Feeling puzzled? common symptom after brain injury.

Frequently x-rays and other diagnostic tools are "Normal". Need healthcare professionals to monitor symptoms and clues to changing status.

I did not think I could go deeper into the twilight zone and neither did I think I had a brain injury.  After all, I had many injuries prior to this assault and recovered from every single one without residual effects.  What was I thinking as a nurse? I guess I was thinking it only happens to my patients, they improve, go home and all is well.  What I did know and understood so well was the multiple problems brain injured patients and families go through during the inpatient rehabilitation.  I experienced that patients with neurological conditions and head injuries need time to socialize and learn how to interact with others so their behavior is appropriate. Behavior modification is a priority to the safety of all involved.  There should be a psychologist or psychiatrist on staff in every unit and rehabilitation center.  In this institution there was neither a psychologist or psychiatrist on staff of the neurology and head injury rehabilitation unit. Observing these behaviors helps let one understand what the patient is really going through and how they can be helped. By observation they would be better able to identify injury versus criminal behaviors and better able to potentially prevent such assaults.

While these patients are still having extreme outbursts it is not the time to mainstream them with the rest of the population in rehabilitation.  Every patient has their own limitations and issues and are already going through their own crisis.  Even if their outbursts are caused by their medical conditions, these need to be controlled.  If the patients can be or need controlled by behavior modification or medicine, these issues need resolved before putting patients in social settings.  Reminder to everyone … assault is assault regardless of where it occurs and that is a felony.

There were 11 people in this relatively small occupational therapy room and that included 6 staff members. Obviously not enough staff to control this one violent patient.  Workplace violence is prevalent in the nursing profession.  In less than a fraction of a second my life changed forever.  I told the patient his therapy was over and he needed to return to his room.  I was standing at right angles to him with my back at the wall and to my right was the door.  He was looking at the window, when he struck the right side of my head.  He was left handed.   I kept my composure, but before I realized it he hit me again.  That were two blows to the right side of my head.

Brass Knuckles Image via Wikipedia

One to the frontal and temporal lobes and one to temporal and parietal lobes.  His hand was either huge, or he had brass knuckles. Who would have ever checked to see if he had brass knuckles on him?

Assault is a Felony...Report it!

I never fell to the ground.  Of course I lost my footing a bit and either I stepped into the wall, or was punched into the wall.  That part remains a bit hazy.  Like all the other nurses, I responded as expected.  Keep it together, and do not jeopardize the safety of the patient.  I truly was more concerned about all the patients in the room at the time of the assault.  How horrifying that must have been!  All the patients were at risk of being injured as well.  He only chose to assault healthcare staff during his lengthy hospitalization of a couple months, and fortunately never injured or struck one patient.  He was assaulting staff in trigger point areas on the body.  His actions were very selective and deliberate and were documented as such.

I was not able to take care of the patient at that point immediately following the assault and other nurses did intervene.  I would say that was a good thing!  I did go to the back shower room and sat in a quiet corner with ice to my head. My colleagues did get the ice. When I could finally get my composure and feel less dazed I did see the employee health nurse.  She did offer to drive me home, but I felt certain I would be okay.  In the meantime, someone notified my husband that I was assaulted.

Several hours later I arrived home.  It was one of the hardest drives I have ever had, even though it was only about 20 miles away.  I kept pulling over.  I did not even make it out of the parking garage at work when I needed to pull over in the emergency room parking lot and wait a while till I could see clearly. When I could see clearly I walked into the emergency room, but it was not to get treatment.  I used the pay telephone to make an appointment with my family physician for the next day.  I knew something was very wrong, but I also did not believe it was urgent.  I wish I knew what I know today, as this should have been an important warning.  When it is happening to you, there is no way to even think clearly, albeit I was expected to.

My appointment with the family physician went okay.  He documented the bruising about the head.  I only wish we had taken pictures.  The knuckles marks around the head were huge!  Just brushing my hair was painful.  I kept my hair over my forehead so others would not wonder what happened.

Please Protect Nurses and Healthcare Employees

I did take the next couple days off.  I had a horrible unrelenting headache, vomiting, visual difficulties, balance problems and as far as I knew my memory was fine.  It probably was, because I did not have to remember anything.  All I did was sleep, vomit, sleep…a vicious cycle.  I did get medication for my nausea and vomiting that helped.

CAT Scan or MRI important during first couple MONTHS following assault.

I hope that if anyone presents with constant vomiting and sleep following a head injury the physician would investigate further rather then just prescribe something for the symptoms.

Related articles

• What is a closed head injury? (zocdoc.com)
• Violence Against Nurses
• AthletiCo Physical Therapy Launches Head Injury and Concussion Management Program (prweb.com)
• Behavior Modification with Traumatic Brain Injury
• Is it normal for your head to be a little uneven? (zocdoc.com)
• Baby’s head injury leads to assault charge (cbc.ca)
• Skiing, snowboarding top list of winter sports injuries (ctv.ca)
• Head injury link to violent crime (independent.co.uk)
• December 2011: Discussion about Childrens’ Brain Injuries and Computed Topography (CT) (braininjuryresourcecenter.wordpress.com)
• How the Tutors Are Used in Rehabilitative Therapy for Non-Restrained Limbs (handtutorblog.wordpress.com)
• Tutors Help Cognitive Developement (handtutorblog.wordpress.com)
• Tutors Exceed Robots and Other Gadgets in Rehabilitation Therapy (handtutorblog.wordpress.com)
• St. Charles sued over diagnosis; Parent claims hospital overlooked meningitis (bendbulletin.com)
• Bedside device enables ‘vegetative state’ patients to communicate (independent.co.uk)