Hunan States of America

9781483526911

1

Awakening! – Awareness!

W-h-a-t is h-a-p-p-e-n-i-n? W-h-e-r-e—am—I? Who—am—I? What’s going on? Can’t o-o-open eyes. Tryin – can’t. I can feel my eye lids flexing but they’re not opening; maybe a little movement – but not opening. What’s going on; what is this? Why am I like this? Eyelids letting in some light now, see shadows moving around me but can’t open eyes enough to make them out. I need help – need to call out. Can’t. It’s like that dream when someone is after you and you try to yell but can’t. But then I used to make a mumbling noise that my wife called talking in my sleep. I’ll try that. Help me!

Memfff! .... Mummf!

Hey! The veggie’s making noise. Get the nurse. Come and see, I think he’s trying to move!

I heard that – kind of muffled but I heard it. Maybe I can move my hand to get attention, I can feel the muscles try to tense but -- so weak."

Hey! His finger moved a little – I swear it did. Wow! And the orderly told me he was going to get dumped off life support tomorrow.

Can’t ---keep ....... The patient drifted back into his comatose state. Darkness again, blankness.

The orderly comes briskly into the room with the nurse close behind. What’s that you’re carrying on about, Rummy? This patient’s been in a coma for a couple of years now, it’s not likely that he’s talking or moving purposely, chided the orderly.

Look, we’re supposed to prepare him to get taken off the support machines tomorrow. If it will satisfy Rummy that we examined him, it probably won’t change anything and we’re already here. Go through the test procedure to see if there’s any response. The nurse’s instructions to the orderly seemed a bit passive and condescending.

OK. The orderly reluctantly assented, It’s going to be colossal waste of my time but, if that’s what you want me to spend time on, here goes nothing and I do mean nothing.

Where is his darn chart? Alright, I’ve got it. His name is Sevan; I’ve been calling him the veggie for so long that I forgot. Mr. Sevan! No response. MR. SEVAN! The orderly increased his volume as is protocol but still no response. This is a waste. Can we stop now?

The nurse moved to the bed side. Nurse Constantine was a good sized woman, not fat but well muscled like she worked out. She was a good physical specimen and attractive in that toned sort of ‘hard body’ physique. Anna Constantine was about five foot, eight inches tall with dark brown hair that she wore in an athletic style cut, not too short but just covering her ears, a style reminiscent of Dorothy Hamel’s style when she was in the Olympics but with more curls in it. She had magnetic green eyes that captured your gaze when you looked into them, set in an oval face with a heart shaped chin below full fleshy lips that were naturally reddish, as the lips of someone eating berries, and her eyes and lips displayed beautifully against her light milk chocolate colored skin with a little rose on her high cheek bones. If she had not answered the calling to be a nurse she could have easily been a successful film actress or model. She grabbed the patient’s hand and squeezed. Wait. Did I feel feed-back or am I just being hopeful?

W-h-a-t w-a-s that? Did someone touch my hand? Our patient returned to some faint awareness of those beside his bed.

Squeeze my hand! Nurse Constantine ordered. The patient tried feebly to contract his fingers around the hand in his; the effort was great for him and the results were barely discernible but Nurse Constantine felt enough to hold the opinion that the patient was somewhat responsive. He’s responding! We need to find the doctor.

Oh crap. Just let him go, he’s going to be a lot of work if we keep trying to put off the inevitable. Groused the orderly but he abided by the nurses instruction and went to find the doctor on duty in this special care unit of the government run hospital.

Again the patient slipped back into unconsciousness, blackness, emptiness. Maybe the orderly was right, maybe the incident was a fleeting last awareness, if the nurse actually felt anything at all rather than her own optimism.

The nurse stayed by Mr. Sevan’s bed, she tried to get further response by saying his name, then by shaking him slightly then more vigorously, she pinched his arm but to no avail, there was no reaction. Nurse Constantine was feeling foolish. She usually was professionally detached from the patients, as she felt that was important to provide proper care and treatment, but there was something about this patient that had stirred feelings of affection, not the romantic kind but more like compassion for a pathetic, helpless soul. And now she might be embarrassed by the orderly’s ‘I told you so’ taunting in front of the doctor.

Kevin Priestley, the orderly, was cynical beyond his years. He was somewhere in his late twenties but had a reputation that would be the pride of any aged curmudgeon. Kevin was thin, almost gaunt which made him look taller than he really was at about five foot, nine inches tall. He had dark blond hair which he wore at medium length long enough to comb straight back in a pompadour. His pale complexion and light blue eyes seemed to approach the look of an albino. He had some effeminate mannerisms and could be sarcastic and curt and some would even say ‘bitchy’. He didn’t seem to enjoy taking care of sick people; to him it was a job, an unwanted chore of drudgery necessary to provide for his materialistic wants.

