The Accident, My Disability, And The Hospitals at Panama and Miami.

The 4th of February of 2011 was the fateful day of my accident.

After having dinner in a restaurant in Panama (where we were living) with my wife Isabel, we went to visit some Venezuelan friends at their home (the married couple of Fabiola and Gustavo), and afterward we were returning home late at night, with Isabel driving and me half asleep in the car’s front right seat.

Suddenly, a cat crossed the road in front of the vehicle, according to my wife, for as I said before I was asleep.

To avoided it, Isabel braked abruptly, turned the wheel to the right and went to crash against a small tree, planted in a portion of soil between two portions of the sidewalk, over which the vehicle stopped.

Defeated by the fatigue (or maybe it was my destiny), I wasn’t wearing the seat belt, and the frontal airbag of the SUV didn’t deploy so, asleep as I was, I was propelled forward, and my head hit the vehicle’s windshield, which broke but not completely, for the car was traveling at a low speed (some 34 mph).

The car ended up with the front smashed, but it started and moved, so Isabel was able to drive it to our nearby building’s parking garage.

In view of my semi-consciousness, Isabel decided to take me to the Punta Pacifica Hospital, located near our home, where I entered walking (always according to my wife, as I don’t remember anything).

Panama’s Punta Pacific Hospital. Photo: http://elvenezolano.com.pa/pacifica-salud-hospital-punta-pacifica-en-el-ranking-de-los-mejores-hospitales-de-america-latina/

In the hospital, they attended me with some difficulty at first, as the doctors treating me needed to cool my body and not having the necessary equipment, the hospital’s Administrator, initially, refused to rent the necessary cooling equipment, although after Isabel’s intervention the Administrator gave in and authorized the rental.

The fact is that at the end, the doctors treating me told Isabel that there was nothing else they could do for me, and waiting was necessary (I was in a coma at the time).

Fearing for my life and discontent with that medical opinion, Isabel arranged my transfer by air-ambulance to Miami, USA, where I was treated initially at the ICU (Intensive Care Unit) of the Trauma Center at the Jackson Memorial Hospital.

Trauma Center of the Jackson Memorial Hospital in Miami. Photo: Ryder Trauma Center.

In the middle of all that, I only remember an hallucination I had, in Panama I believe, according to which, I was laying on my back on a ping-pong green table, being watched by some bandits with a threatening attitude, ready to jump on me, hiding in the ceiling behind a gigantic lamp of the kind used in the operating rooms.

I remember having talked to Isabel (in my hallucination) in whispers, telling her that I already had no remedy, for I couldn’t run, but she could still save herself, if she ran to the door, that I would obstruct the bandits pursuing her, with my body.

I must say that such a hallucination was very real for me.

THE HOSPITAL IN MIAMI

Some 2–3 days after being discharged from the ICU, and having got out of the coma, I woke up in a hospital bed in the hospital in Miami, not remembering anything about the air-ambulance trip, as I said, already out of the ICU (about which, I didn’t remember anything either), with several people trying to dress me up, and with the movements of my right side’s extremities severely limited.

According to the doctors, I’d suffered two strokes to the cerebelum, causing my hemiplegia, but fortunately, I had no injuries whatsoever in my brain.

They had performed a tracheotomy on me, so I had bondage in my throat.

The nurses administered me a yellow, thick liquid instead of normal food, such liquid was administered by the nurses with a gigantic syringe that they unloaded in a little tube on my belly, connected directly to my stomach.

Feeding patients with liquid food, through a tube attached directly to the patient’ s stomach. — — -:: — — — Graph: https://www.fairview.org/patient-education/89299

In the same manner, 4- or 5-times day or night, the nurses administered me some medication, which looked similar to gelatin of various flavors, which they brought in the gigantic syringes and unloaded them also in my stomach, through the little tube on my belly.

Trough the tube in my belly…wit large syringes, the nurses administered me some drugs, which looked similar to gelatins of various flavors. Photo: https://www.health.harvard.edu/blog/4-ways-avoid-mistakes-liquid-medicines-2017062711971

For some reason, those days they decided to apply a blood transfusion to me.

