Are there any doctors in the house?

[jill999]

I'm starting an outline for my next story and I'm in desperate need of some medical advise. If any of you have knowledge in this field please feel free to respond.

The story centers around a young lady who at the request of her boyfriend has elective breast augmentation surgery. The Anesthetist makes several crucial mistakes during the surgery and our heroine is left in a coma.

What I need help with is the following:

Is there a type of coma in which the patient is able to still comprehend the world around her. In this type of coma the senses still function but voluntary movement is not possible. Is there a medical term for this condition?

What could cause this type of coma? For example, if the blood pressure went to low during the surgery.

I wish I knew more about the medical field. I think there are so many stories there. In my story the boyfriend shows up less and less during the long coma. Only the heroine's parents and one very kind nurse are there for her as she tries to recover.

I don't want to give away the ending.

Please help this poor author who never attended medical school. My research is not going well on this subject.

Jill

 

[ElizabethWest]

God, it's been a long time since I was a real nurse and I never worked in surgery. Usually comas after surgery are a result of an anoxic brain injury. The brain does not get enough oxygen for whatever reason. It can be that the patient's heart stops beating and the resuscitation efforts are not that effective. Or low blood pressure so that not enough blood supply is getting to the brain. A stroke (CVA) or a heart attack (MI) on the table could also contribute.

The data on what a coma is like for the comatose patient is pretty subjective. I dug up an article that may give you a little insight. http://www.nrlc.org/news/2001/NRL10/coma.html

There are also types of drug-induced comas where the patient is completely aware of their surroundings but are unable to move at all because the meds have a paralyzing effect. I don't think this is what you are looking for though. These types of comas are usually induced when movement by the patient can adversely alter the outcome of their treatment. A severe orthopedic injury would be an example.

I don't know if this helps you at all, and everyone, feel free to correct me if I'm wrong. Nursing school was a long time ago!

 

[Weird Harold]

Is there a type of coma in which the patient is able to still comprehend the world around her. In this type of coma the senses still function but voluntary movement is not possible. Is there a medical term for this condition?

Total Paralysis.

It's not precisely a "coma" but it is what you described.

However, Comas are not well understood even today with all of the monitoring and diagnostic technology available to doctors. Feel free to just describe the symptoms you want your patient to have and write your story. Use some Nebulous "brain damage we dont understand" diagnosis to explain it.

 

[rgraham666]

I had to do research for a similar story recently. Ruby and Bill A plug, I know, but the story will give some idea of the problems facing the person in a coma, and the people around them.

What you are describing jill is paralysis, not a coma. If the person's aware, they're not comatose, as I understand it.

However people in comas do respond to stimulation. They may turn towards sounds or withdraw when touched. But this is automatic. How aware they are is open to speculation. Coma is like sleep in some ways. Outside phenomena will impact the person, but on a subconscious level.

One thing to deal with is the physical effects. If the person is under more than a couple of months their muscles start to atrophy and their ligaments to stiffen. Eventually they'll curl into a fetal position. If under a long time and they become aware, a great deal of physical therapy is required to overcome this. Too long and they can never recover completely. I found one testimonial of a man who was under for three years. Twenty years later, he still needs canes to walk and his limbs are a little twisted.

Also, bedsores can be a problem. Lying still chafes the skin. These spots can become infected or even gangrenous.

And there is a chance of pneumonia. As I understand, lying still for so long sometimes allows fluid to build up in the lungs. The patient can die from this.

Hope this helps.

 

[jill999]

God, it's been a long time since I was a real nurse and I never worked in surgery. Usually comas after surgery are a result of an anoxic brain injury. The brain does not get enough oxygen for whatever reason. It can be that the patient's heart stops beating and the resuscitation efforts are not that effective. Or low blood pressure so that not enough blood supply is getting to the brain. A stroke (CVA) or a heart attack (MI) on the table could also contribute.

The data on what a coma is like for the comatose patient is pretty subjective. I dug up an article that may give you a little insight. http://www.nrlc.org/news/2001/NRL10/coma.html

There are also types of drug-induced comas where the patient is completely aware of their surroundings but are unable to move at all because the meds have a paralyzing effect. I don't think this is what you are looking for though. These types of comas are usually induced when movement by the patient can adversely alter the outcome of their treatment. A severe orthopedic injury would be an example.

