Chapter 9
Happiness to Pain
There is plenty of medical information in this chapter; I am not a doctor or claim to be one. I gathered all my information on WebMD and other sites. Explanations are at the end of the chapter.
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Now let us discover who the man in the lift is and maybe Louisa's thoughts on another will come to light… I love the drama ;)
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As we wait for Doctor Thyring, Louisa falls into a contented sleep cuddled around my arm; she is hugging it as if it is a lifeline. I smile looking down at this alluring woman, self-possession as long as she is near, I am content. The words of the song we last danced to come to mind, she introduced it on our last evening before she left for London. The song talks about his woman teaching her man the art of love, and that is what Louisa has done for me this past year. I close my eyes as I recall the words;
'She said, it's time to teach you the art of love, She said, we're gonna reach to the heart of love, A place you never knew, a place that lives somewhere inside of you'
'I know I'm on a journey I won't forget, I know I had it in me to give and yet I never could, before I had to, if I wanted to be yours'
'You made me see I'd have to be a brand new man, He lives in me, so here in me is where I began'
'You showed the kind of lesson I can't erase, you showed a way to get from that lonely place, to where love comes alive, And you'd be waiting there when I arrived'
'The truth was clear, Love's not a place you to find, It lives in here, Just leave it space, give it time'
'I learned that I could stumble and maybe fall, I learned in being humble I'd have it all, A brand new way to live, That love's not what you have but what you give, And the art of love is who you share it with'*
I open my eyes and look at the love of my life, my medical mind formulate the necessary actions required to take place this morning; the removal of the IUD, her scan determining if we will continue the pregnancy, with the question of an ectopic pregnancy lingering in the back of my mind. Louisa hasn't had any signs for me to think the worse, but what if I missed those signs. I remember her the morning she was getting ready to leave; standing naked in front of the mirror in our bedroom and I noticed but thought nothing of it. My mind travels further back to our weekend escape and my attention to her breasts; how did I miss the change. As a husband, I enjoyed the view but as a doctor, I should have noted the difference. The exam and scan will tell us our next step. Once again my medical mind processes the odds on this pregnancy; an IUD is ninety-nine percent effective as a contraceptive, add my age, my biological clock is working just as hard as hers. The changes of defective sperm are greater and can cause DNA damage to the fertilized egg resulting in higher cases of structural, functional, or developmental birth defects. The importance that we maintain an optimal healthy lifestyle can be the deciding factor with this pregnancy. We were lucky Phillip is so healthy. Suddenly it dawns on me that I will be involved from the very beginning with this pregnancy. Watching as Louisa's girth grows with the development of our child, something I missed until the last three incredible months a year ago.
Louisa stirs, readjusts her position on the bed, and releases my arm, my numb arm. I watch to assure she isn't in pain when I hear the soft tapping on the door just before it opens by the ward nurse. She quietly walks in carrying the chemical pad for Louisa's back. She carefully places it along her lumbar and recovers her with the bedding, then taking Louisa's notes and jotting in the information for the record. Louisa moans as the heat starts to ease her pain and she relaxes more into a deeper sleep. The nurse leans towards me,
"Doctor Thyring has scheduled the scan and IUD removal for half nine this morning. She should be along soon to talk."
I nod acknowledgment. She speaks again seeking my attention to waver from Louisa once again,
"A Mr. Pettyjohn is at the nurse's station down the hall and wishes to talk to you. He is a lead consultant on another case."
"Tell him I'll be there shortly."
"Yes, Doctor," she says and departs.
I stand up and check Louisa's intravenous line, take her unbroken wrist checking her pulse and adjust her bedding, pulling it over her arm that escaped as we cuddled. I kiss the top of her head before I leave; I check my watch, it is just past seven.
As I exit Louisa's room I see a doctor talking to a nurse, and walk along the corridor towards them, he notices me and walks my way; extending his hand and introduces himself;
"Mr. Jason Pettyjohn, Neurologist, if I may, I need to talk to you regarding a patient of mine."
