(This is a continuation of an earlier post called “Critical But Stable”)
Prisoner X, was quite clearly severely brain-damaged by his attempted hanging, and he stayed on our intensive care unit for some weeks. You see he still had the capacity to breath for himself, and to regulate his blood pressure etc. These are functions of the brainstem, the lowest part of the brain, which receives blood from the vertebral arteries and these, which run within the spine itself were not compressed or damaged by the ligature which pinched off his carotid arteries at the front of the neck as he hanged himself. I doubt he considered these anatomical niceties as he plotted and committed his suicide, which was possibly in response to his hopeless and helpless full life term sentence.. Whether he was now in a coma, a vegetative state, or a minimally conscious state, was a moot point as these terms hadn’t been clearly defined at the time, and it was still too early in his clinical progress to tell which anyway.
Two prison officers were tasked with keeping an eye over him 24/7. He was handcuffed to his bed-rails at first whenever they suspected he might make a run for it, but gradually these precautions were dispensed with. My only previous experience of wardens was as a viewer of the TV programme and movie “Porridge”. The true-life counterparts of Messrs McKay and Barrowclough looked rather similarly past their prime, and spent a lot of their time polishing the seats of their pants at a little desk set up outside X’s cubicle.
Mr Mackay, left.
I started duty on ITU one Sunday morning and wandered in at 8 am to receive handover from my
Mr Barrowclough, right.
exhausted predecessor. The first staff I met were the two prison officers who were both engrossed in each reading their own copy of the same Sunday tabloid newspaper, called “The News of the World”.
In total innocence, I had a light-bulb moment and said to them
“Ah! That’s why it is called the “News of the Screws*!”
They both eyed me severely as if I was taking the Micky out of them. I truly wasn’t. I had just reached an erroneous conclusion.
Another memory of X was when I had to accompany his dormant form down to the CT scanner to see if there were any radiological changes in his brain’s grey and white matter which might help us reach a prognosis. The scanner was at the polar opposite end of the hospital from ITU. The two wardens, clinking with chains and keys, a nurse and myself accompanied X as we trundled his bed through many long corridors. He travelled feet first. and I was at the head of the bed watching the monitor and his face.
It was the custom in those days to dress the eyes of unconscious folk with small rectangles of a glass-clear hydrated polymer gel. This stuff kept the eye surface from drying out while allowing inspection of their pupils etc. It also had the unsettling effect of making the patient look like they were wearing rimless spectacles because of the way the ceiling lights reflected unevenly off the curved surfaces. I have always found an emotionless face bedecked with characterless glasses to be rather sinister, like this guy’s:
Even SpecSavers couldn’t help here
The reader should also note that these events were occurring shortly in the aftermath of that horrifying movie “The Silence Of The Lambs”, which I had seen and which had unsettled me greatly with its imagery.
I couldn’t help my imagination. For the whole of that transit, there and back, I became convinced that Prisoner X was in fact all along faking his coma, and that at any moment he would jump out of his bed and slay us all with his bare hands before making off to the local underworld. The sweat ran down my back and I could only communicate in sparse, panicked one syllable words.
As it turned out, everything went by without any slaughtering at all. The scan got done, and Prisoner X was returned to his cubicle as if nothing had happened. The scan result was inconclusive. We had to keep him going with intensive care until he died of natural causes, or we had a good reason to withdraw treatment.
Here is my final X anecdote: One evening after several weeks, I was looking after the complex caseload on our 10 bedded ITU when suddenly the Nutty Professor burst through the doors and told me he wanted to do a ward round. His involvement with day-to-day clinical work there was completely unheard of, but I suspected his mania had put the idea into his head. Although I enjoyed his company socially, the prospect of a close clinical encounter with him made my knees begin to knock. Anyway, he press-ganged me towards the first cubicle, where Prisoner X was, and asked me for a brief summary of his case. I started well, middled badly, and was finishing worse (I was nervous you see), when he put his hand on my quivering shoulder, and with a smile said, in his strong northern accent and way:
“Cut to the chase lad! Is he a cabbage, or is he a vegetable?”
It was at that moment that I noticed we were not alone. There behind the door was sat X’s mother, knitting and listening to us.
I am sure everyone reading this can understand my cringing, embarrassed, discomfort at that moment. I said quietly “Professor, this is the young man’s mother…..”
The Prof’ took it all in his stride. His simple response to her was:
I’m sorry for your troubles Ma’am, but the outlook is bleak.
And with that we quickly moved to bed 2.
Prisoner X was eventually extubated and moved to a ward. Within a few weeks, he succumbed to aspiration pneumonia due to his swallowing difficulties and poor cough. May God rest his soul.
*The “News of the World” is nicknamed the “News of the Screws”. In English, “screws” can refer to illicit sexual congresses, prison wardens, and also metal fasteners,