Thursday, Sept. 21, 2017
Before dawn on Aug. 8, Derrick Bayard began having severe pain in his abdomen, followed by body spasms. Soon after, it became hard to breathe. He was home alone, a detail made exponentially more important — and dangerous — by the fact that he’s a quadriplegic, unable to use his hands and feet. Bedridden.
“I thought I could wait it out, but the pain was getting progressively worse and no one else would get here until 9 a.m.,” Bayard said.
So, using his head tracking mouse to press keys on the laptop monitor mounted above his bed, Bayard got on Facebook to see if any of his friends were online at such an early hour. He found three: one in West Virginia, one in New York and one in Richmond. They sent emergency help to Bayard’s Richmond home, but he couldn’t let first responders inside. One of them saw Bayard through a back window, but couldn’t gain access. A rescue team eventually broke through Bayard’s front window and transported him to Virginia Commonwealth University Medical Center. He was treated for a urinary tract infection, a common and potentially life-threatening ailment for quadriplegic patients.
Bayard is familiar with VCU for several reasons. It is the health system from which he has received primary care for more than 20 years. It is also where Dustin Mays, Lars Hofland and Evan Amabile attend graduate school in the School of Allied Health Professions’ Department of Occupational Therapy. This past spring, the three students built a customized computer table for Bayard’s laptop monitor. If the monitor had been anywhere else, and not tilted perfectly above him, Bayard would have lost precious time summoning assistance.
“It took me less than a minute to send for help,” he said. “If I just had [the computer] sitting somewhere else, it would have taken [longer] depending on what position I was in.”
Lack of dexterity has been a longtime nemesis for 56-year-old Bayard. Forty years ago he was felled by a bullet to the neck that was intended for someone else. He was paralyzed instantly. Like most people, he uses his computer for everyday tasks such as accessing the internet and social media. A few years ago, however, he began developing pressure ulcers on his elbows and chest, because he used them to prop himself up while laying on his stomach to face his computer screen. At the time, there was no way his laptop could be tilted above him. Bayard’s home attendant at the time, Latoya Harvey, wasn’t able to configure a way to keep the laptop steady enough for Bayard to use while on his side. It occasionally toppled onto him in bed.
Enter a team of VCU students with a $10 budget and an idea.
Seeing the person behind the patient
Bayard is part of the VCU Medical Center House Calls program, which provides home-based medical care and personalized care coordination to Medicare beneficiaries with limited mobility. He is a longtime patient of Peter Boling, M.D., chair of the Division of Geriatric Medicine, who also founded the House Calls program.
Boling met Bayard as a clinic patient more than 25 years ago, and has been to his home several times as his physician. His needs are unique and serious, Boling said.
“For a quadriplegic person, there are specialized care needs,” he said. “Getting a stable cadre of well-trained, hands-on caregivers in place makes a big difference. Fortunately for Derrick, that team includes our social workers, nurse practitioners, students and professors who’ve taken to his case.”
When Boling expressed a need for an out-of-the-box solution to help Bayard with mobility and communication, Megan Stucke, a VCU Health clinical social worker, began brainstorming what type of device could best serve him. She met Bayard in 2012 through the VCU Transitional Care Program, in which VCU Health nurse practitioners manage a patient’s care, and make home visits for people who temporarily have difficulty getting to a clinic.
“I began speaking with the Department of Occupational Therapy back in March 2016,” Stucke said. “[Bayard] and I completed a form requesting help from students to work on the project in January 2017, and gave two ideas of what might be helpful.”
At the time, Mays, Amabile and Hofland were in the Occupational Therapy Practice Activities III class, taught by Dianne Simons, Ph.D. Part of the class includes an adaptive project where students must make a low-tech device or positioning adaptation to help a client or facility participate in an occupation, use a computer or use an augmentative communication device. The students are given a $10 budget to get them started.
“[Eventually] I was able to find a donor to help cover $200 worth of supplies needed for this device creation,” Stucke said. “The students were so sweet and initially offered to cover the expenses themselves.”
Instead of treating me as a clinical assignment, they took a few moments to converse with me, telling me a little about themselves and listening to my life story.
Mays, Amabile and Hofland delivered the computer station to Bayard’s Southside Richmond home in April. In response, he wrote Simons a letter thanking her for allowing the students to help him, the only letter she’s ever received after work on this type of project.
“From the moment Megan introduced them to me, the trio conducted themselves in a very professional manner that immediately set me at ease,” Bayard said in the letter. “Instead of treating me as a clinical assignment, they took a few moments to converse with me, telling me a little about themselves and listening to my life story. All the while, they were gathering information about my condition and my needs. Besides the fact that one of them is a Boston Red Sox fan (I am a lifetime Yankee fan), my experience with the young men was not only totally enjoyable, but also life-changing.”
Creating art out of spare parts
The computer station at Bayard’s home is a clever combination of spare hardware, building supplies and computer parts.
“We needed to find a way to help [Bayard] access his computer while he lay on his back or side. [Our team] met with [him] several times to discuss what he wanted and to take measurements of his surroundings,” Mays said.
Though it eventually took shape, Mays admits the first iteration of the computer table wasn’t, and still isn’t, the most aesthetically appealing. But, it works.