"I don't understand I no longer have privileges here. I am only here for one patient, my wife."
"You are Doctor Martin Ellingham, former vascular surgeon here at St. Mary's, correct?"
"Yes," I curtly reply.
"My patient is a former surgeon Christopher Ellingham."
"My father, he is here, in your care?"
Yes, he was involved in an accident last night, came in with a head injury. Can we go to the ICU rooms, so we might discuss his medical issues?"
My thoughts swiftly enter and exit as I recall all the painful memories throughout my life because of this man. I am torn – Louisa is just down the hall and he is somewhere in this hospital and I will ensure the two will never meet. Finally, I ask,
"Why do you need my input?"
He pulls me aside towards the edge of the ward. "Your father has a slow bleed in his brain due to the collision with a metal railing when the lift he was riding in unexpectedly jolted to a stop. The force of the stoppage caused him to lose his balance and slam into the railing to the ground of the lift. The blow to his head caused TBI with edema; I relieved the ICP. Your father suffered a hemorrhagic stroke. I would like you to look at the CT scan to determine what more can be done."
I look at this doctor as I try to push the anger aside and see my father as just a patient, a body needing my medical expertise to save his life.
"I… can give you some help, but I need to be with my wife for her medical procedure at half nine, but I need to talk to her doctor first."
I practice the breathing exercise I have worked on for so many months as I got my haemophbia under control; now more than ever I need to get in control of my emotions.
"Let's go, show me what you have. I assume you are using supportive care for the brain edema?"
As we walk Mr. Pettyjohn informs me of everything they have done for my father in the past nine hours.
"Yes, his body temperature has been lowered along with the use of hyperbaric oxygen therapy. I performed a ventriculostomy very late last night and of course, the use of medication to break up the clot is being used. I know you are no longer a vascular surgeon, but I would like you to talk to my colleague who will perform the surgery to repair the bleed."
"I haven't performed surgery in more than four years, many procedures have changed. I can't see how I can help him."
"My colleague has studied every paper you ever wrote and admires each new technique you introduced to surgery; he is very capable and wishes to work with you. He came in the ambulance with your father and started working on him immediately. The only reason your father is still alive is because of him."
We have finally reached the ICU and as I walk up to my father, I no longer see the bully but a frail old man. The last few years have not been kind to him; his arms have lost their muscle tone and are thin. If the stroke doesn't kill him, the noticeable skin cancer on his neck and face soon will. Nevertheless, he is a striking man for his age, full head of silver-white hair and more than likely continuing his affairs. I take the medical notes, read through them as I glance at the monitors for his updated numbers. As I continue to read, I notice another person examining my father, shorter than myself with perturbing ears, not unlike mine. When he turns to look my way it was like looking in a mirror; our eyes, nose, and ears were familiar but unlike me, his lips are more normal. Mr. Pettyjohn interrupts my thoughts when he introduces his colleague,
"Doctor Ellingham this is Mr. William Shaw, a vascular surgeon."
"William this is Doctor Martin Ellingham, the patient's father."
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Louisa is startled awake by the nurse taking her vitals and the removal of the heating pad; her eyes flutter open and slowly the room comes into focus as she realizes Martin is not sitting in the chair.
"Nurse, do you know the whereabouts of my husband, Doctor Ellingham?"
"He stepped out to talk to another specialist. He should be back soon. Doctor Thyring will be down shortly to get in a quick examination before you are sent upstairs for your scan and IUD removal."
"Thank you," Louisa says. "Nurse, please can you help me adjust my 'doughnut' so I can sit up for a while."
The nurse quickly helps Louisa and leaves. Louisa stares off as she wonders what specialist Martin would talk to and how it could relate to her injury.
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Mr. Shaw shows me the latest brain mapping scan showing the exact location of the bleed and explains how he has chosen to surgically repair it.
