She's Coming Home

Regression

As the meds were wearing off she starting getting tighter again and having muscle spasms, which scared us every time because when she's asleep it can be hard to tell the difference between a spasm and the start of a seizure. She was breathing over the vent a little so they decided to extubate and try her on bi-pap since she was moving around and they didn't want her damaging her airway with the ET tube again. Nat came in to try switching her.

Nat- ok, I'm going to kick you guys out for this because I might need to intubate her again if she's not ready for bi-pap
We both quickly said bye to Gabby and went to wait in the hall. 15 minutes later Nat walked up to us
Nat- she's on bi-pap. Her SATs aren't quite where we want them but she's managing and she's moving around more so to keep her intubated we'd have to sedate her again which we don't want to do. So we're just monitoring her breathing, it should improve as she keeps waking up.

A few hours later she started actually waking up and opened her eyes. I noticed her looking around, seeming confused.
Antonio- hey Gabby. You're at Med, you had a big seizure. How are you feeling?
She didn't say anything, just looked around a bit more than fell back asleep. I asked a nurse to page Nat because she wanted to know when Gabby woke up, she walked in a few minutes later.
Antonio- she woke up for a minute but then fell asleep again
Nat- that's fine, she's probably tired and the meds wont have worn off completely yet. Did she say anything?
Antonio- no she just looked around, confused then closed her eyes again
Nat- ok, I'm going to hang out in here for a bit so I can check on her next time she wakes up.

Nat POV
I managed to convince Antonio and Matt to leave to get lunch while I sat with Gabby, about an hour after the first time she woke up she opened her eyes again.

Nat- hi
She was looking around the room and moving around more
Nat- hey Gabby, it's just me right now, I sent your brother and Matt to get themselves some food
She finally looked at me when I grabbed her hand
Nat- hi. I'm just going to do a quick neuro check ok

I checked her pupils and got her to follow the light, then my finger, she did fine with that. Trying to get her to squeeze my hands, touch my hand or just move didn't go as well. She was moving around but she couldn't follow directions, confirming what I'd been thinking that its just muscle spasms and uncontrolled movements.

Nat- ok, now I'm going to take you off bi-pap and see how you do with that.
I took her off bi-pap and she seemed to be breathing fine on her own
Nat- good, I'm just going to put you on oxygen to make sure your SATs stay up
I put her on a nasal cannula and a bit of oxygen just because we wanted to keep her SATs above 98 in case lack of oxygen was part of what's causing the seizures.
Nat- there you go, now to finish the neuro check, can you say something for me?

She didn't say anything for a bit but I could tell she was trying
Gabby- h-... ha
Nat- hi, that was good. I know everything's probably harder than it was but you had a really big seizure and we had to put you in a coma for a bit to stop it. Your brain probably just needs time to wake up more and recover
Gabby- ... ya
Nat- do you need anything
Gabby- uh
Nat- I'm sorry Gabby, I don't understand, can you try again?
Gabby- uh, si- ... chai
Nat- oh, you want to get up in your chair
Gabby- ya
Nat- ok, I just need to get a few more people to help move you

I went into the hall to find people and Maggie was walking by so I got her and another nurse. Maggie and I lifted her while the other person made sure she stayed attached to the EEG. It was hard to get her sitting in her chair properly because she's so tight, eventually we got her to bend enough that she was actually sitting and quickly did up the seatbelt to keep her there. Once she was strapped in I tilted her up but not all the way because I don't think she could hold her head up.

Nat- is that good?
Gabby- fi... ya
Nat- fine? Is there anything I can do to make it better?
Gabby- na
Nat- ok, I've got to go check on some patients, I'll see you later.

I walk out of her room, I don't actually have to check on other patients, I need to talk to people about her but I didn't want to tell her that.

Luckily everyone's available and soon I'm in a room with Sam and all Gabby's therapists.

Nat- so Gabby's awake but I'm concerned the seizure caused more brain damage. She's breathing on her own but other than that she seems to have lost most of her progress. I think her spasticity is the worst its ever been, at least in the legs. The involuntary movements are back, mostly her upper body but a bit in her legs, I think her legs are just too tight to move much.
Kate- her legs have always had less movement and more spasticity but this sounds worse.
Nat- her speech is also concerning me, its very slow and hard to understand. She's only using single syllables. I hope its just because she can't control the muscles but it could also be that there's damage to the parts of her brain that control speech.
Lisa- how is she medically?
Dr Abrams- she's stable, unless she has another seizure. We're doing an EEG for the next few days and keeping her here until the seizures are under control
Lisa- I can do a speech assessment if that's ok
Dr Abrams- as long as you can do it in her room so she can be on the EEG and be monitored.
Lisa- sure, I just need to get stuff ready, I can do it today
Nat- great
Kate- I can do a PT assessment too
Janet- I'll come with you so we can assess everything
Nat- that would be amazing
Kate- we can either do that today or tomorrow morning if she's too tired after speech.
Nat- ok, sounds like a good plan. I also think she should be NPO until she gets a new swallow study.
Lisa- I haven't seen her yet but from what you're describing I agree. Once I've assessed we can talk about it more.
Nat- alright, let's just all keep each other updated.

A/N
I was going to post last night but the power was out for hours!! I hope you like it, let me know if you have any ideas