The ghosts of amputees and the comatose might know.
Compartmentalization, it's how I get by. Everything is stuffed into its cubby hole until I'm ready to deal with it. I wish I could deal with each event in turn as it comes but it is not possible. It's a luxury I can't afford. But what happens when the levees break and the putrid Pontchartrain waters contaminate already poorly healing wounds? Disaster.
For the better part of four months my partner and I battled alongside, D., who was yet another unfortunate victim of last year's hurricane season. D. had the misfortune of having diabetes, HIV, and poor circulation. Unfortunately, he had surgery to try to ease the circulation in his legs a few days before Katrina hit. When the brown tide came he was on the second floor of his apartment. It wasn't high enough. The toxic stew poured into his flat and into his fresh incisions. He and his wife were trapped for a few days without food, water or medications until they were rescued. Then the real tragedy happened.
I don't know what they put in the waters in Louisiana, but people should not be allowed near it. The bacteria and toxins festered in his wounds until the gangrene was too great and overwhelmed his already weakened body. It caused too much swelling, putting undue pressure in the compartments in his leg and cut off the already poor circulation. It was amputation time: first his foot, then the rest of his leg. And then he went into kidney failure and got a super-infection from his antibiotics and went in and out of delirium and on and on ad nauseum. It was looking grim and my friend and I traded off taking care of him as we became fatigued and had rotate off service. D. saw the writing on the wall and had pens made with his name on them to give away as a memorial of himself that he could personally give away. But we battled it together and helped him pull through it. He gave me one, but as a reminder of the joy of living and making it rather than as a memorial, "because I don't need one no more."
But he couldn't go home, he was too sick for that. However as an out of state person, he had no local benefits and without funding no long term care facility would take him. We tried to arrange for emergency benefits but it took awhile. He was again trapped in limbo, too well to be in the hospital yet too ill to just go home. We finally made arrangements and found a facility to accept him. Then his other foot developed an ulcer. He was fearful that he had to undergo another amputation and that if he did, he'd rather die. I tried to reassure him that with aggressive wound care it was possible to save his foot. We then transferred him to finish his care at the other facility. A few weeks later my partner came up to me with a grave look upon her face. She told me that she learned that he died. Shocked, I asked how and she told me that after some time of trying to care for his foot, his new doctor suggested that it would need amputation. They found him dead the very next day. I hoped it was from a broken heart and not suicide, though neither one was a desirable outcome.
The world keeps spinning and the pager keeps ringing. A few days ago I was consulted on a lady 86 years young. She leaned over, lost her balance and bonked her head. It was an innocuous injury, yet over the next few hours she became more lethargic and finally slipped into a coma. The CT scan of her head showed blood. Everywhere where blood could possibly be, it pooled. The skull is an inflexible compartment and as the pressured built up, the brain started to shift and then herniate. We each conferred with the family to prepare them for her grave prognosis. "The next 24-48 hours will tell us how she'll do, but I don't think it will be good...and even if she does recover, her quality of life won't be the same again," I said echoing the trauma surgeon's assessment. But they said she was a "fighter" and that she nearly died before and came back to everyone's surprise. I left it open that we would watch and wait and they agreed to a Do Not Resuscitate order just in case.
I used the opportunity to teach my student the finer points of coma scales, ventilator management, family conferences, drips, radiological interpretation, EKG reading and calculations. There wasn't much to do for patient except watch and wait and I wasn't going let what was left of her life go to waste without it doing some good. So I pimped and pimped and spewed forth a surprising amount of information to eager ears. Then it happened: a few days later she opened her eyes, started moving her limbs spontaneously and began to over-breathe the ventilator. She followed some commands and we began the process of weaning her off of the blower. The trauma surgeon and I discussed her and we were both shocked. "...but I guess with her old, atrophied brain, there was a lot of room for it to move before it got too squished," he said. I nodded in agreement, but stated that there was quite a bit of dead brain matter, too much for her to even close to the same again. He grunted accord. And so did she.
The compartments of my life are overflowing and intermixing. I'm overwhelmed with grief and joy and loss and gain and betrayals and friendship and love and hate and anger and peace and pain and euphoria and fatigue and insomnia and lies and truths and dreams and realities ad nauseum. It's a toxic stew and it's festering both personally and professionally. I'm stymied and there is no agency to help. So I have to deal, I just wish I knew how.
