Terry Becker was my longest and most miraculous patient at Laguna Honda Hospital in San Francisco, the last almshouse in America. She was the patient who teetered the most on the edge of disaster, and she ended up by surprising me the most.
Terry was a street person, a heroin addict, and a prostitute. She'd been fine -- at any rate, in her usual health -- until twelve days before, when she woke up to find that she could no longer move her arms or her legs. So her boyfriend took her over to the emergency room and there the diagnosis was made: she had transverse myelitis, which is an inflammation of the spinal cord that, in just a few hours, can cause a section of the spinal cord to swell against the inner bony sides of the spinal column. This swelling is devastating to the body's ability to move because the spinal cord is made up of nerves that act like wires, transmitting messages and impulses between the brain and the rest of the body. When the spinal cord swells, the nerves stop working, and everything past the swelling can't function. Terry's swelling was in her neck. So she couldn't move anything past her neck -- not her arms or legs, bowel or bladder.
She was worn, and looked to be in her fifties, though I knew from her records that she was only 37. She was very thin. Her long, colorless hair was stringy and unwashed; her face was tired and drawn, and there were dark circles under her dark eyes. Her teeth were decayed; her nails dirty, untrimmed, and stained with nicotine; and she was positioned uncomfortably in the chair, with her neck awry. Her eyes, when she looked up at me, were slightly out of focus.
"Can I sit on the bed?" I asked.
"Can I have a cigarette?" she replied.
I sat down. "After I talk to you for a bit and examine you; how about that?"
She sized me up. I wasn't very big, but I was determined, and she couldn't move.
"Do you have anybody to take care of you when you leave?" I asked.
"My boyfriend. Mike. He'll be here soon."
Soon after her admission, the first of the month rolled around. In our city this is "payday" for the homeless, because anyone who shows up at City Hall on the first of the month receives $360, no questions asked, as part of General Assistance. And right on schedule -- that is, on the first of the month -- Mike the boyfriend did show up. He was blond, cute, and in his twenties; and he wore tight and not-entirely- clean Levi's and a denim jacket. He was not unkempt, and he was polite, but he was not kempt, either.
He wanted to take Terry out, he told me, just for a few hours, down to South of Market, where she could sign her check over to him.
I watched as he wheeled her off in a wheelchair, a bag of urine, covered, at her side. She was somewhat better than when she arrived. Her hair was washed and brushed; her clothes were clean; and she could move both shoulders. Mike put a cigarette in her mouth and off they went.
Over the next several months, Terry was admitted to the County Hospital many times -- mostly for kidney infections and once after Mike beat her up and robbed her. Finally, in the middle of winter, she was found sitting in her wheelchair on the streets, cold, unarousable, and without a heartbeat. Someone called the paramedics. Even though she was clinically dead, they began resuscitation efforts and also warmed her body. It took them a while, but once she warmed up, her heart resumed its steady beat; her pulse returned; and she began to breathe. After two hours, she woke up.
The paramedics took her to the County Hospital, and a few days later, she came back to us.
This was the second time I'd seen her. She'd lost quite a bit of function since her brief rehabilitation. She could still move her arms, but not her legs, and she couldn't stand anymore. The rehabilitation staff went to work. After a few months, she was back to her baseline; she could stand again. And again, after a time, Mike appeared with alcohol and drugs, and Terry left the hospital.
I admitted Terry for the third and last time, four and a half months after her second flight from us. This time she seemed played out, her spirit tired, given up. Her flesh -- the tone of her skin, the absence of muscle -- told the same story; it, too, lacked that vital force, that vis vitalis that is the essence of health and the substance of life.
Then I saw the open wound on her back. The description from the County Hospital had not done it justice.
Terry's bedsore was the worst I'd ever seen. It was huge, enormous, and deep. It went from the middle of her back all the way down to her tailbone, and it spanned both of her sit bones. The skin was completely gone, of course, but so were the fat and the muscles that cover the spine. In their place was an unidentifiable mass of decayed and decaying and infected tissue and at the bottom of this wide, deep hole I could see bone -- Terry's spine.
