My name is Mary-Anne. I am seventy years old and I continue to work four days a week for an investment firm in downtown Toronto where I have been employed for over sixteen years.
I have diabetes, and as a result of complications arising from this condition, my left leg was amputated above the knee some time ago. Earlier this year, I began to have problems with my right leg. In order to avoid a similar amputation of my right leg, it was imperative that I get treatment.
My determination to remain independent is essential as I need to work, but I also didn’t want to become increasingly reliant on my daughter — her name is also Mary-Anne, so I call her JR.
This is my story. Diabetes causes poor circulation and nerve damage, and this makes your feet vulnerable to skin sores (ulcers) that can become worse very quickly, making them difficult to treat. I had developed foot ulcers on my right foot. My diabetic foot treatment specialist recommended that I not use my left leg prosthetic and stay completely off my right leg. This was because the foot sores on my right leg were not healing. I was applying pressure on my right leg when I lifted my prosthetic leg to walk.
In December 2013 my sores were still not healing and it was determined at Toronto General Hospital (TGH) that I required an angioplasty — a technique of mechanically widening narrowed or obstructed arteries to improve blood flow and overall circulation. The operation was performed, and while it improved the situation, I was told that it would be best if I stayed off my right leg. Over the next three months, it became increasingly difficult to not use my right leg, as I needed to use it to transfer from my wheelchair to the toilet or to my bed.
In March 2014 I was back in the emergency department at TGH, complaining of severe leg pain. The pain was so bad that I could no longer stand on my leg. In fact, I had twisted my ankle quite a few times and, in one case, pulled the ligament in my knee. It became apparent that the angioplasty conducted in December 2013 had not been completely successful. My foot ulcers on my toes had healed well enough, but the wound on my leg had not.
When I first arrived at TGH, although not all my health staff team members agreed, there was a prognosis put forth indicating that it might be easier to amputate my right leg. This frightened me. I saw myself completely wheelchair bound and even more dependent. My daughter, JR, spoke to my vascular surgeon and requested that they not go through with the amputation, as this was not my wish. He assured us there was no amputation planned and that they were going ahead with another angioplasty. Two and half weeks after the angioplasty, my wounds were healing but I needed rehabilitation.
In April 2014, I was admitted to the Post Acute Care Rehabilitation (PACR) Program at The Salvation Army Toronto Grace Health Centre (TGHC). The care was exceptional and all the nurses on the fourth floor were fantastic — they were alert and professional.
About a week after I arrived, the nurses noticed a redness and swollen area on my leg. I had contracted cellulitis, a bacterial skin infection. They quickly informed Dr. Ruth, who had me immediately transferred to an acute care hospital where they prescribed antibiotics, washed my wound and monitored my leg until the blood circulation was back to normal.
I returned to the TGHC and was very happy to begin my rehabilitation. When I met with the interprofessional health team, I told them that my goal was to be able to walk. I was unable to use my prosthetic because it no longer fit and my right knee could only achieve a 45-degree bend. This was going to be a challenge. I was told not to make my goal unattainable. I was frustrated and hurt. However, after a few discussions the interprofessional health team realized that for me the term walking really meant the ability to perform independent transfers.
I must say, right from the beginning the nurses were remarkable. When I was admitted I still required the wound on my leg to be managed. I feel shameful that I can’t remember the name of this one particular nurse. She always did a fantastic job cleaning my wound and changing my bandage — such care and compassion.
I was long overdue for a new wheelchair and Emily, my occupational therapist, immediately set out to explore my options. Because of my finances and the fact that the doorways of my current residence won’t accommodate a new wheelchair, the only option I had was to have my old one repaired. In the future, when I am accepted into supportive housing, I will be able to upgrade to a newer model.
Sarah, my physiotherapist, was unbelievable; she really listened to what I said and saw my determination. Because I hadn’t been able to stand for a long time, I had lost the ability to balance and transfer my weight. We began my rehabilitation by re-educating my body. We practiced positioning my body so that I could offload my weight, making it easier to stand. We practiced standing — at first for short periods of time, because I still had a lot of pain — and we also did stretching exercises, because my muscles were really tight.
When I could stand for longer periods of time without Sarah’s assistance, we began to work on balance and functional transfers. We actually worked on standing and turning to simulate a bathroom situation or getting into my bed at home. Regaining the ability to use the grab bar in an accessible washroom was of particular importance for me. Sarah understood my concern and the challenges with the washroom facilities at my work. Knowing I was going to return, she improvised and set up a washroom layout like that in my work environment. We practiced transferring over and over until I was comfortable. We also practiced transfers in the different bathroom layouts throughout the TGHC so that I would be comfortable in different public accessible washrooms. Sarah encouraged me to look at different situations and motivated me to figure out how I could transfer safely.
I worked hard at my physiotherapy, but I also found the recreational therapy programs at the TGHC very rewarding. I took Tai Chi, Sitting and Dancing class, Movement to Music and Yoga. I arranged my recreational therapy programs around my rehabilitation schedule. I wish everyone who finds themselves in hospital would participate in recreational therapy. I know there are some patients that are physically unable to attend, but if it’s possible, I would recommend it. It’s better to be active and to socialize then to remain in your room.
One of the special things that I attempted in recreational therapy — something that I’d never done before — was to paint. Emily, a recreational therapy student, began a community art project that would allow all the patients in recreational therapy to participate. With her encouragement, I began the art project. I painted the trunk and branches of a tree across four separate canvases, to represent the four seasons. Before I left the TGHC I placed the first thumbprint on one of the branches to represent a leaf.
Later, Emily had other patients in recreational therapy put their thumbprint on a branch to represent a leaf. She also took the paintings around to the different patient care units so that the patients who were unable to come to recreational therapy could each make a thumbprint. The community art project was now complete: the TGHC had made a community tree touched by all the patients across the four seasons. (See this painting and more information on the Art Show and Silent Auction.)
However, Emily and I had no idea that our community art project was similar to the TGHCs ‘Tree of Memories’ campaign – a tree for all seasons to remember loved ones. It was Cherry, the executive assistant to the CEO, who recognized this when she saw the seasonal tree across four canvases on display in recreational therapy. The symbolic similarities of the seasonal trees and of remembering the patients appeared too close to be a mere coincidence – I say it was good karma. I believe the painting was purchased at the TGHCs Recreational Therapy First Art Gallery Show and Silent Auction. I was very proud of this project and happy that I was encouraged to paint.
In June 2014, I was discharged from the TGHC, and have since returned to work. I live with my daughter, but I’m on a list for supportive housing and I hope to eventually retire. JR has been very helpful and attentive these last few years and I couldn’t have persevered through my amputation, my angioplasty treatments and my rehabilitation at the TGHC without her strength and devotion.
I would like to thank the TGHCs interprofessional health team, the nurses and the doctors for their dedication, exceptional teamwork and excellent care. On the last day of my rehabilitation, the health team measured my knee and I was able to bend my leg up to 20 degrees. With my type of injury, it’s very rare for anyone to completely straighten their leg — I think everyone was impressed.