I recall that, after the blood transfusion, I wasn’t able to breathe normally.

For the first and only time during my hospital stay, I thought that I’d die there, for I couldn’t breathe normally. However, little by little, the thin thread of air that I could inhale initially, gradually grew until I could breathe normally, and the scare subsided.

Every two hours or so, day and night, an assistant entered into my room, towing behind her a noisy piece of equipment with wheels, which she used to take my arterial tension with, and placing a device (It was a thermometer) inside my ear, she also took my corporal temperature, making a note of both readings in a notebook which she also carried with her.

Noisy tensiometer with wheels. Photo: https://www.girodmedical.es/pie-con-ruedas-5-ramos-para-tensiometro-omron-907.html

A couple of times a day (once during the day, and another time at night), a male hospital technician walked into the room and painfully pricked one of my fingertips (I had the fingertips of my left hand, all perforated) to check if I was diabetic.

Painful finger-pricking, checking for diabetes, was performed on my left-hand fingers, while I was hospitalized in Miami. Photo: http://www.themalaysiantimes.com.my/device-keep-tabs-blood-sugar-levels-without-finger-pricking-available-singapore/

Saying I wasn’t diabetic was useless.

Can diabetes be developed on you while interned at the hospital?

That only, nothing else, except for a sadistic inclination, would explain the zeal that man showed at pricking my fingertips (Twice a day, on the fingers of my left hand only!), in spite of my saying, repeatedly, that I wasn’t a diabetic.

The room at the hospital was also visited every 6 hours, twice during the day and twice at night, by respiratory therapists from the hospital’s Breathing Department, who always came with a device that consisted of a long, transparent, plastic tube, which they connected to a valve on the room, located on the wall above my head.

The long plastic tube terminated in a face mask also plastic, which covered my nose and mouth with an elastic band which, going behind my head, subjected the mask to my face.

Just below the mask, the tube ended in a lengthened cylinder with transparent walls, in which the therapist poured a liquid medicine, then opened the valve at the wall and air circulated through the tube and into the cylinder, making the liquid medicine to burble and to emanate sort of a mist, which mixed with the air I breathed.

Later, I found out that the breathing therapy helped patients with phlegm or with liquid in their lungs, to expel it and breathe better.

However, I had no phlegm or liquid in my lungs, and they administered me the therapy anyway. Therefore, I often rejected it.

The therapists administering the treatment were surely used to rejection, I think that way, for they always announced their presence in a loud voice, device in hand and standing at the door of the room, and only if I explicitly accepted the treatment, they’d move in and would enter my chamber.

Sometimes, some of the Breathing therapists gave me the impression of not wanting to work, of waiting for the patient to say that the treatment wasn’t accepted, so they could finish their round more quickly.

With so many night visitors, it was impossible to sleep, so it was better to dream awake or to hallucinate.

The hospital is very close to the airport of Miami, so every early morning, at 6 a.m. or so, I regularly heard the landing noise of a plane (a cargo plane, I think, given the very early time of the day).

In rainy mornings with a soaked landing strip, it was possible to hear perfectly the sound of the water being displaced by the plane’s wheels.

Dusk sky on a rainy evening at Miami International Airport. Photo:https://www.reddit.com/r/pics/comments/9c33n3/dusk_sky_over_the_miami_airport_on_a_rainy_evening/

During several days, at such mornings I dreamt (or hallucinated, I’m not sure) that I was traveling into a hydroplane, and that the hydroplane would take me to a tropical island, where I would dive in a green and warm water in the company of my wife and son, who dived with me.

In addition, the helicopter which often transported people who had suffered accidents, provoked hallucinations on me when landing noisily on the roof of the hospital, just a floor above my room and in the same building.

Rescue helicopter about to land at the roof of the Ryder Trauma Center of the Jackson Memorial Hospital. Photo: http://anesthesiology.med.miami.edu/trauma-anesthesiology

Every time I heard the noise of the helicopter, which always took some time to land, inexplicably I saw (or I think I saw) how all straight lines on my room turned diagonal: roof, walls, furniture, etc. as if they were going to be lifted and transported by the helicopter.