"I have expanded on your technique; instead of clipping the base of the weakened blood vessel, I like to perform a coiling procedure."
"I read about this latest type of procedure in an issue of the BMJ and I am impressed with both the success rate and the recovery percentages for the patient. When do you plan to operate?" I ask.
"I am waiting on the latest labs; the numbers will determine the timeframe for intervention. Mr. Pettyjohn's earlier surgery has slowed the bleed along with the medication. Now we wait and watch, but I always plan for different options in cases like this one."
"Good. I would appreciate an update on any changes and when you do operate I would like to observe if I am allowed. Now I need to return downstairs to my wife, she was admitted last night."
"Yes, I know. She was in the second ambulance called. Kevin escorted her and I took the first ambulance with your father, as he was the more serious case."
My anger streaks across my face, BREATHE, I tell myself. Now I know who the man in the lift with Louisa was… my father. Mental imagine flash as I see my father making moves on my wife; the knowing smile, undressing her with his eyes, the nasty suggestions. I quickly turn away from his body lying on the bed…. Did he touch her, the ways I have witnessed him do in the past? 'I am in control, just relax and breathe, control' I continue my exercise.
"Keep me informed, I will be with my wife," I say as I bolt from the ICU rooms. I have to escape, I flee down the hall and find a window at the end of the corridor. Facing the sky, obscured by clouds rendering a gloomy day, akin to my thoughts at the moment, I take hold of the sill tightly making my knuckles turn white, I am in conflict with so many emotions vying to dispose of in my heart. I close my eyes, remembering the last days leading to this horrible night; Louisa and I spoke of her going to a medical affair with her friend and boyfriend; the phone from Holly informing me of Louisa being injured in the lift and a man with her. Now I know the man was my father. I try to recall, two years ago when my parents visited, did Louisa see my father – speak to him? Did Louisa see my father at the hotel, introduced herself as my wife, and what? My mind blinds me as I see my father say his snarky comments; 'did he drug you? Whatever do you see in him?' Then jealousy strike below the belt; did he touch her? Remembering mums words 'couldn't see me as a woman only a mum and sought out other women, wasted forty years of my life.' My father sought out other women for his pleasure; the resemblance between Mr. Shaw and myself, could there be a connection between us? I suddenly have the urge to vomit; hurrying to the loo, and vomiting in the available toilet. I finally emptied the contents of my stomach, and stand in front of the mirror, an ashen-drawn face looking at me, with shaking hands I scoop cold water onto my face as I clear the mental images to the back of my mind. I need to see Louisa; her presence always helps settle me, calm me as I feel her love for me.
As I walk down the stairs to her floor, my self-worth is returning, just knowing Louisa is waiting for me, carrying my second child. I push open her door, Louisa's eyes look up into mine and for now, all is well.
"Where did they drag you off to?" she asks.
"The man injured in the lift with you. There are complications and his consultant requested my knowledge."
That is the most I can say now as the uneasiness starts to boil up again; Ellingham breathe. I walk over, take her hand in mine and kiss her, taking as much pleasure as I can get from those lips. I kiss her forehead, relaxing, pushing my mind onto another subject, I take her pulse and look at the monitor; I go into doctor mode, part of my life I truly understand and feel comfortable.
"How are…."
As usual, we are interrupted with a knock at the door and it opens as a tiny woman with bright smile strides into the room.
"Doctor Thyring," she announces as she introduces herself, and offers her hand to each of us to shake. "Let me look over your notes and we can discuss our next options, shall we."
She spends several minutes reading Louisa's notes, checking the lab results, nodding, and making sighs as she reads. Finally, she looks up at us,
"Ok, let me ask a few questions and then I'll do an examination. First how long has the IUD been in place?"
"Roughly nine months," Martin replies.
"Have there been any issues with it?"
