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A Brain Injury Patient’s Journey through the Neuro Care Continuum
“Why does my neighbor keep calling me?” thought Monica Lavery as she watched a movie at a local Raleigh movie theater with her children. The answer became clear when she later answered a call from the Raleigh Police Department. John Lavery, PhD, Monica’s husband who was 68 years old at the time, had fallen 30 feet from a ladder while cutting tree limbs and was being taken by ambulance to WakeMed.
When Monica arrived at the WakeMed Emergency Department, she learned that John had suffered numerous serious injuries including an aortic tear, internal bleeding, broken ribs, and spinal and pelvic injuries. “He had so many immediate needs to keep him alive that we didn’t even talk about his brain injury until quite a bit later,” Monica recalls.
John spent the next month in a semi coma in the WakeMed Medical Intensive Care Unit (ICU). Monica hung a brief biography about John in his room so the staff could learn about him. John, who has a doctoral degree in mathematics, was employed as program manager of the U.S. Army Research Office, Mathematics Division. He also served as adjunct faculty in the N.C. State University Materials Sciences Engineering department and speaks six languages.
John was in the ICU for a month. He had a feeding tube, a breathing machine and other equipment to keep him alive. Acute care therapies were initiated at this time. “The autonomic nervous system in John’s brain was injured. This is the part of the brain that regulates basic functions like breathing, blood pressure and heart rate, which is why he needed so much support. We were in total awe of all the things the people in the ICU could and were doing for him,” said Monica.
The WakeMed Neuro Care Unit was John’s next stop along the continuum of care. The WakeMed Neuro Care Unit team of therapists, nurses, physicians and neuropsychologists provides limited therapy and nursing care for patients who need extensive care but cannot tolerate the three hours of daily therapy necessary to qualify for a rehabilitation hospital stay.
It was in the Neuro Care Unit where Monica first learned about the high level of expertise in brain injury recovery that is available at WakeMed. Providers explained to Monica that a brain injury can cause other bodily processes like bone regrowth to malfunction. This can result in a painful condition in which bone tissue grows into the muscles. The WakeMed Neuro Care Unit team administered blood tests and appropriate medication to reverse John’s bone regrowth issues. The Neuro Care Unit is also where the Laverys encountered Karen Wilhelm, PhD, a neuropsychologist. Dr. Wilhelm became the main resource for education about John’s brain injury and introduced Monica to the WakeMed Patient & Family Education Group. She also administered tests to help the team determine how John was progressing throughout his recovery.
John remained in the Neuro Care Unit for six weeks. Then, in mid-March, during a visit with family John became significantly more alert and responsive. This positive change in his condition meant he could move to the WakeMed Rehabilitation Hospital to begin intensive therapy.
After a medical setback that sent him back to the acute care hospital, and two months in the WakeMed Rehabilitation Hospital, John’s case manager helped Monica find a suitable nursing home where he continued his recovery. A bout of pneumonia sent him back to WakeMed for a couple of weeks, but he then was able to return to the nursing home. From there, he went to Learning Services, a private residential brain injury treatment community. Learning Services contracts with WakeMed Rehabilitation for therapy services. Therefore, John could continue working with many of the same therapists he saw at WakeMed.
The expertise of the WakeMed team coupled with John’s never-give-up attitude and family support helped him reach his goal of returning home for Christmas 2014. Once at home, John received care and therapy from WakeMed Home Care providers. WakeMed Home Care therapists helped the family adapt their home to accommodate John’s disabilities, and the Home Care nurses taught Monica how to care for him on a daily basis. He is currently enrolled in the WakeMed Day Treatment program and has made excellent progress.
Today, John takes care of most of his daily activities by himself and is walking with a rollator. He is learning to understand his limitations as well as his abilities. In 2016, John plans to join Club REACH at WakeMed and he will continue to work independently on recovery activities such as strengthening his speech and fall prevention therapy.
Monica, a licensed social worker, is no stranger to the efforts involved in coordinating the right care for patients. “I was highly impressed by the social workers and the accessibility of the nursing staff. At WakeMed, there is collegiality across disciplines – team members have a professional respect for one another and truly coordinate care on behalf of the patient and family. The WakeMed Rehab team is the cream of the crop.”
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