D. gave me this picture in addition to his pen. He took it as the surge came crashing in. I keep them to remind me that I don't want to be washed away. Like him.
For the better part of four months my partner and I battled alongside, D., who was yet another unfortunate victim of last year's hurricane season. D. had the misfortune of having diabetes, HIV, and poor circulation. Unfortunately, he had surgery to try to ease the circulation in his legs a few days before Katrina hit. When the brown tide came he was on the second floor of his apartment. It wasn't high enough. The toxic stew poured into his flat and into his fresh incisions. He and his wife were trapped for a few days without food, water or medications until they were rescued. Then the real tragedy happened.
I don't know what they put in the waters in Louisiana, but people should not be allowed near it. The bacteria and toxins festered in his wounds until the gangrene was too great and overwhelmed his already weakened body. It caused too much swelling, putting undue pressure in the compartments in his leg and cut off the already poor circulation. It was amputation time: first his foot, then the rest of his leg. And then he went into kidney failure and got a super-infection from his antibiotics and went in and out of delirium and on and on ad nauseum. It was looking grim and my friend and I traded off taking care of him as we became fatigued and had rotate off service. D. saw the writing on the wall and had pens made with his name on them to give away as a memorial of himself that he could personally give away. But we battled it together and helped him pull through it. He gave me one, but as a reminder of the joy of living and making it rather than as a memorial, "because I don't need one no more."
But he couldn't go home, he was too sick for that. However as an out of state person, he had no local benefits and without funding no long term care facility would take him. We tried to arrange for emergency benefits but it took awhile. He was again trapped in limbo, too well to be in the hospital yet too ill to just go home. We finally made arrangements and found a facility to accept him. Then his other foot developed an ulcer. He was fearful that he had to undergo another amputation and that if he did, he'd rather die. I tried to reassure him that with aggressive wound care it was possible to save his foot. We then transferred him to finish his care at the other facility. A few weeks later my partner came up to me with a grave look upon her face. She told me that she learned that he died. Shocked, I asked how and she told me that after some time of trying to care for his foot, his new doctor suggested that it would need amputation. They found him dead the very next day. I hoped it was from a broken heart and not suicide, though neither one was a desirable outcome.
The world keeps spinning and the pager keeps ringing. A few days ago I was consulted on a lady 86 years young. She leaned over, lost her balance and bonked her head. It was an innocuous injury, yet over the next few hours she became more lethargic and finally slipped into a coma. The CT scan of her head showed blood. Everywhere where blood could possibly be, it pooled. The skull is an inflexible compartment and as the pressured built up, the brain started to shift and then herniate. We each conferred with the family to prepare them for her grave prognosis. "The next 24-48 hours will tell us how she'll do, but I don't think it will be good...and even if she does recover, her quality of life won't be the same again," I said echoing the trauma surgeon's assessment. But they said she was a "fighter" and that she nearly died before and came back to everyone's surprise. I left it open that we would watch and wait and they agreed to a Do Not Resuscitate order just in case.
I used the opportunity to teach my student the finer points of coma scales, ventilator management, family conferences, drips, radiological interpretation, EKG reading and calculations. There wasn't much to do for patient except watch and wait and I wasn't going let what was left of her life go to waste without it doing some good. So I pimped and pimped and spewed forth a surprising amount of information to eager ears. Then it happened: a few days later she opened her eyes, started moving her limbs spontaneously and began to over-breathe the ventilator. She followed some commands and we began the process of weaning her off of the blower. The trauma surgeon and I discussed her and we were both shocked. "...but I guess with her old, atrophied brain, there was a lot of room for it to move before it got too squished," he said. I nodded in agreement, but stated that there was quite a bit of dead brain matter, too much for her to even close to the same again. He grunted accord. And so did she.
The compartments of my life are overflowing and intermixing. I'm overwhelmed with grief and joy and loss and gain and betrayals and friendship and love and hate and anger and peace and pain and euphoria and fatigue and insomnia and lies and truths and dreams and realities ad nauseum. It's a toxic stew and it's festering both personally and professionally. I'm stymied and there is no agency to help. So I have to deal, I just wish I knew how.
D. gave me this picture in addition to his pen. He took it as the surge came crashing in. I keep them to remind me that I don't want to be washed away. Like him.