The Microscopic Spider Guy

I see a lot of disturbed people in the course of doing my job. We had a patient last month who had purportedly sprayed himself with pesticide in an effort to kill what he believed was an infestation of microscopic spiders. Now there are all kinds of mites that live on people, and there are pesticides made for this, but he was using your garden variety stuff, and he had no mites. What he did have was kidney failure, and his liver was going south as well. We admitted him, gave him IV fluids and antibiotics, and he started to feel better. That's when he began telling me his story.
He said all of his symptoms were caused by tiny spiders.
He told me the spiders colonized him when he had a medical procedure, a minor hemorrhoid surgery. He began itching after that, and decided that the "mothership" of spiders had been placed in his anus. (I would never make that up. The doctors even noted it in his chart.) As time passed he got weaker and weaker. He tried many things to kill the spiders, but nothing worked. He began crawling around his house, because he could not stand up without passing out. Finally his sister came and got him, laid him in her car, and dropped him off at the ER. It's a good thing.
I gave him exercises to do in bed, and tried to get him up daily, even raising the head of the bed inch by inch but he would panic at 45 degrees and demand to be put back to horizontal. Eventually his labs improved and his heart function normalized and they moved him off the telemetry unit where I work. I heard from a colleague on the med-surg unit a few days later that he had finally gotten up and walked to the shower with assist. I stopped in to say hello and congratulate him on his progress. He looked much better, pink where he had been yellow before. He said he was bored and was looking forward to going home. He complained about having heartburn, and asked if he could have something for it. I said I would ask his nurse, and made a joke about the hospital food.  "No," he said, "I don't think it's the food....Do you have any pesticide?"

Glass Bone Guy, or the Boi with OI

He was lying in the hospital bed, fingers flying across his tablet, a nice-looking college kid who ended up in the hospital after an accident on holiday at the beach. It happens. He had been drinking and had taken a fall, breaking his pelvis in two places. That last part was novel. 22 year olds don't normally break unless a lot of force is involved: high speed, long drops, crush injuries, etc. The admission note said he was just getting out of a parked car. Upon further review, it turned out he was with a group of male friends at a bachelor party, and they had driven to another location. They were all pretty drunk, and it was raining (very rare event here lately, by the way), and because of the way they parked, OI Boi needed some help to get from the car seat to his wheel chair, so his buddies lifted him across, except the wheelchair wasn't locked and they dropped him into a puddle. It was all hysterically funny and they got him up and back in his chair and the festivities continued but later that night OI Boi sobered up and realized he had sustained more fractures, in fact, he had fractured the 36th and 37th bones of his short lifetime.

"Osteogenesis imperfecta (OI) is a congenital bone disorder characterized by brittle bones that are prone to fracture. People with OI are born with defective connective tissue, or without the ability to make it, usually because of a deficiency of Type-I collagen." --Wikipedia

This particular young man had been able to walk until he was in his teens, with the help of titanium rods tamped down the center of his long leg bones, spine surgery and many foot surgeries, but eventually it was just too painful and slow, so he got a nice light sporty wheelchair, which made him faster than his peers. He modified it to make it even lighter and faster. He graduated high school and went on to college, and was living independently. He flew to California by himself for this party, and to do a little research on his passion, which he told me was beach accessibility for wheel chair users. 

OI Boi needed a few days to recover, but he didn't need more surgery; his bones were expected to heal by themselves. The hardest thing was regaining his wheel chair transfers, because he had to land on that broken pelvis, and because he had to get over the big wheels of his sport chair, without having armrests to press up from, because he had taken them off. 

As in all my stories, I'm not sure what became of him. We sent him on to rehab to build sitting tolerance and work on those transfers before flying back East, where he could stay with his parents for awhile. Maybe he will come back with a business plan for beach wheelchair design; this would be a great town for it. 

60 is the New Middle Age

I'm a woman of a certain age, and we do not speak of this. I haven't hit the big 6-0 yet, but it is looming. I said something to my husband about being middle-aged, and he quipped, "Really? Do you think you will live to 120?" It was then I realized that I was....old!

I live an active life. The kids are grown, I have more free time after work and on days off, and I like to spend it bicycling with friends. We took a two day tour down the coast a few weekends ago, over big hills and dramatic descents. We stayed in a hotel that used to be a vacation ranch house for William Randolph Hearst. It's kind of funky but cheap and scenic, perfect bike tour qualities. We got our rooms and showered off the day's sweat and grit, (it had been a hard and hilly 80 miles) and as I sat down on the patio overlooking the sunset, with a cold beer and a bowl of salty chips and pretzels, I got a text message from a dear friend. She is a bicyclist, rides maybe 4 or 5 thousand miles a year, and has ridden in dozens of countries. I have been lucky enough to go with her a few times. She wrote that she had bad news. She had been to the doctor and then to a test, the consensus was that she had a cancer of the colon. As I read this, a chill went through me, even though I was sitting in the sun.  There it is again, we are mortal. Even those of us that refuse to age and never slow down, gadding around the globe on bicycles, hiking when we are too sore to ride, eating our fruits and veggies with gusto, resolutely dieting off in spring the pounds we pick up in winter. Even us.

