(The chart she published says 1968 but is clearly calculated for 1958.)
Dr. Millard wrote:It was with great pity and a sense of guilt that I studied the record: "The woman was an obese eighteen year old, dull looking but seeming to understand. She was in a wheelchair. The chief complaint is of fecal incontinence secondary to her long previous history of paraplegia. She enters hospital to have a colostomy."
Gayle was born with a meningomyelocele. The lower end of the spinal cord, from which arise the nerves supplying the bladder, bowel, and legs, was exposed in a sack, and covered only with a thin layer of skin. (Neural tube defects can now be diagnosed in pregnancy by a blood test on the mother, and by a test of the amniotic fluid.)
In the old days, the sac always began to leak spinal fluid and became infected. Then the child died of meningitis.
About twenty years ago, surgery had become sufficiently advanced to be able to operate on these children. The nerves in the sac can be freed and covered with skin. The children then lived, because they did not become infected, and even the most 'successful' cases developed hydrocephalus and mental retardation.
When Gayle was born, this complication was well recognized, and to prevent it, a shunt was constructed to take away excess fluid from the ventricles of the brain. In her case, the left kidney was removed and the shunt placed in the left ureter.
The technique has improved, and now it is placed in the atrium of the heart. The excess fluid passes into the circulation... However, Gayle was born before this method was introduced. Her developing hydrocephalus was arrested, and though a "slow learner," she definitely was not retarded. She seemed a normal nine year old, although desperately ill when she entered hospital with E. coli meningitis, which had then reached the brain from a urinary tract infection on November 17, 1967.
It seemed that she would probably die. Meningitis alone is a potentially fatal disease, but meningitis in the presence of a brain to ureter shunt is impossible cure without removing the shunt, which acts as a foreign body. Antibiotic treatment began at once, but despite this, the pressure in the brain was very great and kept increasing. The blood pressure rose with it, in order to maintain the flow of blood through the brain. It reached the incredible height of 300/200, and we had called in a neurosurgeon to put a pressure monitor in her skull when she suddenly herniated her brainstem through the foramen magnum and sank into a very deep coma. She was totally paralyzed, both arms and legs, and death seemed but hours away.
It was the weekend. I was on duty and sat with her. She was bleeding into her stomach and into her skin, lungs, and b rain. Unless the blood pressure could be reduced, she would bleed to death. I started [various drugs] but none brought it down. As a last resort, I put up an Arfonad drip... to dilate the blood vessels which were in spasm and keeping her pressure as high. She was insensitive to it, but I sat with her through the night and monitored her. Little by little the bleeding ceased and so she lived.
I never thought she would be paralyzed. Her arms gradually returned to normal, but her legs never moved again.
After her blood pressure and intracranial pressure had stabilized, and her kidney function, which temporarily had ceased, returned, she was taken to the operating room and the shunt was removed. The meningitis slowly cleared.
I do not know how much her brain was damaged, and whether it was due to the meningitis or the high pressure. She seemed much more retarded after her illness. Her family could not cope with looking after her in a wheelchair, and she was sent to an institution for retarded children where she remained for several years.
The legs used to go into intolerably painful muscle spasms. As cordotomy was done... to cut the nerves in the spinal cord. She was incontinent of urine, so her bladder was removed and her ureters diverted into the bowel. Then she was incontinent of faeces, so a colostomy was carried out in April 1977.
She had a nervous breakdown and was in the psych ward in the summer of 1976. She must have insight int her condition, for people who are very retarded to not have acute psychotic episodes.
I have seen her once since then. She was in a wheelchair, and she did not remember her illness. Since then, she has seen more doctors than one can count, and her treatment must have run into thousands of [1970s] dollars. Worse than that is the thought as to the kind of future she has to look forward to.
