By Kathy Chaffin
Salisbury Post
Brenda Boltz’s journey after a May 20 accident almost claimed her right arm last year was far from over.
After 42 days of agonizing pain, she was back at Duke University Medical Center on July 2 preparing to be transferred to a nearby rehabilitation center for the second time.
Because of the concerns her husband, Bob, had raised about her stay there before, the center’s chief executive officer arranged for a nurse to observe Brenda’s bandage changes so the staff could care for her without causing more pain.
On July 9, she was transported to the rehab center, where therapists began helping her to walk. At first, it took all of Brenda’s strength just to get out of the bed. But after a while, she was able to venture into the hall.
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Before Brenda could take a step, Bob says her legs had to be wrapped because the pressure would cause them to bleed.
It took three people to help Brenda walk ó one to follow her with a wheelchair, another to walk backwards in front of her holding a belt around her waist for support and a third to walk beside her and hold her injured arm.
She had worked her way up to 265 feet, Bob says, when the external fixator surgically placed after the accident to stabilize her splintered humerus started causing her problems. “The screws were slipping on my bones every time I would try to get up,” Brenda says, “and it would cause this pain that was just unreal.”
Brenda was scheduled to see Dr. L. Scott Levin, chief of plastic and reconstructive surgery at Duke, on Aug. 3. Levin had performed the skin flap and grafts when she was first transported to the medical center from Lehigh Valley Hospital in Allentown, Pa., and most of the followup surgeries since then.
Anxious to get the fixator removed, Brenda could hardly wait for the appointment. The rehab center had arranged for an ambulance to pick her up in plenty of time to get to Levin’s clinic, but the EMTs on duty got there late.
When they showed up to get Brenda, they were carrying a regular-sized stretcher and had to go back and get a wider one to accommodate the fixator. By the time they got back, got her loaded and started across the city to the clinic, their dispatcher called and said Levin had called and canceled Brenda’s appointment.
As a result, Brenda had to spend another week waiting in pain to see the busy surgeon, who only sees patients on Fridays.
The pain had worsened to the point that Brenda couldn’t stand up, Bob says, and she was bedridden for most of the week. In the meantime, a blood clot developed in her left arm.
The PIC (peripherally inserted central catheter) line allowing medication to enter her bloodstream quickly had to be removed, and Brenda was placed on a blood thinner.
The doctor at the rehab center took her off the blood thinner the day before her appointment on the 10th. By that time, Brenda’s temperature had started to spike, and she was placed on antibiotics.
Bob says the ambulance arrived on time the next day, but the EMT at the wheel was driving so fast over the bumps in the road that his colleague in the back with Brenda had to shout for him to slow down.
After ordering X-rays of the humerus, Levin decided the external fixator needed to come out. Brenda was scheduled for surgery the following Monday.
Sadly, she would face yet another setback. “When they started taking the screws out of the humerus,” Bob says, “it snapped.”
Levin placed the broken arm in a soft cast, then took her back into the operating room for the next three days so they could change her bandage under anesthesia.
nnnOn the fourth day, the surgeon fitted her with a contraption that strapped around her body and featured a metal platform to support the injured arm.
At some point during the week, Brenda looked over at her arm during one of the bandage changes. “My arm was as green as grass,” she says. “It looked like some kind of fungus was growing on it.”
On Aug. 16, Bob arrived home from work to find that Pookie, Brenda’s 15-year-old, black miniature Schnauzer, had died. “I just broke down,” he says. “I said, ‘What am I going to do?’ All I could think about was Brenda and how it was going to hurt her.”
When she asked about Pookie that night on the phone, Bob couldn’t bear to tell her what had happened. “He’s fine,” he told her.
The next day, a Friday, Bob suffered a kidney stone attack at work. He was pale, sweating and almost doubled over in pain.
He declined his coworkers’ offers to take him to the hospital and drove himself. A doctor in the emergency room at Carolinas Medical Center-NorthEast in Concord diagnosed him as having an 8-mm kidney stone and sent him home until he could see a urologist on Tuesday and have a lipotripsy to bust up the stone.
nnnIn the meantime, Brenda had just about reached her breaking point. Her pain had become unbearable, and she was missing Bob terribly.
The nerve block that had been surgically placed in her arm earlier in the week to help relieve the pain wasn’t working, and she says she couldn’t take much more.
Her screams could not be denied. One nurse refused to change Brenda’s bandage because she said she couldn’t stand to torture her anymore.
That’s when a doctor went in Brenda’s room and said their only other option was to amputate the arm.