Post script: I started writing this story in October, and now it is February. My friend is okay. She had a big surgery and a rocky recovery, but all is finally well. The tumor was contained, the nodes were negative, all 21 of them. She is back on the bike and planning her next tour: Poland, maybe followed by China. What is the take home message? Live each day like it could be your last, or at least your last really good one. Start right now. And get a check-up!

The Man Who Swallowed a Spork

He was in his mid-30s, nice-looking guy, short blond hair, blue eyes. It was his eyes that got my attention. His stare wasn't vacant, but it did not meet my own. He had his boundaries, and he was not going to connect with or acknowledge anyone. He was shackled to the bed at both wrists and ankles, plus the nurses had put soft foam wrist restraints on him, mostly to protect his skin from the hard metal cuffs placed by the police. Two security guards were stationed in the hall outside his door. They were required to be present because this was a prisoner, and one who had assaulted a police officer.

According to the record, the man had been seen beating his head against a brick wall on the main street of our little tourist town. Someone called the police, who stopped him from doing this and brought him to the hospital for a medical checkup. He was found to have a mild concussion, but no internal bleeding or fractures, and he was sent back to the police station. He was placed in a cell and given food, with a plastic spork  instead of dangerous metal utensils. Later he was noted to be choking, which required another trip to the hospital, this time to remove the spork from his esophagus, which was fairly easily done by the docs.

Now they ordered PT to get the patient up and exercise or walk him, so he wouldn't get deconditioned from so much bed rest. (This is where I always come in. I'm the getter upper.) I was allowed into his room with the two-man security team.  The patient followed commands for muscle strength and range of motion testing. He was normal, strong and fit. The guards released his shackles so I could get him out of bed. He stood up, all the while focused on a point about two feet in front of his face, totally without expression. As he let me guide him to a chair, I noticed a trail of blood drops on the floor. I asked the guard to pull the curtain, then I looked under the patient's gown for the source of blood: there was a three inch wide shallow hole gouged into his buttock, fresh and beefy red, where I assume he was somehow able to rub against one of the shackles or maybe the bed itself, until his flesh opened. I left him with the guards and found his nurse, who applied bandages, and in another day or two he was discharged, probably to a psych facility like the one he was recently released from, before he decided to come visit our town.

Mental health facilities are overburdened. People who do well on their medications are released, no doubt with some kind of plan of care, but they often go right back on the street, maybe in a different town, and descend back into their personal hells, right in your backyard or on the main street of your town.  I don't have answers. I don't know what this man needed. I know we didn't fix him.

Mortality and Me.

I work in a small hospital, in a small town that is trying very hard not to become a large town. I see a lot of different people every day as they enter and leave the hospital system. Sometimes they come electively, to get a joint replaced or a heart repaired, and sometimes they come traumatically, after a fall or a stroke or a car crash, and sometimes they just get sick, and then sicker, until they call 911 or they go to their doctor or clinic and get referred to the ER from there. So I get to know a little bit about a lot of people's' lives, during their average length of stay, which is about 3 days.

What surprises me most is how long people can manage at home, even in poor health, even with terrible balance, even with dementia: they are driving their cars to the same market they have always shopped at, parking next to an empty cart so they can balance with it to get into the store, pick out the things they like to eat, swipe a card and get their purchases back to the car, drive home, get it into the house, up the 3 or 6 or 20 steps, day after day, year after year... until something goes wrong, something out of the routine, and it all falls apart.

There was an old couple once who were admitted to the hospital together after a farm worker found them sleeping and nearly dead under an apple tree in a large commercial apple orchard. They had been to church on Sunday, as usual, but while waiting to make the difficult left hand turn out of the church parking lot to go home, the man decided he would turn right instead and go home a different way, but he got lost. He drove around and around until they ran out of gas, and then they decided to go together on foot to get help, but they wandered deeper and deeper into the orchard until they were too tired to walk any more, so they just laid down to rest. Days went by before the worker found them. They had hypothermia, dehydration with kidney damage, but they had each other, and they both made it out of the hospital, which is where my stories always end.

This could be kind of a dark blog, being about life and death and all, but really, what else is there? I also have to keep it anonymous, since I swore an oath to not violate anyone's privacy. I think it will be good for me to share the stories, you can decide if it is good for you to read them.