High Drama in Appalachia

My husband is a gun enthusiast, a cowboy action shooter, and regularly wins competitions at his gun club. He is a survivalist, reloads his ammunition and takes great pride in his skills with firearms. He hunts, but usually only once or twice a year. One hunting trip he rarely misses takes place the week of Thanksgiving near Fort Seybert, West Virginia. We have relatives with a hunting cabin there and they gather there the Saturday prior to the holiday, and hunt starting Monday through Wednesday. 

This is a remote area that is bout 30 minutes from cell coverage, and when you look at it on a satellite map, you can see there is nothing much around it. He loves it there, since wilderness appeals very much to him, where he can get down to basics and enjoy the land. The camp has no running water, so that means no showers but he does fine with shower wipes and "bird bathing" for those few days. 

One of our twin daughters, age 12, wanted to go with him for this trip. She has been squirrel hunting and has been eager to try hunting deer. She shoots with her father at the gun club and at the last annual shoot this summer she placed 4th in her class, which is not too shabby, considering how little she actually gets out there to practice (even when you reload, shooting is expensive!). 

He did his best to scare her off, explaining that there would be 5 smelly men in the cabin, farting, belching, staying up late, smoking and telling stories. Then there would be rising at 4:00 a.m. to get out on the mountain to start early, and it would be COLD as well. She was not dissuaded and insisted she still wanted to go. We then learned that as a non-resident in West Virginia she would not be permitted to hunt without having taken a hunter safety course, which is fine, but it would not be possible to take the class prior to the trip. She decided she wanted to go anyway, and simply shadow her father and observe. 

The first day of hunting, Monday November 19, 2012, She was ill in the morning, having stayed up late eating junk food that she typically doesn't eat, though in hunting camp no dietary rules are followed. That's fine with me, and is part of the experience, by the way! She was sick out by the hunting blind, and there was some concern that the odor of it would scare off the game, so they changed position, and even though she still felt queasy she spotted a small buck. He was able to take it down, and She felt vindicated that she had not ruined the hunt with her stomach ailment! The adrenalin of the experience vanquished her queasiness.

She was very excited and helped him field dress it, and was curious enough to dissect open the stomach to determine what he had been eating. This was a young buck but very, very healthy, and He remarked that there was fat in the abdomen and among the viscera, and the coat was shiny and thick - these deer were not suffering. 

The next day, the 20th, they started out early and by 7:00 a.m. He took down a doe. This was a great shot, right through the heart at 100 yards with open sights. He began to field dress it, and when he was cutting through the breastbone, straddling the animal and pulling the knife towards himself between his legs to open the chest cavity and remove the heart and lungs, his knife suddenly went through the bone and he stabbed himself in the right upper calf near the knee. He is also a professional knife sharpener, and when our knives get as dull as a razor he touches them up (just to give you an idea of how sharp this knife is). 

The wound soon began pumping blood, and action needed to be taken. Suddenly, the plans had changed for the day. He had only his minor first aid kit that he packs into the woods, and this did not contain anything to help him stop the bleeding. He had Her run back down to camp, which was not too far down the mountain (they had driven the F250 pickup) and she returned with duct tape and paper towels. She was alarmed but was holding it together. He made a compression dressing and distracted her with small tasks to let her know that he was okay and reassured her that they would just be doing something different that day, which would involve a trip to an urgent care center and stitches. He had his two deer, so he was happy!

He managed to drive the truck down to camp where they could at least be warm while they waited for the others to return from their hunt. This is his right leg, so driving was difficult. He kept it elevated and dressed and waited. He expected the others back by 11:00, so he wasn't too concerned, since he knew he just needed stitches and would be coming back in the evening. Time passed and he noted the swelling in his leg to be increasing. She pointed out that he might want to consider loosening the bandage, and he did so. This proved to be good advice. 

They decided they needed to go ahead and call the boys home, so She went outside by the earth dam near camp and she fired the shotgun in the three-shot distress call of hunters. She did this repeatedly, to no avail. She then went out and honked SOS in Morse code on the truck horn several times, also to no avail.

