Time is Everything

We've all been there. That rut where our goals and desires become obscure. That point where we let uncertainty prevail. That instant in which we tell ourselves "Can I make peace with whatever comes at me?".

Of course, this is a very general question that can be applied to any sphere of life. What we must realize, however, is the interconnected of all our dimensions: friends, family, work, health, social interactions of all sorts. Whenever there is an imbalance is one area, sooner or later, the rest catches up ... unless you choose to bridge the instability.

We all have personal experiences that relate to such a phenomenon. Whether it be a husband avoiding conflict in his household by taking on multiple shifts at work, or a grieving widow who choses to withdraw herself from society, we all have the ability to decide how we react to what we are unable to control.

---

During the holidays, I took care of A., a six-year old boy from France who had been in status epilepticus as of Christmas Eve. At the time, the New Year was approaching, and so was his birthday. Unfortunately for the boy, he wasn't capable of celebrating the festive season due to being sedated and intubated. His brain activity was being monitored via an electroencephalograph (EEG) for several days. Despite high doses of anticonvulsants and intravenous sedatives (i.e. Midazolam at 18 mcg/kg/min), none were able to stop the erratic patterns captured by the EEG. Although he didn't have tonic-clonic (uncoordinated, nonpurposeful, stiff and at times repetitive) movements, he was still having ongoing seizures invisible to the naked eye.

This neurological condition is not new to me; I've dealt with adult patients in the similar situation as A. for three years. Yet, management of status epilepticus in a child brought me slightly out of my comfort zone (see image below). Do I perform a thorough neurological assessment including the application of pain? As I looked at my tiny patient, with his long beautiful eyelashes (Side note: Why is it that boys always have beautiful lashes?????), I felt reluctant to pinch him to elicit a reaction. Inflicting pain assess a person's neurological standard practice. And so, I did it once during my shift.

Given his seizures’ resistance to anticonvulsants, the goal of care set by the neurology team was to achieve complete burst suppression, which in essence is no brain activity, in hopes to cease and prevent their reoccurrence. We could only hope and see if the birthday boy would wake up … But at what cost?

That would also be the questions A.‘s mother asked. Upon my first encounter with her, one thing I truly admired was her calm demeanour in a stressful situation. As I updated her about her son’s condition and anticipated treatments, she listened intently, taking in the news one word at a time. Aside from her anxious furrowed brows, her outer display of anxiety was non evident.

She spoke to me about the kind of boy A. was prior to this hospitalization. His gentleness and eloquence were two traits of his that made him appear older than he actually was. “If you’d have a conversation with him, you wouldn’t believe he were six”, bragged his mother. She also informed me of A.‘s older sibling (a seven-year-old boy) whom she is currently trying to entertain these past few days as they were on holiday. She admitted that he is unaware of the severity of his younger brother’s status, and chose to keep it that way for now. As she is opening up to me, I realize how much is really on her plate. It’s quite full indeed. Another thing she mentioned to me was that A. hadn’t had the opportunity to open his holiday and birthday presents. On that day, A.‘s mother had brought his gifts; Bluey books, Bluey balloons, Bluey-themed items.

“I hope he’ll be able to open up his gifts soon”, she says while on the verge of tearing up. I get her tissues and hugged her tightly. “I hope so too”, I replied empathetically.

Nearing the end of my shift, I receive word that, unfortunately, A. was still having seizures almost every two hours according to the EEG report. Hence, once again, the dosages of his current medications are increased, and a new medication is added. As I shared the news with A.’s mom, she had a look that conveys despair and hope simultaneously. She got up, went to A.’s bedside and looked at him with unconditional love. She spoke to him and read him books he would have surely enjoyed.

Prior to her leaving the hospital, I commended her on her poise and strength. She thanked me and responded: “I am, by nature, a very calm person. I’ve got to be strong for my boys. I have my moments when I cry, but what A. needs right now is strength. There is no point in staying in a rut. Only time will tell.”

For everything there is a season, and a time for every matter under heaven: a time to be born, and a time to die;a time to plant, and a time to pluck up what is planted;  a time to kill, and a time to heal;a time to break down, and a time to build up; a time to weep, and a time to laugh;a time to mourn, and a time to dance; a time to cast away stones, and a time to gather stones together;a time to embrace, and a time to refrain from embracing; a time to seek, and a time to lose;a time to keep, and a time to cast away; a time to tear, and a time to sew;a time to keep silence, and a time to speak; a time to love, and a time to hate;a time for war, and a time for peace.

Ecclesiastes 3:1-8