Finally, the couple reached the ICU floor and they tried to hurry to see what was taking place, but a nurse stopped them before they could enter.
"We need to know what is going on!" Roy demanded, more upset at seeing a large number of people inside Johnny's cubicle.
"You will. But, right now the doctors and nurses are working on John, so you will have to be patient. Now, why don't you and your wife sit on the chairs while you wait? One of the doctors will be out as soon as they can," she told them in a gentle, yet firm voice.
Running his hands through his hair, Roy let Joanne guide him to the chairs that filled the pale cream colored space filled with hard gray chairs and a few sofas scattered around. Just as they were about to sit, Dr. Early came out.
"Doc, what happened?" Roy asked in a rush.
Holding up a hand, Joe motioned them to take a seat before answering, "He had a seizure and unfortunately, it lasted around six minutes before we were able to stop it."
"What? Why?" Joanne asked, horrified.
"It's not uncommon with head injuries, especially ones this severe and we were watching out for the possibility. Why it is happening now and why it didn't happen sooner, I can't even hazard a guess. It could be that the myoclonus is not as benign as we thought and could be what is called cortical reflex myoclonus. That is a type of epilepsy that takes place and originates in the information processing center of the brain. Since that part of the brain is damaged in Johnny that is one possibility we do have to consider."
Seeing the horrified looks, Doctor Early tried to assure them, "I am running an EEG to see what is going on. It may not be this condition, but if it is, there are medications we can use to help control it. If I had to guess however, considering the time between when the first muscle twitches that indicated myoclonus was taking place and this seizure, I think it is a good possibility that the seizure is due to something other than cortical reflex myoclonus. Despite seizures being uncommon after a head injury, it isn't unheard of either."
"Well, Johnny doesn't exactly like listening to the rules all the time," Roy huffed out with a small smile.
Smiling as well, Joe agreed, "No, he doesn't."
"So what if this seizure is due to the head injury?" Joanne asked. "Will it happen again? If it does, what do we do? How long will they happen?"
Sighing, Doctor Early told them truthfully, "Honestly, if the seizure is due to the brain injury, it could keep happening. It all depends on what caused the seizure in the first place and it could take a while for us to figure that out, even after getting the EEG results. There are other reasons why Johnny may have had a seizure and even though the root cause is the damage done to the brain, we have to rule out the other factors."
"What type of issues? I mean from what I remember, seizures occur because of the electrical impulses in the brain go haywire," Roy asked in confusion.
"That is true, but in this case, we have to rule out a few other things. Although Johnny is running a slight temperature of 99.5 degrees, I don't believe that is the cause. I also am running some blood work to check his to make sure his sodium and magnesium levels aren't too low and his calcium level isn't too high. If one of those values is off, that could be a contributing component as to the cause of the seizures. It could also be the explanation of why the seizure took place. Hopefully, when all the results are in, I will have a better picture and be able to know for sure why it took place, as well as if it will keep happening.
"I don't want you two to worry however," Joe stated firmly as he looked at them kindly. "I really am hopeful that this is something that can be managed very easily if for some reason it keeps continuing. We just have to keep hoping that as Johnny's brain heals, the seizures will lessen or disappear."
"So you think that this issue will eventually resolve itself?" Roy asked.
"It's a possibility," Dr. Early said.
"How good of a chance?" Roy pressed.
Breathing out slowly, Joe calculated before answering, "Maybe 60 to 65 percent chance that the seizures will eventually stop. But again, you should know there are no guarantees in medicine and we can't predict when or if they will stop. Just try and hang in there, ok? As of right now, I have Johnny on Lamictal to ward off any other seizures that may occur until the results are back. Even if it turns out that this is something that Johnny will need to deal with, there are a good number of anti-seizure medications and combinations of meds that we can try, so don't give up hope."
"Thanks, doc, and don't worry, we won't give up," Roy truthfully said, feeling anything but thankful at that moment.
Why is it just when things seem to finally be looking up, something else seems to come along and knock us around? Roy wondered, unaware Joanne was thinking the same thoughts. I just hope when Johnny finds out about this, we can help him deal with this.
"I wish I could have given you two better news," Dr. Early apologized. "Unfortunately, the brain is a mystery and there are a lot of things we just don't know about yet."
Smiling gently at him, Joanne said, "At least you're honest with us. I can't tell you how grateful I am for that."
"No problem you too," he said as he stood up. "If you'd like, you can see Johnny know, but he is sleeping pretty deeply and hopefully will for the next few hours."
"I think we'd just like to see him anyway, doc," Roy confessed after looking at his wife.
"I figured as much," Joe smiled. "Just be sure to not bump the wires on his head and not disturb him in any way. I also ask that you keep the visit short, maybe ten minutes? After he wakes up again, we'll try to finish up the tests if possible. Afterwards, Karl will be meeting up with you here just in case you two would like to talk. I'll make sure that there is a conference room open so you have some privacy."
Nodding their agreement, Joanne took Roy's hand and they headed to check up on their friends. Letting out a gasp at the sight of so many wires encompassing John's head, Joanne left fairly quickly. Roy too, was stunned, but sat down for a few minutes, hanging onto Johnny's hand.
"Hold on buddy," he whispered before getting up and leaving.
Finding Jo crying silently in the ICU waiting room, Roy went to sit next to her and enveloped her in a hug.
"Shh, it's okay honey," he tried to assure her.
"I'm sorry, it's just…I can't believe how much worse he looks," she explained. "He looks a lot paler and even more tired than before."