I don't know if this helps you at all, and everyone, feel free to correct me if I'm wrong. Nursing school was a long time ago!

Elizabeth,

Thank you so much. That was an excellent article you attached to your reply. It's going to help me move forward with this story.

I can tell you must have been a very caring nurse while you were in the profession. May I ask you a favor? I would like to name the nurse in my story after you. Elizabeth West is going to be the true hero in this story. It's her caring for the victim of this tragedy that brings her back from the brink.

I will understand if you don't want me to use your name. But I think it would be perfect. Please let me know if it's OK with you.

Jill

 

[ElizabethWest]

Elizabeth,

Thank you so much. That was an excellent article you attached to your reply. It's going to help me move forward with this story.

I can tell you must have been a very caring nurse while you were in the profession. May I ask you a favor? I would like to name the nurse in my story after you. Elizabeth West is going to be the true hero in this story. It's her caring for the victim of this tragedy that brings her back from the brink.

I will understand if you don't want me to use your name. But I think it would be perfect. Please let me know if it's OK with you.

Jill

Flattery will get you anywhere, my dear. Sure, why not! It's not the first time I've been named in a story, but I won't tell you who or where because they've used my real name.

And I am still a practicing nurse, I just have more of an administrative job now. I got out of floor nursing eight years ago. Stress is high, but believe me, the ones who can do it full time are true angels.

 

[jill999]

Total Paralysis.

It's not precisely a "coma" but it is what you described.

However, Comas are not well understood even today with all of the monitoring and diagnostic technology available to doctors. Feel free to just describe the symptoms you want your patient to have and write your story. Use some Nebulous "brain damage we dont understand" diagnosis to explain it.

Thanks Harold,

I'm still leaning towards Coma but paralysis is maybe the correct term. I think that I would like to use the coma terminoligy for the literary effect I desire.

I have always associated paralysis with an accident caused by extreme contact such as an automobile wreck.

I think of comas being caused in the operating room.

Thanks again

Jill

 

[Weird Harold]

I have always associated paralysis with an accident caused by extreme contact such as an automible wreck.

Actually I think paralysis is more common as a result of stroke than accident -- either way it's usually a brain or spinal cord problem.

 

[jill999]

Actually I think paralysis is more common as a result of stroke than accident -- either way it's usually a brain or spinal cord problem.

Your right, I forgot about strokes.

Thanks again.

Jill

 

[jill999]

I had to do research for a similar story recently. Ruby and Bill A plug, I know, but the story will give some idea of the problems facing the person in a coma, and the people around them.

What you are describing jill is paralysis, not a coma. If the person's aware, they're not comatose, as I understand it.

However people in comas do respond to stimulation. They may turn towards sounds or withdraw when touched. But this is automatic. How aware they are is open to speculation. Coma is like sleep in some ways. Outside phenomena will impact the person, but on a subconscious level.

One thing to deal with is the physical effects. If the person is under more than a couple of months their muscles start to atrophy and their ligaments to stiffen. Eventually they'll curl into a fetal position. If under a long time and they become aware, a great deal of physical therapy is required to overcome this. Too long and they can never recover completely. I found one testimonial of a man who was under for three years. Twenty years later, he still needs canes to walk and his limbs are a little twisted.

Also, bedsores can be a problem. Lying still chafes the skin. These spots can become infected or even gangrenous.

And there is a chance of pneumonia. As I understand, lying still for so long sometimes allows fluid to build up in the lungs. The patient can die from this.

Hope this helps.

Thank you rgraham666.

I hope to have my patient start to emerge from her coma after about four months and take another six months to return to semi normal health. Does that sound reasonable based on your previous research?

I intend to read your story on this subject today. I look forward to a good read.

Thanks for your help and please let me know if my time line seems about right.

Jill

 

[rgraham666]

Thank you rgraham666.

I hope to have my patient start to emerge from her coma after about four months and take another six months to return to semi normal health. Does that sound reasonable based on your previous research?

