The Unexpected Change Of Life

Imagine being in your early seventies, cruising through your golden years, content with knowing that you've lived a pretty blessed life. The kids have turned out well, you are still married to the spouse you fell in love with fifty years prior, and you end each day with a smile and a good book.

A well-deserved twilight in a much-appreciated life.

Unfortunately, though, life can be cruel. And being in your seventies doesn't guarantee you a trauma-free life. Or the use of your legs.

I walked into Room 17 to meet my next patient, a woman in her mid-seventies who was wheelchair-bound. As I walked into the room, I was graciously greeted by a smiling woman who sat upright in her treatment cot, her hand warmly outstretched, her straight legs extending limply in front of her. Her soft brown hair and matching eyes exuded good energy, matching the room's atmosphere. I immediately liked her. This patient's husband sat in a hospital chair under the room's cardiac monitor. His face, unlike his wife's, was etched with hesitation and concern.

Sitting in the room's far corner, tucked neatly away from both the patient and our medical team, sat a mechanical wheelchair, all black and high-backed, its leg-support frames jutting forward from the seat. A black shiny direction ball sat on the right armrest. Despite it's obscure location, the wheelchair was an elephant in the room.

"Hello, Mrs. Wilson," I said, walking up to this patient and grasping her extended hand, "I'm Doctor Jim. It's a pleasure to meet you." I turned to her husband, offering my hand, and we shook as well. He eyed me warily, his expression one of a fierce protectiveness that I have appreciated on a spouse's face of previous sick patients. I recognize it for what it is--a simple expression of deep love.

"Mrs. Wilson," I continued, turning back to the patient, "what can we do to help you today?" I sat down on the physician stool by the side of her bed.

"I'm worried I might have another blood clot in my leg," she said, eyeing her own left calf.

As explained by Mrs. Wilson, she had had a blood clot in her left leg several years prior. As a result, she had been placed on the blood-thinner coumadin, mainly to prevent any further blood clots from forming. In January of this year, she added, the coumadin had been stopped under her doctor's guidance. "And let me tell you," she said, sweeping her arms for emphasis, "I don't miss that medicine at all. Making adjustments with the daily dosages, getting endless blood draws to check the levels, and worrying about bleeding and bruising all the time. Who needs that?"

I laughed at her spirited animation. "I'm here today, though, doctor," she continued, "because my left calf is swollen and I am worried I may have developed another clot." With this, her husband spoke up, his husky voice contrasting his thin, wiry frame. "I hope not, honey. I know how much taking that medication bothered you."

I approached the difficult subject--her being wheelchair-bound. Wheelchair dependence equates to some degree of immobilization. Immobilization equates to a higher risk of blood clot formation, since the lack of contracting calf and thigh muscles decreases the vigor of the venous blood returning to the heart from the lower body.

"Mrs. Wilson," I asked gently, quietly, "do you mind me asking why you are dependent on a wheelchair. What happened?"

As she spoke, her husband looked down at his restless hands folded in his lap. Mrs. Wilson took a deep breath before starting. "It was a few years ago. I was driving alone in my car on a rainy day when, unfortunately, I had an accident. A horrible one at that. As soon as it happened, I couldn't move my legs. I thought that maybe I had broken them both. Or maybe they were pinned under my dashboard. As hard as I tried, though, I was stuck, trapped in my car." As she had approached these last spoken words, her voice had subconsciously lowered.

Her smile belied her anguish and I remained silent, patiently waiting for her to finish. "It turns out," she softly whispered, "that I was wrong. I didn't break both of my legs. And my legs weren't trapped under my dashboard. I had broken my lower back and this resulted in a spinal cord injury." An injury that changed her life forever.

Her husband contributed. "She had real bad arthritis and, because of this, her lower back vertebrae were brittle and couldn't tolerate the awful force of the accident. Her broken back pushed into her spinal cord and paralyzed her legs."

Imagine the wide circle of hurt that her injury had created. Her children, her grandchildren, her husband, her friends--the pebble of her injury must have rippled through too many unimaginable facets of the life that she knew.

I shook my head. "How awful," I muttered, immensely sad for her. I tried to imagine my mother or father in such a predicament, the changes in their life that would be necessary after so many complacent years without tragedy. Going from the general aches and pains that come with age to simply not having the use of their legs.

