An Acute Case (article still at the level of rough case notes)
by Stephanie Forshaw on Thursday, 24 March 2011 at 15:37
It's the 19 Jan 2011. Your loved one is late home from work. The minutes tick slowly and increasingly sickly by. Then the phone rings ... but, such a dark surprise, its not him.
"Hello, this is Intensive Care. We have you listed as next of kin. Your partner's in sedation following a serious road traffic accident. If you want to see him again can you get here as quickly as possible?"
"So that's why he's late!" As you struggle to get a grip on the reality of what's happened, frantic thoughts come rushing in, crushing hope with a vice-like finality. "He's in intensive care, dying, his beautiful, perfect body smashed to bits. The light of his life glowing dim, right on the knife-edge of extinction".
But I have faith, or is it just naiveté? I know he will survive, but what horrors will I find waiting in I.C.U? Face smashed beyond recognition? Body, broken, twisted and crumpled into a tragic, awful mess?
But nine weeks later, here he is standing next to me, leaning over my shoulder, reading this very text! Oh Gray! How did you survive?
Of course the team in I.C.U. did an incredible job. Instant responses - to every crisis, from moment to moment, for day after terrible day, on life-support, as he desperately and instinctively hung on to the strings of life, with fractured skull, clavicles and rib-cage smashed to smithereens back, front and sides, bone fragments causing collapse of both lungs and lacerations to his liver.
I approached his consultant about the complimentary use of Homeopathy in this situation. His only real objection was that I'm too close to the patient to be an unprejudiced observer. Quite right, of course, but after his discharge, who else would be there, every minute of every day and night, listening to every breath, and every whimper of pain?
The following is an brief account of the Homeopathic treatment, in both physical and mental/emotional spheres, given in the first four weeks after discharge.
Working with physical aspects of trauma
In violent acutes remedy selection and potency are more critical than ever. The traditional techniques of Classical Homeopathy become very important. The immune system's response to any remedy is heightened. Additionally, in acutes unstable situations quickly become serious and one has to prescribe on the presenting symptoms from moment to moment. A wrong remedy choice, contrary to popular belief, can cause the most horrendous aggravations.
At this point, the first week of Feb, when delicate new bone callus was forming in order to hold his chest together Ruta became one of the most significant remedies for rib and chest pain relief. It has gnawing, stitching and pressing pains in the sides of the chest, sternum and ribs and cutting pain in the clavicles. It is also good for inflammation of the lungs, where there is a sensation of heat and burning pain.
In the 'generals' section we find ...
INJURIES - Bones; fractures of - slow repair of broken bones. INFLAMMATION - Bones; of - Periosteum; of.
The theme is echoed in 'extremeties' section, where Ruta is listed for fractures, and helps clean healing by reducing inflammation or induration of the periostium. Ruta also covers inflammation of ligaments and tendons, which are common when there is strain or a dislocation.
The pain relief from just a simple, single dose of Ruta 30c was immense, so I repeated it, at 30c several times that week, even adding some to the bath water! It gradually gave more freedom of movement. When dealing with manifest, physical pain the action of the lower potencies is nothing less than amazing.
Botanically, Ruta is a member of the Rutaceae (the Citrus family) which belongs to the Sapindales order. Common sensations in the Rutaceae are of being restricted and paralyzed, to compensate for this state of enforced immobility there is a constant desire to be on the move - which is a close fit for the sensations produced by this kind of injury, both on a physical and mental or emotional level.
Although I had no idea if the fractures were correctly aligned or not, the main indication for the use of Symphytum - I was not shown any X-Rays - the lumpy fracture calluses that were appearing almost everywhere suggested that Symphytum (Comfrey) was now urgently needed.
EXTREMITIES - CALLUS of fractured bones - excessive
Again a lot of pain reduction was felt, and after a few days of Symphytum 30c the suppleness of the rib-cage improved even more, enabling Gray to lounge fairly comfortably on the sofa. We were still relying heavily on the pain relief provided by the Hospital prescription at this point.
A further indication for the need for Symphytum was that there was a cloudy discharge from the eye on the injured side of the head. The eye seemed to have sunk deeper into its socket (he'd had a MRI at hospital - the results were withheld as per usual). However, both symptoms are rather frightening indications that the floor of the orbit is damaged, as can be seen from the rubric:
EYE - INFLAMMATION - Orbit - periosteum of orbit.
Like Ruta, Symphtum is found in the rubric:
GENERALS - INJURIES - Bones; fractures of - slow repair of broken bones.
The time modalities for Symphytum are both morning and night so I elected to give it at bed-time, which frequently conicided with the pricking, crawling sensation which is a characteristic sensation of this remedy.
Another well known bone remedy is Calc Phos, which is also found in the 'slow repair' rubric (above), and functions to aid nutrition. It also has affinity for specific areas ...