"Yeah, seizures can take a lot of a person, especially if they last a while from what we are told in training."
"How are we going to be able to tell the kids about this?" Joanne asked, worried about how the kids might react.
Pausing to gathering his thoughts, Roy said, "I think we should do as we promise and be open and honest with them, no matter how hard it is. They deserve to know what happened and that it could happen again. Chris and Jenny also deserve the chance to say that dealing with something like this might be too much."
"You're right," Jo sighed. "It's just unfair…"
"Hi, you two," Doctor Druthers said quietly as he approached them.
"Hi," Roy said, not looking up so the doctor wouldn't see his red eyes. "I guess you heard what happened."
Sitting down, Karl sighed, "Yes, and I'm sorry about this. I wish I knew what to say, but I don't."
"Its okay," Jo told him. "I don't know if there really is anything to say."
"Just seems like Johnny has rotten luck," Roy added.
"Some set backs are to be expect though," Dr. Druthers realistically pointed out. "This may seem like a big one, but from what I understand, at least this is happening now and not after he is out of the hospital."
"What do you mean?" Joanne inquired.
"Some people who have the level of injury Johnny has will sometimes develop seizures months or even years after the initial injury. Even though he is one of the unlucky few to have this occur, at least it is occurring in a hospital where he can get the treatment needed fast. If it occurred outside of the hospital, Johnny wouldn't get the help as quickly and well, it may have turned out as well as it did for him," Dr. Druthers pointed out gently.
Closing his eyes, Roy tilted his head back and sighed deeply.
"Never thought of that," he said wearily. "I just don't know how we are going to explain this to the kids. Or deal with this, I mean, sure I've dealt with this on the job, but…"
"If you still feel like you want to try, there are resources out there that can teach you and your family what to watch for. The doctors can also help to educate you and provide you with instruction on what medications to give Johnny and when," Karl reassured them. "I will want to make sure that all four of you understand the basics of seizures, even if the doctors figure out the cause and they stop, just in case they return. I also want to make sure everyone feels as though they are able to, as well as willing to handle this challenge."
"You don't have to worry about that," Joanne gave him a weak smile. "Roy and I both agreed that we will be open and honest as possible about what is happening with Johnny. If either Chris or Jenny feel that something is too much to handle and they don't want to or can't deal with something, our family will find a place where Johnny is treated well. I'm not sure we should look into places or not yet, but I think we should considering what happened today. I know there is no way we'd allow Johnny to go stay at New Horizons."
"I don't blame you. Especially since it is now being investigated," Doctor Druthers informed them. "I can get a list of other places and have them checked out ahead of time if you'd like."
"That'd be great," Roy said.
"It's hard, what with all the things we need to do for Johnny, the kids ending school today, making sure that all the summer activities are lined up and making sure that a schedule is adhered to when possible right now to be able to do something like that ourselves," Joanne explained. "I am just grateful Irene offered to take Chris and Jenny after school so we could spend today with Johnny."
Smiling, Karl admitted, "I rarely see the type of support system that you guys have in place. It's really quite amazing. Anyway, have you two eaten lunch yet?"
Shaking their heads no, Karl said, "Well, the medications Johnny was given should be wearing off in another hour and a half or so. That should be enough time for you two to get something to eat. Why don't you go down to the cafeteria and I'll stay up here and keep an eye out? I'll come get you if Johnny starts waking up at all."
Roy looked uneasily towards Joanne and saw that she was just as uneasy at the idea of leaving the waiting room.
"I know last time you tried to get lunch, things went wrong, but you need to take care of yourselves if you are going to be any good at all to Johnny, Chris or Jenny," Karl reminded them. "I won't tell you not to worry, but just remember, Johnny is in good hands and is being monitored even more closely right now. Besides, you can't visit him for almost another hour anyway."
As an added incentive, Doctor Druthers added, "Maybe by the time you get back, Dr. Early will have some of the test results back."
Sighing, Joanne realized that he was right and gave in, "Alright, but you promise to page us or find us if anything changes?"
"I promise," Karl said solemnly as he watched the two of them stand up slowly.
"Thanks, doc," Roy said in a low tone.
"No problem. From what you guys have been telling me, he's a pretty special person and I'm more than happy to watch out for Johnny."
Nodding, Roy and Joanne slowly walked to the elevator and glanced towards the ICU doors before stepping on the elevator.
Please God, take good care of him and watch over him, Joanne asked. Help our family deal with this new turn and learn how to be there for him without ever losing sight of one another.
AN: 20% of those with closed head injuries that cause bleeding between the brain and the skull experience seizures.
A seizure in the first week after a brain injury is called an early post-traumatic seizure and about 25% of these people will have another seizure months or years later.
Late post-traumatic seizures occur more than seven days after a brain injury and about 80% of these people will have another seizure.
Conditions that can increase the risk of having a seizure:
· High fever
· Loss of sleep and extreme fatigue
· Drug and alcohol use
· Chemical changes in the body such as low sodium or magnesium, or high calcium levels
Cortical reflex myoclonus is thought to be a type of epilepsy that originates in the cerebral cortex - the outer layer, or "gray matter," of the brain, responsible for much of the information processing that takes place in the brain. In this type of myoclonus, jerks usually involve only a few muscles in one part of the body, but jerks involving many muscles also may occur. Cortical reflex myoclonus can be intensified when individuals attempt to move in a certain way (action myoclonus) or perceive a particular sensation.