Mrs. Wilson placed her hand on top of mine, which was resting on her side rail. "Dr. Jim, I look at this injury as a blessing. Sure, there are inconveniences that come with each day, but I'm lucky to be alive." She paused, resting her eyes on my own. "I still get to wake up each day. I get to talk to my children, my husband, my grandchildren, and my friends. There is still a lot I can do." Her eyes lit up and her smile broadened as she talked. I had no doubt that this resilient woman had acquired a deeper understanding of the important things in life. "Don't get me wrong," she continued, "it's been hard, sometimes really hard," she said, nodding to her husband, "but I'm here and I'm alive. And I feel the love of my family."

Her perspective was inspiring and well-timed. I had been having one of those "poor me" days. Just the previous night, one of my favorite aunts, my Godmother, had died. I was struggling to wade through my next few shifts before heading home to be with my family throughout the visitations and funeral. For various reasons, my aunt's death had reminded me that I am entering another phase of life, where the people I respect and look up to for spiritual guidance were gradually leaving this world for greater things. I was sad for her children, my cousins.

Thanks to Mrs. Wilson, though, I lost my "poor me" attitude pretty quickly. I changed around my thinking, too. I pictured my aunt being reunited with my uncle, her husband. I pictured her being greeted by previously deceased family (including my mother) and friends. I pictured her smiling and pain-free. I pictured her as a protective angel who, undoubtedly, would watch over all of us. I would miss her, yes, but she was not suffering anymore.

Looking back at Mrs. Wilson, I saw nothing but smiling and warmth, an infinite aura of graciousness. Her appreciation for life was evident and dazzling. Her subtle lessons about life and loss and positively readjusting under difficult times were not lost on me.

Thank you, Mrs. Wilson.

I am happy to report that Mrs. Wilson didn't have a blood clot in her leg, after all. In other words, all that blood was returning to her heart just the way it should. With energy and vigor.

I wouldn't have expected anything less from this amazing lady.

As always, big thanks for reading. Have any of you sustained a tragedy that you've had to overcome? Next post will be Friday or, at the latest, Monday. See you then...

The Coumadin Goose-Egg

Despite the light drizzle of rainfall, she pushed the grocery cart filled with her unwashed clothes to the local laundromat. It was Tuesday and, like any other Tuesday, it was laundry day. Despite her dislike of rain, habit and her dirty clothes dictated that she make this journey.

Her apartment was just a few short blocks from the laundromat. Being elderly and recently widowed, a local laundromat, a supermarket, and a bus stop were on her short list of requirements for her new apartment's location. She had never taken the time to learn how to drive when her husband was alive. On hindsight, though, she should have insisted that he teach her. Now, she relied on public transportation and her steadfast grocery cart, given to her from the local grocer's manager when she had asked him about buying one.

She smiled to herself as she remembered that recent day. "This ones' an old one," the manager had said as he patted the cart's handlebar, refusing her money, "just take ol' Bessie and get some good use out of her, okay?" She blushed before taking Bessie, not quite sure how to deal with the random kindness of a stranger.

As she pushed her cart slowly along the sidewalk, she came to a slight decline just a half-block from her destination. Even in dry weather, she had fretted about guiding her cart down this gentle-sloping hill. Now, with the rain-slicked walks, she stopped at the top and appreciated the wet sheen of the approaching pathway. She briefly contemplated turning around and returning another day to wash her clothes.

She should have.

Slowly, after deciding to proceed to the laundromat, she guided her filled-cart down the sloping walk. One step. Another. And another. Her hands tightly gripped the cart's handlebar, her elderly, frail forearms beginning to burn from the effort it took to maintain her sliding cart.

Another step. And another. The muscles of her arms tremored. Her calves tightened. She leaned her body back, struggling to keep the cart from careening out of her control.

It was all in vain. Just a few short yards into this declining slope, she lost control of her cart. It began to slip and slide over the sidewalk, pulling her resisting body along, her hands still death-gripping the handlebar. It veered towards the left, almost jumping the curb and joining the local traffic, before she was able to over-correct the cart and steer it right.

The cart jumped the sidewalk and smacked right into a telephone pole. And, unfortunately, so did she.