I intend to read your story on this subject today. I look forward to a good read.

Thanks for your help and please let me know if my time line seems about right.

Jill

That seems about right jill.

In my story, the comatose character was under just a little over a year. It was a year before he left the hospice he was in. And a year after that he still needed a cane occasionally.

From what I read, a one to one seems to be standard. That is every month under requires about a month of therapy for recovery.

It just came to my mind you might also have to deal with the psychological aspects. Depression is quite common with coma victims when they recover. Suddenly being trapped in your own body is rather traumatic, and the physical therapy is quite painful.

Glad to help.

 

[Lisa Denton]

I dunno all the medical stuff and neither will the reader in most instances, however I understand your desire to be accurate.

My understanding is that there are numerous drugs which could cause the condition you are talking about, or close. Perhaps someone, the helpful nurse, he, he, maybe is playin around with some of these drugs to create a new coma type state of mind. That would still give you the word use of coma, without the usual unconscious type problems.

Hope this gives you some ideas where you could take it.

Oh yea, have a banana.

 

[jill999]

I dunno all the medical stuff and neither will the reader in most instances, however I understand your desire to be accurate.

My understanding is that there are numerous drugs which could cause the condition you are talking about, or close. Perhaps someone, the helpful nurse, he, he, maybe is playin around with some of these drugs to create a new coma type state of mind. That would still give you the word use of coma, without the usual unconscious type problems.

Hope this gives you some ideas where you could take it.

Oh yea, have a banana.

Thanks for the suggestions Lisa. I want the anesthesiologist to be one of the villains in my story. I also take it out on the boyfriend who abandons her during her coma even though he was the one who pushed her to have her boobs done.

I think two villains are enough. What a coincidence that they are both men. LOL

Jill

 

[SeaCat]

rom what little I have read and/or heard about this subject, and way too little is known about it, some patients who are comatose do hear what is going on around them. There have been several documented cases where this was true. Hence some of the training we go through on the floors is in how to approach and treat a comatose patient.

What others here have already said is also true. What you have described sounds a lot more like a form of paralysis, although that need not be the case. Most of the cases of Coma I have heard about after an operation were caused by Anoxia. (An older book dealing with this in a Medical Mystery way was "Coma" by Robin Cook.)

As RG mentioned there are other problems which need to be dealt with while the patient is comatose. These are mainly the excercising of the limbs to keep them supply and attempt to stave off Atrophy. The patient also has to be kept clean, as well as their position changed on a regular basis to stop bed sores, also known as Pressure Ulcers, from forming. The Pneumonia can be caused by a couple of things. One is laying in the same position for too long, the patient doesn't breath as deeply as normal and the body will fill the unused spaced wth fluid. The other cause is Aspiration, or the patient inhaling liquids from any source into the lungs.

One thing you'll have to think about is the method of feeding the patient. This is done through a tube. Either inserted through the nose and into the stomach, (usually reserved for the shorter term patient.) Or one which is surgicaly inserted through the abdomen and into the stomach. Both have good points and bad points.

I hope some of this helps, if for bno other reason than backing up the information given to you by others.

Cat

 

[Colleen Thomas]

I'm starting an outline for my next story and I'm in desperate need of some medical advise. If any of you have knowledge in this field please feel free to respond.

The story centers around a young lady who at the request of her boyfriend has elective breast augmentation surgery. The Anesthetist makes several crucial mistakes during the surgery and our heroine is left in a coma.

What I need help with is the following:

Is there a type of coma in which the patient is able to still comprehend the world around her. In this type of coma the senses still function but voluntary movement is not possible. Is there a medical term for this condition?

What could cause this type of coma? For example, if the blood pressure went to low during the surgery.

I wish I knew more about the medical field. I think there are so many stories there. In my story the boyfriend shows up less and less during the long coma. Only the heroine's parents and one very kind nurse are there for her as she tries to recover.

I don't want to give away the ending.

Please help this poor author who never attended medical school. My research is not going well on this subject.