Now, my brain was telling me that was impossible, but…

… Everything looked so real …

Just a few days after I waked up, Isabel had transported me in a wheelchair to the hospital’s Therapy Section, so all therapists there got to know me, as soon I’d start to receive 1 hour a day of each of 3 therapies: Physical, Occupational, and Language.

In those days, I couldn’t hold my neck upright, so I had to use a wheelchair with a high back and head support, where I could rest my head.

I couldn’t withstand to lay face-down either, as I felt suffocated, and I breathed with difficulty.

In Physical therapy at the hospital, they always used to set my wheelchair on top of a machine, which once my wheelchair was in place, it was taken away and I remained seated on a seat that the machine had; afterward, the therapist repeatedly moved up and down a lever like one of some hydraulic jacks for vehicles, that activated a mechanism by which I was elevated upright; later the seat disappeared and I ended standing up, having in front of me some sort of table-desk formed by the machine, with my knees pressing against some cushioned protuberances, and my arms and elbows resting on the formed table, remaining in that position for approximately ½ hour.

Stand-up equipment used in Physical/Occupational therapies. Photo: Wikipedia

In reality, seen from the optic of a patient with injuries similar to mine, that machine was really perceived as a sophisticated instrument of torture, designed just to produce pain.

Also, during physical therapy, the therapist sometimes placed me laying face down on a fixed stretcher with no wheels, and in that position, I remained for a ½ hour.

Exercises of Physical therapy required the patient to lay face-down, which I couldn’t stand. Photo: http://www.activeedgewellness.com/about-us/our-gym/west-linn-location-photos/physical-therapy-photo-6/

It was a ½ hour of torture, as all the time I screamed and begged loudly to be turned face up.

On those occasions, I finished the therapy sweating and almost crying, for I felt like dying in such a position.

In fact, sometime after, I needed surgery to enlarge the Achilles Tendon in both my feet, which had contracted as a result of my neurological condition, impeding my feet to touch the floor completely, as one does in normal walking.

When they moved me inside the operating room, the male nurses tried to position me laying face down, but I reacted moving violently, as I felt suffocating in that position.

The surgeon then initially wanted to suspend the operation, for he said he couldn’t operate me unless I was lying face-down.

Previously, I had repeatedly said to him that, unless he brought to the operating room one of the stretchers used by masseurs, with a cushioned device at one extreme to rest your head, and with an opening to allow free-breathing, I’d not be able to be positioned face-down.

But obviously, my words were not listened to.

After half an hour of discussions, the surgeon agreed to perform the Achilles Tendon-enlargement operation with me facing up, but with both my feet elevated.

Something like a month after I began the therapies, without any apparent reason, the hospital authorities decided that I’d not receive therapies there unless I used a neck brace during the sessions, as the hospital didn’t want to assume the responsibility of any mishap if I didn’t use it.

It was useless on my part to say that I would accept gladly any document they wanted us to sign, exonerating the hospital of any responsibility.

One of the things that I learned during my stay there, was that when you are at the hospital, at least being disabled as I am, nobody pays attention to what you say; they treat you like a child.

I couldn’t understand why, if I really needed a neck brace during therapies, had they allowed me to receive therapies FOR A MONTH without one!

So, I said that if they didn’t want to give me therapies there, that was their decision, but I wasn’t wearing a neck brace during therapies either (have you ever tried to exercise with something squeezing your neck?), as the brace didn’t allow me to breathe properly.

I held the fort for about a week, not receiving any therapies, but in the face of constant pressure by my wife, the doctors, the therapists, and the nurses, I had to give in and began to use (very loosely adjusted) a neck brace during my therapies.

The sessions of language therapy, really consisted of language exercises, in which I learned to speak again and to breathe properly, but also of exercises of swallowing, by which they taught me to eat and drink again by the mouth.

