facilitator I can vouch for the desperate need for case managers like Anne who can help a family access evaluation and treatment as the situation changes years after the injury. In our present system of care and insurance coverage, there are few resources available even though we now understand that brain injury is a chronic disease for many survivors. We can anticipate that many Wounded Warriors will need skilled case managers and treatment programs for many years. Janet M. Cromer Author of Professor Cromer Learns to Read: A Couple\'s New Life after Brain Injury.
Sep 13th, 2010 3:07pm