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A rehab team deals with having one of its own as a patient
Quality care became personal for Alabama facility
Editor’s note: Staff at Healthsouth Rehabilitation Hospital of Montgomery, AL, found their normal empathy for patients stretched to the limit in February 2000, when one of the facility’s case managers became a traumatic brain injury patient after suffering from two berry aneurysms. June Fowler, RN, nearly died from the aneurysms, which occurred during the Christmas season of 1999. Her slow and miraculous recovery was championed by the entire rehab staff, who helped her recover to the point that she’s since returned to rehab work. Fowler and a co-worker/friend each wrote an article about their experiences when Fowler went from being a member of the rehab team to being a patient. Fowler’s physician also wrote a brief piece explaining her injury. Rehab Continuum Report presents their stories as follows:
By Joan Greene, RN
Healthsouth Rehabilitation Hospital
At lunch in December 1999, rehab case manager June Fowler had her usual salad and was smiling and looking ahead to a long-awaited trip with her husband over New Year’s. We were talking about Christmas with our families when June suddenly looked around to the other case managers seated at the table and remarked, "I hope nothing catastrophic happens to me early in life." Her remark surprised no one at the table, because in rehab we see this reality on a daily basis. What we also see is the wonderful work our team at Healthsouth Rehabilitation Hospital in Montgomery provides.
Later that afternoon, as I walked toward the front door, one of our rehab techs came running up to me, saying, "Come see about June, we think she’s fainted!" A Dr. Stat was in progress. As I arrived in the room, I could not believe my eyes. There was my friend and co-worker in an apparently life-threatening crisis. An ambulance took June to Baptist Hospital in Montgomery, and our rehab hospital’s physiatrists were our eyes, ears, and messengers through the crisis period. Her status was listed as a massive subarachnoid hemorrhage. She was not expected to make it through the night.
We prayed, and our close-knit staff began an immediate outpouring of love, financial support, and other gestures of aid. Our human resource department set up an area for ongoing donations of cards, gifts, and food for the family as they kept vigil at the hospital. We did everything we could, but were not permitted to visit her during those first traumatic days.
June made it through that night. And another, and another. Finally, the ventilator was discontinued, and June was transferred to an Atlanta hospital to be seen by a neurologist who specializes in aneurysms. The MRI revealed not one but two aneurysms, one of which had bled massively. June was diagnosed with having had berry aneurysms, which we knew made her outlook bleaker.
She remained unconscious. New crises emerged regularly, and it began to look as if June’s time for recovery was running out. Then June began to defy all odds. Her extremities began to move, and she began to recognize her family and friends. She began to speak, asking about her patients at Healthsouth, and she even woke up one day worrying about being late to work.
Weeks passed. The staff continued to pray for her, and the Atlanta hospital continued with many tests and surgeries. At last in February, 2000, June was transferred to our own rehab hospital, and William Rogers III, MD, was her physiatrist.
Although June had many challenges ahead, we were encouraged by how she remembered each of us by name. Only her short-term memory was absent. The staff did everything we could to help her, including eating with her, bringing her homemade soup, and spending time with her. Soon, she was trying to convince us to give her scissors so she could cut off her pelvic restraint, or "just untie me," she said.
One day, she rolled her wheelchair into the case managers’ office and went straight to her desk where she proceeded to pick up a pencil, access her voice mail, and retrieve all of her messages. We had left her messages intact because no one had her personal voice mail code. We were so excited! Words cannot describe the utter joy we felt as we witnessed her triumphs.
There were disheartening times, such as her double vision, but we were still convinced she was on her way to recovery of an independent life. We were glad we could assist her in this objective, because as with all of our patients, she was going to get our best efforts, and the staff had moved into high gear. Before we knew it, June was discharged home. She continued to visit Healthsouth for her outpatient therapy, despite the 45-minute drive, each way, three times a week.
What happened next was no surprise, because it was what we had been planning and hoping for to happen: June returned to work in the case managers’ office. Our administration had supported June by keeping her job secure. Then, as part of her outpatient treatment, Darlene Barnes, speech therapist, designed a vocational rehab program for June in which she would work in our office. So June sat in on team conferences, discharges, and admissions, while under supervision and while receiving staff support. We used competency checklists and other tools to make certain June was getting what she needed in order to return to independent work, play, and life.
