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Hidden Compartments

There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy. – Hamlet

Friday afternoon was the first true Spring day. It was sunny, with a warm breeze and I wished I could goof off and enjoy it when I got into my car around noon. But more serious business awaited – I had a meeting at my son’s school to talk about educational evaluations, so I tried to enjoy it by rolling down the windows and turning on the radio on the drive over.

The meeting was like many others. A lot of subtext and undercurrent, various agendas moving this way and that. One of the administrators present told us she was concerned that Ryan was falling behind his peers, specifically in Social Studies and Science. She wondered (aloud) if that was because of a “cognitive problem,” (read: incapable of being taught) and if, therefore, he belonged in a program with fewer demands (read: the most expensive baby-sitting the state can buy). Hence, the tests. I droned on about the lack of credence that can be placed in these things. At least one person on the team agreed with me. To be fair, I think there was some basis for the concerns, but our son is complex. Those who know him well know that he is secretive, with hidden currents that flow under the surface. There is much that he knows but ordinarily leaves unspoken.

When I was studying for my EMT license, one of the things the instructors drilled into us was the importance of evaluating whether trauma patients had palpable pulses, normal sensation and normal motor responses in their limbs (particularly in an injured limb). On every flow sheet there was a reminder: “Did you check pulse/motor/sensory?” I was terrible at finding one of the pulses in the feet – the posterior tibial pulse – I fretted and worried that I would fail my trauma exam, so I practiced on everyone in my family and in class, hunting around for that mysterious pulse that is nestled behind the ankle bone.

Our EMS textbook admonished us to heed the warning of a person with recent trauma and diminished pulses in the affected limbs. Such a disappearance, our textbook warned us, was a sign of Compartment Syndrome, “which is a medical emergency requiring an immediate upgrade to Priority 1 status for all patients.” What was this mysterious syndrome? Our instructor talked about it briefly, but did not dwell on it. There was a limited space between the muscle and the fascia layer, he told us, and if swelling or bleeding exceeded the capacity of that space, bad things started to happen. He also told us it was rare and we would probably never see it.

Until Saturday, that was the sum and substance of my knowledge of Compartment Syndrome. That is, of course, until an out of breath resident came running up the stairs from where my son was in the OR, having his broken tibia set, and informed us that there was a problem….pressure in the compartment…..fasciotomy…..incision….closing difficult with swelling….keep him in a medically-induced coma until we can achieve closure…..

Ryan’s compartments in his leg had swollen with blood from the fracture. Shards of bone had lodged into his muscle and tissue and he had slowly been bleeding into the space, so by the time they got him in the OR to reduce and set the fracture, his leg was pale and pulseless, just as my flow sheet warned. It is important to understand that this was an inevitable consequence of the fracture he sustained. What was not inevitable was how long it went undetected, which is, unfortunately, an indeterminate length of time. We need to wake Ryan up to know for sure what he feels and can do with this leg, and that might not be evident for some time. Before he went to the OR, our ordinarily secretive and uncommunicative boy was almost poetic in his expression.

“Mom, when the swing broke, I was flying through the air for a minute, like a pilot. But I was a pilot without an airplane, so I crashed.”

“That’s an interesting way to look at it, honey. Next time make sure you bring your plane with you, please.”

Our boy, who some believe has fallen far behind even his developmentally disabled peers, has some hidden compartments, and they are not in his leg.  In the ambulance, he asked me, “am I going to die?”

“Of course not honey,” I soothed, not realizing the events of the next 36 hours might bring us slightly closer to that prospect than I ever could have imagined. “Why would you think that?”

“Because I saw this man on the news, and he fell jumping into the pool. He hit the edge of the pool and he broke his backbone. He almost died. He’s in a wheelchair now.”

And I thought he watched the news every morning for the weather report. Of course, he hasn’t — he’s been absorbing it all, the stories he has seen, secreting it away inside. I wonder what the school administrator would think, if she could see him as he truly is, if she could see what I see.

I can’t wait to see him again.

Posted in Autism, EMS, Healthcare

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