CHEST - PAIN - sore - Clavicle
CHEST - PAIN - sore - Costal cartilages - Short ribs
Calc Flour, again found in the 'slow repair' rubric was given to prevent swelling and bony overgrowth. The Calcs were given in the morning since the mineralisation effect gave a sensation of active healing, which is perhaps, not what's wanted at night-time!
Both calcs were used in low potency i.e. alternating between 6C and 12c.
Another aspect of the case was the actual damage to the lungs. Initially his breathing was very difficult and his face flushed at almost every exertion. Later X-rays showed some congestion. We found several doses Phos 30c over a few weeks helpful, one dose of Sulph 30c and one dose of Ant-c 30c helped clear up a persistant spasmodic cough in the larynx. Kali phos really helped improve expectoration.
Working with mental and emotional aspects of trauma
Symphtum is a member of the Boraginaceae family, which belongs to the Lamiales order. Dr. Sankaran describes the theme of the Lamiales as a sense of lost connection. The result can be a desperate need to try to hang on to the reality of the outside world.
Anyone who has been in hospital will recognise the state of sensory deprivation that arises from living in the sensually sterile and womb-like space of the wards, with very restricted mobility, and cut of from the outside world. This situation is found in the sensations of the Rutacea (Being cut off is also a characteristic of Dr. Scholtens stages 15 to 18).
Further, day and night only made discernable by the dimming of the lights and marked only by changes in the routine, such the clocking on and off of the staff, the medication trolley, and the consultants morning round. This situation fits the Lamiales state described by Dr. Sankaran perfectly, and again echoes the experiences of stages 15 to 18.
Add the elements of intense fear and pain, and an hourly dose of morphine to the situation and the final connection to reality is well and truly lost. Events and days begin to blur into a confused jumble of disconnected memories. The state has been given a pet name, it's known as ICU Psychosis. Its is a perfect similimum of the Opium state.
This was the state of the little soldier entrusted to my care. Memory gaps more like a colander than a sieve. The time-line confused and almost lost. This all came together to create a truly desperate and overwhelming need to get out and make contact with the world. The situation had created a powerful need to get out do normal things, in the hope that this would restore some sense of self, regardless of the seriousness of the injuries.
This seems to be a common experience. We spoke to several accident victims who had felt this way. The need to get out and be normal and do normal things, especially to socialise in this case (Phos), is so overwhelming that they will not suffer any interference or restraint from carers. Any such interference causes extreme agitation, sometimes rage, and even a desire to get away (Opium).
The feeling could be described as a mad fight for recovery. Fighting is exaggerated and overdone in the Sycotic miasm. The first mental/emotional remedy I gave was Dysprosium Phos 1M. This was on the 28 February - the physical pain was so severe that it was still my first priority, but this mental battle was becoming so reckless that I felt I had to make an intervention.
There is a special connection between Dysprosium and the situation found in Intensive Care. Even more so with pneumothorax, where the battle for survival is nothing less than a battle to draw the breath of life.
His response was brilliant. He suddenly became reflective and friendly. The "mission to get well" became more relaxed. I felt that giving Opium at this point might be useless because the remedy effect could simply be lost in the morphine he was still taking for the pain. Although the desire to escape is covered by Opium I felt that this desire to 'get away' could also be symptomatic of the Dysprosium battle for survival.
Nature can be very cruel. The next morning his little cat Sophocles started fitting and we had to take him to the vets to be put down. Gray's reaction was of intense grief of course, and also of disbelief. In the afternoon he suddenly retired to his room and lay lamenting in the dark. He had lost the will to fight.
On the rubrics "Grief" and "Despair from the Pain" I gave Aurum Mur. Half an hour later he was up watching telly ... still morose, silent and a bit grim, but after another hour he was Ok. He went to bed fairly early and had the first solid sleep since the accident. Gray woke up feeling as if the light had broken through and a weight had lifted.
Around this time Gray stopped using morphine for pain relief, but again nature took a hand in the unfolding of the case. We both watched a recording of the accident. Gray started having memory flashbacks and it was at this point I thought Opium would help clear out some of the fogginess and confusion. Three days after Opium I gave Arg-met 1M, which helped clear up Gray's memory problems immensely, bringing back the memory of many buried aspects of his experiences in hospital and of the accident itself. It also gave back the lost sense of self he had experienced.
After Argentum I introduced Staphisagria, Grays constitutional remedy, to the prescribing repertoire. A dose of 30c gave immense pain relief, which he described as a feeling of warmth in his whole chest. I followed up with 200c which helped even more.
After Staphy 1m his mental state is holding, he's quite emotionally stable, relatively pain free (there is still beaucoup discomfort, of course) and beginning to enjoy his convalescence a little more every day.
What an interesting dynamic there is between the sense of disconnection (Ruta and Symphum) and fighting for connection (Dysprosium Phos) there is in this case!