For those of you who don’t know me, I’m Aquo. I’m outgoing, impulsive and straight down the line – most of the time. Three years ago, I started the blog Once bitten Aquos not shy… where I write about my accident, injuries, how I’ve rebuilt myself (into a freaking awesome human being if I must say so myself) and more recently about the fact that I’ve found my purpose! I have joined this group called Mummies on a mission – everything about this amazingly supportive group aligns with my soul! I’m digging deeper to try and release my inner phoenix by jumping in the deep & develop a kickass startup!
I had a horrific quad bike accident on 14th September 2013, maybe you saw me on the news, in the papers, or maybe you were following Aquo’s Page on facebook. I would love to be a support system for others that have similar struggles to me, or those that are going through a hard time that need a bit of respite.
Fast forward five odd years and my speech & language skills have developed in leaps and bounds. My behavior has advanced in leaps and bounds – because I have a traumatic brain injury (TBI) as a result of my accident, it took me back to being like a 12 year old child. My speech, my behavior – everything. It was hell to say the least.
Throughout this journey my family and I lost the support of our extended family and most of our friends, personally & collectively. I guess they just couldn’t deal with the dramatic changes that were happening at the time, depression, anger, you name it. Thank you to these people, you have taught the six of us to be better people, and you have showed us how strong we really are. We are now the closest we have ever been, it’s an amazing feeling.
I personally have lost 75% of the people I called ‘friends’ before my accident and I’ve come to realize that that’s OK. I have rebuilt myself and I’m now a better person than I was before, I’m stronger both mentally and physically and I’m a hell of a lot more successful. I’m so much more mature now, and thinking about it, the people I did call friends before my accident, I wouldn’t have anything in common with now.
Now – I’m a positive influence in the Hinchinbrook Shire – I hold no grudges, malice or anything like that to my past, present or future – I’ve been given a second chance and I’m going to use it in the most positive way I can to be the change I wish to see in the world.
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“Successful people do what unsuccessful people are not willing to do. Don’t wish it was easier; wish you were better.” – Jim Rohn.
Recent advances in the field of neuroplasticity have been able to prove how your brain is hardwired and genetically designed to heal, change and even rewire itself after all types of traumas, including but not just limited to brain injuries. Research also explains how your brain changes, and how, with the support of a rehabilitation team, you can retrain your brain to be similar, if not better than before the trauma.
Brain injuries are quite common. According to the Australian Bureau of Statistics, over 700,000 Australians have a brain injury, with daily “activity limitations” and “participation restrictions”. Three in every four of these people are aged 65 or under. As many as two out of every three acquired their brain injury before the age of 25. Three-quarters of people with a brain injury are men.
The fastest improvement happens in about the first six months after injury. During this time, the injured person will likely show many improvements and may seem to be steadily getting better. The person continues to improve between six months and two years after injury, but this varies for different people and may not happen as fast as the first six months. Improvements slow down substantially after two years but may still occur many years after injury. Most people continue to have some problems, although they may not be as bad as they were early after injury. Rate of improvement varies from person to person.
It is common and understandable for family members to have many questions about the long-term effects of the brain injury on the injured person’s ability to function in the future. Unfortunately, it is difficult to determine the long-term effects for many reasons.
The more severe the injury the less likely the person will fully recover. The length of time a person remains in a coma and duration of loss of memory (amnesia) following the coma are useful in predicting how well a person will recover, I guess I was just an exceptional case.
Over the past 5+ years, I have had to work extremely hard to get to where I am today. Four years ago, if you told me in four years time you will be married with two kids I would have laughed in your face. I had to retrain my brain to walk, talk, eat, communicate – you name it. I still have trouble at times trying to say what’s in my head. When I’m tired, I slur when I’m speaking – it’s as if I’m drunk. AND on top of all that I suffer at times with my fatigue, I get so run down it’s hard for me to do anything.