I walked into Room 22 to find a very sweet-appearing elderly woman in her late seventies. She was sitting upright in her treatment cot, a hospital gown loosely draping her frail body, answering her nurse's interview questions with her matching frail, high-pitched voice. One that crackled with nervousness. On her room's counter, I noticed a pair of comfortable leather beige shoes, old and well-worn. Beside her shoes, a pair of pastel-blue pants. Polyester, of course. And on top of the pants, a blood-soaked floral shirt.

"Mrs. Taylor," I said, extending my hand as I entered, "I'm Dr. Jim. Nice to meet you, maam." She looked up at me and gave me a feeble smile, extending her hand, cold and covered in paper-tissue skin and blue-ribbon, spidery veins. I took it between both of my gloved ones.

"Maam," I continued, "what happened that brought you by ambulance to our ER, today?" Despite asking, I already knew the answer. Whether it was my nearness or the brightness of the overhead fluorescent lighting, I could now appreciate the significant cephalohematoma of her right frontal region. Othewise known as a contusion. Or, for those of you in my age group, a "goose-egg" or "goose-bump." You know, those big swollen bumps that our mothers used to hold the flat edge of a table-knife against to reduce the swelling when we were young and had just fallen off our bikes.

Anyway, Mrs. Taylor's goose-egg was quite impressive, covering most of her right forehead with the lower border extending into her upper brow and eyelid on the same side. Even her nasal bridge was swollen. Overlying the goose-bump, a superficial abrasion seeped a touch of thin, watery blood. The overall injury gave this kind woman a lopsided, deformed appearance suggesting that she just went ten rounds with Rocky.

Mrs. Taylor, in-depth, told me what happened. It was important to her that I understood two things. One, that she was a recent widow and missed her husband terribly. And two, that she had tried everything in her power to stop her cart from going out-of-control.

I patted her shoulder. "I understand, Mrs. Taylor. Thank you for sharing that with me."

What complicated Mrs. Taylor's history, besides Mrs. Taylor being elderly, was the fact that she was on coumadin, a blood-thinning medication that is used in the treatment and prevention of clots and, in Mrs. Taylor's case, for an irregular heart rhythm that otherwise increases the likelihood of stroke. I knew this, from the sheer size of her injury as well as the thin, watery blood oozing from the site.

I asked her a few more questions. Had she lost consciousness? No. Did her neck hurt? No. Did she have numbness or tingling or weakness in any of her extremities? No. Any chest pain, shortness of breath, or abdominal pain? Again, no. No arm, leg, or pelvis pain, either. On exam, outside of her impressive contusion, she didn't have any other significant findings. Well, unless you count her damaged pride.

I sent her, frail smile and all, to the CT scanner, where we imaged her head, her neck, and her facial bones. We were overly-cautious in her testing as her injury was considered a "distracting injury," meaning that with all of her attention focused on her goose-egg, she might not realize if she had neck pain. Thankfully, though, her reports came back well. No skull fractures or intracranial bleeding, just the large collection of swelling and bleeding outside of her skull cap in the frontal region. Her neck CT? Negative. Her facial bones CT? A questionable non-displaced distal tip nasal fracture. Her coumadin level had been in therapeutic range.

I discussed all of Mrs. Taylor's results with her. "Thank you, dear," she said, after I explained her next course of action. Since she was on coumadin, despite not having any significant bleeding within her intracranial space, we were going to admit her to the medical service for overnight observation. This is our hospital's protocol. Had she had a significant brain bleed, she would have been admitted to trauma and neurosurgery services and had her coumadin's effects reversed.

I never saw family or friends during the time Mrs. Taylor spent with us in our ER. Despite her frailty, though, she demonstrated a piss-and-vinegar attitude and resilience that assured our nurses and myself that she would be okay. She was one neat lady.

My one wish, though, for Mrs. Taylor? Well two, actually. One, I wished she had learned to drive at some point in her life. I meet too many elderly women who's husbands did all the driving so "I never had to learn." Of course, though, that would probably be me stuck behind her driving 15 mph in a 45 mph speed-zone. And two, I wished her husband had still been alive to hold a table-knife against her big ol' goose-egg.

Just like my mom used to do.

As always, big thanks for reading. I hope you had a great weekend. Next post will be Wednesday, June 9. See you then...