Stories from Naoh’ra Rabntah

Notes from the ICU

Patient Profile

Name: Rosfield, Matthew
Age: 33
Designation: Trauma 1
Status on Arrival — ER Fellow L. Kovac:
Mechanism: fall from height, high-energy impact on right side.
Blunt-force cranial trauma. Suspected subdural bleed.
Multiple rib fractures with flail segment. Right pneumothorax.
Abdominal trauma—liver laceration, right kidney shattered.
Unresponsive on arrival. No motor function below waist.
Suspected spinal fracture at thoracolumbar junction.
Right shoulder complex injury—fractures to humerus, clavicle, and scapula with suspected ligament tears.
Right wrist: comminuted distal radius fracture with dislocation.
Right femoral comminuted shaft fracture.
Right tibial open fracture with soft tissue loss.
Left tibial closed shaft fracture.
Right knee instability; ligamentous injury suspected.

Week 1, Day 1

Author: RN Carol H.
Note:
Craniotomy. Rib plating. Trauma laparotomy—right kidney gone, partial liver resection. Temporary spinal stabilization completed; definitive decompression scheduled for tomorrow.

Patient now on full ventilator support. ICP holding. Chest tube placed.
No motor function below waist. TLSO brace fitted preemptively.
External fixators placed on R wrist, femur, tibia.
R shoulder left unsupported—no way to immobilize it with everything else going on. Hopefully he doesn’t miss the arm too much if he survives this.

Vitals stable, somehow. Skull mostly intact. Whoever spec’d those helmets deserves a medal and a raise.

Week 1, Day 2

Author: Neuro Fellow K. Weaver
Note:
Spinal decompression and thoracolumbar instrumentation performed this afternoon. Intraoperative swelling noted; dural sac decompressed. Prognosis guarded.
Patient remains intubated and sedated—full neuro exam pending. Intake notes no voluntary movement below waist.
Vitals stable. Pretty sure Benton’s already outlining his next paper.

Week 2, Day 6

Author: Trauma Fellow P. Benton
Note:
ORIF of right femur completed. With how much damage that leg took, it’s honestly impressive the ankle came through untouched. Too bad those boots aren’t sold to civilians.
Tracheostomy placed for ongoing vent dependency.
PEG inserted. Vitals stable post-op.
Ongoing post-surgical inflammation: low-grade fever, elevated CRP, mild abdominal distension. Monitoring labs.
Patient remains sedated per protocol; reflexes intact, neuro exam unchanged.
Respiratory team predicts prolonged weaning timeline.

Going to be a hell of a case report. I’ve already got a working title.
Also: someone warn the fire department’s finance office. This is going to hurt.

Week 4, Day 3

Author: RN Haleh A.
Note:
Chest tube removed after stable lung expansion.
Patient remains ventilator-dependent with VAP—culture pending, empiric antibiotics ongoing. Sedated and unresponsive, eyes closed throughout care.
Therapy deferred; respiratory status remains limiting.
Right shoulder: swelling and bruising still significant. Passive ROM deferred due to instability.
Visible atrophy developing. Pain managed with scheduled IV opioids.
Family present daily. We’re trying not to get attached. We are all failing, spectacularly.

Week 6, Day 4

Author: Attending R. Romano
Note:
VAP resolved. Ventilator support remains, but patient initiating spontaneous breaths—finally.
Pulmonary fatigue still evident, likely post-infectious; compensatory effort improving.
EEG stable. No ICP fluctuation. Sedation taper started.
Reflexes intact. Still no meaningful response to verbal cues.
We’ll see how the cortex holds up once the drugs clear.
Family informed. No change in prognosis, but at least we’re moving.