No matter what age you are, your brain has the ability to form new connections and neurons, a phenomenon known as neuroplasticity. In a way, your brain is like a muscle – the more the use it, the stronger it gets! Did you know that every time you learn something new, your brain forms a new connection? Participating in leisure activities that keep you thinking and learning (such as reading, playing board games, playing musical instruments or dancing) will help keep your mind sharp over time. However, cognitive abilities like memory and mental focus aren’t the only ways that you can exercise neuroplasticity – you can also train your brain to think happier thoughts, stop eating bad foods, or turning to alcohol or drugs during stressful moments by using a technique called cognitive behavioural therapy (CBT). Retraining your brain isn’t an easy task, and it can take time to overwrite old neural pathways with new ones, below are some ways to achieve a stronger brain.
Don’t try to change everything all at once. The gradual approach is the surest way to success!
Believe you can do it. If you don’t believe in yourself, you will never achieve your goals.
Reward yourself for the small successes. When you reach your short-term goals, give yourself a pat on the back… but don’t celebrate with substances that harm your brain.
I chose to add the next video, I really admire Andrew’s attitude – he reminds me so much of myself. Even with Cerebral Palsy he pushes himself and takes on challenges that people without a disability wouldn’t take on. He was transferred to a normal high school from a special school which is amazing in itself and is currently completing a masters degree in disability studies – GO ANDREW! His outlook on life is quite amazing for a person with a disability, I know myself how hard it can be at times to think positively about our situations.
Regular physical activity has so many benefits to every part of the body… well, close to. Some benefits include:-
Controlling your weight. Along with diet, exercise plays an important role in controlling your weight and preventing obesity.
Reducing your risk of heart diseases. Exercise strengthens your heart and improves your circulation.
Helping your body manage blood sugar and insulin levels. Exercise can lower your blood sugar level and help your insulin work better. This can cut down your risk for metabolic syndrome and type 2 diabetes. And if you already have one of those diseases, exercise can help you to manage it.
Helping you quit smoking. Exercise may make it easier to quit smoking by reducing your cravings and withdrawal symptoms. It can also help limit the weight you might gain when you stop smoking.
Improving your mental health and mood. During exercise, your body releases chemicals that can improve your mood and make you feel more relaxed. This can help you deal with stress and reduce your risk of depression.
Helping keep your thinking, learning, and judgement skills sharp as you age. Exercise stimulates your body to release proteins and other chemicals that improve the structure and function of your brain.
Strengthening your bones and muscles. Regular exercise can help kids and teens build strong bones. Later in life, it can also slow the loss of bone density that comes with age. Doing muscle-strengthening activities can help you increase or maintain your muscle mass and strength.
Reducing your risk of some cancers, including colon, breast, uterine, and lung cancer.
Improving your sleep. Exercise can help you to fall asleep faster and stay asleep longer.
Improving your sexual health. Regular exercise may lower the risk of erectile dysfunction (ED) in men. For those who already have ED, exercise may help improve their sexual function. In women, exercise may increase sexual arousal.
Increasing your chances of living longer. Studies show that physical activity can reduce your risk of dying early from the leading causes of death, like heart disease and some cancers.
For the last six years, I have constantly suffered from nerve pain, which spikes when it’s cold – it sucks!
So… what’s the reason I suffer from nerve pain you may ask – I had an accident (read my first few articles) back in 2013 that left me with a severe Brachical Plexus Injury to my right arm as well as a Traumatic Brain Injury. A Brachical Plexus Injury is an injury to group of nerves that come from the spinal cord in the neck and travel down the arm. These nerves control the muscles of the shoulder, elbow, wrist and hand, as well as provide feeling in the arm. My injury was pretty severe, it has caused permanent disability to my right arm.
pain (Neuropathic pain) is
by damage or disease affecting the somatosensory nervous
be associated with abnormal sensations called dysesthesia or pain
(allodynia). It may have continuous and/or episodic (paroxysmal)
So what this means is nerve pain is caused by damage or disease to the nervous system. You’re nerve pain may spike from things as simple as someone touching you etc. Things that normally wouldn’t hurt.
People have asked me how I manage my nerve pain with having two kids? Well the simple answer is my husband at times has to carry much more of the load than most other husbands do. Like last night, I was having a pain attack & our new born wouldn’t settle, I went and got my husband up to take over because sometimes the pain is so bad it takes everything I have just to deal with an attack.
But at the end of the day, it was OUR choice to have children, so something that was instilled in me at a young age was – you have to do what you gotta do to do what you wanna do, so most of the time I push myself as hard as I possibly can for my children. I don’t care if I don’t complete things for myself, but I make sure I do everything for my kids – fed, bathed, make sure there not over stimulated, try my hardest to stick to our ever changing routine, etc.