"Not really, my periods increased in length. They normally lasted five days with the first couple very heavy, but now they last a couple of days longer and heavy bleeding lasting most of the time. About two months ago my periods returned to normal."
Martin adds, "Louisa is monitored for anemia and I ensure iron-rich nutritious meals especially during her menses."
Doctor Thyring nods and writes a few notes. "How many pregnancies and were there any issues during labor and delivery?"
"I was pregnant only once with delivery last June, as far as I know, nothing uncommon with the labor or delivery. Martin, you would agree?"
"I agree with nothing uncommon during the pregnancy but the delivery was seventeen days earlier than the due date. According to her notes, her delivery was not a concern."
"Let me do a quick examination, then we'll move you up to have the scan. Doctor Ellingham, did you plan on staying during the exam?"
I look at Louisa and she shakes her head. "No, I will step outside while you examine my wife." I stand, kiss Louisa on her cheek, and walk out. Actually, I need this time to clear my mind and focus completely on Louisa. I stand just outside her door, guarding it against any unnecessary intrusion. After some time Doctor Thyring pulls the door open, announcing she is finished and walks over to the nurse's station to request Louisa is moved upstairs for the scan. After several minutes an orderly wheeling a wheelchair enters the room, gently helps Louisa out of bed, and placing the medical cushion and Louisa into the chair, covering her with the warm blanket he brought with him. "It is cold in the corridor, I don't want you to get cold," he says.
Louisa gives him her ever-present smile and thanks to him for his thoughtfulness.
We quickly move along the corridor to the bank of lifts, I look over to Louisa to see her reaction and she displays no agitation as we enter, as the lift moves I continue to watch her and make a mental note. When we reach our destination the orderly again helps Louisa onto the couch in the examination room, as a technician moves the ultrasound scanner across the room towards Doctor Thyring; I appreciate the doctor will perform Louisa's scan herself. I watch as the grainy array of images present themselves on the screen. Louisa looks at me, squeezing my hand either reassuring me or asking for my reassurance, in my frame of mind I am not sure, so I squeeze her hand and lift it to my lips. I continue my intense gaze and begin to relax a bit; Louisa and our baby are fine; I squeeze Louisa's hand and rub my thumb across her palm. Doctor Thyring clears her throat, looks over towards us, and flips the speaker on; the sound of a strong heartbeat is music to our ears. But I hear something different, like an echo.
Louisa makes a gasping joyful sort of sound, "Is that the heartbeat?" Louisa looks up at me, "Martin is everything fine? We didn't talk about another child so soon, How did this happen?" She picks up my concern and turns her head back to the screen I am intensely staring at with a shocked look.
"Yes, strong at one hundred seventy-five bpm," Doctor Thyring says. "Let me finish the measuring and we will talk." During the measuring, she moves the wand and the speaker picks up another sound, a separate sound of another heartbeat. She moves the wand around a bit more and finds a second fetus; preoccupied with the measurements she mumbles under her breath, "At their age a contraceptive failure ending with twins."
I look at Doctor Thyring and she nods her head acknowledging my knowledge of this new development.
She finishes her measurements and replaces the scanning wand as her nurse hands Louisa tissues to wipe the lubricant from her lower umbilical area. I scan the doctor's face, trying to understand her facial expressions; from what I viewed, the pregnancy is not ectopic, good heart sounds, or better two beating hearts.
"First let me put your mind at ease Louisa, it is not an ectopic pregnancy. The fetuses are securely located in the uterus and developing well with my measurements estimate ten weeks, two days from conception. Does that sound correct," she asks looking at Martin.
I nod and am very sure of the exact evening I impregnated Louisa; Louisa and I can discuss this further alone in private. "Doctor, you need to explain to my wife the term 'fetuses'. I am not sure she understands your discovery."
"Mrs. Ellingham, Louisa; you are carrying two fetuses, not one. You are pregnant with twins."
The look of shock on her face is an understatement; she turns to look at me, trying to read my eyes for how I feel. "Martin, how… and two babies?"