She had no protection. Everything delicate and crucial in her body -- bones, kidneys, spinal cord -- was exposed and vulnerable. Giving antibiotics to try to prevent infection wouldn't protect her, I knew, because germs would rapidly become resistant to them. And the bedsore was too big to graft. It would have to heal on its own, and that would take years. In the meantime, what chance did Terry have of not getting an overwhelming infection that would kill her?
I thought about Hildegard of Bingen, the twelfth-century Benedictine nun who was known for taking a gardener's approach to the body in her practice of premodern medicine. I asked myself: What would Hildegard do? How would she treat Terry Becker's huge and open wound?
What she would do, I suddenly saw, was remove obstructions to Terry's viriditas, to Terry's natural ability to heal.
What was in its way? I asked myself.
The mass of dead tissue was in its way, and every bit of it had to be removed.
Any pressure on Terry's body, from wrinkled bedclothes to hard mattresses, was also in its way and had to be removed. Anything that interfered with the circulation of her blood -- nicotine, for instance -- was in the way of viriditas. Dirt, unkemptness and stale clothes. Unnecessary medications. Fear, depression and hopelessness. All were in its way.
I would fortify Terry's viriditas with earth, water, air, and fire. That is, with good nutrition -- tasty food, vitamins, liquids -- deep sleep, fresh air and sunlight.
After that? Peace. Rest. Safety.
Oh, and time. As much time as Terry needed.
It was quite amazing how fast Hildegard's prescription worked. Within a few weeks I began to see signs of healing deep within Terry's wound. There was no infection, and deep down, at the base of the wound -- (was it my imagination?) -- there was a smooth and pink glistening, which was starting to cover and protect her spine.
But then the first of the month rolled around, and Mike showed up.
The nurses made him wait in the smoking room, and Terry wheeled herself on her gurney, facedown, back covered, the whole length of the ward. Then she rolled into the smoking room. They were there a long time. Then the door opened, and Mike came out and left.
Terry had thrown him out. She told him never to come back.
Then she stopped smoking. Without nicotine constricting her blood vessels, the tiny new arteries and veins at the base of her bedsore could absorb the vitamins and protein she was eating, and the hole in her backside began to fill in.
It took a long time. It took two and a half years. But we were in no hurry, and neither was she.
During that time, Terry's teeth had been repaired by our dentist, and eyeglasses prescribed by our optometrist. She'd gained a considerable amount of weight. Her hair grew in thick and dark; and behind her new eyeglasses, makeup appeared.
One day toward the end of the two and a half years, the social worker found her brother, who was living in Arkansas with his wife and two children. He asked whether his sister could come and live with him. He was not rich; he didn't have the money to send for her; but if the hospital would send her out to Arkansas, he would do the rest. Since we had a Patient Gift Fund, donated by families for just this kind of situation, the social worker bought an airplane ticket and made arrangements for Terry to be cared for in a hospital in Arkansas.
After that, I don't know what happened to her or how she lived. I only know what I read in her obituary, eleven years later, which mentions children and grandchildren but nothing about her long stay in our city; nothing about Mike or living on the streets or the big bedsore. Or the effort of will that saved her life, that reaching down for a sense of self she'd forgotten or didn't know she had, or didn't have until that moment on the gurney in the smoking room.
This story is part of a HuffPost Healing, a Huffington Post series about physical, mental and emotional healing. Have you had an experience with healing? If so, we'd love to hear it. For Terry, it was Dr. Sweet's removal of obstructions to her to natural ability to heal. What was it for you? Reach out by e-mailing firstname.lastname@example.org.
Excerpted from God's Hotel: A Doctor's Pilgrimage to the Heart of Medicine, published by Riverhead Books, a member of Penguin Group (USA) LLC. Copyright ￂﾩ 2012, Victoria Sweet. Reprinted with permission.
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