Having ongoing chronic pain can have a significant effect on your entire life. It can cause problems sleeping – I’ve had to sleep train, listen to sleep meditation… even having to resort to sleeping pills at times. It can affect your ability to work and attend social events – at times I suffer so bad I’m unable to go places.
In many people, they won’t attend classes or seminars to help them better deal with their situation. Those classes and seminars have helped me in so many ways to better deal with the chronic pain I live with every day. There is so much information people can learn, better than medication so that they too can also live a much better life.
Adequately treating nerve pain and learning coping strategies to manage pain are very important to make sure that you maintain a good quality of life. Physical activity can help reduce stress and improve fitness. This is why I became obsessed with fitness. Not only did it help with managing my nerve pain, it also helped me become much stronger, fitter and leaner – really, I am 30+ kilos lighter, 4 weeks post having another baby! Gentle stretching and yoga can be good options as well.
Getting enough sleep and eating a healthy diet are also important. When it comes to sleep, at times I have very little of it, or very restless. A healthy diet tends to reduce inflammation in the body and this may be helpful with nerve pain. I did change our entire diet for the better – healthy food is so yummy!
There are good days where I’m in go-go gadget mode and get so much done in a day, then there are days where I’m lucky to keep my kids and myself alive. Nerve pain can also turn you into not a very nice person. The only way I have been able to stop all my anger was to go on antidepressants – and they are really helping. I would love to be able to do more for my family, but truth is, living with chronic pain – you just can’t. Having to constantly fight off pain is exhausting! I have learn’t not to be scared of another pain attack but to embrace it, this has been one of the best coping mechanisms I have learnt.
If there’s any advice I can give to people suffering nerve/chronic pain, I would stress that firstly, you need to educate yourself about your condition and learn strategies to deal with pain being a constant factor in your life. Maybe look into if there is a pain clinic (public system) in your area. I was taught so much at different seminars the Townsville Pain Clinic held.
Look after yourself – Start living a life where you are able to manage your pain, not be crippled by it.
Below you will find details to Pain Australia, this organisation works with governments, health professional and consumer bodies, funders, educational and research institutions, to facilitate implementation of the National Pain Strategy Australia-wide. To contact a Queensland Health Pain Management Practice, the best way to do so is to get a referral from your GP.
Now – I know there was nothing funny about me being in hospital to my family and friends, but for me I found something mischievous to do, without fail, every. single. day. I was in bed 20, I had to share a room with 3 other people which is another story all together.
Our wheelchairs were parked outside our room, I’m guessing so unless we had a staff member with us we weren’t supposed to use them…. WEREN’T haha – that was a joke. Before I could walk again, i used to drag myself along the walls and sneak out to my wheelchair, hop in, and run riot!
I used to sneak around the halls of rehab to pinch biscuits off smoko trolley that was parked up just around the corner from my bed. I would stash them in my cupboard, under my mattress, in my pillow cases, and this was all before I could eat solids again.
I was on thickened water (which tastes like shit) and pureed food which I used to call shit on a stick. The staff would hand dinner out and I’d say what’s for dinner today, not shit on a stick again I hope.
I used to be so sneaky, one of the other ladies in my room used to give me her ice cream (which I wasn’t supposed to have) as she was a diabetic, yet every night they put ice cream on her tray.
Than one day dad convinced mum to go over to a cafe in the medilink building across the road from rehab. It was the first time she had left my side during visiting hours. Little did they know I was just having a skat-nap.
Again I made my way to my wheelchair, got in, and smoked my wheels as I broke out of rehab. Mwahhaha! I got to the desk that was staffed and told the lady I was just ducking out for some air – LIE!!!
I made my way out of rehab, pushed myself across the pedestrian crossing without looking for traffic (that was before I regained my sense of danger) and proceeded across to a path that was too narrow for my wheelchair.
lucky mum saw me and rushed out of the cafe to stop me. “Amy what are you doing?!” “Just looking for you guys.” Lucky she stopped me, cause otherwise I would have tipped my wheelchair, hit my head on the concrete pavement, and it would have been all over.