I know my face shows panic, but in reality, I am proud and concern starts pushing forward above all other thoughts. "Ahh… Doctor… two fetuses and my wife's injury are going to be a problem. A single feotus we could adjust her recuperation, but two will double the strain, and she is more likely to have serious problems in the later stages." My mind races through every article I read when Louisa turned up six months pregnant, thinking of her slight frame had problems containing Phillips' growth; what will happen with two if they are as large as Phillip.
"Your wife will need extra care with this pregnancy. I understand you live in Cornwall near Royal Cornwall Hospital so I have the perfect Obstetrician, Doctor Rawle. He has some highly regarded research in high-risk generic pregnancies."
"We know him… he was my OB for my last pregnancy and the one that inserted my IUD." Louisa continues to look at me with a questioning look upon her face as she answers Doctor Thyring.
"Louisa studies show that older women tend to release more follicles each month during their menses and are more likely to yield twins than younger women,"* my medical mind recalls as I continue to understand all that we have learned this hour. The next nine months are not going to be easy for any of us. I look into Louisa's eyes as she listened to my medical ramble and I can see she understands the emotions that are coursing through me and the hard time I am having controlling them.
She squeezes my hands and looks back to the screen, "Doctor, what other information do you have?"
The doctor fumbles a bit understanding the enormously important information she has just provided, "Now the due date is December second."
"Doctor, I delivered two weeks early with my first?"
"Babies come when they are ready unless there is a medical issue that spurs on labor," she says with a smile, "A pregnancy with twins will be different but I don't want to get too far ahead of your OB is Truro. How was your overall pregnancy last time?"
"Louisa had no medical issues and our son has no medical issues either," Martin recounts as he continues to look at me.
"Let's go to my office and discuss this pregnancy with your injury becoming the upfront issue," she says as she stands moving her rolling chair out of the way as the technician moves the scanner out of the way. The nurse and orderly help Louisa back into the wheelchair and we all move out of the room and down a few doors to Doctor Thyring's office.
She sits behind her desk, places her notes on her desk, looks at us waiting for us to meet her face ready to start; I feel like a ten-year-old in Professor 'Strick-dick's' classroom waiting for his lecture to begin in Biology.
"The pregnancy looks good so far; the fall didn't cause the fetuses to abort themselves, which usually happens within the first twelve hours. I didn't have to remove the IUD as it dislodged itself, I could not find it during the physical examination I did downstairs and the scan showed no sign of it; as I said it was a contraceptive failure."
Louisa looks at me as she says, "Again, when will I get to choose the right time?"
Doctor Thyring is startled by this announcement and looks in my direction, but doesn't say anything. I grunt and say,
Our first child was a contraceptive failure, a… a condom failure during our engagement." Admitting this private matter is not as hard as I thought it would, I didn't show embarrassment as I answered a doctor's question with a medical answer.
Doctor Thyring smiles, as she has heard many of these types of answers but for this to happen twice to the same couple would be a good opening line at a medical conference on birth control; she laughs internally. "Now your coccyx injury will make this entire pregnancy difficult, mostly uncomfortable. During pregnancy, your hormones will cause your coccyx to shift throughout the next thirty weeks. As the uterus grows it will apply pressure on the coccyx; you will experience pain throughout your lower back, hips, and upper legs. The pain may be sharp or dull and will vary in intensity."
I can see the understanding in her face and eyes as the knowledge comes to light; Louisa is only now realizing how this injury and now the pregnancy will affect her life for the next six-plus months. I raise her hand that I am holding over to my heart and firmly place it against my chest hoping to reassure her I will be with her through all of this.