She told them she didn’t know what she wanted to do. “I can’t take anymore,” Brenda says she said. “I just don’t know what to do. The pain is too much.”
Bob did his best to encourage Brenda on the phone. “I was calling her every couple of hours,” he says.
During this time, Brenda says staff members from the psychiatric ward visited her, prescribing medication for depression.
The hospital also brought in an alternative healer, who Brenda remembers only as Ann. She moved her hands back and forth a few inches over Brenda’s arm before slinging them as if she was throwing away the pain. “She never touched me the whole time,” she says.
Amazingly, it seemed to help.
Ann started visiting Brenda regularly, she says, helping to relieve the pain in her arm and working on her legs before she would start to walk.
When Brenda accidentally pulled the tube to the nerve block out, doctors put it back in. This time, the nerve block worked, and the pain began to ease.
nnnInfectious disease doctors at Duke checked Brenda daily while treating the MRSA staph infection in her arm. “They were pumping antibiotics in her like you wouldn’t believe,” Bob says. “There was enough in her that her hair started falling out.”
Brenda also suffered recurring yeast infections from the powerful antibiotics.
As doctors began getting the infection under control, staff started her back walking, wrapping her legs every time.
Bob says he talked to Levin over the Labor Day weekend. The surgeon said he had decided to put in another external fixator and had sent Brenda’s X-rays for a fixator specialist to review.
“When Brenda heard, she started crying,” Bob says. “She said she didn’t want another fixator because of the pain it put her through the first time.”
As it turns out, the doctor with whom Levin had consulted said Brenda wasn’t a candidate for another external fixator and recommended that the humerus be plated.
On Sept. 11, Brenda was taken in for surgery yet again. A titanium plate was inserted in her arm and her humerus screwed to it. “The plate will always be in there,” Bob says.
Though he was pleased with the results, Bob says Levin found something in a bone sample taken during the surgery that concerned him and said he wanted to keep her on the strong antibiotics.
Within six days, Brenda had recovered enough to return to her home on Cloverdale Drive in Rowan County.
The day before she was to be discharged, staff used an similator at the rehab center to prepare Brenda for getting in and out of a car.
nnnThat night, Bob broke the bad news about Pookie. Brenda had asked about the dog every day, and every day, he’d said Pookie was fine or playing.
The time had come to tell her the truth. Bob says he asked a nurse for a sedative for Brenda beforehand. “She’s going to need it,” he told her. “And of course, she was devastated.”
Brenda says she had a feeling something was wrong. “I kept asking, ‘Are you sure my boy’s OK?’ ” she recalls. “He’d say stuff like, ‘He’s good as can be expected.’ ”
When Bob said he had something to tell her, Brenda says she knew it was about Pookie. “I broke down,” she says. “Pookie was my baby. He was a Mama’s Boy.’ ”
The hospital staff was so concerned about her emotional state that they arranged for a psychologist to talk to her.
The next morning, on Sept. 17, almost four months after the horrendous accident, Bob and Brenda left Duke University Medical Center headed for home.
“I was so happy,” she says, “but then I knew my dog wasn’t going to be there, and that upset me. Bob said, ‘Don’t worry. We’ll get you another dog when you are able to take care of it.’ ”
nnnBack at home, the challenges continued.
Levin wanted Brenda to continue taking antibiotics intravenously for six weeks, so Bob got up every morning at 5 to hook her up to an IV for two hours. Afterward, he’d flush the line with saline and Heparin, a blood thinner, before wrapping her legs to take her to the bathroom.
After he went to work, Brenda would be alone for 30 minutes to an hour before her mother, Mary Rose Carter, would arrive around 8:30, followed by her daughter, Stephanie Husers, at 9.
Stephanie would leave by 2 to pick up her 5-year-old daughter, Peighton, and Brenda’s mother would leave when Bob’s father, Wilbur, arrived at 2:30. Stephanie and Peighton would return later and prepare dinner, and the five of them would eat together when Bob got home after 6.
Home Health staff dropped by two or three times a week for about 15 minutes, checking her vitals and making sure everything was going OK. After a while, physical and occupational therapists from Gentiva Health Services started going by to help Brenda build strength in her arm and legs.
Bob took Brenda back to Durham to see Levin’s physician’s assistant on Oct. 5, then returned with her again to see the surgeon on the 19th.
After examining her arm, Bob says Levin commented on how well Brenda was doing. “He called her his poster child,” Bob recalls. “He was just ecstatic about the way things had turned out … He said she was a lucky, lucky lady.”
nnnA benefit golf tournament held Nov. 10 at Corbin Hills Golf Club raised $4,000 to go toward Brenda’s medical bills. Stan Honeycutt and Perry VonCanon planned the fundraiser, and several of Bob’s coworkers from The Hartford Group participated.