Week 7, Day 1

Author: Psych Resident S. Lewis
Note:
Patient awake. Tracheostomy with speaking valve trial tolerated for short phrases.
Speech limited by fatigue. Orientation impaired.
Expressed confusion re: date and condition. Emotional lability noted.
Cognitive recovery underway; memory gaps significant.
Quote: “What happened?” repeated three times in twelve minutes.
No one answered the same way twice.
We keep rewriting the truth softer. Doesn’t help.
This is the part no one trains you for—when surviving doesn’t look like recovery yet.

Week 8, Day 3

Author: RN Lydia W.
Note:
Patient now breathing ambient air at rest.
PEG remains primary nutrition source; soft oral trials initiated.
Right wrist ORIF completed; internal fixation placed, casted and slinged—finally possible now that respiratory function allows it. PCA initiated post-op; pain controlled. Function remains limited; median nerve’s not interested.
Shoulder got support as a side effect. Two months too late to matter much.

Almost ready to clear for transfer.

Week 8, Day 7

Author: Ortho Resident D. Ross
Note:
Fever spike traced to R tibia pin site—purulent, erythematous, warm.
Emergency bedside debridement performed. Culture sent. Antibiotics escalated.
Planned ORIF remains on hold until infection resolves; timeline to be reassessed.

So much for transfer. Good news is he couldn’t feel a thing.

Week 9, Day 6

Author: Pulmonary Resident A. Lockhart
Note:
Pleural effusion confirmed. SOB with minimal exertion.
Second chest tube in five weeks. This time he was awake for it. Didn’t flinch, didn’t speak—just watched us like he’d already decided what it was going to cost.

Fatigue limiting therapy. Speech abbreviated.
No neuro change. No motor/sensory findings.
Sleep disrupted—nightmares reported by nursing staff. Patient refuses to discuss content.
Mood: withdrawn. Affect flat.

The “T-word” is now banned. Direct order from Romano.

Week 10, Day 5

Author: RN Malik M.
Note:
Chest tube removed. Tracheostomy site closed.
Transitioned to nasal cannula. Tolerating well; saturations stable.
Speech therapy cleared for unrestricted verbal communication.
Oral intake progressing with soft textures; PEG support being weaned.
Right wrist cast removed; transitioned to removable brace.
No motor or sensory return in lower body.
Patient visibly uncomfortable but has yet to request anything for pain. Remind me never to piss off a rescue captain.
Mood: flat. Verbal output minimal, monotone. Participates only with external prompting. Continues to ignore psych consults entirely.

Looks stable. Still not saying the “T-word.” Don’t you dare either.

Week 11, Day 2

Author: Attending E. Corday
Note:
Present for consult on step-down transfer evaluation. Apparently there was a ban on the “T-word.” No one told me.

SCI classified as T12 incomplete; ASIA B on current assessment.
Reflexes intact. No sensory return observed. Voluntary autonomic control preserved.
PEG recently discontinued; oral intake stable. Bowel regimen appears effective.
Patient alert, oriented, and independently signaling. Interaction minimal but appropriate.
No incontinence since sedation taper; skin integrity intact.
Currently total assist for all transfers; mobility progression deferred to PT.

Medically appropriate for transfer. Greene lifted the ban accordingly. Romano was... less enthusiastic.

Week 12, Day 3

Author: Attending M. Greene
Note:
PEG removed. Oral intake sustained above 80% of caloric requirement.
No supplemental oxygen required; maintaining saturations on room air.
Right tibial fracture remains aligned with external fixation; ORIF scheduled post-transfer.
Right knee injury remains under orthopedic evaluation; imaging suggests multi-ligament and joint surface involvement. Surgical planning deferred pending systemic recovery and formal clearance.
Remains total assist for all transfers.
Psych: depressive features noted. Patient alert, oriented, minimally verbal.

Summary: Patient fell fifteen meters down an elevator shaft, landed on his right—the harness likely saved his spine but cashed out the rest. Survived because he was in full protective gear, built like a damn triathlete, and went lights-out before his body could finish deciding how to die.

We spent twelve weeks putting him back together, and now he’s leaving like none of it was worth fixing. We are not okay.

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