The fellows did not return until 1:00, and had not recognized the distress signals. At about 1:30 I received a call from Him telling me his tale of woe, that he needed stitches in his leg, and I found on the map that Harrisonburg, Virginia was the closest civilization. This is home to James Madison University, so I knew there had to be a hospital there. I made arrangements for the other kids and made my own way to Harrisonburg. Meanwhile, I get a call on the road that he had "compartment syndrome," and would need emergency surgery. 

I know from my 25 years in the medical field that compartment syndrome is dangerous, and this news changed my attitude about the situation. Time is of the essence with this condition, since pressure builds up in the muscle cavity surrounded by inflexible fascia, which does not permit stretching to accommodate swelling. Over a period of hours the muscle, nerves and blood vessels can die and the limb needs to be amputated. My 2-hour drive to Harrisonburg was an agony of worry and supposition, with all kinds of scenarios going through my mind. A very difficult drive! 

I arrived and an ER nurse brought Her to me. She welled up a bit when she saw me, immensely relieved to have me there, finally, and she could relax. She'd been waiting alone while he was in surgery, though the ER nurse kept an eye on her. This was a life-changing day for this girl, but she never lost her cool and did her best to help her father. It could be said that she saved his life being there with him. 

Hours go by and he was put in a patient room, admitted for the coming days. His surgery was a success, though they were still monitoring the leg and keeping their eye on pulses. He was not out of the woods. He was in a tremendous amount of pain, but was in good spirits and was still quite elated about what a good shot it was taking down the doe. We knew he had to have a fasciotomy to relieve the pressure in his leg, and now had an open wound that would need to be closed at a later date when the swelling went down. His foot looked like a sausage and his right leg was twice the size of the left. He tends to joke and banter with people when he is anxious or in a tense situation, and he maintained his wit and humor the whole three days we were there. The nursing staff were amused and maybe a bit frustrated at times with him, since when they were trying to be serious and get accurate information he would be quick with puns and sarcasm.

Since the hospital room had only one charming cot (hard as a rock and narrow) I decided to take Her to a motel nearby and spend the night, so she could get a shower and get some sleep. She had not bathed since the previous Friday night, and was not getting much sleep at camp due to the loud TV and snoring. She wasn't complaining, but I thought she'd appreciate some good rest. We found a Days Inn nearby and crashed, arising early to get back to the hospital promptly. 

My next-door-neighbors, a wonderful family who have been great friends and neighbors to us over the years, offered to drive to Harrisonburg and bring me some clothes, as well as our two other daughters, so they could visit with their daddy, and then bring all three girls home while he recuperated there. At first I was hesitant, not wanting to put them out, but they insisted, and I agreed. That was such a comfort for us all to be together and me to know my girls were safe and taken care of - that hospital was no place for Her to stay day after day. While she was there, however, as we walked the halls, visited the gift shop (I bought her a half-sized floor model stuffed cheetah that she had been ogling since she got there - it was the least I could do to reward her for being such a brave young lady) and got meals in the cafeteria she was stopped and congratulated on her courage by hospital staff. The word had gotten out about what she had done to help her father, and how mature and capable she had been throughout what must have been an extraordinarily frightening experience for a young girl. I am SO proud! 

The next day was the first dressing change, and I'm sure this post would be flagged as inappropriate if I posted the picture I took of his post-fasciotomy leg, but that wound was a doozy! He had an incision from knee almost to ankle, and it was 4" wide open from the swelling. All the leg muscles were exposed and visible, like a page out of Grey's Anatomy. At first I was quite alarmed, because it did not appear that this was a wound that could possibly ever be closed, and he'd have to have a flap or a graft to cover it. I was very discouraged. However, I know how to maintain a wound like this with wet-to-dry dressings, and I was not daunted by the prospect - whatever he needed I could handle it. The wound was very clean and looked good, all things considered. There was no dead tissue and very little drainage of serosanguineous fluid. When they came in to do the dressings, I stepped right in and assisted, and explained that I do this regularly at work, handling postop patients, taking out sutures, handling prescriptions, assisting in minor surgery and doing all the dressing changes. 

