Stories from Naoh’ra Rabntah

Notes from the Hospital

Patient Profile

Name: Hartfield, Matthew
Age: 33
Handoff Summary — Attending M. Greene:
No motor or sensory recovery below T12. TLSO brace required full time. Voluntary autonomic control present.
Vent wean complete; breathing stable on room air.
PEG removed; oral intake adequate.
Residual cognitive symptoms from TBI; alert and oriented.
Psych: depressive features noted; recurrent nightmares observed. Minimally verbal. Consult initiated but not engaged.

Right leg non-weight-bearing.

• Femoral comminuted shaft fracture healing post-op (3 months).
• Open tibial fracture post-infection and debridement, aligned in external fixation; ORIF anticipated in six weeks, pending clearance.
• Knee instability under orthopedic evaluation; extensive ligament damage and suspected joint surface involvement. Surgical timeline contingent on systemic recovery and specialist clearance.

Left leg non-weight-bearing for symmetry. Tibia fracture stable.
Right shoulder stiff with limited ROM following loss of early treatment window.
Right hand weak with impaired grip and fine motor control, post-ORIF (1 month), due to median nerve injury.

Severe muscle atrophy. Total assist for transfers.
Physical therapy in ICU limited to passive range and assisted sitting. Joint mobility preserved in unaffected areas; right shoulder and knee remain restricted due to injury and prolonged immobilization. Active participation minimal.
Medically stable. Cleared for progressive therapy.

Week 1, Day 1

Author: RN Connie O.
Note:
Transferred from ICU following acute panic episode during elevator transport. Sedated in transit. Unresponsive on arrival. Eyes closed. No verbal, no motor.

Neuro eval deferred. Psych consult requested.
First formal PTSD flag on chart.

ICU warned us. Still didn’t expect him to drop like a boss fight on day one.

Week 2, Day 2

Author: Attending E. Corday
Note:
TLSO tolerance adequate. Trunk control holding.
Marked atrophy in shoulders and upper back.
Transfer attempted with 2-person assist; movement passive, no volitional push.
Seated 11 minutes with full stabilization. No complaint. No engagement.

Refused OT. Declined psych consult without explanation.
Denies pain, fatigue, and participation.
Observed awake during night shift. Call light unused.

No signs of confusion or psychosis. Just deliberate stillness.
Recommend reduced verbal scaffolding. Nothing shuts a tough guy down faster than good intentions.

Week 3, Day 5

Author: PT Jeanie B.
Note:
PROM initiated for hips and ankles; passive range within expected limits for immobility of this duration. Assisted positioning throughout.

Upper-body and core activation trialed with resistance bands. Output minimal. Right shoulder visibly stiff. Notable weakness in right hand; grip inadequate for resistance load. Core fatigue at three minutes. Full cueing required. No spontaneous initiation or verbal engagement.

Did not refuse. Did not participate beyond compliance.
Recommend continued low-load introduction. Push harder and he’ll either check out or black out. Hard to say which he’d prefer.

Week 4, Day 4

Author: Rehab Resident J. Carter
Note:
Per PT report, bilateral sensory mapping completed. Patient demonstrated delayed but consistent recognition of vibration stimulus at upper thighs. First positive response since admission.

Recommend initiation of lower limb sensory retraining.
Unofficial pool updated. Sensory response paid out at 3:1.

Week 5, Day 5

Author: PT Jeanie B.
Note:
PROM for hips and ankles maintained. Stiffness improving slightly.
Sensory mapping expanded to include temperature variation. Delayed recognition at anterior thigh, inconsistent at patellar line. No response below knees. Latency high.

Assisted sliding board transfer trialed; no initiation, but followed weight shift cues. Seated upright 18 minutes with stable posture. Required prompt for pressure relief.

Tracked without verbal response; affect flat, but noted as nonverbal engagement.
First time he looked like he meant it. Paid out at 5:1.

Week 6, Day 4

Author: RN Wendy G.
Note:
Planned ORIF postponed due to system-level triage adjustment. No physical decline noted.

Patient presented for therapy without incident. Seated session initiated; followed weight shift cues with low latency. No verbal response. Tracked intermittently. Movements completed as directed. Session tolerated in full. Affect flat, but participation holding steady.

Staff planning quiet acknowledgement of upcoming birthday. No formal prep. Bets are heavily skewed toward silence.

Week 7, Day 3

Author: Psych Resident S. Lewis
Note:
Consult requested after nursing reported increased nighttime disturbance. Multiple awakenings, clenched posture, eyes open on bed check, no call light use. Pattern consistent with recurring nightmares, frequency escalating.

Patient unresponsive throughout consult. No eye contact, no verbalization.
Psychological availability remains theoretical.

We’ll try again next week. Still banned from the board for “insider trading.” If only.

Week 8, Day 4

Author: Ortho Resident D. Ross
Note:
ORIF performed on right tibia, delayed secondary to prior infection.
Internal fixation placed without complication.

