Unthinkable - Tips: The ICU Dixie Fremont-Smith Coskie, Wyatt-MacKenzie Publishing (page 1 of 3) Page 1 of 3

Multimedia

• 
  BrainLine talks with Dr. Brian Greenwald about seizures after TBI. The risk of having a seizure is highest during the first week and months after a brain injury and decreases steadily from there. But everyone — and his or her brain injury — is different. Transcript of this video.
• Is There a Window of Time for Developing Seizures Post-TBI?
• 
  Dr. Jeffrey Bazarian is an emergency physician with a strong research interest in traumatic brain injury. He is associate professor of Emergency Medicine, Neurology, and Neurosurgery at the Center for Neural Development and Disease, University of Rochester Medical Center. This is BrainLine's exclusive interview with Dr. Jeffrey Bazarian recorded on September 26, 2008. Transcript of the video here.
• Dr. Jeffrey Bazarian Talks About Treatment of TBI in the Emergency Department
• 
  This documentary work-in-progress shares poignant stories of people with TBI — from a victim of a road-rage beating to a Marine infantryman returning home wounded from Iraq. From David L. Brown Productions and Epic Way Sports. Used with permission. All rights reserved. Going the Distance is a 26-minute work-in-progress. Learn more about the project and the final documentary: http://www.goingthedistance.info Transcript of this video.
• Going the Distance

Dixie Coskie is the mother of a child who lived through both a traumatic brain injury and cancer. In this chapter from her book, Unthinkable! A Caregiver’s Companion, Dixie shares her experience helping her son while in the ICU.

In the ICU

• Be patient; pray if praying is a part of your belief system.
• Don’t be ashamed to cry or to ask more and more questions.
• Talk to your child, hold his or her hand, and believe that he or she can hear you. Ask him or her to please give you a sign that he or she can hear you. Let your child know you are there and that you will not leave him or her. Reassure your child that he or she is receiving good care.
• Get to know the surroundings. Ask about the equipment and monitors in the room, such as how to read information such as heart rate, pulse, and oxygen levels. Ask a nurse to explain the purpose of each tube. Ask how to operate the hospital bed.
• Ask for the names, purposes, and possible side effects of medications that are being administered. Ask about the time intervals of dosages. Write down this information as well as any procedures being done and any questions you have.
• Find the locations of the light switches, the coffee machine, the time-out areas, the bathroom and waiting area for visitors, and cots for parents.
• Find a private area in the hospital where you can meet your spouse or significant other to talk and cry in private.
• Ask and demand that you can spend the days and nights with your child.
• Get to know the nurses; you’ll soon learn which ones are the most helpful and which ones are less so.
• When any medication is being administered, check and double-check the name of the drug and the dosage.
• Realize that nurses work in shifts and are not “on” every day. They could not possibly always be up-to-date with changes being made in procedures or with all medication changes; you need to be aware to watch and help if you can.
• Seek out a social worker. He or she can help during this tremendously emotional time and can also help you with your insurance company to retain a case worker to follow your medical case and work with you on financial coverage.
• If your child is about to turn eighteen, many states require that families notify the insurance carrier of the child’s disability for the health insurance to continue under the family’s plan.
• Government programs such as Medicaid and/or Medicare may help with medical costs.
• The department of insurance in your state may help with problems such as being uninsured or underinsured.
• If your child is eighteen or older, he or she is a legal adult and has the power to make all medical decisions. If your child is impaired and not able to make decisions, you may consider becoming his or her legal guardian.
• Allow yourself time to feel what you are feeling and to express those feelings. Anger, extreme sadness, and grief are normal.
• If you have not been very religious in the past, perhaps you will feel your spiritual life awakening or past religious beliefs surfacing.
• Call your employer, let them know the situation and that you will not be coming to work.
• Take time to bring other family members up to date; regularly call your contact person to relay information.
• Make sure you have put someone you trust in charge of taking care of your other children so that you and your spouse/partner can focus on your injured child.
• If you are not married or don’t have a good relationship with your spouse/partner, ask a friend to stay with you at the ICU.
• Search for hope; ask to talk to a social worker or spiritual director, or seek out other parents who have gone through a severe head injury in a child. Learn of their experience…and their recovery.
• Be awake and ready to talk to doctors early in the morning when they make their rounds. Have your questions ready. For example, is my child stable? Responding to the medications? What can we expect? When — or will — he or she awaken? What can we do?
• Trust the nurses when they ask you to take a walk, go to the café, get some sleep, go home, take a nap, talk to your spouse. Be patient.
• Don’t try to project what will happen in the next two weeks or two years — live and deal in the moment.
• Set a schedule. Try to have one parent home for your other kids, and one at the hospital for the injured child. If you are divorced, try to put differences aside. If one parent is not available, enlist another family member or friend.
• Don’t forget about your other children at home. Check on them by phone, text messaging or e-mail. Reassure them and allow them to cry, vent, and show their fears. Try to best answer their questions, and when words cannot console…pray.
• Seek out someone other than your spouse/partner to express your fears and frustrations. Find someone who will listen and not judge.
• Try to understand the situation is not caused by you or God — get rid of guilt.
• Know the difference between coma, induced coma, and persistent vegetative state.
• Consult the ethics personnel at the hospital so that you become informed on how the hospital deals with issues such as continuing life supports or allowing one to die.
• Continue to ask questions and know everyone involved in your child’s treatment; this will include numerous health care personnel, including the ICU personnel, trauma doctors, neurosurgeons, plastic surgeons, respiratory nurses, physical therapists, occupational therapists, speech therapists, social workers, financial advisors, and more.
• Realize that your emotions, which are likely to be many, strong, and swing frequently, are normal: anger, denial, forgetfulness, disorganization, confusion, feeling disconnected and alone.
• Having arguments and disagreements with your spouse/partner is normal; you are both under tremendous stress.
• Forgive quickly and move on so as not to add even more stress to the situation.
• Vent your anger alone, perhaps while driving to and from the hospital, or just have time to cry in private.
• Think and visualize positive thoughts. Be conscious of your breathing and think positive in any way you can.

From Unthinkable by Dixie Fremont-Smith Coskie. Copyright © 2009 by Dixie Fremont-Smith Coskie. Reprinted with permission of Wyatt-MacKenzie Publishing. www.wymacpublishing.com. For more information about the author, go to dixiecoskie.com.

 Comments [2]