The “Alarm Clock” clinic for adults in Olsztyn is the first facility of this type in Poland. The second one is only being built in Warsaw. In the “Alarm Clock” unusual things happen every day, although apparently every day looks the same. Doctor Łukasz Grabarczyk talks about how the facility works and why it is better than others in the world, as well as who works in “Budzik”.
The “Alarm Clock” clinic for adults has been operating since December 2016 and is located on the premises of the University Teaching Hospital in Olsztyn. Initially, there were eight beds in the ward, recently there are 15.
Magda Rozmna, Medonet editorial team: The enlarged clinic “Alarm Clock” means more places for patients. Are all beds occupied?
Doctor Łukasz Grabarczyk, neurosurgeon: Occupied No, but are occupied. The very process of admitting patients is not that simple. Due to the fact that all patients are in a serious condition, they often stay in intensive care units in hospitals, which means that they are colonized with various bacteria. This makes the diagnostic process longer. We don’t want an epidemic in the ward. Now hospitals are raging Klebsiella and other antibiotic-resistant bacteria. Luckily the alarm clock is clean.
How many patients are there at the moment in the ward?
There are 12, of which three patients are currently in the hospital, in the so-called diagnostic process. The admission criteria for the clinic are detailed by the Ministry of Health. These are patients with six to eight or even nine points on the Glasgow scale. We follow the criterion that the patient must be in a state of minimal awareness. This is extremely important and extremely difficult. The alarm clock is a hospital ward, not a care facility, and our task is to heal. In the diagnostic process, we differentiate between the vegetative state and the state of minimal consciousness. The latter is a potentially reversible state and we can fight such a patient because he or she can potentially return to normal functioning. Due to the fact that in Poland and in the world there is little knowledge about the treatment and differentiation of these two conditions, we have to deal with the issue of qualifications ourselves and assess whether the patient really has a chance or not. Before we only had eight beds, now there are only 15.
A selection is needed.
Yes, but we try to be very optimistic about our patients. We are actually looking for this awareness rather than disqualifying patients. However, it should also be remembered that, unfortunately, it often happens that the patient’s condition is irreversible. These injuries are sometimes so dramatic, whether after cardiac arrest or after a communication injury, that we already know at the stage of diagnosing the patient that there is no chance and we have to accept it and give someone else a chance. It may sound a bit harsh, but unfortunately it is.
I have read that there are about 600 people in a coma in Poland. It is not that each of them could be awakened in the “Alarm Clock”?
To start with, we don’t know how many patients are actually in a coma. These are estimates that we rely on, but I think they have a large margin of error. We don’t really know how many of these people are. Coma is a short-term condition, lasting about four weeks. Then it goes into a chronic state – a state of minimal consciousness or a vegetative state, or the patient wakes up. When the patient becomes chronic, it may disappear from the system. When there is no improvement in the patient within a certain period of time, he goes to a care and treatment facility or to the care of his family at home. They usually get out of control. As a result, we do not really know how many of these people there are and how many of them we could help. It is estimated that there may be about 600 of these patients, but in my opinion it is just like that 600 new patients a year are added to this pool. And the “alarm clock” can be for those 600 people who are in the first year after an injury. Due to the fact that we are implementing a pilot program, in accordance with the criteria of the Ministry of Health, we currently deal with patients from three months after an injury and up to a year.
See also: Prof. Maksymowicz: I could try to wake Gienek Loska from a coma
The criteria are quite stringent, there are plenty of applicants, and there are 15 beds. On average, a patient stays in the ward for several months. Is it not so that due to the insufficient number of beds, not everyone gets a chance to be treated in the “Alarm Clock”?
Unfortunately, this may be the case, which is why we are very happy that another clinic is being created in Warsaw. I also know that new facilities similar to us are being created, which at least solve this problem a bit. Of course, 15 beds is dramatically not enough. I think that such a network of four, maybe six “Alarm Clock” would start to solve the problem with the availability of this type of treatment in our country. 15 beds is definitely not enough.
What’s the queue for bed now? How many people are expecting?