For me, it was always very important to eat, as I consider good eating, the enjoyment of a dish well prepared, as one of life’s greatest pleasures.

However, during swallowing therapy, I learned that for many people, disabled or not, eating is only a routine function necessary to survive, and not a source of enjoyment.

There are medical tests, which allow doctors to evaluate the quality of the swallowing of any individual.

Dysphagia, as in medical terms is known the inability to eat and drink properly through the mouth following neurological impairment, increases the risk of dehydration, malnutrition, aspiration pneumonia, and even death.

Screening for dysphagia has been reported to change negative outcomes.

In such screening tests, called Dynamic Swallowing Tests, the patient is placed sitting sideways in a machine, which allows the doctor to see in a screen, like in X-rays, an image of a transverse cut of the patient’s head, allowing her or him to see clearly the mouth’s cavity, the tongue, the throat, and the beginning of the individual’s trachea and esophagus.

An X-ray image is seen by specialized doctors, during swallowing tests. Photo: https://www.researchgate.net/figure/A-still-x-ray-image-taken-from-a-videofluoroscopic-swallowing-study-This-image-shows_fig1_221922023

Meanwhile, an assistant with a small spoon will place inside the mouth of the individual taking the test, small quantities of solids and liquids of different thickness, from baby food to cookies and bread, and from gelatin to water, all of them speckled with barium, a contrast agent used in X-rays.

The specialist doctor will then watch on the screen and will follow the barium-tinted bolus, the screen will show how each type of solid foods and liquids are manipulated inside the mouth, its circulation inside the oral cavity and the throat of the individual, thus determining if the chewing, movements of the tongue, swallowing, and treatment of the food remains are adequate (that is when the complete bolus is swallowed, with no residues/coughing/choking), or if filtration/aspiration of residues to the trachea and then to the lungs is occurring, being then in an optimal position to authorize or not, the ingestion by the mouth of solids and liquids.

Before I was authorized to eat and drink by the mouth again, I took the mentioned test three times in different hospitals, the last one in Panama, having been fed through the tube during two years after the accident.

My health was improving little by little; sometimes I left the hospital bed and my son Eugenio would take me downstairs, pushing my wheelchair. We would go down to the ground floor in the elevator and strolled by the hospital’s gardens.

I still had nightmares when sleeping, and frequently I woke up with a suffocating sensation. For quite some time, I felt that tight belts crossed my chest, not allowing me to breathe properly.

When I was discharged from the hospital, 3 months after my admission (I was out of danger then, but I still wasn’t feeling completely well), Isabel rented a furnished apartment in Miami, where I lived with her and with my son.

I had a caregiver full time (8 hours a day) and still needed assistance 24 hours daily, so two women took turns ensuring that somebody was with me day and night.

In one occasion, I blew my nose strongly and began to bleed profusely by it, helped by the medication anticoagulant Plavix, which I take daily. Aiming to stop the bleeding, I leaned my head back and the blood flowed to my throat, and as I had problems swallowing, I began to cough… blood.

Scared by what she was seeing, Isabel phoned 911, in spite of my unintelligible protests (please, remember that it was difficult to understand me), and very soon, two bearers were at home who, very rapidly, tied me to a portable stretcher with wheels that they brought with them, and transported me in an ambulance, with sounds of emergency siren and all, to the nearest Emergency Room of a hospital, which happened to be… the Jackson Memorial!

The same hospital of which I’d been discharged just a few days before!

In the Emergency Room, they administered me intravenous fluids and decided — against my opinion — to admit me in the hospital.

Again, the known hospital’s routine during the three days of my unnecessary admission: the constant entry of hospital’s personnel into my room, day and night; the pricking of my left fingertips; the assistant towing the tension taking device; the nurses armed with their gigantic syringes, etc.

I now know — among other things — why the USA had the highest health cost in the entire world. Too much of everything: too many emergency calls, too many unnecessary hospitalizations, too much food, too many deaths of cancer, too many people in jail, too much pollution, etc, etc.

