Spasms

I spent weeks monitoring Joe Cowart at Walter Reed Hospital in Bethesda, Maryland. He was one of the more interesting cases. As a budding intern, I had an almost morbid fascination with macabre cases. Patients with third degree burns over most of their body, people with genetic abnormalities that turned them into ghoulish grotesqueries like Thalidomide deformities or Fetal Alcohol Syndrome, but the most interesting case was Joseph Cowart.

Joe Cowart had the unfortunate fate of falling victim to the cosmic joke that we know as the Gulf War. He was on patrol when he triggered a Bouncing Betty otherwise known as an S-mine. This mine, instead of exploding from the ground up, pops three or four feet out of the ground and then detonates. This inflicts massive injuries and shrapnel wounds to the torso and appendages. It was not created to kill; it was manufactured to maim. It maimed Joe Cowart although the true mercy would have been if the mine had killed him.

Before Joe Cowart could be brought to a hospital, he had suffered severe trauma to his arms and legs. As a result of the concussive blast, he lost both arms from the bicep down and his right leg up to his trunk. Perhaps the worst result of the S-mine was the shrapnel that sliced in-between two of his cervical vertebrae and rendered him paraplegic and brain dead.

The comatose body of Joe Cowart spent his days in a hospital bed, slowly atrophying while machines kept him ventilated, intravenous tubes supplied him with the essential nutrients to survive, and a catheter assisted in removing his waste. His eyelids had been taped closed to prevent them from drying out. Medicine has advanced so far that a person could be kept in a vegetative state for years, maybe even decades. Joe had been in this condition for over two decades and with medical innovations, it was quite possible that he would live another couple of decades, if you could call it living.

Every once in a while, the attending doctor would take first year interns on a tour of the facility. He would always stop in Cowart’s room. It was on my tour that I first saw Joe. As I stood in that room, trying to be as deferent as possible to the man’s condition; the doctor drew a needle and asked all of us a simple question.

“What’s the difference between this man and a vegetable in the cafeteria?” He didn’t wait long enough for any of us to give an answer.

He jabbed the needle into Joe Cowart’s big toe and I winced as the sixteen-gauge needle sank half an inch into his flesh. The comatose man didn’t wince, cry out in pain, or give any indication that he felt the jab.

The attending doctor put on a wry smile and said in a mock-conspiratorial tone, “I won’t get in trouble for eating a vegetable in the cafeteria.”

The sudden black humor caught me off guard and I laughed. I was one of the few who did and I think that was what got me in the good graces of the attending physician, Dr. Byrd.

He said, “It is impossible for this individual to experience sensations like pain or pleasure; happiness or sadness. He is as unfeeling and unthinking as the dead. For all intents and purposes, he has been robbed of what makes a person a person, the only reason he is being sustained is that the military is determined to say, ‘We care for our soldiers.’ Whether that’s true or not really has no impact on the care we are providing to him.”

Later, when I asked Dr. Byrd about Joe Cowart’s family, he told me that they visited for the first few years; hoping against hope that they could find some sort of acceptance in his condition. They never came to terms with it and slowly, the visits started getting further and further apart. The last time they visited, they had signed a consent form so that their son could give one last thing in an already long list of things he had already sacrificed. The waver allowed interns to practice minor medical procedures on him.

I would go in that room whenever I had free time. I used to sit by his bed with my lunch and listen to the slow cadence of the electro-cardiogram, the rising and falling of the respirator, and seclude myself from the hustle and bustle of the hospital. I credit Joe Cowart as the reason I made it through that first hellish year of interning at Walter Reed Hospital. The hours were rough and they paid me minimum wage. I would have fallen behind in my techniques if it weren’t for Cowart.

I used my downtime at the hospital practicing my techniques. I gave him sutures and stitches; I drew blood from his femoral artery, and practiced inserting IV’s. Practicing on Joe Cowart increased my confidence and proficiency. I would frequently take my lunch into his room, seeking a moment of peace and quiet. It was while eating my sandwich that I first witnessed one of his seizures.

I had been halfway through my sandwich one late afternoon when Joe Cowart started convulsing. To be perfectly honest, it scared the shit out of me. The only way I can describe how it felt would be this; imagine yourself attending a funeral when suddenly the corpse sits up from the casket and starts twitching and shaking. I watched the writhing man with my mouth agape.

I sat there for a few seconds, too stunned to do anything, before my training kicked in and I hit the nurse call button. I set to performing the ABC’s (Airway. Breathing. Circulation.) as I waited for assistance. His airway was unobstructed, the respirator seemed to be properly attached and there were no kinks in the line, and while his skin was pallid, I managed to find a pulse using his femoral artery. (The ECG also confirmed that there was no arrhythmia.) Some more senior doctors arrived and we managed to get him stabilized.

We spent the next couple of days trying to figure out what had caused the seizures. Apparently this wasn’t the first time he had gone into convulsions, a few years before I began my internship at Walter Reed; he began seizing up on a nurse who was doing a blood panel on him. Tests proved inconclusive and as they didn’t happen again (until now), it was chalked up as a freak occurrence. We scoured our brains trying to find out what was causing the seizures.

