I woke to the sounds of people walking in the hallway and bits and pieces of conversations as they walked by. My alarm had not yet gone off, and it felt like I'd just closed my eyes. I did not feel rested in the least, but figured I'd better go see how Kedron was doing. Usually no news was good news, right? I sure hope I'm right.
In a rather unsteady gait, I make my way to the restroom to use the facilities and freshen up. Once I'm as fresh and put together as I can be without a shower, change of clothes, and maybe a brush, I check to make sure I have all my belongings and check the time. It's only quarter to six in the morning. No wonder my alarm haven't gone off yet. Having no calls or messages, I made my way into the hallway and out toward my brother's room.
I know the nurses work twelve hour shifts, but for some reason, it surprised me that the same auburn haired nurse was there as when I went to bed. She smiled at me as I entered the door. "Good morning," she said quietly. "I hope you were able to get some sleep."
I gave her a small smile in return as I responded, "well, I closed my eyes, but it really does not feel like I slept. Anyway, enough about me...how was Kedron's night?"
"Well, I am cautiously optimistic at this point. His vital signs have remained stable since you left last night without any additional support from medication. So at least Kedron hasn't worsened during the night." The nurse looked over and met my eyes before she continued, "the truest test will be when we back off the medications. We won't do this until his body has time to rest, to heal itself, and then we'll see if he can sustain his blood pressure and oxygen level on his own."
I took a deep breath, feeling a tad overwhelmed by the information she had just given me. That's only the nurse. I haven't even talked to Dr. Adams yet this morning. I couldn't help but wish Dr. Teton would make an appearance today, but he likely went home since his meetings were yesterday. I sigh again and reach for Kedron's hand.
I need to focus on my brother and his needs and put my own on a shelf for the time being. After rounds, I need to decide what to do about work tomorrow morning. I cannot afford to lose the job or give up the hours, but I don't feel right going that far away from Kedron right now. Of course he is in good hands right now. Maybe I should work so I can take time off later when he comes home. His hand feels slightly warmer than yesterday. That has to be a good sign, right? I glance up toward his face and am shocked at the rainbow of colors that is the right side of his head and neck. Well, what I can see of it around the brace. Although he is less pale, the bruising and swelling is alarming to me.
"I'll be heading out shortly but another nurse will be coming to take my place. Is there anything I can do or get for you Kynlee?" The nurse I now knew was names Patricia asked. I simply shook my head. "Do you have any questions I can answer for you?"
"Yeah, actually.." I turn so I'm facing her completely before I ask my first question. "They mentioned surgery for Kedron. Why would they need to operate for a fracture, and how soon could they do it?"
"The chances of complications from a high cervical vertebrae fracture are quite high. Right now they have an external halo immobilizer in place to keep your brother's spine still so he doesn't accidentally move and put pressure on the spinal cord more than it already is. Slight traction can be applied in this way to decrease pressure and further injury of the spinal cord. Unfortunately external immobilizers do not stay in place or work as well as those that are attached internally for this type of injury. Ideally, they'd like to attach a halo to not only immobilize the spine, but allow it time to heal long term without fear of movement. Kedron's injury is quite rare, especially for his age."
Her last comment confused me. "What do you mean his condition is rare?" I continued to meet her eyes as if willing her to answer me, but she appeared to be considering her answer. There had to be something here I was missing. As if on cue, a group of people in white coats, led by Dr. Adams came through the door. To my surprise, at the back of the group was Dr. Teton. Maybe God heard my request to see him again? No, I'm being ridiculous. This is his job after all. I take a calming breath and straighten my spine as I look at Dr. Adams and say, "good morning Dr. Adams."
She looked up from the iPad in her hand, smiled her straight white teeth at me and went on to introduce the group that had followed her into the room, "good morning Kynlee. These white coats with me are all doctors that work for the hospital in neurosurgery. Kedron is quite the popular patient because his case is pretty rare. Right to left are Doctors Young, Calloway, McIntyre, Kryzwaski, Chen, Patel, Kumar, Sherwood, and of course you know Dr. Teton who has been kind enough to consult with us again this morning."
