Patient Overcomes Behavioral Challenges After Intracerebral Hemorrhage

December 14, 2022, should have been an ordinary day, but Elroy Chandler and his wife Natalie woke to a strange situation. Elroy had been pacing around the house performing repetitive tasks and had made an uncharacteristic mess in the kitchen while making coffee.

“There was sugar everywhere. He had spilled sugar and coffee all over the counter,” Natalie recalls. “I went to the dining room, and there was coffee spilled all over the dining room table. I picked up the coffee cup that he was drinking out of, and I took it to the sink. And when I poured it out, it was halfway full of sugar. I asked him what was wrong and how he was feeling, and he just kept repeating what I was saying. Repeating, repeating. I said, ‘Oh, no, let’s go. Let’s go right now.’”

She rushed her husband to her local emergency department. “He must have asked me 10 times in that 30-minute drive, ‘Where are we going? What are we doing?’”

In the emergency department, Elroy was diagnosed with a brain bleed and was taken by helicopter to HCA Houston Healthcare Clear Lake, where neurosurgeons found a ruptured aneurysm on the left side of his brain and a stable aneurysm on the right side. After a successful surgery to place a clip on the left side and a coil on the right side, Elroy spent 10 days on a ventilator.

While her husband was intubated, Natalie noticed that he would attempt to remove his breathing tube anytime he began to wake up from sedation. When he was extubated and placed on oxygen on Christmas Eve, she went home for the night, only to return the next morning to find he had removed all his medical equipment.

“He had pulled everything out,” Natalie says. “He was trying to walk around; he was trying to move around. He couldn’t talk, but he was pulling out everything. He was using his left hand; he couldn’t use his right hand.”

Before his injury, Elroy was very physically active and capable, as both a veteran who had served in Operation Desert Storm in the U.S. Army Special Forces and a third-degree black belt in karate. While the injury affected his ability to use the right side of his body, he remained physically capable after the injury.

“He was always trying to escape, always,” Natalie says. “So, they had to put him in a locked unit with a one-on-one person. He managed to get out of that locked unit. His care team told me that they were going to try to get him into TIRR Memorial Hermann for their neuro rehab. I said, ‘That would be fabulous.’ It’s a nice unit, it’s locked. He can walk around, he can move around freely, and he still can’t get out.”

The staff at TIRR Memorial Hermann were impressed by Elroy’s physical strength. For example, he was able to lift a toilet from its bolted position on the floor and he snapped a sink faucet in half. He scaled the brick wall in the cafeteria courtyard, requiring three staff members to pull him down to safety.

“They worked so well with him,” Natalie notes. “He was hard to deal with. He was very, very, very, very agitated. He tried to break the windows with a chair. They had to take the faucets out of the room because he was trying to break the faucets. The only thing he had was the bathroom. He had a TV and a bed. And that’s it.”

Elroy’s aggression was almost exclusively related to his desire to leave and was rarely directed at staff; when not agitated, he was playful and friendly and appeared to enjoy socializing with staff. In all, he was admitted to the neurobehavioral program for less than three weeks. In that time, the team kept him safe and was able to minimize physical restraints, avoid chemical restraint entirely, optimize medication to the point that no PRN medications were required for agitation and reduce supervision from 2:1 staffing to 1:1 staffing. Eventually, Elroy was able to be discharged home.

“I can’t tell you how great that team is at TIRR Memorial Hermann. I cannot express it to you. All the staff there—I cannot tell you how grateful I am. He is practically normal now,” Natalie says. “My husband is a miracle. And that’s because of all their hard work. They did not quit on him no matter what he did. He was immersed in physical therapy, occupational therapy, speech therapy, and it helped him so much. There was not a time that someone wasn’t trying to help him. There was always somebody there, always.”

She adds, “I would recommend TIRR Memorial Hermann to anyone. Anyone. If they can get my husband better, they can get anybody better, because he was so uncooperative and so impulsive, but they still made it happen.”