Doctor Thyring continues in her soft encouraging voice, "I know they have told you how to deal with your coccyx injury and I only want to emphasize these keynotes. Sitting for long periods causes pressure on your coccyx unless you sit with that special cushion. Stand if possible early in this pregnancy; the faster your coccyx heals before the third trimester the easier it will be for you. So rest, don't overuse your lower body with lifting, moving of furniture, or even lifting your son; you must walk or stand once every hour for a short time. Take strolls, swimming, or light exercise like yoga every day; register for a yoga class for pregnant women it is an excellent way to ease the pain. Do stretching several times a day and when your girth is more noticeable use a maturity belt; using it earlier than usual will help support the weight of the growing fetuses and add less stress on your back. I noticed when I came to your room earlier; you were lying on your side, the perfect way to sleep or lie down during this pregnancy, but add a cushion between your knees to relieve the pain. Later on when you find it difficult to lie on your side use a full body pillow to cuddle around and cushion your back for support or I find that husbands are also a good way to support their wives back."
Louisa looks over to me and I know I start to blush as I see Louisa smile her mischievous grin as I recall the three months the need to spoon up to Louisa at night; the feel of her body and my need to touch her and the baby.
"Now as I understand you were visiting London and will be seen for this pregnancy at the Royal Cornwall Hospital, and you are using Doctor Rawle once again, correct," it sounded more like a command to me.
"Yes I believe if he is available for Louisa; it would be wise for him to follow this pregnancy especially with this new complication," I announce.
"I will call him later today and explain Louisa's situation and send my notes to him, are there any questions I can answer for either of you?"
Louisa and I look at each other, "Unless Louisa has a question I believe I understand what is required for Louisa and the babies to get through this pregnancy safe and healthy."
Louisa shakes her head, "I know Martin will take care of any of the medical issues that will arise from my injury and the pregnancy. Thank you, Doctor Thyring for seeing me on short notice and your thorough examination today."
"I understand Doctor Chen scheduled an ultra-sound for you, the orderly will take you to Orthopedics for it."
The orderly almost immediately walks in after Doctor Thyring's departure and we find ourselves in the lift going down to the second level. Doctor Chen meets us as Louisa is rolled into the clinic and directs the orderly to the room. "Doctor Ellingham while the orderly helps your wife onto the exam couch I wanted a word," he says as he directs me to another room. "I wanted to make sure we are on the same page; if her injury points to a significant angulation it may require a closed reduction and I want to get your opinion," he says.
"Doctor Chen, you are the specialist in this case but as you said if the ultra-sound shows an angulation that requires reduction then it should be done. Before you do it we will need to fully inform my wife what the procedure entails. What medication do you plan to use?"
"I believe intramuscular local anesthesia due to the pregnancy."
"Agree; should we get on with it then," I say knowing this will be difficult for Louisa when the local wears off and her pain will increase until the swelling recedes again.
We walk into the room and I see Louisa on her side stretch out on the exam couch with the machine set up behind her. "Mrs. Ellingham may I call you Louisa," Doctor Chen asks.
"Yes; what is going to happen during this exam?" she asks.
"I will use the transducer gel and wand to show a picture of the base of your spine. I will look at the last 3 to 5 fused bones to see if there are any, what we call avulsion fracturing; a small chunk of bone broken off. If I don't see any, I will look to see if the coccyx is dislocated. My exam didn't indicate any radical displacement, but a small dislocation can be just as painful."
I take my place directly in front of Louisa's upper body; I want to see the screen but I want to be able to notice any reaction to the pressure Doctor Chen will induce during this exam. I look into a set of worried green eyes, I place my hand over hers and smile, "Louisa just relax; you will feel some pressure from the wand, let us know if it is too painful and we can inject a local to ease your pain."
She shakes her head and closes her eyes waiting for the start of the scan.
"Sorry the gel will be cold but will warm quickly as the waves go through," Doctor Chen says and he busies himself with the scan. Slowly the imagine of Louisa's spine comes into view on the screen; working the wand farther down her spine the coccyx comes into view, and sure enough, it is dislocated. "Doctor Ellingham, what degree would you say of the dislocation?"
