Is she not waking up because she's sedated?
Are the medications making him stretch and move like that?
Are the pupils not working because of the sedation?No....no, we're not using sedation. This is from neurological injury.
I can never get over the implications of the difference between sedation and coma. A comatose patient and a sedated patient often look the same to visitors, loved ones, people walking by, and even consulting physicians or residents who first walk into the room and have to ask me if we're sedating the patient. But the difference is the entire world. Their entire world, that is. It's the difference between them waking up and getting out of here, or possibly (probably?) never waking up again
In a single sentence we're declaring with finality the next several months or years of their life. Are they going to return back to normal? Or will they require months of intensive rehab, or a life of nursing home care, or hospice, or will they die right on our unit in the cacophony of a failed resuscitation?
It astounds me that I have to have this discussion with people at, say, 3 am on the phone, in the night shift lull when I'm just starting to get tired. Sometimes the patient has been here a week and I feel like I'm the first person saying to this person that their coma is probably due to them being in a coma, not to sedation: "No, they've been off sedation for days." Or maybe they haven't heard the other times, or they need to hear it again, to have every possible second, third, fourth opinion. I think I would even do that.
I also reflect on how I was never trained to deal with these situations, but I'm still the front line 9 times out of 10 to break this news to people. And that goes whether it's a new emergency admission, or a patient who's been laying in our bed for a week. It's hard to tell a wife or husband or fiance or adult child or young child that the person we're talking about is not waking up not because of drugs we're giving them, but because they're just not waking up.