The support of family and friends often can help turn the tide when a patient is facing a life-threatening situation.
Paul Nelson of Fosston, Minnesota, and his wife, Liza, had such support in the spring of 2016 when Paul was stricken with necrotizing fasciitis (flesh-eating disease) that was consuming the muscles and tissues of his left leg. What Paul and Liza didn’t realize at that time, however, was that their support network would eventually include everyone at Sanford Bemidji’s Acute Rehabilitation Unit (ARU).
“I had big plans and I had a finish-line approach to my recovery,” Paul said. “And the people at the ARU helped me reach that finish line.”
“Paul had a devastating, life-changing injury,” said ARU physical therapist Donna Laakso. “But, instead of coming to the therapy sessions depressed, he came with the attitude of ‘What do we need to do today to get me out of here?!’ And that positive attitude goes a long way in terms of a patient’s recovery.”
Life-threatening illness
Paul’s unexpected journeys to the Sanford Bemidji ARU were part of his treatment after he lost his left leg because of the necrotizing fasciitis. In the spring of 2016 he was working for Canadian Pacific Railroad in Chicago when he began to feel ill. The sickness persisted and, upon his return home to Fosston, his condition worsened.
“Paul seemed to be delirious and then I noticed that his leg was black and swollen. It was septic,” Liza said. “When I saw that, we went straight to the emergency room in Bemidji.”
Analysis of the laboratory samples also indicated kidney failure, and Paul was immediately taken to Sanford Fargo for extensive treatment.
“In Fargo we met with two surgeons who said they were going to operate right away. And they said they would do what they could to save the leg,” Liza remembered.
During the initial surgery, the doctors removed as much of the dying flesh and muscle as possible and did what they could to control the sepsis.
A second surgery followed. That time the doctors knew they had to remove the leg above the knee to save Paul’s life.
During his 10 days at the ICU in Fargo, Paul underwent five different surgeries plus dialysis. A month after his arrival, the doctors finally felt the time was right for him to transfer to a long-term care facility in Fargo.
“The doctors initially thought Paul would need long-term care but, because of his positive attitude and amazing outlook on the situation, they said we could try acute rehab instead,” Liza said. “Paul was healing and his positive approach forced the doctors to say ‘yes’ to the ARU.”
This is what we do
Every patient who receives treatment at the Bemidji ARU is unique, and the staff must formulate realistic goals and a course of action on an individual basis. In Paul’s situation, the treatment plan concentrated on becoming independent and learning how to compensate for the loss of a limb.
“Paul was young (42 years old) and the ultimate goal was to have him go home, go back to work and give him his life back,” said physical therapist Kathy Sawa. “He also was very sick and we had to help him regain his strength after a long hospitalization.”
“Here is a guy who was working and running a crew when he gets this infection and loses a leg. That is a life-changing situation,” occupational therapy assistant Michelle Braaten said. “But you have to admire how he never gave up. Paul wanted to get back to work and the ARU staff is trained in intensive rehabilitation. We are trained to help people accomplish their goals.”
Happy to be here
“We were very happy to come to the Bemidji ARU,” Paul said. “We had worried about things at home in Fosston and about how we would manage renting an apartment in Fargo for six months while I was in long-term care.
“But during our month at the ARU in Bemidji, Liza was able to stay with me the entire time and the both of us became part of the ARU family.”
Liza also became a key member of the recovery team.
“Liza didn’t have to be here all of the time during the therapy sessions but she was. She would watch what we were doing so she knew what to do when she and Paul were able to go home,” Laakso said. “Liza was a great advocate for Paul, and when you have that family support, in addition to our team, you have the makings of success both at the ARU and at home.”
Paul is a heavy-set man and a sense of humor is one of his greatest attributes. That asset helped him break the ice with registered nurse Dave Winge and the rest of the ARU staff from the very beginning.
“When we checked into the ARU I was asked (by Winge) if I had experienced any recent significant weight loss or gain,” Paul remembered. “I asked him ‘What do you think a leg would weigh?’ He said, ‘Probably around 40 pounds,’ and we both had a good laugh.”
“We have a very small core staff at the ARU and we are able to get more out of our patients because we get to know them on a personal level,” Winge said. “We form tight relationships and communicate very effectively with our patients, with their families and with the staff. At the ARU, therapy communicates with the nurses and we, as nurses, can continue to extend the skills the patients are developing with the therapy staff.”
Development of those skills does not come easily, and patients often experience tiny successes over long periods that may be difficult to notice.
“The road to recovery is never a smooth uphill. It usually is two steps forward and one step back,” Sawa said. “Nobody ever gets better as quickly as they want to.”
“And sometimes we have to remind our patients of that,” Braaten added.