Another thing I did was I convinced dad to bring me frozen raspberry slushies – “come on dad, there thick so it will be ok.” Mwahhaha! That was before I could drink normal fluids too.
Another thing that makes me smile when I think about it is there was this nurse that used to irritate me – she was just annoying. When I had started eating in the dining room instead of in bed she tried to make me go when I really didn’t want too – Haha silly nurse! “Ok Amy time to go to the dining room for dinner,” “No, my dad comes in every night to feed me,” and she just kept pushing and pushing.
In the end I had nothing nice left to use as an excuse – “Amy, why don’t you want to eat in the dining room?” “Because there all old ok! And food runs down the sides of their faces when they eat, it’s disgusting!” – she left me alone after that.
Every arv, when visiting hours started, mum and dad would come up. Dad has always worn double pluggers everywhere he can get away with wearing them, and he doesn’t lift his feet properly so scuffed as he walks. So from the way he walks I knew when they were coming down the hall. If they were even a second late, they would cop a million questions.
All in all every mischievous thing I pulled off or tried to pull off moved my reviews forward – So I got to eat normal food and drink normal fluids sooner than I would have if I played by the rules. So really I see it as being worth it. My head is hard for a reason, I get knocked down but I get up again, twice as strong and so much more fierce!
See me – I’m still standing, I might be bleeding but I’m still breathing.
Why dear Lord must the last few weeks of pregnancy suck so dearly?! Jesus knew that the only way for humankind to be saved was for him to give his life for them. So my question is – whyyyy then do women have to endure this kind of suffering?!
Everything else aside, I’m so grateful for this pregnancy and how smooth it has been…. until now – mind, body and soul – as when I fell pregnant for the first time (It was planned and I wouldn’t change it for the world!) I was still recovering from a horrific accident and nobody knew how it was going to go. It was quite nerve racking to say the least – nobody could really answer any questions we had, we pretty much had to wing it.
8 months & 2ish weeks later, along came a healthy little boy who has turned into the prodigy of his mother! Really – it’s scary. At just shy of two years old he is super cheeky, hard headed, knows exactly what he wants and when he wants it and god help you if he doesn’t get his way. Just like – ME!
At 4 weeks of snuggling up with my little prince, we started back at gym. The doctors told me to wait for my six or eight week check up (I can’t remember when it was) before starting back but I couldn’t resist, plus it boosted my energy levels and at that time a bit of a boost is exactly what I needed to say the least.
I decided to go in guns blazing with my approach to become a healthier mother, I figured with my impairments, Loosing a few kilos and changing the way I ate, drank, slept would all work out to be a massive plus for myself and how I was right! I lost over 30kg – during that time our whole diet changed, we ate a lot of chicken, salmon and fish, I started my day with a massive cup of black coffee – no sugar, 1L of water infused with lemon in my first hour awake, along with another two during the day, very little processed foods and all meals/snacks were portion controlled.
With gym, I went and did 30 minutes with a personal trainer three times a week and would go walking for at least 45 minutes everyday, 7 days a week. I allowed myself to have a cheat day every fortnight, instead of every week, and instead of eating whatever I wanted for a whole day, I would allow myself to have a cheat meal and a cheat snack.
The first ten months with bub was a massive shock to the system! As I couldn’t breastfeed due to there not being enough research at the time on the nerve medication I am on, my biggest downfall was Pepper Jack Shiraz, I would have a few vino’s most nights just to get to sleep – which made my quality of sleep even worse! A big plus was never waking up with a hangover.
After about ten months, I started to get this whole mum gig, I stopped drinking unless I was at an event – and even then, I would keep my head on my shoulders. I submerged my head in ‘The game” – reading about nutrition and anything else fitness and implemented what I thought would work for our family (much to my husband’s disgust!) there was a few months of trial and error but we finally created a system that worked for us.
Now, I understand that not every baby comes out as a textbook baby, but mine was close to it – we were very, extremely lucky the first time around! Even if getting him on the right formula was a complete nightmare! And being a stay at home mum I had lots of time, motivation and resilience when it came to lack of sleep to create this new healthy lifestyle for my family and myself.
So now, I’m at 37 weeks and 3 days at the time of writing this, it’s currently 5am and I haven’t been able to sleep from 3.30am (cheers husband for making so much noise snoring 😩😩😩) and last night I thought was going to be ‘The night’. Contractions started than stopped – damn!