Bob’s best friend, Tony Petrea, also flew up from Florida to play.
On Nov. 15, Brenda started physical and occupational therapy at the NorthEast Outpatient Rehabilitation Center in Concord.
When they saw Levin again on Dec. 14, Bob says the surgeon said Brenda’s humerus wasn’t healing fast enough and fitted her with a bone stimulator to wear 10 hours a day until her next appointment on March 21.
After going to therapy twice a week for almost two months, Brenda’s legs had regained enough strength and movement to where physical therapist Erin Ball released her last week.
Occupational therapist Beth Sly says her arm will need considerable more therapy. Though the Boltzes’ insurance only pays for 45 sessions a year, Beth says she plans to write letters to the insurance company asking them to extend the therapy.
“Brenda has made a lot of progress,” Beth says. “She’s got more motion in her hand and more motion in her wrist, but she still has a long way to go.
“We can’t work with her elbow and shoulder yet because of the fracture, and we really use our whole arm to do most things.”
Beth says Brenda has a great attitude. “I think she’s really happy to be alive,” she says. “She knows that it probably could have gone the other way.”
nnnBrenda says she didn’t dare look at her arm until a couple of weeks before she left the hospital. “It didn’t look as bad as I thought it was going to on top,” she says, “but it looked bad enough.”
She didn’t look at the bottom of her arm until a while later.
“The first time I saw it,” Brenda says, “I just busted out in tears. It was just so terrible looking, red and bruised. It looked like something out of a scary movie.”
Brenda says she was devastated when she saw her legs after the flap and graft surgeries. “They were just horrible,” she says. “They were so scarred up.”
The Boltzes have paid out $10,000 in deductibles and out-of-pocket costs so far. The last time he added it up, Bob says Brenda’s medical bills totalled more than $500,000.
nnnLife for the couple became more joyful when Bob surprised Brenda with a special Christmas present.
Zeke, a 9-week-old, black miniature Schnauzer with silver highlights, was supposed to be flown in from a kennel in Indiana on Christmas Eve, Brenda says, but Bob surprised her with him early.
Bob’s brother, Brian, and his wife, Laura, were visiting, Brenda says, when Laura asked when the puppy was supposed to arrive. After she told her, Brenda says Laura asked, “What is that on the floor?”
Bob had slipped in and set the puppy down in front of the refrigerator.
“I was so excited,” Brenda says. “I reached down and grabbed him and started kissing him. He’s just a little sweetheart.”
Bob says Zeke, who also answers to “The Zekester,” is a great therapy dog. Not only has chasing after the puppy helped Brenda to build her strength, Zeke’s antics have her laughing again.
When Pookie died, Bob says he put all of his toys in a plastic bag. After Brenda got home, he asked if she wanted him to throw them away.
“Just put them in the garage,” he says she told him.
One day when he got home from work, Bob says Brenda had washed all of Pookie’s toys for Zeke to enjoy. “So now we go from the old to the new,” he says. “He’s going to be our new little family member.
“We won’t ever forget Pookie, but she just loves Zeke to death.”
Brenda has taught the puppy to sit, lie down and roll over.
When he telephones her during the day, Bob says Brenda greets him with, “Do you know what your son did today?”
Having Zeke around has also helped Bob.
“I’m relaxed now that we’re getting normalcy back in our lives,” he says. “I know when I come home from work and open the door, he’ll be right there wagging that little nub about 90 miles per hour, and he has the cutest little bark.”
Zeke loves to tug on his shoelaces and the bottom of his pants, Bob says.
“I look forward to that after a bad day,” he says. “You come home to your wife and your dog. What else do you need?”
nnnBob says he carries the business card that Dr. Geoffrey Hallock gave him after he assessed Brenda’s arm for a second opinion at Lehigh Valley Hospital. Unlike the first orthopedic surgeon who saw her, Hallock said he thought Brenda’s arm could be saved.
When Bob told him he wanted her transferred to Duke, Hallock recommended Levin and wrote his name on the back of the card.
“These two men are probably our angels that we needed when we didn’t think there was any hope,” he says. “They gave us hope.”
Bob pulls out the card every time he tells the story of the accident. It’s showing some wear around the edges, but he says it’s something he needs to carry as an act of gratitude.
“These men saved my wife’s arm,” Bob says.
Contact Kathy Chaffin at 704-797-4249 or kchaffin@salisburypost.com.