The first day of my unnecessary hospitalization, a doctor specialist in the nose, visited me and with a cotton swab applied a solution to the internal mucosa of my nose, supposedly to avoid any future bleeding.

Nothing else was done for me during that unnecessary hospital admission.

During that admission, one night two hospital female assistants entered my room to prepare me to sleep.

I heard them talking among themselves in a dialect I couldn’t understand, but I noticed that included some words in French.

To my surprise, one of the female caregivers that accompanied me at home, who was in her night shift, joined that noisy and incomprehensible chit-chat.

I concluded they were all Haitians, including my caregiver whose perfect English didn’t give her away.

The assistants — all colored — treated me with a lot of disdain, almost — I felt — racially driven.

But my complaints were not attended even by my caregiver.

The entrance in the room of the night’s male nurse didn’t help me at all, as in the face of my complaints, he just gave me the cold shoulder and joined the conversation with the women in that incomprehensible dialect.

He was Haitian as well!

The complete hospital’s Haitian mafia!

The following day Isabel, on my behalf, told the representative of the agency that was sending us the personnel (nurses and caregivers), that we didn’t want that caregiver back.

From that night at the hospital, I took a dislike to Haitians and never again we hired one.

The doctor that was treating me at the hospital had his own neurological center, in which they also gave therapies, so Isabel decided that I was going to be treated there during our stay in Miami.

To that center I went during 6 straight months, receiving three therapies a day and five days a week.

The first days, physical therapy (legs) and occupational therapy (arms) caused me a lot of pain. So much pain, that I would spend the two hours screaming, and tore apart the paper cover that the female therapist used to protect their clothing from my abundant drool, which I didn’t control either.

I pulled their hair and even hit the Occupational therapist with my left hand, the only one I can move.

I must render homage to those two ladies, and offer them from here my sincere apologies, expressing my gratitude to Flory (Physical therapy) and to Maggie (Occupational therapy), authentic professionals, who in spite of my rude attitude, continued offering me their services.

I always will ask myself if my screams of pain and my aggressive attitude towards the therapists, were due to the novelty of pain, and my health condition at that moment, or to a low tolerance level to the pain itself.

The truth is that pain in various forms, had been part of my life ever since the accident happened, and I’m also asking myself if I won’t be already accustomed to it (I don’t take, by the way, any pain killers).

In the Clinic, the language therapist, Marcela, taught me progressively to eat and drink by the mouth again. Marcela always brought to our sessions food items that were sold in supermarkets, and which allowed their chewing with little residues to swallow.

At the end of the session, she also told me where to purchase the stuff. Thus, with cookies that dissolved in the mouth, with cheese whiz that left almost no residues to swallow after chewing them, I started eating food and swallowing it by mouth, without coughing or suffocating myself.

Giving me sips of beverages of different thickness, at first with a straw, and later taking little sips from a cup, Marcela also taught me to drink again.

She also taught me some “tricks” to swallow without coughing, and to avoid food items or liquids to go down the trachea (and not through the esophagus), and what to do to expel those items if the worst happened.

With regards to the language therapies, with Marcela, I learned to breathe properly and when speaking, to avoid speeding, acquiring a slow cadence, and an exaggerated pronunciation if you will, as a way to be understood. She went even beyond her duties, designing a program of exercises that I now follow in Panama, all on my own, without a therapist.

After our stay in Miami for 6 straight months, we returned there 5 times in the next three following years (usually for periods of 30 days) until 2014, always attending the same clinic and always attended by the same therapists (Physical and of Language), while several Occupational therapists, attended me.

To Flori, the Physical therapist who taught me to move my legs and walk again (Although still helped by a three-legged cane and a therapist), and to Marcela, the language and swallowing therapist who taught me to eat and drink by mouth, to improve my breathing, and to be understood once again, I’ll be eternally grateful.

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Eugenio Magdalena

Eugenio Magdalena

Eugenio is a disabled Economist (UCAB, Caracas), cursed a post-graduate Diploma in Marketing (Strathclyde University, Scotland, UK), and an MBA (England, UK).