Our second son was born on 3rd May 2019 at 12.57am – he made an extremely fast entrance into this world. We arrived at the hospital 6 minutes before he was born! The whole show wouldn’t have been four and a half hours long. He was born as I was standing in the shower, the midwife caught him – it was pretty epic! In all honesty – it’s about time things started to become a bit more straight forward for me!
I guess every mum finds having more than one baby a lot easier because they already have had the practice. You know little tricks to make bub happy and it’s just so much more crusier. With your second child there’s not really any such thing as rest, especially for a cane farmer’s wife.
This time I was able to give birth in my small home town rather than having to travel 110km to the closest city. I’m no longer classed as high risk like I was for my first pregnancy as doctors didn’t know what to expect the first time around. I really hate hospitals now – you would too if you have been through what I’ve been through! But not having to leave home, it wasn’t so bad.
This time around I wanted to remember the birth, I haven’t got much memory of my first birth – probably because it was so traumatic. This time around I remember everything! I was opting for a water birth this time around as I couldn’t last time, being high risk and all. I wanted to be more relaxed and just let it happen.
And boy did it happen! I was at home in the shower for a bit, it was so relaxing! I didn’t want to leave. I’m so thankful I was able to be able to remember everything this time around, and I will remember that forever. I do wish however, fathers were more understanding of child birth. When we are in active labour, don’t stand there winging at us, we can’t focus on what you’re saying and it’s just going to piss us off. We will go to the hospital when we’re good and ready (even if we are cutting it extremely fine!) Yes, it is your child too, but we know our bodies better than anyone – have a little faith in us.
My husband made the comment to me the other day that my journey has been similar to that of the six million dollar man – He had a horrific accident, I had a horrific accident – he was rebuilt to be faster, stronger, better – I have rebuilt myself to be faster, stronger, better.
On 14th June 2013 was when I had my quad bike accident then on my first weekend home to Ingham I was in another car accident (that sent me back ages in my recovery), and from those days so many doctors, specialists, surgeons – you name it, put so much energy into rebuilding me for the better. I had to put in a lot of effort to get myself to where I am today – rehab, research, implementing what I had learnt from all those wonderful people to build myself up again.
I was extremely depressed after the second accident, all my injuries had been agrivated! I had come so far and because of some wanker not paying attention my life changed all over again! I was set back in my recovery and at times I didn’t know how I was going to go on. I HATED being in a car!
In April 2017 I had my right arm fused to try and reduce the pain, before that I struggled so bad there were days I wouldn’t get out of bed, it was too much effort to make something for myself to eat so I just wouldn’t eat, and frankly I was too exhausted to do anything about it. This operation was life changing to say the least. My pain reduced significantly (although I will always live with pain), my mood improved significantly, and my mind started working better than it ever had before.
I used to spend four days out of seven in bed, after the operation, once I recovered, I would spend maybe a day a fortnight. Now when my son goes down for his lunch time nap, I go for mine too, it’s not everyday either, sometimes I have too much housework to do. I no longer spend days in bed, I’m not palming my child off to everyone else because I am incapable of being a mother.
Before the op I was a mum who was flat out functioning, in the mornings I was flat out getting Jack ready for daycare, but in my head I pushed myself to get through to drop off time, go home and die for the day and pick him up by 5pm. I had Jack in daycare for five days a week from 4 months. I felt like crap. I wanted to be the one teaching him about life and at that time it seemed impossible.
I had a lot of help from my family, which I can’t even begin to say how grateful I am. They would go shopping for me, some days, a lot of days pick up Jack and take him home for outside play, feed him, get him ready for bed, then daddy would pick him up and bring him home for bed.
I’m now able to do all the things I was unable to do without significant effort before the operation, things like running errands, shopping, visiting – you name it! And to top that – I’m able to do it with an almost two year old, that’s right – one functional arm with a two year old.
Pain does horrible things to a person – it really screws with your head! I was an asshole to my in-laws to say the least. I felt that from the time Jack was born that I was constantly being judged and it made me feel as if they thought I wasn’t good enough for their son, and I wasn’t good enough to be Jack’s mum. I have had a really hard time dealing with negativity since my accident and my go to response is to shut people out. I shut them out, I feel like shit about it, they missed out on quite a bit of our lives, so much of Jack’s first 18 months, and it’s all my fault.
