One of my more memorable home health patients was Sam. He was a paraplegic (paralyzed from waist down) due to being born with Spina Bifada, a neurological disorder causing the spinal cord to bulge out inappropriately.

Sam lived in a very remote area. This area was known to be inhabited by those who were trying to hide from the law, and by a few other brave souls who took the challenge to live as if they were in a previous century, without running water or electricity.

Lydia, Sam's mother, had chosen this forsaken spot to escape her abusive husband. He had beaten poor little defenseless Sam, leaving deep ugly scars over most of his body. She had tolerated the injustice to herself and Sam, until he started sexually molesting her five year old daughter, Lizzy. That was the last straw, and she managed somehow to escape, and took her violated children with her. She worked two full-time jobs as a waitress in the nearest town, one hour away from where she currently resided. This left the now teenagers alone, to fend for themselves most of the time.

I had the assignment to provide wound care for Sam, with little warning as to what I might find. I called for directions several times, with no answer. So I called the physician, and he told me where Lydia worked. I went to the restaurant and found a tiny weather-beaten lady, who appeared to be a zombie.

She drew a map of how to find her humble abode, and warned me that there were several guard dogs, and to honk a "secret" code, when I arrived, so that Lizzy could pen them up before I opened my car door. The map started about 20 miles south of town, heading east from the highway, with no more of a landmark than a dirt road on the north side of the highway ¼ mile past a certain milepost.

I loaded the necessary supplies in my beat up jalopy and headed on down the road. I found the appropriate ruts in the dirt and headed east. I looked for the third tamarack bush on the right, hoping that my car wouldn't bottom out over the deep ruts. The looming clouds overhead looked ready to burst into a rain shower, causing the whole area to turn into a mud bog. I'd never be able to get out in my vehicle if that happened.

After finding the bush, much to my dismay I noted a fork in the beaten tracks that Lydia had not indicated on her hand-drawn map. I tried to discern which fork looked more used. This was impossible; elk tracks and rabbit prints crossed both. I played eenie, meanie, minee, mo, and chose the left fork, hoping I could find the spot again if it turned out that I had chosen the wrong way later on.

I then started counting groups of junipers. On the fifth group to the right, I curved to the left and to my amazement I saw a cluster of three trailers, that looked as though they had been burned out, standing in a circle. There were no vehicles around, but there were at least four dogs barking loudly enough to announce my arrival to the southern hemisphere.

I pulled my vehicle in next to the largest trailer, an 8'X40' model from the 50's, standing on axles with rotted-out tires. I honked the "secret" code and was surprised to see a beautiful young girl of about 13 come bouncing down from the next little travel trailer.

She waved happily, like she was glad to see another live human being, and calmly led the now docile canines to the third trailer, opened the door, let them in, and then closed the door.

I got out of the car and told her, "Hi, I'm Rachel. I'm the nurse. I came to see Sam."

Lizzy politely told me, "He's in that trailer, with the platform." The platform was made out of plywood with no steps. Stretched out from the platform were two 2X4's approximately 2-1/2 feet apart.

I had three large boxes of dressing supplies and cleaning solutions with me. I hoisted each box up onto the platform, got out my black nursing bag, and then tried to figure out how I was going to enter this abode. I found an old milk crate tossed over by the garbage barrels, and set it down to make a step by the platform. Then I climbed up onto the platform, not very gracefully. I have never been much of an athlete.

Inside the quickly-darkening trailer with a musty, pungent smell, I found Sam sitting in his wheelchair, busily engaged in working a jigsaw puzzle. His young 17-year-old body was torturously curved over to the left side from severe scoliosis. He had tousled blond hair, and astute green eyes.

I explained, "I'm Rachel, the nurse that's going to change your dressings." Sam smiled back with a little quirky grin, and said, "All righty, you've come to help the mighty," and rolled over to his cot in the corner of the small, dusty room. He swung out of his wheelchair before I could bat an eyelash.