Louisa opens her eyes and I can see panic, squeezing her hand tighter, "I would say it is borderline to significant." I know what the next step will be, "I believe it requires a closed reduction."
"I agree," Doctor Chen announces as he looks over to the nurse standing near a table with a sterile towel covering a tray, "Nurse roll that over here."
"Louisa, your coccyx is dislocated, the degree of the dislocation is called a significant angulation or displacement and requires a closed reduction, meaning an intra-anal manipulation," I say looking directly at her. Doctor Chen and I agree this is needed and because of the pressure of the procedure we feel pain relief is required. Normally a different medication would be used but with the pregnancy, he will use local anesthesia to temporarily numb the small area," I tell her. "Doctor Chen will clean the area then apply a topical numbing agent before injecting the anesthesia in a circular patch near your lower back buttocks region.
She nods, "I understand Martin if you feel this is necessary."
"I do, but I need to tell that when we anesthesia wears off, the intense pain from the manipulation could be as severe as last night. The area will once again swell up putting pressure on the coccyx. Louisa, you need to keep them informed of your pain levels; I couldn't bear to see you in pain."
"Are you ready Louisa?" Doctor Chen asks.
"Yes," she says as she increases her hold and looks deeply into my eyes.
"Okay, here is the first injection, should sting just a bit for a short time. How are you doing, Louisa?"
"Fine, really didn't feel much."
"Good, then you should not feel much more as I finish here." Doctor Chen finishes his injections and we wait for the medication to take effect. "Louisa, your husband is going to help you pull your knees up and hold them. Just like last night, I will apply gentle pressure to your rectum as I manipulate the coccyx back into position." As he is explaining the procedure he moves into position pulling on a surgical glove, as a technician applies the gel once again to Louisa back and starts moving the wand to focus on the coccyx; soon the tailbone comes into focus. "Louisa I will insert my finger into the anus. I will slowly and gently follow the normal contours of the rectum until my finger touches the coccyx. I will gently palpate all the structures as far as my finger reaches. These structures will include the coccyx, lower sacrum, lower SI joints, the sacrotuberous and sacrospinalis ligaments, and their attachments. After I check the entire area, I will know where there is tenderness, swelling, asymmetry of the structures, the tautness of the ligaments, and deviation of the sacrum. Louisa, tell me of any pain; my contact on the coccyx should be continuous, and a firm pull in the direction of correction will change the pressure so that the adjustment is comfortable. I will massage the ligaments on one side up to the sacroiliac joint as there is commonly one ligament that is taut and tender due to sacral deviation. I will repeat the same with the opposite side. I will repeat the entire adjustment a total of three times while increasing the pressure slightly each time within the comfort level for you. It could take up to ten minutes, please try to relax."
With Louisa's acknowledgment, Doctor Chen starts; I watch the screen as the manipulation takes place, glancing periodically back to Louisa's face judging her pain. It is a long ten minutes for me, the pain medication dulling the procedure worked as Louisa never revealed any increase. I notice on the screen Doctor Chen is retracting away from the coccyx, upon further inspection the reduction is complete. I look down and whisper to Louisa, "He is finished; we should be done here shortly and will get you back to your room."
The nurse finishes cleaning the gel from Louisa's body and reties to close her gown. They slowly move her into a sitting position, off the table, and onto the wheelchair. The orderly starts to wheel her away, "I would like to take her back to her room myself but I want to talk to Doctor Chen, can you wait for me in the hall."
He looks over to the doctor who nods and he leaves for the hallway with Louisa. When she is out of the room I ask, "Are you satisfied with your manipulation of her coccyx?"
"Yes, as we saw it was just significant enough to have the procedure, if I went with just my examination last night I would have let Doctor Gee deal with it in twelve weeks if it hadn't improved. I asked for your objective examination and when you felt the ultra-sound was needed I knew the displacement was more in line for the adjustment," he says.