I’m one of those people who really could not care less about what people thought about me, but to me, being my husband’s parents, there opinion mattered.
I wasn’t just an asshole to them, I was horrible to my family as well – probably even worse, because you know, they understand you the most out of anybody, they have been with you your whole life.
I had my operation and it improved my quality of life significantly! I became a functioning mum, it really is the best success in my life to date. I have mended my relationship with my in-laws and we are now closer than ever! I love seeing Jack interact with them, he’s such a little character it’s so heart warming to watch.
Try not to be so hard on your judgement of others, they may just be having a down day, you don’t know, your not living in their body, and, more likely than not, you don’t live in chronic pain.
Since my accident my friends circle has changed dramatically! It went from being friends with the wild ones, the bad asses because let’s face it, they are the fun ones, to being friends with doctors, ambo bearers, firies, solicitors, accountants, financial advisors, business people – you name it.
I’ve become friends with the doctor in charge on the morning of my accident, I asked him if he would write me a piece about what he was confronted with on that morning, he obliged and this is his story – Mum, do not read this! You will be an absolute mess and I don’t want to do that to you!
It’s 5am and the phone rings.
“Hello, doctor? There’s been an accident, a patient is coming in after an accident with a head injury, they’re GCS 3, and the other doctor wants you to come in.”
“Yes, of course, I’ll be there as soon as I can.”
I am, of course, not ‘on call’ for the night, but this sort of event needs anyone available to help.
My wife and I have been living in Ingham for 9 months. I’m not popular at the hospital with the other staff because I tend to tell it like it is, which in the healthcare setting can cause friction.
Whenever we get a call like this, the mind starts racing. Do we know the patient, particularly likely in a small town? What injuries could they have? How are we going to manage them? What are we going to walk into? Will they even make it to hospital? Often we get the call, race in only to find that the person has died before arrival.
The physical act of getting dressed into a pair of scrubs and driving allows the fog of sleepiness clear. I think of a line from a medical book, ‘Cautionary Tales’ which reminds us to slow down, drive properly to a call out so as not to cause another accident. I slow down, just as well! Some idiot has thought that 5am is a great time to wheel their bloody motorbike out onto the middle of the road, when it’s as foggy as all hell and visibility is shot to shit. I narrowly avoid them.
Wouldn’t that have been great… one severe injury becomes two, and takes out the doctor going to help the first one…
I arrive at the hospital, not five minutes later, right in front of the ambulance, the adrenaline already pumping.
The paramedics bring the patient in. Their condition is as said over the phone, GCS 3, with a probable head injury, having come off a quad bike.
The GCS is the Glasgow Coma Score, which is an assessment used to guide how severe a head injury is. 15 is a normal person, and 3 is the lowest you can get, meaning the person is completely unresponsive with no external signs of any brain activity; common medical knowledge and medical research gives such persons almost no chance of surviving such injuries.
Yet, the way people in this situation present, they often appear remarkably intact from the end of the bed, with almost no external sign of injury. That is the case here, a young girl, quite pretty actually.
“What’s the situation?” I ask.
“We’ve been called out to the scene, quad bike injury, we think there’s been alcohol involved. Head injury, GCS 3 on arrival. We think her name is Amy Aquilini.”
They say this because having someone’s name and date of birth becomes important for us to arrange retrieval to a larger hospital, and so that we can give a name to the person. Also, if the worst should happen the police will need to attend the hospital and this information can help them get an identity and make the dreaded trip to the family to inform them.
We’ve put this information onto the whiteboard. I am the most senior doctor on the ground and so this is my scenario to run.
The management of someone in this situation is driven very much by a system and protocol to run through, and follows an ABCDE format.
A is for Airway. Airway compromise, meaning that the person cannot move air into and out of their lungs, is very common in this situation, but right now Amy has a clear airway.
B is for Breathing, the action of moving air into and out of their lungs. This is currently being controlled by the paramedic, who is using a device called a Bag Valve Mask over the face, to provide ventilation. I listen to both sides of the chest, and hear air moving in and out equally. This is important, because what we call a ‘tension pneumothorax’ can occur, where the lung space becomes occupied with so much air that nothing can move in or out, and it can kill within minutes.