Post-op orders: immobilization, elevation, no weight-bearing.
Pain managed via PCA. Neurovascular checks normal.
PT/OT deferred until cleared.
Surgical dressing dry. Transport tolerated.

Last time I cut into this leg, it was full of pus. This was an improvement.

Week 9, Day 2

Author: RN Connie O.
Note:
Patient located on floor by staff after audible impact and vocal distress. Found lateral to bed, bracing displaced. Eyes open. Responsive to verbal input. Breathing shallow. No call light activation.

Spinal precautions initiated. CT lumbar spine confirmed no new injury.
Right shoulder deformity noted; imaging confirmed anterior dislocation. Manual reduction performed under sedation.
Examination revealed partial suture disruption at right tibia surgical site, increased edema at right knee, and extensive bruising over right lateral ribs.

Pain managed. PT/OT suspended pending surgical and psychiatric evaluation.
Psych hold initiated. Safety protocols activated per fall response policy.
Unassisted movement now considered active risk due to demonstrated behavior. Supervision level elevated.

Week 9, Day 3

Author: J. Coburn, PsyD
Note:
Initial inpatient therapy session conducted per psychiatric hold protocol. Patient arrived with wife. Classic presentation; here under pressure, not choice.

Minimal verbal engagement. Total speech output <10 words. No spontaneous speech. Eye contact intermittent. Affect flat. No signs of active psychosis. No dissociation observed.

Content inaccessible. Posture defensive. Remained seated, alert, and non-disruptive. No participation beyond physical presence.

Session duration: 45 minutes.
Therapeutic rapport not established.
Baseline recorded. Resistant type: intact insight, full control, no intent to engage.

Week 10, Day 3

Author: RN Chuny R.
Note:
Psych hold remains active. Mandatory therapy ongoing; engagement minimal. No further self-harm observed.

Patient continues to refuse visitors outside designated list. Noted that recent visits from one off-duty responder, listed as family by wife, have been tolerated without incident.

PT board is back. I’m taking the long odds. Guy shows up, posture holds a little longer. Close enough.

Week 11, Day 2

Author: RN Yosh T.
Note:
Psych hold expired this morning. Therapy sessions continue under mandate. Sleep disturbance persists. Multiple awakenings consistent with nightmare pattern. No subjective complaint.

Per PT report: tilt table elevated to 20 degrees for 12 minutes without orthostatic symptoms; patient cooperative, nonverbal. Wheelchair trial limited to posture only, no propulsion. Full assist required for midline; fatigue at 7 minutes, earlier than prior baseline.

Scheduled imaging later this week will require elevator transport. Sedation prep pending per Hartfield protocol.

Week 13, Day 2

Author: Rehab Resident J. Carter
Note:
Right shoulder cleared for therapy. ROM limited from post-traumatic restriction; pain manageable. Expected deficits due to prolonged instability and nonstandard early management. Long-term functional ceiling likely affected.

Per PT report: upper-body and core strengthening resumed. Endurance low but holding. Movement initiation present on cue. Verbal output minimal; did not engage during task.

Sensory mapping expanded. Delayed recognition at knees, inconsistent response at anterior shins. No response below. Follow-up scheduled.

Just saying. Patient could’ve had a working shoulder. We got job security instead.

Week 13, Day 7

Author: RN Chuny R.
Note:
White noise on. Same action movie loop. Duct tape square in hand, held through all turns.

Sleep logged at 5.25 hours. No assist. Less guarding.
Tracked vitals. Shoulders down. Didn’t flinch at gloved touch.
No speech. No freeze.

Called it. If he makes eye contact tonight, I’m cashing out and buying scratch-offs.

Week 14, Day 2

Author: RN Yosh T.
Note:
Right leg cleared for PT post-tibia ORIF. Weight-bearing remains restricted. Joint stability adequate for passive mobilization. Slide board transfer and tilt table planned later this week.

TLSO currently ordered for upright activity only. Brace off while supine; compliance appropriate.

Transport to imaging required use of descending elevator. Patient became nonverbal and visibly distressed; duct tape square observed clenched in left hand. No intervention required. Baseline restored within 15 minutes.

Hartfield protocol not activated. Guess I owe Connie a coffee.

Week 15, Day 3

Author: PT Jeanie B.
Note:
Initiated right hand reconditioning for stabilization, light load only. Grip uneven, but tolerable. Shoulder held within neutral plane, no regression noted.

Upper-body sets extended by two reps without prompt. Postural control improving. Responding to cueing with low latency. Verbal engagement holding. Sarcasm showing up mid-task now, not just in downtime.

New board’s up. Assisted stand pool opened this morning. Odds are criminal.

Week 17, Day 4

Author: RN Wendy G.
Note:
Ortho consult completed for right knee. Imaging confirms complete ACL rupture with additional damage to supporting ligaments and joint surfaces. Surgery deferred pending weight-bearing progression.