June’s double vision, sleepless nights, and headache persisted, and so did we. On the last day of June’s therapy, she visited our office once more. She was chomping at the bits to be 100% recovered, and we assured her that with time her vision would clear. Her cheerleading squad of myself, Marlene Herring, Sharlotte Rogers, Elizabeth Eiswerth, Joane Green, and a host of other staff sent her home with well wishes and continued hope.
Weeks later, I was called to the clinic. My heart raced as I sped there, hoping all was well. June had already been through so many challenges! When I walked in I immediately saw June, sitting beside her husband, Bennie Fowler. Smiling like a new penny from ear to ear and wearing no eye patch, she exclaimed and laughed, "I can see perfectly. I’m ready."
June now has been discharged by her physicians as "100% cured." She’s begun attending continuing education unit programs and is back to full-time work. The members of the rehab team stop and smile each time we see her walk confidently down the hall, talking with patients, or driving her car. It’s such sweetness to be able to welcome her home.
By June Fowler, RN
Healthsouth Rehabilitation Hospital
Joan Greene, a friend and co-worker, has done a good job telling the story of my injury and recovery. What she cannot do for me is thank everyone on the Healthsouth rehab team who contributed to my recovery. I had to ride in the wagon a while with some of the staff pulling and the rest pushing.
Due to a short-term memory deficit during the early stages of my illness, my memories were through the eyes and ears of my husband, Bennie Fowler. Now my memory is intact, and when I think of where I was then and where I am today, I can only smile because I know how many dedicated and professional rehab people helped me get here.
What I remember most during my experience as a patient is how positive and caring the staff were to me. I cannot recall any one specific therapist during the time I was an inpatient because all of their smiling faces parade through my mind. Still, I know that each and every person on the rehab team was involved in some way, if only by a smile or encouraging word.
My family kept a book for me. It was a testimony to the love and support the rehab staff provided us. Some members of the rehab team even devoted time at home to cook for Bennie, who spent every spare minute at my side. My physicians, Felix James Allen, MD, and Thomas Rigsby, MD, were supportive and willing to refer me to an expert on aneurysms when it became medically necessary. When I returned to Healthsouth Rehabilitation Hospital, William Rogers III, MD, became my physiatrist, and despite my antics he carried on and got me through the ordeal. The doctors and entire staff cheered me on.
As a patient, I was no exception. I tried everything, including escape, and as a result I had to sleep in a vail bed and use a pelvic restraint. The difficult part was probably the fact that I am a nurse and thought I knew it all. Yet, the staff persisted in their dedication to their job and to me and gently prodded me to go on.
By the time I was discharged to outpatient rehab therapy, I was so geared up that I wanted it all, and I wanted it NOW! However, there was Ted Price, physical therapist, cracking the whip. You can believe that he knew how to keep me in line. My stubbornness kicked in a few times when he insisted I jump flat-footed on a 2x4 and stand in the middle of the gym like the crane bird on one foot. But you know what? I did it all! Now I’m back to work.
Since returning to work, I have been meeting one of the biggest challenges of my life. It would have been far more difficult for me to meet this challenge if it weren’t for the support of everyone in the rehab hospital, including the administrators who held my job, speech therapist Darlene Barnes who was instrumental in my vocational rehabilitation, and especially the support I received from the other five case managers, who have cried, laughed, and sacrificed to have me back to work with them.
By William N. Rogers III, MD
Healthsouth Rehabilitation Hospital
A berry aneurysm is a small, localized widening or outpouching of an artery that looks a lot like a berry. Berry aneurysms usually occur at branching points of arteries. Classically, they can be found at the point at which a cerebral artery departs from the circular artery known as the "Circle of Willis" at the base of the brain. They are thought to occur due to the congenital absence of media and internal elastic lamina within the blood vessel wall, with ballooning occurring as blood pulsates through the vessels over the years.
That is to say, one is born with the abnormality, and high blood pressure or straining can ultimately cause the aneurysm to rupture. This may result in subarachnoid hemorrhage and the patient reporting the worst headache of his or her life. Rupturing most commonly occurs when the patient is in middle age, and it can cause neurologic deficits and even coma. The treatment includes surgical clipping to stop the bleeding, followed by rehabilitation.