C is for Circulation, the beat of the heart pumping blood to the body. We check this by measuring heart rate and blood pressure and by looking at the person. These are often well maintained in young, fit and healthy people which proves to be the case here. The heart rate is high, which is to be expected in this situation.
D is for Disability – given the story of a head injury, some form of compromise to the brain function seems entirely likely, and this assessment refers to the person’s conscious state among other things. It reminds us to be wary for an injury to someone’s neck. The GCS is 3, move on.
E is for exposure. When someone has a serious head injury it is not uncommon for other injuries to be present. Amy’s clothes are removed completely. This is no time for dignity. There are some bruises to her right shoulder and arm, but no signs of injury to her chest, abdomen or pelvis. By the time the night is through I will have done things like check for nerve injury to the rectum, and to help the nurse insert a catheter into Amy’s bladder. This was not in the brochure…
I’m then on the phone to retrieval services to arrange a helicopter to retrieve Amy from Ingham to Townsville, where she will get the care she needs. They’re on their way.
It’s about this point where a difficult situation becomes much worse – where everything turns to shit.
The paramedic, who until now has been admirably managing to provide ventilation through the bag-valve mask, tells us that they are starting to struggle to move air in and out.
This can be due to any number of things. Sometimes it is because there is swelling in the mouth or voicebox because of injury, or bleeding. Sometimes it’s because the stomach contents are regurgitating up, which can also be life-threatening – this is literally someone ‘choking on their vomit’ and it’s how Bon Scott from AC/DC died. Whilst I am sure that someone like Amy would consider that fact somewhat cool, it’s not really what we’re aiming for.
I must take over. There’s me, the other doctor, and a couple of nurses. In the big smoke there would be a team of probably at least 15 people to look after this situation. Oh, well!
We need to secure the airway, which means inserting a breathing tube. This is called a Rapid Sequence Intubation and it is one of those things that raises the hair of even the most experienced emergency doctor.
I ask the nurses to get things ready, as I’m busy trying to ventilate Amy. We need the tubes themselves; a laryngoscope (this is a device that pushes the tongue back and allows us to insert the tube), other pieces of equipment that help guide the tube directly into the voicebox, and drugs that will allow us to insert the tube by inducing complete anaesthesia (no pain or awareness) and paralysis, so that the muscles and reflexes don’t prevent the tube going in.
This team is very much unpracticed in this sort of procedure. I am by far the most senior person on the ground with the most experience here, but I’m only three years out of medical school.
The KISS principle applies here – Keep It Simple, Stupid! There is a simple trick to this procedure called the 3/2/1 rule, to simplify the drugs used, based on body weight. 3micrograms per kilogram of Fentanyl, a potent painkiller. 2milligrams per kilogram of Ketamine, a potent agent that induces anaesthesia. Finally, 1milligram per kilogram of Suxamethonium, an agent which blocks a chemical that causes muscle contraction, therefore paralysing her. Similar agents are used in poison darts, another useless fact.
Amy is now completely paralysed and her life is in my hands. If we have made the wrong decision, or if this procedure doesn’t work, she will die right here.
I insert the laryngoscope, which has a video camera attached to improve visibility – we need every little bit of help we can get. I can see her vocal chords. I ask for the tube, but it’s too big. I specifically asked for the smaller size! OK. “Hand me a bougie.”
“What’s that, doctor?”
Fuck. Me. Dead.
Now I have a paralysed patient, who cannot breathe for herself, and I cannot breathe for her without a breathing tube, and this is not the time to tell me that you don’t know what a standard piece of equipment is.
“OK, on the trolley, 20 metres away, to the left of the defibrillator, is a long piece of blue plastic. Please bring that to me right now.”
This direct instruction works better than assuming people know what things are and how to set up for this procedure, as they really should in this situation. I recognise that by far the most important thing to do is to remain calm, and even. Shouting like they do on TV is guaranteed to kill someone, literally, from lack of oxygen.
Amy is blue at this point, from lack of oxygen. Keep in mind that her oxygen levels were low and her breathing was in peril before we started. In the big smoke and in an operating theatre this would have been done in a carefully controlled environment, with a perfectly well patient, with doctors and nurses who do this every day. The odds are stacked up against us.
