Fanny is fifty-eight years old and a Complex Continuing Care patient at The Salvation Army Toronto Grace Health Centre (TGHC).
In October 2016 Fanny was treated at Toronto Western Hospital (TWH) for an arteriorvenous malformation (AVM), a tangle of abnormal and poorly formed blood vessels that can occur in the brain. This condition is serious and leads to various complications. She underwent a staged embolization of the AVM to prevent bleeding; however, Fanny then suffered a subarachnoid hemorrhage, a life-threatening type of stroke caused by bleeding into the space around the brain. After receiving treatment, she was very weak, but was eventually able to be discharged to a rehabilitation facility.
After a week in the facility, however, she experienced a seizure and was transferred back to TWH. She was found to have an intracerebral hemorrhage, as well as hydrocephalus (excessive accumulation of fluid in the brain). She was admitted to the ICU and underwent an external ventricular drain (EVD), which involves the insertion of a catheter to divert fluid from the brain to relieve pressure. A tracheostomy (breathing tube) and a g-tube (feeding tube) were also inserted. By late December 2016, she was slowly responding and her tracheostomy tube was removed. She was admitted to the TGHC for rehabilitation in January 2017.
Fanny has been at the TGHC for over a year. During an interview with her husband, Chad, Fanny sits in her wheelchair as he displays pictures on his phone of her in the ICU, attached to life support and unable to communicate. Looking over at his wife, Chad says, “It’s a miracle,” referring to her survival and the progress she has made. Fanny gives a smile.
Jewel, her daughter, says, “When my mother first arrived, she could not talk or eat, and she was unable to move.” It would be more then a few months before the health care team and the family would begin to see any progress.
Lisa, a speech language pathologist, was assigned to work with Fanny because she was not communicating. “It was difficult,” said Lisa, “just to get Fanny to open her mouth.” This was important since Lisa was trying to gauge if Fanny could remember language or process information.
Other rehabilitation team members also work with Fanny. In the beginning, they came to her room three times a week to help her perform bed exercises, Fanny was not always receptive; however, she was eventually able to transfer by a mechanical lift to her wheelchair and sit up.
Chad and Jewel understand how hard the health care team and staff work and that they cannot be there all the time. However, Chad wanted more therapy for Fanny and they wanted to participate in Fanny’s care. The rehabilitation team understood this desire, and with their guidance he and Jewel have been providing additional rehabilitation for Fanny. Chad is at the TGHC every morning to help Fanny get up. He has been taught the proper way to transfer Fanny from her bed to her wheelchair. Most days, weather permitting, he and Jewel take Fanny out into the community to stimulate her and to allow her to engage with people. Fanny enjoys going out. Her favourite part, she says, speaking softly, “is going to the mall.”
Fanny has improved considerably during the last few months. Lisa says that Fanny has gradually begun to communicate and is now able to eat and drink. She is meeting all the nutritional needs through her mouth, and so her g-tube (feeding) has been removed. Although Fanny is now able to eat on her own, the nurses still do a few activities of daily living, like bathing and washing.
The health care staff and family agree that Fanny has made great progress. Cognitively, she has become better. Whereas before she could not say what she needed, she is now more independent and is able to direct her own care by asking for help with certain activities. There is room for improvement physically, but Chad and Jewel hope to see Fanny become more independent, perhaps able to walk.