As she was going through these thoughts of dread in her mind, the doctor arrived in tow by the orderly. Nurse Constantine, Kevin here tells me that you’ve detected responsiveness in our coma patient. Is that so? What tests have you done? The doctor wanted to get right to the point but by the smirk on his face Nurse Constantine suspected that he was already primed for skepticism by the orderly. The nurse began explaining the hand squeeze that she felt but the seeming lack of subsequent responses, the orderly jumped in and continued to make his case to the doctor that it wasn’t willful by the patient, Rummy chimed in uninvited to tell the doctor what he had heard and saw, and with the three of them talking at the same time the doctor couldn’t make out what anyone was saying. He raised his hand and firmly instructed them, One at a time please!

W-h-a-t’s that noise. I think I hear people talking. The patient seemed to gather coherent comprehension more rapidly now, not quickly but faster than his original awakening.

Look! I’ll do a couple of the standard tests and we’ll put this to bed, said the doctor dismissively.

MR. SEVAN!

Whaaa.

What the heck! Get me a flashlight. I sure heard that. Nurse, hand me his chart. This patient might actually BE in Rancho Scale Level two.

Charles T. Mosley, MD was a large man but composed mostly of muscles, he stood around six foot – three or four and weighed in at 280 – 290 pounds. His hands were, as they say, the size of ham hocks, his face was round but with a square protruding jaw. Doctor Mosley had wrestled at heavy-weight division during his undergraduate college days and, by accounts heard around the hospital, developed a pretty good record. He kept his light brown hair neatly combed with a part on the right side, the only departure being that he was slightly graying at his temples and he wore the hair there a little longer so he could comb it back and accentuate the gray, thinking that it made him look more distinguished and looking distinguished was a distinct advantage for a medical doctor. His hazel eyes always appeared dispassionate in the professional mask he adopted for his work but the wrinkles at the corners of his eyes and the sides of his mouth gave testimony to a good nature that enjoyed a good laugh; somehow he managed to never let that person show through, when in his doctor mode. He customarily arrived at the hospital in a suit but soon donned his white coat and was never seen without it during his shift of duty.

Doctor Mosley was more animated than usual upon the discovery of this patient’s potential recovery, from the coma that he had been in for the past two years. He knew it was rare for such a patient to recover and even more unlikely that the recovery would be substantial but he seemed genuinely excited at the prospect of being involved in such an event; probably that old scientist thing in his makeup. He seemed pleased to have a novel case to offset the boredom of the more routine cases he’d been handling.

I’m not able to shine the light into his eyes because his lids are still not open. Nurse, hold open his lids one at a time so I can see if there’s a reaction to the light.

Yes doctor, Nurse Constantine replied and promptly began holding one eye lid and then the other open, as the doctor moved the light beam back and forth in front of the eyes.

There seems to be eye movements but they’re intermittent, although that’s to be expected at this early stage. Any recovery would be expected to have set backs instead of a constant improvement. If we’re to see if there will be a recovery and, if so, how much, we’ll need to initiate the protocol to help him get along in the process.

What!?, protested Orderly Priestley, We don’t have enough staff to baby set this patient. I hope you don’t expect me to volunteer any extra time for this lost cause. Can’t we just transfer him somewhere else?

No, snapped the doctor, obviously agitated by Priestley’s constantly negative, black attitude about everything. I’ve been told that every bed in every other yi yuàn is full. Transfer is not an option; we need to come up with something else. The protocol for helping a coma patient at this Rancho stage to recover is to use balanced periods of stimulation and rest, to talk to them, keep telling them the day of the week, the date, the time, where they are and anything we know about their family or friends and yes, that will be time consuming, and I’m afraid that Priestley may be right, it may be impossible for us to do.

At this point Rummy piped up, I hate that Chinese name for hospital, yi yuàn, having been in and out of hospitals enough lately I know the words but I don’t like them. It’s just not American.

Doctor Mosley was running short of patience with the useless, non-productive comments from Orderly Priestley and now Rummy, That’s the standard National term and we’re obliged to use it so your disdain for it is of no consequences. Now, if there are no useful comments about our situation, please be quiet. What’s this patient, this Rummy doing here anyway, while we’re discussing the coma patient’s personal and private information?

That’s right, you have no reason to be here. Orderly Priestley was happy to take the queue from the doctor’s comment. It gave him the opportunity to do what he enjoyed the most, exert his authority. Go on now; get back to your own bed.

Wait! Rummy protested, as he was being physically pushed along by Priestley. I was just going to say that I would take the job of trying to help this guy. I could set and talk to him and do those things you said need to be done, ‘cause it’s not like my schedule is too full. That last comment was a subtle poke at orderly, Priestley.

That’s ridiculous, quipped Priestley, Rummy’s not a medical professional. Let’s just ship this guy somewhere else.

