Severe hemorrhaging after eclampsia and stroke

A family faces a life and death decision when a patient is given a poor prognosis after experiencing a major stroke from eclampsia.

Severe hemorrhaging after eclampsia and stroke
Severe hemorrhaging after eclampsia and stroke

A 33-year-old patient was pregnant with her second child when she experienced a major stroke from eclampsia. She was rushed to the operating room, where her healthy son was delivered. The patient was then sedated and placed on a ventilator.

Computed tomography and magnetic resonance imaging showed severe hemorrhaging. Neurologists informed her husband and family that the patient would not recover but could be kept alive with the ventilator and tube feedings. It would be up to them to decide her fate.

On day 14, the patient underwent tracheostomy and percutaneous endoscopic gastrostomy. She was moved from the acute intensive care unit to the step-down intermediate care unit (IMC). The family expressed their religious convictions and their belief that she would be okay despite the diagnostic scans. They requested a second neurology opinion and family, friends and members of their church came every day to see her.

The patient's 4-year-old son and his newborn brother came with their father every Sunday to visit her. They decorated her side of the room with family photos, religious items and played her favorite gospel music at her bedside, so she could hear it at all times. In the meantime, we continued to clean her, turn her, talk to her and support the family in the best way we knew how.

The second opinion came around week six and, unfortunately the patient's prognosis was the same. She was not expected to regain consciousness, and the hospital again approached the family regarding long-term care planning. The day on which the family was to provide their decision brought a glimmer of hope. During the day shift, she began over-breathing the vent. Not one peep from her for seven weeks, and now we all knew she was there! On night shift that same day she was taken off the vent and was breathing on her own. One other change: while her pupils were still non-reactive, she began showing the slightest movement with her eyebrows to painful stimuli.

Given the change in her status, the hospital agreed to keep her on IMC, but informed the family that if she did regain consciousness, she would be in a vegetative state. However, the family believed otherwise and continued their visits as always, praying for her at the bedside and keeping her up-to-date on current events. So it went day-by-day.

We kept her clean and otherwise healthy and free from decubiti, and her family came and went. Week 10 arrived and there had been no further change in her condition. She had moved from a bed near the nursing station to the last room at the end of the hall, where chronically ill and stable patients were roomed.

Those of us on night shift had learned that she would be moved to a long-term care facility within the week. We would miss her and her family. They demonstrated such strong faith and hope that she would recover. We knew how to care for her, and it was sad to think of letting her go to strangers who might not care for her as well as we did.

The night before the patient's discharge, I arrived on the floor to a large commotion outside the room nearest the nursing station. I assumed it was a code and rushed over to help. But it wasn't a code, it was nothing short of a miracle.

At 3:30pm the patient had woken up while the day nurse was caring for her, and mouthed "How is my son?" She was alive, awake and fully cognitively intact! We were stunned, joyous and crying happy tears. After nearly three months, she was back and better than anyone could have imagined. The patient stayed one week longer with us, which was enough time = to get her a Passy-Muir valve and perform some passive range of motion exercises, and then off she went to the rehab facility.

I keep thinking about the life that would have been lost if the family had stopped all interventions based on her medical prognosis. This patient is proof to me that there is more to healing than what we learn in school. I have seen miracles, and she is the most memorable one.

Michelle Mantel, GNP, BC, is from Wellington, Florida.
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