It was just like any other day on the ward in Neurosciences. I had my regular 4 patient load assigned to me and while the day was not particularly busy, I was still on my feet for almost 10 hours of it. One of my patients was admitted for a brain bleed. It was simple enough to fix, the surgeon just had to drill a hole into the top of the patient’s head to drain the blood and alleviate the pressure. In some instances, the surgeon will place an indwelling drain in the patient’s head, which is basically a method to allow fluid to escape slowly. This patient was one of those who had a drain in his head.

        One of the residents came by to assess the patient’s burr hole, what we call the hole drilled surgically into the skull, and to see if the drain could be removed. He asked me a few questions about the drainage and the patient’s status. I mean the drain was barely collecting any fluid so it was definitely time for it to come out. The resident quickly removed the drain and reported no complications. He told me about a dilemma he was having which was to stitch or not to stitch? Any time a tube is removed from a hole, the hole will still be there, often maintaining the resemblance to the tube’s diameter. He told me that the other residents had boasted about, “not even needing to use stitches” to close the hole. He said that many of them had said to just leave it open. The resident seemed to want my opinion but as a new nurse I simply had no idea. I could see him mulling over the two options in his head, he was new too I gathered. He finally decided on testing the theory of not stitching and leaving it alone but as a precaution, he would come back in 30 minutes to check and see if everything was still fine. I’m no doctor, but I felt his decision made sense to me at the time. He had basically chosen to test both options, no stitches if nothing goes sideways and stitches if it does.

        He left the floor and I spent the next 20 minutes tending to unfinished documentation of previous affairs. I wanted to be certain that I had recorded every last detail down to the colour of the serosanguinous fluid that escaped the burr hole as the drain was removed. After feeling satisfied with my documentation, I decided I should probably check on the patient to make sure that nothing had changed since the drain removal. I discovered that about 4 family members had entered the room while I was documenting at the nurse’s station. I greeted them and explained that the drain had just been removed and everything went well. We were going to send him home soon, now that he was in stable condition. I took the patient’s vital signs including blood pressure and wiped the machine down after use. I was just about to leave the room when the patient let out a very large cough. At the time, I could not have predicted what would ensue. As he coughed forcefully, a tall spurt of blood extending almost 2 feet in the air shot out of his burr hole in perfect cylindrical form. It resembled a whale ejecting water from its blowhole. As if in slow motion, the blood fell back down and landed all over the patient’s bedsheets, down his chest and on his face. It appeared as a horror film, he was coated in his own dark red blood, holding his hands out in front of his face in shock. There was a long silence that followed as the four family members standing around the bed stared at me with disbelief in their eyes. Until finally one of them said, “Was that supposed to happen?”

        I was not sure what expression I had written across my face before, and I had absolutely no idea if that was in fact supposed to happen. One thing I knew for certain was that I needed to remain calm. I quickly gathered my thoughts and responded in what I could only hope was a very natural tone, “Yes.” As I spoke, I swiftly covered the blood with some towels. There was another long pause and so I continued, “The tube has just been removed from that hole where it was draining fluid, like blood and things, and so it’s normal for some leakage. The doctor will be in shortly to stitch the hole up to ensure it does not happen again but don’t worry it’s completely normal.” I was not entirely certain that it was normal, but I was surprised at my clear explanation. The family chuckled with some relief and thanked me.

        I left the room and bumped into the resident outside. I explained the situation to him and he burst out laughing. “Are you serious?” he was keeling over with laughter. Then he said, “Okay, okay I’ll go talk to them and stitch it up. But first I need to go tell the other guys.” He then skipped down the hall a few paces to the group of resident neurosurgeons stationed by the computers. As I hooked up the vitals machine to the wall I heard them all explode with laughter. They were slapping the resident on the back and playfully shoving him around saying, “That’s what you get for not stitching it up!”

        I saw the resident enter the room with vivacity, his face still burning from laughter. I saw him stitch up the patient’s head as he apologized for the scare. Then as quickly as he had arrived, he disappeared from the unit, probably called off to deal with another nurse’s concerns for a patient. I sat down at the nurse’s station, extending my tired and achey legs. “Alright, onto the next thing.” And with that I got up to prepare another patient’s medications for the afternoon.