At the time of Monica’s diagnosis of aortic aneurysm, her physician made a strong recommendation for emergency surgery as the condition in Monica’s case was deemed to be life-threatening.

However the surgery was not without its own risks.³⁴  Monica found herself shocked at the unexpected diagnosis and undecided as to what to do. Her fragile health condition was serious and could take her life at any moment. In the face of this extreme and serious condition and risky treatment option, she simply didn’t know what to do.

Against the advice of her medical team, she left the hospital and returned home to discuss the condition with her family. One long and nervous week later, Monica made the decision to return for the life-saving aortic surgery.

The aortic aneurysm repair was performed successfully. However, it also resulted in a spinal cord injury (ASIA B, at level of Th8) — one of the most serious complications associated with the surgery.

This resulting SCI required further treatment and rehabilitation and caused even more complications. In the same year, these included one instance of a serious, stage IV pressure ulcer at the right trochanter major, which also resulted in osteomyelitis. Following the successful treatment at the rehabilitation centre, two years passed where she otherwise adapted her life to living with incomplete paraplegia.

However, preventative health behavior was still lacking. One potential risk factor³⁵ worth noting here was her addiction to cigarettes: Monica smoked roughly 40 per day and unfortunately possessed neither the desire nor the intention of quitting — certainly a risk factor.

To put this into some context, the following statements offer some insight into Monica’s own perceptions of health behavior and feelings towards her situation:

Paralysis to me means that I’m really no longer free; that I can’t do the things I want to.

To cope with this disability, I have to say that my emotions aren’t relevant anymore. They certainly were in the beginning, when I fell into a deep hole of depression. Now I have to constantly say to myself, “This is simply the reality. I’ve got to make the best of it.” That’s what I’m doing.

Sometimes I have to cry all of a sudden for no real reason. I feel so much anger at crying and not knowing why … but I’ll have a cigarette and go outside; then everything’s OK again.

I just don’t want to know the consequences of this disease … I really don’t want to know.
—Monica in 2007.

Despite her previous dread and experience with ulcers, in 2007, two pressure ulcers again developed on her left and right hip. These were only diagnosed during a routine examination at the rehabilitation center and classified as one stage II ulcer, and even more seriously, one stage IV ulcer.

She was admitted to the rehabilitation center for treatment. Again, there was infection of the bone and a surgical intervention was necessary. After a successful operation, a standard post-operative management intervention was conducted without any further complications.

•    A rehabilitative strategy to treat pressure ulcers should seek to implement a patient-oriented, comprehensive approach, not only focused on regaining functioning that existed prior to the ulcers, but also minimize the risk of recurrent ulcers and complications. Therefore risk factors had to be taken into account (View Box 2)

A number of risk factors clearly play a role in Monica’s case. To plan comprehensive rehabilitation, the Rehab Cycle was implemented four weeks after the surgery.