I gave a meek wave toward the group, but made eye contact with Dr. Teton who nodded at me with a kind smile. Suddenly, mouth was dry and I felt butterflies in my stomach. I could hear Dr. Adams addressing the group, "this patient is 19 year old male, Kedron Knutson. The limited information we were given was that Kedron was carrying shingles up a ladder yesterday morning, when his foot slipped on the rung near the top of the ladder. Consequently, Kedron fell backwards head first, unable to catch himself. His injuries are consistent with hitting the right temporal lobe and then landing with his head between the bottom two rungs. We believe the landing was what fractured the C2 vertebrae. The odontoid process of the axis appears intact, however, the atlanto-axial joint does appear to have bone fragments of the transverse process and the spinous process which were broken off during the injury. The artery appeared uninjured on the imaging. If not for the quick thinking of one of the construction crew members to hold C-spine while waiting for the ambulance, this accident may have had a very different outcome."
One of the younger doctors draws my attention when he asks, "is this what they call 'the hangman's fracture'?" Using his fingers he motioned like he was putting quotes around the term.
Dr. Adams's expression became solemn, she looked my way, then looked back at the doctor who asked the question. "Dr. Young, now would not be the appropriate time to ask for clarification on that term."
Dr. Young's eyes became big as saucers as he looked at me sheepishly, glanced at Dr. Adams, then back at me before saying, "I apologize Mam. That was very thoughtless of me."
I was unsure how to respond and simply gave him a slight nod to acknowledge the apology.
Thankfully Dr. Adams seemed to sense my discomfort and again took the lead. "In answer to your question Dr. Young... a true hangman's fracture is bilateral. This fracture is unilateral, but appears to have caused injury to the spinal cord just the same. The term you seem to be searching for is 'atypical hangman's fracture' in this case. Mr. Knutson had some issues with increasing pulse rate and decreasing oxygen saturation rate at about 1800 hours yesterday. A 'code blue' was called and Kedron was intubated and placed on a ventilator so his body could rest to heal. Supportive medications were given to stabilize his low blood pressure with a loading dose of Levophed and then a sliding scale was given based on the patient's vital signs. It appears he remained fairly stable on the lowest dose throughout the night. The facts he has not needed an increased dose and his vital signs have remained within normal limits, is all promising. We also started a muscle relaxant, a sedative to keep him in a deep sleep, and a steroid to help lessen the swelling. This particular fracture with displacement is the least common among our cervical patients. The intracranial pressure caused by the head injury only makes his condition more complex. So, what should be our game plan for Kedron doctors?"
A young, taller than average, female doctor raised her hand and waited for Dr. Adams to nod in her direction before she spoke, "our first concern has to be stabilization of vital signs. The Levophed and ventilator seem to be keeping his sats within the normal range for now. As long as that continues, keeping intracranial pressure low would be our second concern as long as it doesn't exacerbate and cause abnormal vital signs. A hypertonic saline solution should be given as well as keeping the head of the bed elevated as tolerated at 45-90 degrees. External immobilization is satisfactory as long as Kedron remains sedated, but once the client becomes conscious, we may need to revisit surgery to fuse the spine and use an internal halo immobilizer to prevent further injury and give him the best chance of recovery."
Dr. Adams smiled slightly and nodded, "Thank you Dr. Sherwood. Anyone else have anything to add?"
I felt better knowing we had a short term plan. Once Kedron was stronger, we could look at the long term. For now we were more focused on preventing complications and keeping him alive.
To my surprise, Dr. Teton stepped forward and grabbed Kedron's free hand. His voice was gentle but commanding as he proclaimed, "Kedron, I'm Dr. Teton. I just wanted to tell you that we are all pulling for you. We doctors can do our jobs, but we need you to fight to get better. You are lucky to have your sister here by your side. Your also lucky to be young and healthy. All these things will be to your advantage, but ultimately the decision is yours. I hope to meet you formally some day soon."
The young doctors seemed to be looking at Dr. Teton with confusion, but he said nothing as he turned to exit the room with Dr. Adams trailing him.
I couldn't help but feel emotional at the pep talk he had just given my brother. How I hoped it made an impact.