It was because of my experience that I had the idea to ask if we could take him home, to be followed by my boss, a plastic surgeon. I had been in contact with my doc since the injury, explaining what was happening, and getting advice. I sent him a photo of the wound and he reassured me that once the swelling went down, in a week or more, it would indeed be able to be closed surgically, and not to worry, assuming his circulation was strong and there were no other issues with nerves or tendons having been cut. The surgeon involved in his care assured me that no major structures were damaged by His knife, miraculously, and he ought to recover completely. After we discussed things and I was able to prove that I was capable of handling his wound care, they agreed to let us go home to Richmond, with assurances that he would be seen promptly. His venous duplex and ultrasound studies were normal, and after 3 days we were released to go home.

It was a difficult trip. It was hard for him to do anything but lie in bed, and movement of any kind was painful to the point of vomiting. Getting dressed, getting into a wheelchair, getting into the car, etc. were all extremely stressful and challenging tasks. Vertigo, sweats and nausea resulted after just about any movement. Driving home I really wondered about the wisdom of him being out of the hospital, with inadequate oral pain control and being on bed rest. I'd have to care for him completely, and we had a lot of hurdles. He was using crutches, and our church lent us a wheelchair so his leg could be propped up. He could not let the leg hang down for more than a few minutes, when the whole lower limb would turn cold, and he'd even run a small fever. 

Then there was the dressing changes. These took mental and medicinal preparation on his part, and were very, very hard on him. It did not seem that the oral meds could help with the pain of it, and though I tried to do it as gently as possible there is no way to do it and not hurt him. I found this to be a challenge, causing my husband pain like this, though I did not let on to him. 

Meanwhile, He still had all his gear, guns, blinds, clothes, food, sleeping gear, etc. at the camp in Fort Seybert. He was a little obsessed about getting the deer, also. I thought he ought to just forget about the deer and concentrate on saving his leg, but he could not let it go. My brother-in-law very graciously, and at no small inconvenience to himself, offered to pack up our truck and drive it all the way back to Richmond for us, which was a generous offer since he lives in Charleston, 6 hours away. I'm extremely grateful to him and my sister-in-law for doing this for us, since it was a huge load off His mind to have his truck and gear at home and off the mountain. They drove the truck in the same evening we drove home from Harrisonburg.

Then we had two deer, field dressed only, in the back of the pickup, and they needed attention before they started to decay. My neighbor stepped in, once again, and took the two deer to the processor about an hour away and turned it in, and we promised him one of the deer for his family. 

A week after injury my doc takes a look at the leg, and declares it ready for attempted closure of the surgical wound. He was not sure if it could be closed completely, but a wound closure device might need to be utilized in the center to gradually advance the edges together over a period of days, in order to avoid a skin graft. While I was doing the daily dressing changes I noted that the wound was filling in, and granulation tissue was forming, and it remained clean and healthy. I also noted that his leg was not as swollen and the skin of his leg did not seem so tense, but looked like it could be mobilized for closure. 

Two days after that he had the wound closed surgically, 100%. Now he has a 25 cm sutured wound on the medial calf area of the leg, and about an 8 cm sutured wound on the lateral side, where the surgeon in Harrisonburg performed fasciotomy there but repaired it at the time since it was not needed on that side. 

He's getting around pretty well and is not in anywhere near the same pain that he was before. He is off narcotics and in a few days will be able to bathe over the wound. Sutures will stay in for a good long while, as lower leg wounds tend to come open. He's looking forward to returning to work and driving again, and getting his life back. This has been an adventure, to say the least. An extremely high deductible, emergency surgery, three days as an inpatient and then an additional outpatient surgery means our "adventure" isn't over yet, and the bills will start rolling in, just in time for Christmas! We are, however, very fortunate that things didn't go down a different path, and we are all grateful for that.