Wait doctor, interjected Nurse Constantine, who had been trying to consider some useful solution, isn’t the protocol you referenced frequently performed by family members?

Yes it is but, as I’m looking at his chart, the only family member for Mr. Sevan that we knew about was his wife, who died last year.

I know but my point was that laymen often do the work necessary to help a coma patient recover. Why not give Rummy a chance? I’ll instruct him on what to do and supervise his work. We really don’t have a viable option. At least that would buy us some time.

After a long pause to consider the nurse’s proposal the doctor assented, Alright that sounds like an interim approach. I’ve got other patients to see, I’ve got to move on. Nurse, I’ll leave it to you to instruct Rummy on what to do and he can get started tomorrow. In the meantime, I’m changing the instructions on his chart regarding the ‘plug pulling’ that was scheduled for tomorrow and you all need to keep this between us. We don’t need some government hospital inspector snooping into this or we’re all in the soup, got it!

Oh great! This will be a colossal waste of space, complained the orderly.

Priestley! What I said about keeping mum goes for you too, do you understand me? snapped Doctor Mosley. The orderly nodded his head reluctantly and finally sensing that he was not going to win this argument, at least not this time, he turned on his heels and slunk away to attend to his other duties in the ward.

The doctor’s parting comment sort of over his shoulder as he walked off was, And nurse, make sure the progress notes are copious, we may want to publish a paper about this.

2

Rummy Recovery

Edward Rumenski was his given name but everyone at the hospital called him Rummy, which was probably started by Orderly Priestley just like the name ‘Veggie’ was for the coma patient, since he regarded Mr. Rumenski with contempt because he had been in and out of hospitals for years with chronic Schizophrenia. His mental illness has caused him to become a vagrant at times, to drink too much and to generally make a public nuisance of himself. His current confinement in the hospital had been court ordered and, becoming comfortable here in familiar surroundings, he has made little progress toward his own recovery and discharge from the hospital.

Rummy is a short fellow with a face that causes the mind to consider references to a mole. He stands about five foot, six at maybe 135 pounds, with dirty blond hair that hangs straight down at the sides like the straw that hangs over an opening in a loft of a barn. His nose is proportionately big for his face, which is a large contributor to that mole image; his complexion is ruddy and he seems to always have uneven, unkempt facial hair stubble. But when he was lucid, he was a kindly soul, anxious to help others, even when his help wasn’t wanted or appreciated. The prospect of helping the coma patient, the veggie as he had unfortunately referred to him following the orderly’s example, seemed to perk him up with anticipation of finally being considered useful. His disposition had become decidedly more cheerful.

The next morning, Nurse Constantine gave Rummy instructions in laymen’s terms for what he should do and when, not wanting to confuse or overload Rummy she was sticking to only the first two Rancho Scale stages that she expected to see from the patient (Stages II and III).

Stage two is where he’s at now, meaning that he responds inconsistently to stimuli such as sounds, sights (when he has his eyes open), movement, touch or pain and responses may be hard to discern or to attribute to the stimuli, so you’ll have to watch him carefully, as you do things. Here’s a check list of things you should present to him and record his reactions, if any, and, if no reaction, make a note of that when keeping your good detailed record of things. On this list are; talk to him in your normal voice, neither yelling nor whispering, talk to him about anything you normally would to a person you were having a conversation with, tell him the day, date, time, where he is and what happened to him. I’ll give you information for that part in a minute. Talk to him about his family members, taking that information from what I’m going to give you, also. Assume that he hears everything you say, so be careful what you say and no more of that ‘veggie’ stuff. Got that!?

Yeah, yeah, I understand. I’m pretty lucid when I stay on my meds. Rummy assured her.

And another thing...I think I told you this but don’t overload him right away, don’t get anxious for success, this could take a while so be patient and start slow, only a few hours at a time to start. He needs periods of rest now along with the stimulation.

OK, so what do you suggest for a schedule?

Well for this week, let’s do one hour after breakfast and I mean yours, I don’t expect him to be eating normally yet, and one hour after lunch, then let him rest. And you and I must meet each day before you begin to discuss the plan for the day and we will meet each day after your last session with him to go over what happened and, hopefully, his progress. That will determine what we do for the next day and I want to see your notes, at that time. Make your notes as you go, don’t try to wait till the end of the day and catch them up. Your memory’s not that good. Are we clear?

Yes, yes, yes. I’ll do what you say.

Good. As his responses improve, to become more regular and more directly associated with your stimuli, we’ll discuss the next level and develop a new check list of things to try. And Rummy, thanks for doing this. If this guy has a shot at some portion of recovery, it wouldn’t be likely without your help. Trust me, it’ll make you feel good and help with your own improvement to wellness.