“Our faculty was a little skeptical about our project once we started bringing in steel pipes and old wooden doors, but they came around once the project began to take its final form. We replaced the base with a solid wood slab, installed Lazy Susan hardware to allow the computer base to spin 360 degrees, mounted a monitor to the top platform and added castors to the base to allow for easy movement of the entire station,” Mays said. “We then took the station to his home and spent several hours configuring his existing computer setup to work with the new monitor and station. We pretty much built the entire thing from scratch aside from the monitor and monitor mount.”
The computer monitor is positioned slightly above Bayard’s bed, tilts toward his eye gaze and spins 360 degrees. Thanks to the students, Bayard can now use his computer safely and with ease, and his nurses can turn him in the bed, which is necessary every few hours to prevent bed sores, without hindering his computer access.
“They went above and beyond for me,” said Bayard. “This is a work of art.”
Graduate Students Build an Assist Device
Despite his limited mobility, Bayard is a self-professed social butterfly. He earned a bachelor’s degree in interdisciplinary studies from Virginia Union University in 2006. He has tutored at Binford Middle School and Maymont Elementary School. Now that he can use his computer routinely and without taxing his body, Bayard plans to continue advocating for and working with children, and staying abreast of current, community events through social media.
“Having this device here opens up these types of opportunities,” he said.
Harvey, who until recently was Bayard’s home attendant for more than a decade, said she witnessed firsthand his enthusiasm at being able to stay linked to society.
“Every time I come in here, he has something new to show me,” she said. “He’s not bored. He can do more than one thing at a time.”
Maintaining any level of independence can be paramount to a patient’s overall well-being, Boling said.
“The quality of life and the options and freedoms available to persons with incapacitating illnesses are limited. Most are living with family or are institutionalized, often in facilities that are less than the best because of the way that long-term care is funded,” Boling said. “[Bayard] is bright, articulate and fiercely independent and has experienced institutional care as a quadriplegic, which was a scary, dangerous experience. Still, he has tried in every way he can to remain independent in the community. I respect his efforts to keep his autonomy and applaud our students’ efforts to help him maintain it.”
Aspects of the students’ adaptive project requirements, like meeting with the client, establishing a timeline and developing written instructions, ensure students have direct contact with whomever they are serving. That’s by design, and indicative of the onus VCU has for students to render care outside of the classroom.
“Occupational therapy students enter their education to prepare for careers that will help people live fuller, more satisfying lives,” Simons said. “The American Occupational Therapy Association’s vision for 2025 is that ‘occupational therapy maximizes health, well-being, and quality of life for all people, populations, and communities through effective solutions that facilitate participation in everyday living.’ That’s just what we did for Derrick.”
For Simons, seeing the students’ personal efforts and empathy as they worked on Bayard’s project was particularly moving.
“Dustin lost his grandfather [while working on the project] and the [computer] monitor came from his grandfather’s house. Dustin donated it to [Bayard]. He wanted him to have it,” she said. “A faculty member can’t require that kind of thing. It comes from the heart.”
Students in the OT program are required to complete multiple fieldwork experiences in places such as rehabilitation hospitals, mental health facilities, public schools and pediatric facilities, whether locally or anywhere in the country. Simons has witnessed students’ fieldwork efforts turn into passion, and then compassion.
“What I have seen is that an actual assignment was for a project that could be done by a team of two or three students and each was required to put in approximately 10 hours,” she said. “But students got so personally involved in their projects that they each spent 30 to 40 hours working because they wanted to create a quality project and do something special for their clients.”
‘We take care of people’
According to 2015 data from the Centers for Medicare and Medicaid Services, 55 million people, like Bayard, rely on Medicare for some form of health care. Combined with economic and societal needs, health care and empathy for patients like Bayard can mean the difference between life and death, Boling said.
“One of the great things about VCU, is that we take care of people with complicated health problems and that also have limited resources and therefore need extra help in order to survive and thrive in the community. That requires us to think about the whole person,” Boling said. “The solution the students created was slightly different than what I imagined, but is fantastic. Solving these types of problems requires ingenuity, a willingness to look beyond the simply medical aspects of health care and engage with the barriers and constraints that society, poverty and illness impose, and find solutions.”
Bayard couldn’t be more thrilled with his new computer table. As a heartfelt added touch, Hofland affixed a handmade Star Trek emblem to the computer monitor, after learning that Bayard is a fan of the series. Bayard mentioned it in his thank you letter to Simons.
“In our initial conversation, I expressed my admiration for the sci-fi series and [Hofland] remembered, created and blessed me with this work of art,” Bayard’s letter read.
Though Bayard loves his indoor independence, he is ready to venture outside. A stint in a nursing home left him with a pressure sore that has restricted him to his bed since 2012. But, he’s been healing well, he said, and is ready to get out of the house and on with his life.
“I will be able to get outside soon, once I get my new wheelchair,” he said. “When I am healthy, I am out the front door, almost as soon as I get in my chair.”
Three days after being shot, Bayard was in the intensive care unit of Bellevue Hospital in New York. Oddly enough, his bleak surroundings that day are his motivation today.
“When I was in ICU there was a baby who was born there and died. I was like wow, that baby’s whole life was just trying to breathe,” he said. “At that point, I would have felt really stupid feeling really sorry for myself. I asked God to let me walk. He said no. I asked Him for the strength to deal with what His will was, and He said yes.”
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