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Mother Love

Profile of Jennifer Boggs

From InsideRHCI, Spring 2007

A young woman returns to her family after brain surgery and a series of strokes.

For years, Jennifer Boggs of Forestdale thought her headaches, muscle pain and fatigue were due to migraine headaches. Eventually, an MRI revealed the cause of her symptoms: an Arnold-Chiari manformation, a rare condition in which part of the brain (the cerebellum) bulges into the spinal column. The remedy was brain surgery at a specialty New York hospital in January 2006. But six weeks later, symptoms reappeared. Jennifer then spent six grueling months in a body brace to reduce pressure on her brain stem. In a second operation in August, surgeons placed rods and screws in her skull to "pull the bone off the brain stem," Jennifer describes. The next day she suffered four strokes.

Jennifer spent nearly a month in a coma. As her condition stabilized, her husband, Wayne, and mother, Karen Thatcher, looked into rehabilitation options. "We walked in the door [at RHCI] and Wayne said 'She's coming here,'" remembers Karen. "We feel the progress she made is due to being at RHCI."

Enjoying quality time together: Jennifer curls up with Brandon (left) and Connor (right).

During her month as an inpatient, Jennifer learned to do everything again: to sit up, get out of bed, dress herself, shower, walk, eat - even to speak. Every aspect of her medical, nursing and therapy care was designed to enable Jennifer to reach her goal. "I wanted to get back to being myself, to go home so I could take care of my kids," she says.

Jennifer's rehabilitation team was led by David M. Lowell, M.D., RHCI's medical director and a neurologist. The 32-year-old nurse, wife and mother of two small boys was very weak, disoriented and needed assistance for every aspect of daily living. She had a tracheostomy to help her breathe, a feeding tube because she could not swallow, and a special collar to support her head and neck. Persistent dizziness and double vision complicated therapy. Her team included physical, occupational, speech and respiratory therapists, a case manager, nurses, rehabilitation aides, a social worker and psychologist.

"Jennifer had complex medical, neurologic and emotional needs," says Dr. Lowell. "The organization of our program enabled us to work as a team to address and treat these needs. In addition, she was highly motivated. She and her family worked incredibly hard to promote recovery from her initially devastating strokes."

Jennifer's care required constant collaboration among team members. "She had already gone through so much," says Larry Coons, R.N. "Understandably, she had periods of feeling depressed. And anything neuro makes you so tired." To encourage her, staff set reachable goals each morning and built in frequent rest periods between therapies.

A nurse who had worked in long-term care, Jennifer had devoted recent years to raising Brandon, 7, and Connor, 4. Her hospitalization was especially hard on the boys, and not seeing them distressed her. One of her first goals at RHCI was to visit with them.
"She felt she had missed so much. She so wanted to hold her kids," says Kim Patota, physical therapist. "Just to sit up and visit with them was a very big effort - physically and emotionally," she said.

Janet Mooney, senior social worker, helped Jennifer anticipate the strong emotions elicited by the visit. Her team attended to all the details. "Jennifer was so particular about her clothes, her hair, her nails. She wanted to look as much like their mom as possible when they came in," says Mary Ann Almeida, advanced rehabilitation aide.

At first the boys were nervous, notes Wayne. "But the staff did a great job of preparing Jennifer. She was sitting up, and they had a scarf covering up the trach. Brandon and Connor were so happy to see her."

In fact, taking into account the family's needs is a critical aspect of rehabilitation. "Not only did they take great care of her, they always looked out for what we needed," says Wayne. "And they'd call when there was improvement so I could be there. I saw her use the walker the first time - that was amazing."

Over the next month, Jennifer reached many other milestones. "When I could take a shower - that was great," she says. "And when I could eat real food, I wanted to eat everything in sight."

Slowly, Jennifer improved. She opted to focus rehabilitation on getting home as soon as possible. "She was willing to trade some independence for getting home sooner. She thought that would make things easier for her family," says Kim. Her team did a home assessment and recommended modifications to create a safer environment.

"They taught me how to help transfer Jennifer and supervise her meals," says Wayne. "We were well prepared for when she came home."

To give Jennifer a realistic picture of what to expect, a volunteer in RHCI's Stroke Peer Visitation Program (see sidebar) met with Jennifer. "She had had a stroke as a young mother and knew what it was like," says Jennifer. "It was so helpful to get tips from someone who knew what I'd be going through."

High spirits: Jennifer and Wayne with their sons. “They’re so happy to have Jennifer home,” says Wayne.

Jennifer's case manager, Jenny Stickney, had arranged for home care services during her first weeks home. By November, Jennifer was back at RHCI for outpatient therapy to improve walking, balance, stamina, strength and voice. Though she was able to swallow an increasingly normal diet, her voice was still very high and she had trouble coordinating breathing and speaking, notes Carolyn Slesinski, inpatient speech and language pathologist.

Reading to her children was one activity Jennifer tried to normalize life for her family, but her altered voice bothered Brandon. Kelly Roscoe Brooks, outpatient speech and language pathologist, taught Jennifer to use breathing techniques, relaxation exercises, daily checklists and a home exercise program. "As she got more relaxed, the pitch came down and she was able to speak without losing air mid-sentence," says Kelly.

Today, Jennifer's ability to do daily activities is greatly improved. She helps with cooking, laundry and homework and is driving short distances. Her mother comes by to assist with housework and gets the kids ready for school. And now Jennifer has more energy to be a mom.

"Everything else will get better with time," Jennifer says. "I just feel thankful to be alive. And I'm so grateful to everyone at RHCI. They made me feel at home, and that was so important."