We have hundreds of applications, but many people do not meet the criteria at the very beginning. We have a lot of inquiries from the families of people who have been in a state of disturbed consciousness for many years and they automatically, at least at the moment, cannot be treated in the “Alarm Clock”. Many people do not meet the formal criteria because they are not completely in a coma. The situations of our potential patients are dramatic and traumatic for the family. They seek help everywhere, but this is not always possible. There are situations where the patient is de facto dead and is classified in the center as an organ donor, and the family submits a request that we admit such a patient to the “Alarm Clock” and help save him. These things happen.
At the moment, there are less than 100 applications, a few days ago a medical council gathered to analyze and qualify these applications.
See also: What is brain death?
What does awakening patients in the clinic look like?
This is a fantastic thing. It is not only work, but also all kinds of emotions and great moments. Physiotherapists and nurses play a major role in the recovery process. They are with the patient 24 hours a day. In addition, speech therapists, psychologists and many doctors work with our patients. The treatment of patients in a state of disturbed consciousness is a separate and emerging area of medicine that must bring together all specialists. Because apart from the fact that they are in a coma, they also fight the effects of the injury that led to this coma, or cardiac arrest due to heart disease, lung disease, etc.
Patients undergo rehabilitation all the time so that they do not develop contractures, so as not to develop bedsores. They must also be properly fed. We use music therapy, volunteers come to us and play concerts. We use virtual reality, magnetic and electrical stimulation. We are learning all the time and trying something new. For some patients, some things work better than others. It happens that awakening occurs spontaneously, because sometimes the patient simply needs time and rehabilitation. We approach each patient individually. Each, even a small change in a patient is extremely satisfying for us.
Anyone can work in the “Alarm Clock”?
People working in “Alarm Clock” must have a certain mental structure. There it seems that every day is very similar. Patient rotation is not frequent, they can stay for up to a year, but on average it is about six months. You have to remember that nurses, therapists, doctors and the whole medical staff see this patient all the time. Sometimes it seems that it comes to a standstill, nothing changes, and the process of waking up from a coma sometimes takes a long time. In other hospital wards, it usually happens that the patient shows up in the ward, gets treatment and leaves after a week. This is not the case in “Alarm Clock”, which can be frustrating for some. Not everyone can stand it. We work with determined people who enjoy their work a lot and get along with patients.
A suitable team must be created for such work. People who have a strong psyche and a lot of empathy. We live in times like this that the whole world has gotten so frustrated. People are extremely unpleasant to each other and I don’t know why. There is no space for such behavior with us. You have to remember that a patient in a coma is also a human being and a person who cannot defend himself. That is why there is no place in “Alarm Clock” for people who are unfavorable to other people. Here success comes very, very slowly, but it is extremely satisfying, because it is fun to bring someone back to life, heal a patient who everyone said could not be done.
How many people were able to wake up in “Alarm Clock”?
19 people. We have approx. 60 percent. effectiveness. Thanks to this qualification, the effectiveness of therapy in “Alarm Clock” is better than in the world, because there are several such clinics in the world. Due to the fact that our criteria are quite strict and the therapies we conduct, we have an effectiveness that we can boast about in the world.
Each case in “Alarm Clock” is difficult, but there are patients whom we especially remember. There were times when at some point we didn’t know what to do ourselves, we lost faith, and then the patient suddenly improved a lot. Each patient wakes up very individually. The biggest surprises were in the beginning. The first patient to wake up in our clinic was Tomek Szulżycki, who woke up within a few days. In general, amazing things happen in “Alarm Clock”. We had a patient who was in a coma, it was difficult to reach him, and then it turned out that he began to communicate with us in English. He lost or had a definitely handicapped ability to communicate in Polish, but he knew English perfectly well and then he started to write to us in this language. There were also patients who came to us in the so-called the closure team and there seemed to be no communication with these people. Then, in MRI, these patients responded and solved very complex tasks. We, “eye to eye”, could not communicate with them, and during the examination they “answered” every question very matter-of-factly. There are many such amazing and fantastic moments.
The most difficult cases are when the patient does not wake up. We don’t know why. We think these patients should recover, but for some reason they don’t. These are the most difficult moments, but we are still struggling. You can’t give up.
Thank you for the conversation.
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