The bougie arrives. I put the laryngoscope in again. I put the bougie in, which thank Christ sails right through the vocal chords. I ‘railroad’ the tube in over the top of the bougie, and straight through the vocal chords. We attach the breathing bag and I start pumping furiously – we need to get her oxygen now! Amy’s chest starts to rise, and fall, and within a minute her oxygen levels have returned to normal. She is lovely and pink again.
We can hook her up to the breathing machine, finally.
We have fixed the immediately life-threatening problem. It’s funny how the mind works. I remember every single bit of the intubation itself as if it was yesterday, but only patches of what we did before and afterward.
At this point, the retrieval team of expert doctors and paramedics arrive. They’re surprised in a good way at what we’ve managed to achieve. They transfer Amy to their ventilator. The sun is up now. I remember the sunrise. A new day, new hope?
I remember the retrieval doctor barking instructions after a line had become kinked and it appeared as if Amy had no recordable blood pressure.
I remember Amy’s family, particularly the moment Allen – or Amy’s dad, as we knew him then – leant forward to give Amy a gentle kiss on her forehead. That moment stuck out, and to be honest I thought that would be their last kiss goodbye, so sick Amy was.
Did I talk to the family? I can’t remember. I remember going home for a rest, then heading into work that afternoon. Naturally, we debrief. “Back then” the best way to keep up with what had happened to our patients sent to Townsville Hospital was to ‘stalk’ the blood test results. Amy’s treating doctor was a general surgeon and often this means that the person is likely to be a candidate for organ donation. This, at that time, was not unexpected and is what happens to the vast majority of people who have this injury. One medical journal I read even said there was no chance of survival!
I heard that when Amy had to be re-intubated in the Intensive Care Unit a few days later, the team there struggled – with many multiples of doctors and nurses over and above what we had in Ingham, more resources, and in a much more controlled environment – my boss at the time said that was a testament to the job we had done for Amy in our ED.
Then, the news articles. The vigils in Ingham. The recovery, over months and months, that happened, was nothing short of miraculous. The role we had played paled in comparison to the work done by the massive team at Townsville Hospital – but by the same token she probably wouldn’t have made it there if we hadn’t stabilised her. We talk about a ‘golden hour’ in trauma where if injuries and complications are assessed and treated the person has a fighting chance. We caught Amy’s ‘golden hour’.
I followed from afar, not wanting to intrude further on what was an extraordinarily difficult time for the family. Then, some months later, Allen came in to see me for an unrelated matter and we got to talking about Amy. I mentioned that I was there that night.
Then Amy came in to see me, and seeing her alive, well, and chatting to her in person was one of the most amazing experiences of my life, and certainly the most rewarding of my medical career.
Since then, I have thankfully transitioned out of being one of Amy’s medical practitioners to being able to see her and her family socially – never often enough!
Her wedding day remains one of the best of my life. Seeing this amazing young woman, radiant and beautiful on her special day, and knowing that if not for what I’d done she may not have been there, is something that I will carry with me forever.
Medicine can be a tough gig, a demanding marriage partner. It separates us from our family, and takes the best years of our lives, our weekends, our sleep, and sometimes our sanity. At times I wonder whether it has been worth the sacrifice, as I am sure most doctors do at some stage. Then I think of Amy, and I know that it’s all been worth it.
I believe in you.
This was written by Stephen Dick, Doctor in charge.
We had quite a small wedding on the Tablelands, North Queensland but I wasn’t going to stand for Stephen and his wife not being part of the guest list! We don’t catch up half as much as any of us would like to, life is just crazy at the moment! But that doesn’t mean their not always in my thoughts. Hats off to Chrissy for being a doctor’s wife – I couldn’t do it! But then I think I married a farmer so that’s pretty much the same thing, just with a massive reduction in wages! Haha, I make myself laugh at the places my thoughts take me.
I’ve decided to post this as there are a lot of rumours going around about that morning, but that’s what comes with living in a small town, people can be real assholes! I want to make people understand that my accident was a major life changing event for me, my family and really, the Ingham community. I believe it will open a lot of people’s eyes to how bad I actually was, and to Aquo’s golden hour!