I was working as a registered nurse at a pediatric intensive care unit in a large city hospital. A 12-year-old patient had been riding his bike after a large storm the previous night, and rode over a downed power line, sustaining severe injuries.

Although the patient had only small burns, he had been knocked unconscious and could not be aroused. He was intubated for a week, then extubated and required frequent oropharyngeal suctioning.

The patient’s level of consciousness had improved slightly to the point that he could open his eyes, but he was unable to focus or track. This remained the status quo for another two weeks, with no response from the boy, including no cough or gag reflex when being suctioned.

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The patient was the only child of older parents, and it broke my heart to see his mom sit next to him every day trying to capture his gaze time and again without success. One night while I was suctioning him, I said the patient’s name, and then said, “Cough!”

His gaze wandered over to my face, then he made eye contact. I looked at him, this time doing an exaggerated coughing impression with my face all scrunched up and sounding like a cat bringing up a hairball.

He continued to look at me, then got a puzzled look on his face, as if he were thinking “Who is this?”

Again, I said his name and directed him to cough, making the same silly face and sounds. Slowly, the puzzled look faded and he started to smile — a full-face, “Lady, you are crazy,” smile!

I was absolutely floored by the patient’s response. I ran down the hall to the nurses station and told them what had just happened. Their general response was that I was imagining it and informed me that the doctors had held out very little hope for any improvement in his status. I insisted they come back to the room with me.

Standing at the bedside, I looked at the boy and said “Cough!” with the craziest face I could make and deep hacking noises. The smile spread across his face again, and he looked at the other nurses, amused.

From that day forward, his progress advanced slowly but steadily. With occupational and physical therapy, he began walking and talking. His thought processes was still intact, despite his speech being a little slow.

After a month or so in the PICU, he was transferred to a pediatric rehab unit two floors below the PICU. I would stop in as I went home and talk to him and his mom, tracking his progress as he improved over the course of two months, until he was finally discharged home.

Eighteen months later, the patient’s name popped on the admission screen in the rehab unit, so I went to go see him. Standing in the doorway of the room was a six foot tall teenager, saying “Mom, leave it alone, I’ll take care of it later!”

His mother explained they had come back to the hospital for some therapy, but she thought that this would be the last time. His speech was still a little slow, but otherwise he was a normal teenager.

That was more than 15 years ago. I still smile every time I remember that sudden spark of presence — the eye contact that said “I’m here and I see you” — and the smile he gave me when he came out of his nothingness and back into reality to a crazy nurse making faces at him.

Judith Macintosh, ANP-BC, is from Frankfort, Indiana.