A Fight Within the Mind

J. was a 32 year-old gentleman who came into the Neuro ICU following an episode of what appeared to be seizures and increasing periods of confusion and behavioral changes. When J. first entered the unit, his diagnosis was unknown. Multiple tests were being done to rule out causes of these new convulsions that were occurring. Meanwhile, while blood tests were being processed, J. was intubated and heavily sedated as these involuntary movements would not cease at all. It got to a point where Isoflurane, a general anesthetic given via inhalation, had to be used to get his muscles to relax completely. He was in a constant state of rigidity and possessed an absent gaze that made you wonder if J.'s spirit still lied within him.

The neurologists suspected J. of having "autoimmune encephalitis". If you've watched the movie "Brain on Fire" starring Chloe Grace Moretz, this is what her character suffered from (I highly recommend watching it!). But for those that just want me to cut to the chase, it is an autoimmune condition (no shit Cristine!) in which one's own body attacks the brain (encephal-) causing its inflammation (-itis). Over the course of five days, J. was given IVIG aka intravenous immunoglobulin (seriously Cristine, what are all these terms, you're killing me!?). To simplify, he was given a mix of antibodies in a bottle in hopes that they would travel through his veins and tell his immune system to relaaaaaaaax.

Despite J.'s medical issues, it was who he was outside these hospital walls that made the team long for his recovery. He was the young father of three children, one of which was only a few months old. As the weeks went along, his hospital room filled with pictures of his kids, followed by their abstract drawings and hopeful messages for him. "Je t'aime papa" most would say. You could imagine how distraught his wife felt; having to care for three children under the age of 10 while simultaneously hoping her husband would come back to our reality. She visited as often as she could despite all the responsibilities that got put onto her plate. Will J. ever snap out of the altered universe his own mind had created? The answer we all hoped for soon became reality.

As we gradually weaned the sedatives and anaesthetics, J.'s muscles quit jerking as often as before. Although his limbs had residual stiffness, he began to regain consciousness slowly. No more gazing into the distance, he finally made eye contact. As he began understanding where he was, his cognitive ability was examined. "Squeeze my hand", "move your toes", "follow my hand with your eyes". After being deemed alert, the next step was to remove the tube that remained in his trachea. Thankfully, the extubation trial turned into a victory.

I remember having him as a patient on a Saturday morning. As this point in his healing journey, J. was able to eat with some assistance. Given the stiffness in his arms, it was difficult for him to grab utensils or cups and bring them to his mouth. The intensivist was Dr. A., a man with much wisdom and many MANY years of experience at our hospital. He was looked up to by many, and although at times, his methods were not as per "standard practice", his years of experience proved that ultimately, every human being progresses differently and there should not be any fear in trying something new to allow patients to return as quickly as possible to their normal capabilities. To name a quick example, Dr. A. would be the type to gladly offer water to patients with a nasogastric tube to quench their thirst. And I mean, Dr. A.'s got a point. Particularly on weekends, when the majority of occupational therapists and physiotherapists were off, it gave Dr. A. a chance to bypass the protocols and test a patient's swallowing or mobility with the nurses. For J., the moment has come to sit him up in a chair for the first time.

As an advocate for early mobilization due to the traumatic experience with my own mother, I make it a point to get patients up either myself or with anyone willing to help me out (unfortunately, you'd be surprised at how many people fear doing so without the presence of a physiotherapist). On that day, the objective was to get J. in a chair that would allow him to see outside the walls of his hospital room. Despite some rigidity, J. was able to get into a geriatric chair. Once the unit was less hectic, I took J. on a tour of our unit and of the hospital's healing garden. Afterwards, we parked his movable chair near the nursing station where we played music to get him doing some type of physical activity. And yes, J. put his hands in the air (as high as he could) and we waved them like he just didn't care. He also attempted to move to the beat with his shoulders and feet. As we grooved with him, J. became teary-eyed. Later, he stated to me that he did not recollect any of the events that brought him into the hospital. He did not remember the seizure-like movements. He just woke up suddenly, with a tube in his mouth, and in a place that wasn't his home.

Eventually, J. graduated from the ICU and went on to continue his recovery on the neurology ward. A couple of days later, J. paid a visit to the ICU in a wheelchair. What was jaw dropping was the fact that, when provided with a walker, he was able to take a few steps with some assistance.

Today, two years later, J. is still being followed by the neurology team. Although his diagnosis is not 100% confirmed, what is certain is that he is back to work. Although he still has sequelae from the hospitalization (hearing issues, osteoporosis and a frozen shoulder), he became the winner of the fight within his mind. J. came back to us, but more importantly to his wife and three children.