Mr. C is a 44-year-old Hispanic male who was working as a general laborer in landscaping.

He was referred for medical case management after an accident the previous day when a large tree branch fell striking his neck and upper back. He sustained T4 paraplegia and bilateral hemothorax. Major spine surgery was performed to remove fragments from the spinal canal, realign the spine and to fuse T5-10. This resulted in no sensation from mid-chest to his feet, with neurogenic bowel and bladder. Later in the year he was hospitalized for intracerebral bleeding secondary to Lovinox, a blood thinner and blood pressure spikes. On another occasion for H. Pylori gastritis.

After six weeks in a rehab facility with his petite wife by his side, Mr. C was released to go home. They were exemplary students during this training process and I met with them about every 2-3 weeks. They had lived in the US for more than 10 years with a beautiful rural home in Ashe County, NC. They had 2 daughters, 8 and 12 years old at the time. On day of discharge we learned the pharmacy did not have adequate information to fill his prescriptions late in the afternoon. I traveled to meet Mr. C at home, stopping to negotiate with a kind and conscientious pharmacist who provided partial fills for all the necessary medication. About 10 family members were waiting for Mr. C’s arrival at home but we had to stop to perform a catheterization in the car before he could exit the vehicle. A temporary ramp was the sole home modification and luckily the double wide was open inside for wheelchair mobility.

Mr. C and his wife quickly learned to establish a daily routine. They learned about his medications. After several urinary tract infections his condition stabilized and he takes no medication for prevention. Mr. C is nearly independent requiring assistance with his bowel program primarily. He reads, studies the Bible, watches TV and enjoys being outside on a deck around the home. On several occasions he went a little too far on the gravel driveway and was stuck. His wife arrived home from work to assist him with little delay. He made an extra slide board for transfers and a small foot stool to go in front of the toilet. He can drive an Arctic Cat around the property and the car occasionally but he has no drivers’ license. I have been amazed at his adjustment to this life changing event. Mr. C would like to be able to work again but he faces a long list of barriers to accomplish this goal. He does enjoy the simple things and the love of his family.