That day was kind of a rough start for Rummy, as his good intentions were larger than his skill at therapy and he floundered a little and understanding the trial basis of his assignment had the good sense to seek guidance from Nurse Constantine. However, he finished the two hour assignment and did his debriefing with the nurse, who freely critiqued his notes to try to improve them to a style and specificity that she thought would satisfy Doctor Mosley, whenever he might decide to randomly review them. They were off on their mission to help this patient regain whatever he could of a normal mental state. Rummy was his road to recovery.

That’s alright Rummy. This is the first day and you couldn’t be expected to have a good grasp of this process when you lack any kind of training or experience with this sort of therapy.

Or any other therapy except my own, added Rummy.

OK. Think about that ... how do the therapists work with you? They try to be patient, right? And consistent? You might have some experience to call upon after all and I don’t want to pressure you but we need to show something positive whenever Dr. Mosley decides to inquire after our progress, his nature being to check on things randomly whenever the idea strikes him. Think about the things that went on today and get a fresh start tomorrow. That’s an advantage with a patient like Mr. Gary Sevan; each day will be like his first day for a while, so any short comings will be as though they never happened. You’ll get it; you’ll do fine if you don’t lose hope. Start anew tomorrow. Nurse Constantine turned to head toward the change room to collect her things and check herself out from her shift.

Day two started a little better for Rummy. He had gone over his script the day before in a bit of a halting fashion, because he was unfamiliar with the subject matter and the way he was supposed to follow it, making his delivery anxious and lacking in confidence. He still wasn’t fully comfortable but wanted to make Nurse Constantine proud of him and truly wanting to help the coma patient, Mr. Sevan. And, while he tried to suppress the notion, there was a strong motivation to show orderly Priestley up as wrong. He always kept his tongue about it but the constant downgrading by Priestley hurt him, not the least of which was getting tagged with that nickname, Rummy. Everyone now called him that even the doctors and it made him feel ‘less-than’ but he wouldn’t give Priestley the satisfaction of knowing that. Maybe if he’s successful here Anna (Nurse Constantine) will call him by his given name, Edward.

So he sat at the side of Sevan’s bed for the hour in the morning before lunch and before Mr. Sevan’s routine physical therapy, when the therapists manipulated his muscles to keep some tone, and he talked to him.

Hi Gary. Today’s Tuesday, July 1st and the year is 2022. You’ve been here for a couple of years. Drat! I’ve forgotten the date when he came into the hospital. Nurse Constantine said I should keep telling him things specifically because that might help him recover consciousness and remember. Where the hell is that in the notes she gave me?

Rummy sorted through the pile of papers he had on his lap wanting to keep some sort of flow going, feeling the need to break away from the halting style of his monologue and thinking that the more continuity would somehow facilitate the recovery.

Ah, here it is. Wow! March 15th of 2020, during the political season leading up to the presidential primaries.

Your name is Gary Sevan, Rummy started again, You’ve been in this hospital since March 15, 2020 and you’ve been in a coma ever since but a couple of days ago you started to show signs of awareness and I’ve been assigned to talk to you and hopefully help you return to the living from your vegetated state. Ooops! They warned me about assuming that he could hear everything I said. If he begins to dislike me, I’ll probably fail to help him. Gotta watch that.

Gary, it’s 10:45 in the morning and in about 15 minutes the physical therapists will be here to work your arms and legs and stuff.

As Rummy kept going on his script, Sevan became somewhat aware of his presence and his eyelids fluttered as he tried to open them but Rummy was looking at his notes and didn’t see it. Then he jerked his right arm slightly and Rummy caught that out of the corner of his eye and flipped his head excitedly in the direction of Sevan. Gary Sevan’s eyelids fluttered again and this time Rummy’s own eyes opened wider in amazement and anticipation. Could he really be having a positive effect on this guy? This could be the best thing that he had ever done in his lifetime!

That’s it Gary! Open your eyes! Mr. Sevan! MR. SEVAN!

I can ... hear you ... but I can’t quite talk ... hard to even move a little... got to let him know I’m here ... got to try, the patient is thinking.

But then Gary Sevan returned to his sleep state. Rummy started to shake him and shout his name, MR. SEVAN, MR. SEVAN, GARY, COME BACK! His tone was anxious and urgent but to no avail.

Rummy, quit yelling you’re making too much noise and let that guy go, he’s a waste. It was Priestley snapping at Rummy as he pushed a cart of meds past.

Rummy rush out to the floor to find Nurse Constantine, he still had 8 minutes or so left on the assigned hour but he was so excited to tell Anna what had happened. He found her scurrying around the nurse’s desk organizing a tray of medicine to be administered to patients.

Anna! Anna! Er ... sorry ... I mean Nurse Constantine. You have to hear this. Wait till I tell you. This is great. He was speaking hurriedly and still panting between sentences to catch his breath from running the floor to find