We thought it was nutritional issues at first. Blood glucose tests showed he was within normal ranges. Next, we ran a cat scan to see if maybe the concussive blast inflicted so long ago may have had any (extremely) late stage effects. The scan showed no bleeds or any type of infection that might cause seizures. We checked for deep vein thrombosis. Could he have formed a clot that had shifted loose when I had practiced a blood draw on his femoral artery? An embolism could have triggered the seizures. Had I caused this?

The test indicated that he had no thrombosis or embolisms. At a glance, besides being a paraplegic, brain-dead, multiple amputee; Joe Cowart didn’t have any conditions that could have resulted in a seizure. Why was he still seizing? The seizures by now had increased in frequency. Every few days he would go into convulsions that lasted a few minutes before stopping.

During these episodes, he would writhe on the bed as if he were being electrocuted. His one remaining limb would thrash about as if it were a marionette with tangled strings that were being jiggled up and down. His foot would lash out and bang against the bed stand. We were afraid to restrain him as he could break his leg in one of his spasms and hospital regulations prevented a restraint being left on for more than twenty-four hours.

The convulsions soon started occurring every day. It got so frequent that we even had a code on our system. (Code Cowart.) Interns had started going at first out of curiosity. It became a bit of a competition amongst us. Whoever could solve the medical mystery behind Cowart’s convulsions would be the best of the group. We would all sprinted towards Joe’s room with every code, but eventually interest flagged and most interns moved onto more interesting cases. Until eventually it was only me.

I was consumed. I stayed awake at night, looking up possible (extremely rare) genetic causes for seizures. I pored over medical texts looking for rare conditions. I found nothing. It took a week of sleepless nights before one last possibility finally dawned on me. I spent the rest of the night reading up on Dr. Edward Taub’s Neuroplasticity theory.

I had to make sure.

I went into work the next day and spent a majority of the day waiting in Joe Cowart’s room. I didn’t want to be right. I had managed to pull night shift and it was a quiet night, which afforded me plenty of time to monitor Joe Cowart’s condition. At around 2:30 that night, he started to spasm. I quickly shut the curtain and disconnected the ECG. I couldn’t let anyone interrupt us. I was going to let him convulse.

He writhed and shook on the bed like he was being electrocuted. I watched him carefully for any indication or sign. His one remaining foot lashed out and banged against the metal bed stand. His teeth were gritted and a small dribble of blood spilled from the corner of his mouth. I was too busy writing down my observations to treat him. I finally knew what was wrong and what the seizures were. They found me writing in my notes. Joe Cowart had bitten off a portion of his tongue and blood was burbling from his mouth. They managed to elevate him and compress the wound before he could drown in his own blood.

They claimed sleep-deprivation had impacted my judgment. That did nothing to lessen the sentence. I was barred from the hospital and my medical license was revoked under claims of malpractice and negligence. None of that matters though. What matters now is getting the word out. They need to euthanize Joe Cowart. Those weren’t seizures; they were desperate attempts at communicating.

I know you don’t believe me. His family didn’t believe me either. They had a restraining order taken out against me. They didn’t want to accept the horrible truth; he is alive and cognizant. How long he has been in that state, I can’t know for sure. With neuroplasticity, he had regained a bit of control of his leg, but the rest of his body is paralyzed. Apparently the small regeneration was not enough for fine motor skills, but was sufficient for him to try and send out a message.

Joe Cowart wasn’t having seizures; they were his message. He banged his leg against the table in a certain pattern. Repeating over and over again. This was the pattern. The periods are indicative of quick taps while the dashes signify a harder strike.

….

.

.-..

.--.

Don’t you get it?! He’s been like that for months, trapped in his own body. Barely able to exert enough control to convey a message in Morse code spelling out the word “H (….), E (.), L (.-..), P(.--.).” Oh God! Endlessly tapping out that same message, trying to get someone, anyone’s attention. He is trapped inside the shell of his body, begging someone to kill him, but no one will listen!

They won’t allow me back on hospital grounds. They say that I’ve cracked under the pressure, but that isn’t true. They say the head scans show no indication of higher brain function. It’s inhumane what they’re doing. He can only just lie there, kept alive by tubes and respirators; no one to communicate with except himself. Screaming silently for death, but no one can hear him or has their eyes open enough to see his torment.

The doctors think they understand his condition, but they are completely misguided. The army thinks they’re taking care of one of their own by paying his medical bills, but they’re only perpetuating his hell. He needs to be put out of his suffering. I was the worst offender, poking, prodding, piercing him with needle drivers all in an attempt to better myself. Oh God, the agony he must have felt under my administrations! A blurb of lyrics from a song is caught in my head. As I write all of this, it repeats over and over. “Like autumn leaves his sense fell from him, An empty glass of himself shattered somewhere within. His thoughts like a hundred moths, Trapped in a lampshade. Somewhere within.”

“Their wings banging and burning, On through endless nights. Forever awake he lies shaking and starving, Praying for someone to turn off the light.”

I’m sorry Joe. I’m so sorry.