Jill

There are several types of comas. the kind you refer to, is not rare, but there is a lot of controversy over the amount of perception the person actually has. Some people with severe damage to the frontal lobes have a kind of coma here they can remember everything that happened up to the trauma, but are no longer able to process new memories, basically they live stuck in time, on the day of the accident.

The type of coma you are looking at is most likely caused by disruption in the motor cortex. It could be caused by many things, but in your example, you have only to say her body had an adverse reaction to theparticular anesthetic, that caused sweeling and loss of blood flow. One thing we are discovering about the bran is that it can retrain itself, given time and opportunity. People with the speech center damaged can sometimes learn to speak again, with different parts of the brain taking over for the damaged tissue.

Depending ons tory needs, you canhave this take as long as you want. Or you can simply have the motor cortex return to function gradually. Remember, a peson who has been in a coma a long time begins to undergo physical changes, that often take months of PT to correct.

My roomate is a medical social worker, and has experience on the unit where head trama cases stay. I got some specific information for Rg for a story and if you have specific questions I can ask her for you. Just pm me if you need.

-Colly

 

[jill999]

rom what little I have read and/or heard about this subject, and way too little is known about it, some patients who are comatose do hear what is going on around them. There have been several documented cases where this was true. Hence some of the training we go through on the floors is in how to approach and treat a comatose patient.

What others here have already said is also true. What you have described sounds a lot more like a form of paralysis, although that need not be the case. Most of the cases of Coma I have heard about after an operation were caused by Anoxia. (An older book dealing with this in a Medical Mystery way was "Coma" by Robin Cook.)

As RG mentioned there are other problems which need to be dealt with while the patient is comatose. These are mainly the excercising of the limbs to keep them supply and attempt to stave off Atrophy. The patient also has to be kept clean, as well as their position changed on a regular basis to stop bed sores, also known as Pressure Ulcers, from forming. The Pneumonia can be caused by a couple of things. One is laying in the same position for too long, the patient doesn't breath as deeply as normal and the body will fill the unused spaced wth fluid. The other cause is Aspiration, or the patient inhaling liquids from any source into the lungs.

One thing you'll have to think about is the method of feeding the patient. This is done through a tube. Either inserted through the nose and into the stomach, (usually reserved for the shorter term patient.) Or one which is surgicaly inserted through the abdomen and into the stomach. Both have good points and bad points.

I hope some of this helps, if for bno other reason than backing up the information given to you by others.

Cat

Thanks SeaCat.

That was very helpful. Do you have any idea how long a patient in this condition would spend in a hospital before being moved to a nursing facility?

Jill

 

[ElizabethWest]

Thanks SeaCat.

That was very helpful. Do you have any idea how long a patient in this condition would spend in a hospital before being moved to a nursing facility?

Jill

That depends on the severity of the injury and the stablilty of the patient. Believe me, from a reimbursement standpoint, the insurance company will be pushing her out the door as quickly as possible. Acute care is much more expensive than long-term care.

 

[jill999]

There are several types of comas. the kind you refer to, is not rare, but there is a lot of controversy over the amount of perception the person actually has. Some people with severe damage to the frontal lobes have a kind of coma here they can remember everything that happened up to the trauma, but are no longer able to process new memories, basically they live stuck in time, on the day of the accident.

The type of coma you are looking at is most likely caused by disruption in the motor cortex. It could be caused by many things, but in your example, you have only to say her body had an adverse reaction to theparticular anesthetic, that caused sweeling and loss of blood flow. One thing we are discovering about the bran is that it can retrain itself, given time and opportunity. People with the speech center damaged can sometimes learn to speak again, with different parts of the brain taking over for the damaged tissue.

Depending ons tory needs, you canhave this take as long as you want. Or you can simply have the motor cortex return to function gradually. Remember, a peson who has been in a coma a long time begins to undergo physical changes, that often take months of PT to correct.

My roomate is a medical social worker, and has experience on the unit where head trama cases stay. I got some specific information for Rg for a story and if you have specific questions I can ask her for you. Just pm me if you need.

-Colly

Hi Colly,

Thanks for the help. You seem to be on the right track for me. In my outline I have the anesthetist as being the cause of the problem because of his neglect. He had been out doing some weed and screwing with his girlfriend until very late the night before the operation. I intended to have him either administer to large a quantity of the drug which put her under or to have done something to cause his patient to suffer from anoxia.