I asked, "Where's the light switch?"

He chuckled and told me, "You need to hurry while some daylight's left, because Mom doesn't want us to use the kerosene lamp unless it's absolutely necessary."

I looked around and noted the singed, once beautiful lace curtains and decided she was wise. I asked for a sink to wash my hands. He told me the sink was in the bathroom, but there was no water. So I washed as best I could using alcohol-based hand cleansing gel.

I took his vital signs and noted them down while making chitchat, finding out a little more about this boy who seemed to accept his seclusion without any regret. Sam had completed his GED and now was taking a correspondence course from the community college, planning to major in English literature. He spent much time reading Shakespeare and often would play out the scenes with Lizzy, for entertainment.

Lizzy was being "home-schooled," more so that she could be Sam's attendant than anything else, I suspected. But, she merrily flitted about, not seeming to mind in the least.

I finally asked Sam to turn over so I could inspect the wound on his behind. He rolled out a deep laugh, and said, "What behind?" as he complied with my request.

That's when the source of the pungent odor, somewhat like olive blossoms in springtime, came wafting up and almost made me faint. Woooo! The dressing that had been placed the previous day by the doctor was soaked through with foaming greenish-brown pus. I put on double gloves, wishing I had a whole protective body suit.

After I removed the dressing and placed it in a garbage bag I brought along, I surveyed the damage. There were no buttocks to speak of. There was no fatty tissue. The wound was big enough to hold a football. I irrigated the wound with two quarts of saline, then scrubbed it with gauze, stuffed it with clean gauze, and covered it with triple-layered absorbent dressings, secured with almost a whole roll of tape. Then I asked him to turn on his back.

He had a colostomy, a surgical opening in the abdomen for feces to exit the body. He also had a urostomy, a surgical opening for urine to drain from the kidneys. Both plastic bags were full of excrement. I emptied them and washed them out using the sterile saline, since I had nothing else. I made a mental note to take several gallons of bottled water to use for general cleansing on my next visit.

The next orders were to catheterize his bladder and irrigate with betadine solution. I wondered why this extraordinary order was given, but not for long. After I inserted the rubber tube through his penis into his bladder the same foamy greenish-brown pus came exploding out of the end.

I irrigated, and let the bladder drain, over, and over, and over again, until it returned clear. It took me over an hour just to do this part of the visit. The sun was now setting under the horizon.

I took all the trash out to the barrels and burned it. I didn't want the dogs spreading it hither and yon. I hoisted myself back inside the dark trailer, armed with a flashlight from my car. I straightened up and promised Sam, "I'll be back in two days, to do all this over again."

He was back in his wheel chair, making a PBJ sandwich.

I asked hesitantly, "How do you leave the trailer?" I wondered if he could get out in case of an emergency.

His face lit up and said, "Didn't you see my ski jump?" He told me, "I line up the wheels to match the boards, and just fly out any time I want."

I shook my head in utter disbelief. There was no railing for safety, no protection whatsoever. "What if you need help?" I asked. "You're so far away from town. You don't have a phone."

He told me, "We do have a cell phone in the other trailer that Lizzy can turn on with the gas powered generator if we have a life-threatening emergency."

I asked if his mom would allow me to send out a social worker to arrange for some improvements to the property, for safety's sake.

He shook his head no. "You're lucky she let you come," he said. "If you go asking for more troops, she'll move us out of here lickety-split."

I guessed the fear that her former spouse would find her again was still very real. I informed the physician of the deplorable condition in which I found Sam. He told me he knew, but it was Lydia's choice to remain very anonymous. He had promised that only one nurse would come, and that he wouldn't press for more, per her wishes.

I recommended a few changes to the wound care orders, which he gladly allowed, and then told me that he wanted to be kept informed of the case, and thanked me for my diligence in caring for this special patient. I heaved a big sigh of relief as I pulled into my cozy, well-lit home that night. I once again hugged my children, and thanked my Father in Heaven for all my abundant blessings.