Satisfied with his answer, I thank him and turn walking out the door. I take Louisa's wheelchair in hand and walk us down the corridor and into an empty lift, pushing the button for her floor. When the door closes, I turn and lean down so I can wrap my arms around my beautiful wife and kiss her deeply, with as much passion I can provide in a rather old jerky moving lift. As I start to remove my lips from hers, she preempts me with a suctorial grip on my bottom lip, causing our kiss to deepen and linger on as the door slowly opens to an entertained audience; clapping has we depart the lift.
XxXxXx
End of chapter
Medical Explanations:
TBI: Traumatic brain injury, sudden event damages the brain; both the physical contact itself and the quick acceleration and deceleration of the head can cause the injury. The most common TBI are accidents including falls or being hit with or crashing into an object. The initial injury can cause brain tissue to swell. In addition, broken pieces of bone can rupture blood vessels. The body's response to the injury may also increase swelling; too much swelling may prevent fluids from leaving the brain.
Hemorrhagic stroke: Hemorrhage refers to blood leaking from a blood vessel in the brain, intracerebral. Hemorrhagic strokes are the most common type of stroke. They occur when blood vessels in the brain rupture. As blood leaks and the body responds, pressure builds inside the brain.
Supportive care for brain edema may include the following:
Hyperbaric oxygen therapy: providing oxygen through a respirator or in a chamber helps make sure that the blood has enough oxygen in it.
IV fluids: giving fluids and medicine through an IV can keep blood pressure from dropping too low. This helps to make sure that the body, including the brain, is receiving enough blood. Doctors attempt to use the right amount of the right fluids in someone with brain swelling.
Lowering body temperature (hypothermia): Lowering the temperature of the body and brain helps relieve swelling and allows the brain to heal.
Medication: In some cases of brain edema, the doctor may start a drug to relieve the swelling and/or to dissolve any blood clots. The drugs given depend on the cause and symptoms of the swelling.
Ventriculostomy: surgical procedure, a surgeon cuts a small hole in the skull and inserts a plastic drain tube. Cerebrospinal fluid is drained from inside the brain, helping to relieve the pressure.
IUD: Intrauterine device, shaped like a "T" and a bit bigger than a quarter, and IUD fits inside the uterus. It prevents pregnancy by stopping sperm from reaching and fertilizing the egg. There are several types, some release small amounts of hormones, and one that is made of copper working with your immune system to prevent pregnancy. They are safe if breastfeeding. Occasionally there is a chance the IUD will fall out during the menses (period).
Ectopic pregnancy: is also called extrauterine pregnancy, is when the fertilized egg grows outside a woman's uterus, somewhere else in their belly. It can cause life-threatening bleeding and needs medical care right away. In 90% of cases, the egg implants in a fallopian tube, this is called a tubal pregnancy.
During the follicular phase of a woman's cycle, which starts on the first day of her menstrual period, FSH follicle-stimulating hormone and another hormone, called LH luteinizing hormone are released from the brain and travel through the blood to the ovaries. They stimulate about 15-20 eggs in the ovaries in individual "shells" called follicles. Usually, only one of those follicles matures and is released during the cycle. Sometimes more than one follicle gets released, as in Louisa's case. In 2006 a study from researchers at Vrije University Medical Centre in the Netherlands discovered that older women have higher levels of FSH, prompting a greater likelihood of having fraternal twins. The study appears online in Human Reproduction.
Ultra-sound is a non-invasive way to detect avulsion fractures. An avulsion fracture occurs when a small chunk of bone attached to a tendon or ligament is pulled away from the main bone, an example is a stress fracture. Louisa's coccyx was a significant displacement only requiring manipulation; if she had a coccygeal fracture (avulsion fracture) surgery could be required if soft tissue needs debridement of the bone chips, and the fracture is resected (removed), this is called a coccygectomy.
*The song introduced to Martin by Louisa is the Neil Diamond song "The Art of Love"