Lessons From A Tetanus Survivor

– Excerpted from a blog by MedSend occupational therapist Deborah Berruti, who serves at a mission hospital in Niger

When I went to see S.* for our first session on Monday morning, she told me that she didn’t like me and I should just leave her to die. 

S. had concluded that healing was not possible and had lost her will to live. Her mother had also given up hope and was already beginning to grieve.

S. had survived tetanus, a horrific disease that caused all of her muscles to become rigid, including those required for swallowing and breathing – two functions necessary for survival. I was consulted because she needed chest physical therapy for her aspiration pneumonia and speech therapy for swallowing.

The swallowing mechanism isn’t just for transporting food from the mouth to the stomach. If the system is impaired, it can have fatal consequences. Swallowing is a protective response; it keeps saliva (and food/water/etc.) from entering the lungs. Swallowing is a necessary function for living – I couldn’t accept the thought of S. starving or choking to death.

So we began working together several times a day . . . sitting up at the edge of the bed mostly.  She had very poor endurance, nearly no activity tolerance and was incapable of volitionally moving her own limbs. On top of that, she made it very clear how she felt about me.

But we kept going.

Within a few days, S. was able to move into a regular hospital bed.  I brought her a chair for the bedside so that we could keep her from spending all of her time laying down.  At first she was a dead-lift from the bed to the chair, and could only tolerate being upright for a few minutes . . . leaving her to sit in the chair wasn’t an option, as our chairs are junk and the slightest noise or movement that would startle her would cause her whole body to extend rigidly like a board – it’s hard to sit in a junky chair if you can’t bend in half.

Every morning she was the first patient I’d see.  I’d sit on a stool facing her, making sure she didn’t lose her balance and we’d make funny faces at each other – I mean, do speech therapy exercises.

Over the week she was able to semi-wash herself and contribute a little more as she sat up in bed and moved to the chair.  She started to take a few side steps.  But the biggest improvement was her oral ability.

Day after day, S. wiggled and contorted her lips and tongue . . . all the while begging that we remove the nastogastric (NG) tube that kept her alive by carrying food through her nose to her stomach.  Whenever we came to the “smile” exercise, she’d stretch her lips, but it was nothing that remotely resembled a smile.  I tried to make her laugh . . . nothing.  She simply refused to enjoy anything about this process.

On Friday, she refused to sit in the chair during our morning session.  I returned a few hours later to find her already at the edge of the bed.  I got into position to help her transfer, counted to three and started to stand her up.  Only, S. didn’t stand.  She didn’t even make an attempt!

I leaned back, looked her in the eye and said ‘You’re going to make me work for this, aren’t you?’

A great big you-better-believe-it smile spread across her face!

On Saturday, S. didn’t want to do her speech therapy exercises.  There were too many people in the room, staring.  She was embarrassed.

I knew I had to act quickly or I wasn’t going to get her to work so I decided to make her laugh.

“Okay, stick out your bottom lip and lift it over your top lip toward your nose,” I instructed.

“I can’t,” she said stubbornly.

“Do you know why I can do that so much better than you?”

She furrowed her eyebrows at me.

“Because when God made me, He forgot to give me a top lip!  Watch this . . . now you see it, now you don’t!”  (For you who don’t know me personally, I have very thin lips, and when I smile the top one disappears.)

S. watched closely as I smiled, stretching my top lip so thin it was practically gone.  It was just what she needed to crack.

Laughter all around!

On Sunday, we pulled her NG Tube . . . since she was able to begin swallowing foods like guava sauce and tuwo (millet dumplings).  Today I’ve let her start sipping water and milk.

And then, the next morning, another miracle happened.  S. sat herself up in bed!  But it gets even better!!  She then stood up and walked!!  With help of course, but she went about 10 feet, three times!  The whole patient ward cheered as she strutted her stuff!!  And then we had to celebrate with a little dance!

In one week, we went from “I DON’T LIKE YOU . . . LET ME DIE!” to dancing down the aisle of the overflow medical ward!

Just a few days later, we were sitting on a mat, under a tree in the Ambulatory Care Unit behind the hospital. Already she had done her own laundry in a modified position and climbed a small set of stairs. A world away from relearning how to swallow her own saliva.

“Thank you,” S. whispered to me in English before transitioning back to Hausa.  “I thought I was dead, but you gave me my life back.”  I looked up from the patch of sand where I was etching designs with a stick. Our eyes met, and I smiled.

“Thank you, my friend,” she repeated and she leaned her forehead against mine. As S. listened to the first part of story of Mariama’s Son who healed the sick and had compassion on the brokenhearted, I thanked Him for her healing and second chance.

As I sat under that tree, on a mat, next to a living miracle and she pressed her forehead against mine, the closest to a hug her still-rigid body would allow, I tried to remember the last time I rested my head against my Father’s and whispered: I thought I was dead, but you gave me back my life.

Indescribable grace . . . overwhelming gratitude.  I have so much to learn.

– Excerpted from a blog by MedSend occupational therapist Deborah Berruti, who serves at a mission hospital in Niger

* Name withheld