Imaging transport required elevator use. During descent, patient deliberately activated the alarm. Orderly reported he remained upright and verbal throughout, though visibly shaken. No staff action required.

Hartfield protocol updated. Noise is officially part of the plan, somehow.

Week 18, Day 3

Author: Attending E. Corday
Note:
Follow-up ortho review for right knee reconstruction. Prior imaging re-evaluated, ligament damage remains consistent with surgical plan. Joint inflammation within expected range; no signs of active infection.
Surgery scheduled end of month, pending clearance from anesthesia and psych.

Patient performing independent sliding board transfers with reliable safety judgment.
Short-distance manual propulsion initiated. Strength uneven, but initiation consistent. Required rest after five meters. Shoulder maintained alignment.

Tilt table elevated to 75 degrees; patient verbalized foot pressure. First report of distal sensory awareness. No orthostatic response noted. ASIA classification updated to C.

Tone focused. Initiated interaction unprompted. Verbal responses task-relevant. Participation sustained without cueing.

Night waking still noted, but episodes less frequent. No call light activation. Nursing reports trend toward sleep normalization.

Only took four months. Apparently the tough guy just needed some duct tape.

Week 21, Day 2

Author: Ortho Resident D. Ross
Note:
Right knee reconstruction completed. Procedure extended to 6.75 hours due to extensive scar tissue and instability.
ACL and PCL grafted; additional repairs to lateral collateral structures and posterior capsule. Joint surfaces debrided. Intraoperative stability achieved.

Delay in scheduling allowed adequate healing of tibial and soft tissue structures.
Post-op orders: immobilization, elevated positioning, no weight-bearing.
Neurovascular checks intact. PCA continued. PT deferred until cleared.

That was fun. Nothing like carving through eight months of scar tissue to find the joint.

Week 23, Day 3

Author: PT Jeanie B.
Note:
Right knee cleared for progressive mobilization post-reconstruction; bracing to remain in place. Bilateral KAFO fitting completed. Fit adequate, braces held during static weight-shift trials at parallel bars. Right hand stable under load.

Slide board transfers remain independent; brief cueing reintroduced for brace adaptation.
Pivot mechanics introduced with therapist support. No active step yet, focusing on lateral balance and hand placement.

Assisted stand pool’s still open. Odds are tightening. Everyone’s watching his knees like the World Cup.

Week 24, Day 5

Author: Rehab Resident J. Carter
Note:
Per PT report, sensory reassessment earlier this week demonstrated significant improvements in lower limb response: light touch and vibration recognized at shins and dorsal foot surfaces, bilateral. Plantar response variable. Latency reduced.

Assisted standing trial completed today. Initial attempt aborted. Loss of balance during setup. Second trial held for 30 seconds with full support. No orthostatic symptoms. Bracing intact. Fatigue onset immediate; session terminated per protocol.

PT Tasha claims victory with a recorded verbal “thanks” from the patient. Staff reviewing footage for authenticity. Odds board closed. Payouts pending.

Week 25, Day 2

Author: RN Connie O.
Note:
Meets discharge benchmarks: medical stability, post-op clearance, functional baseline established. TLSO now reserved for high-load rehab tasks only; no longer required for routine upright activity. Transfer preparations initiated.

Starting to look like someone’s leaving. Just when he started to warm up to us.

Week 27, Day 3

Author: Attending E. Corday
Note:
Patient transferred to inpatient rehabilitation facility earlier today.

Discharge condition:
Medically stable.
Incomplete SCI at T12 with partial sensory return, light touch and vibration present from thighs to feet. Reflexes intact. Voluntary autonomic control preserved. TLSO required for high-load rehabilitation tasks only. Right tibia healing post-ORIF. No infection, no malunion.
Right knee braced following ligament reconstruction; ROM restricted, partial weight-bearing permitted.
Right shoulder recovering post-dislocation; ROM limited, supports transfers with caution. Right hand improved with conditioning; strength present, fine control limited. Used for stabilization only.
Slide board transfers independent.
Assisted standing achieved with KAFOs and therapist support; ~40% bilateral load tolerated.
Manual propulsion partially independent on flat surfaces.
Pain managed with multimodal regimen; residual discomfort consistent with post-traumatic and post-surgical pain. Long-term symptoms may be activity and environment sensitive. No neuropathic features observed.
No acute complications.

Psychiatric status stable.
PTSD profile consistent. Distress triggered by descending elevator movement.
Pattern aligns with index trauma (fall from height); patient has no conscious recall.
Responses include autonomic arousal, behavioral freeze, and emergency alarm activation without prior verbalization. Staff advised to allow voluntary alarm use as grounding strategy. Also exhibits height-related avoidance. Declines window proximity and avoids visual exposure to elevation.
Nightmares continue at reduced frequency; content remains undisclosed.
Attends mandatory sessions. Engagement guarded.

Chart closed. He’s rehab’s problem now. Next.

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