Does that sound possible?

The story begins in a courtroom two years after she awoke from her long sleep. The trial forces her to remember the events and the relationships which were shaped by her coma. Old loves lost and a new lover found.

Colly, one other question, I was wondering how long a patient remains in a hospital before being transfered to a nursing facility. It is a crucial point in my story.

Thanks again for all your help.

Jill

 

[rgraham666]

Jill? In my story I had the comatose character moved about six weeks after his accident. He had some broken bones as well. Once those had healed and they realised he wasn't coming around soon, he was moved.

I don't know if this would be correct, but it 'feels' right.

Sounds like you've got a winner of a story there jill. Looking forward to reading it.

 

[SeaCat]

Thanks SeaCat.

That was very helpful. Do you have any idea how long a patient in this condition would spend in a hospital before being moved to a nursing facility?

Jill

Jill,

As Eliabeth pointed out the move from the hospital to the nursing home would depend on the stability of the patient. It can be as short as two weeks, or as long as several months. What is most common? That I don't know. There are too many variables. These include injuries to the patient. Procedures for that particular hospital, availability of beds in the type of nursing home they move the patient to. (Not all nursing homes will accept this type of patient.) as well as any legal responsibilities of the hospital.

Cat

 

[Pure]

There is a nice depiction of a deep coma, and coming out of it, and the problem of walking after having lain for too long, in the opening scenes of Kill Bill 1.

 

[SlickTony]

I'm starting an outline for my next story and I'm in desperate need of some medical advise. If any of you have knowledge in this field please feel free to respond.

The story centers around a young lady who at the request of her boyfriend has elective breast augmentation surgery. The Anesthetist makes several crucial mistakes during the surgery and our heroine is left in a coma.

What I need help with is the following:

Is there a type of coma in which the patient is able to still comprehend the world around her. In this type of coma the senses still function but voluntary movement is not possible. Is there a medical term for this condition?

What could cause this type of coma? For example, if the blood pressure went to low during the surgery.

I wish I knew more about the medical field. I think there are so many stories there. In my story the boyfriend shows up less and less during the long coma. Only the heroine's parents and one very kind nurse are there for her as she tries to recover.

I don't want to give away the ending.

Please help this poor author who never attended medical school. My research is not going well on this subject.

Jill

Maybe this is what you're thinking of. The article I linked said that the prognosis for this condition is poor, but miracles are always happening.

 

[Colleen Thomas]

Hi Colly,

Thanks for the help. You seem to be on the right track for me. In my outline I have the anesthetist as being the cause of the problem because of his neglect. He had been out doing some weed and screwing with his girlfriend until very late the night before the operation. I intended to have him either administer to large a quantity of the drug which put her under or to have done something to cause his patient to suffer from anoxia.

Does that sound possible?

The story begins in a courtroom two years after she awoke from her long sleep. The trial forces her to remember the events and the relationships which were shaped by her coma. Old loves lost and a new lover found.

Colly, one other question, I was wondering how long a patient remains in a hospital before being transfered to a nursing facility. It is a crucial point in my story.

Thanks again for all your help.

Jill

It all depends on the patient, cause and complications. A trauma patient, won't be moved until such time as any danger from the trauma is well past. For example, in a car accident, the person would stay in an ICU until all posibility of codeing from the trauma was passed at the very least.

A lot too, depends on the patient's means. A case wehre they have no insurance might well remain in the hospital indefintely, until a bed opened up in a county or state facility. In Rockland, the infirmary's long term care unit see's very little turn around. Comas can last for years and if the patient is in a vegetative state, they stay in the same place for the length of their natural life. That being the case, a bed may not come open for months or even years in the facility. Private pay facilities, generally, are more flexible, and see a higher turn around, as the costs will invariably get to be too much for the families. Interestingly, patients coming from the private pays, have priority on the avialable beds in state & county facilites. This is usually because the state/county, is respnsible for picking up the tab on patients in private pays who need to be transfered, if there is no bed avialable.