Paul, however, did not need much encouragement. With his ultimate goal in mind, and with Liza at his side, he attacked the therapy sessions head-on.
“Paul and Liza were a great team,” Winge said. “She knew how to push him and she knew when to back off. And they were always very supportive of the nursing staff.”
One small victory at a time
“The first thing that sticks in my mind about my therapy at ARU was transferring from the bed to a chair and a chair to the bed,” Paul said. “At the start they had to use a crane for that transfer. Believe me, when somebody my size is swinging through the air on a cable, it is something strange.”
Eventually Paul’s maneuverability improved to the point where he could accomplish those tasks with a transfer board. Moving with crutches and then a walker also were things he had to learn but, in time, those goals were met.
“Therapy is not easy but, overall, things went well,” Paul said. “There are days that you feel strong and you think you have everything figured out. But then you will have a day where you think you can’t do anything.”
“It very much is a slow marathon,” Liza said of the therapy process, “and we celebrated all of the little victories. It really was a fun process watching how all of the little exercises Paul was doing led to greater things.”
Team game
“When I started holding onto a walker I could do it for maybe 10 or 15 seconds,” Paul remembered. Eventually I could do it for 30 seconds and then for a minute. And each time everybody, Liza and me, my therapists and all of the other therapists, would all be cheering.”
“Recovery is a team game and everybody at ARU knows that they are important parts of the team,” Liza said.
The team also included Paul and Liza’s three sons. When their dad became ill, Gunnar was 14, Warren was 12 and Parker 7.
“And during our therapy sessions you could see that the boys were so excited to see what dad could do,” Laakso said.
Paul wasn’t the typical patient to spend time at fourth floor with the ARU staff.
“I’m sure most of the people they see are older and I think the therapists felt bad that something like this happened to someone so young,” Paul said. “But they also probably felt that it was an honor to be on my therapy team. I sensed that they felt it was an honor to help put somebody’s life back together who is only half way through that life.”
Home, and then back again
After a month of therapy, Paul and Liza were able to head back to Fosston to renew their lives. But a few months later, they were to return to the ARU unit.
“One day Liza saw a spot on my shirt,” Paul said.
The spot proved to be a “super hernia” that had extended to just inside the skin. Once again, the Nelsons headed to the Bemidji emergency room and Paul was transferred to the surgeons in Fargo.
“There are only a few hospitals in the country that are equipped to handle a super hernia like this,” Liza said. “And Fargo wasn’t one of them.”
Because Paul was too injured to be moved, however, the Fargo surgeons combined forces and knowledge to develop a plan. During Paul’s emergency surgery, eight feet of intestines, his gall bladder and his appendix were removed. A mesh was also inserted to cover the exterior gap created by the hernia.
“The surgeons finally were able to fix the hernia and they, once again, started to talk about long-term care,” Liza said. “But the people at the ARU in Bemidji said that they knew us and, if he could sit up on a bed, they would be glad to take us.”
“This time the treatment was much scarier,” Paul remembered. “The doctors in Fargo told me they couldn’t fix the hernia if it came again. I was flat-out scared when they told me that. Building confidence again and understanding what I could do without damaging the hernia was very hard for me.
“But I was encouraged by the ARU staff not to set too-small expectations for myself.”
“Therapy can seem slow and be frustrating,” Winge said, “and it’s okay to be frustrated. But when that happens it is important to remember the goals. Many times we (the ARU staff) can see the ups and the downs but, because we are a small group, we know as a team what we need to do. And we also can see the progress our patients are making.”
Welcome home
After another month of therapy, Paul and Liza were able to go home. Soon after their return, the snowmobile club in Fosston sponsored a benefit for them.
“Two of our therapists came to the benefit and the others felt very sorry that they couldn’t make it,” Paul said. “Everybody the therapists meet is having the worst day of their lives, and for them to come to our benefit was very special to us. I think the staff at the Bemidji ARU is very proud of us.”
“And I think they know that they are very special to us,” Liza added.
“Paul was sitting at the door greeting everybody and the people just kept coming. That was nice to see,” said Laakso, who attended the benefit with Sawa.
“It is great to see how the people of the community can also become part of someone’s recovery process,” Sawa added.
Slowly but surely the Nelsons are moving forward with their lives. Paul has returned to part-time work with the railroad and Liza has been able to resume her job with a chiropractic office in Fosston. Periodically they head back to Bemidji and often stop to see their friends at the ARU.
“The ARU was a happy point for us because the staff there made it a happy place,” Paul said. “We liked being there. Every day we accomplished things and you could see us making progress. It felt like we were on our way home and you knew the people at the ARU were going to help us get there.”
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Posted In Health Information, Rehabilitation & Therapy
