These Hinges Are For You

These Hinges Are For You

a POAW story by Abbacor

Recreational casts tend to fall into two categories.

They can be authentic to the medical use for actual injuries, and if worn for more than a few hours or a weekend will usually follow the normal time frames indicated by the ‘injury’ being presented.

Or, a recreational cast can be used to fulfill a fantasy wish or dream. In these cases they may or may not originate from a ‘normal’ medical situation, but will usually evolve into something that would be considered abnormal in the medical profession. These casts also tend to break the standard time frames of medically necessary casts as well.

This is the story of one such fantasy cast that went a bit farther than normal and got caught up in a world where a man’s wish gave a sort of life to casts that could respond to either medical necessity or fantasy wishes.

T Minus 2 Days to Cast Adventure (CA)

“So this is what you want? Are you sure?”

“Yes, I’m sure. You can do this can’t you?”

“I can. I just want to make certain that you know what you are getting yourself into with this. Most of what you are asking for is fairly easy, but the last item is going to be difficult for you. Susan, this will be invasive and if you choose to keep it on like you are thinking then it’s going to seriously affect your life for as long as you keep it in place.”

“I know Steve. But I just have to do this. And that’s why I want to ‘go away’ for a week somewhere to see if I can handle it or not. And I may as well have a little bit of extra fun in the process.

“Are the shoulders going to a problem? I don’t think I’ve ever seen something like I want that works for that.”

“That is going to be out of the normal for sure, but I am pretty sure I can come up with something that should work. I have a couple of ideas in mind.

“What are you going to do if you can’t handle the pain in your head?”

“If I can’t take it for the week then I’ll wear hats or scarves for a while until the scars heal. And if I do keep it to full term like I plan, then you can provide me with the necessary doctor’s notes and such to give to work and insurance, right?”

“I can put in the appropriate forms and give you any letters you need to keep your work happy.”

“Then this is what I want to do.”

“Alright, this is doable. And you’re okay with us take pictures and videos of everything for an extended scene that will get sold online to certain fetish communities?”

“Yes, I’m sure. That way the cost to me for this whole scene will be just for food. Everything else will be balanced against the potential sales of the video and pictures, right?”

“Correct.”

“Excellent. I am so glad that I found out about your little side service you run. This is going to be a fun week I think, and is going to cost me less than taking a vacation somewhere else. Thank you Steve, you’re the best.”

“We’ve know each other for quite a few years now Susan. I was a bit surprised when you approached me about my side business. I didn’t think you were into that kind of thing. But I’m more than willing to accommodate you and even cut you a deal on this. I think you’ll be happy with most of what you’re asking for. I admit that I am interested to see how you deal with that one thing.

“Come on down to my clinical offices on Saturday, everything will be ready. Show up as early as you can but no later than eight AM so we can finish the last minute prep and get started.”

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

CA Day 0

At seven-oh-one Saturday morning Susan pulled into the mostly empty parking area behind the orthopedic clinic. There were several other cars present and she recognized the big SUV as Steve’s. There was also a large van labeled as a medical transportation service vehicle. As she got her overnight bag out of her car Steve came out and greeted Susan.

“Good morning. Nice and early. That’s good, we can get going and get things done sooner. Although we have plenty of time. Here, let me take that for you.”

“Aren’t you going to be seeing any patients today?”

“I’ve just got one patient to see today. She’s going to be a rather difficult case I’m afraid. Seems she’s going to be in for a rather hard time for the next week or so.”

“Oh, you,” Susan playfully slaps Steve on the shoulder as they walk inside. “So no regular patients then?”

Steve smirked, “Actually, I keep the weekends clear of appointments to run the side business and so my staff can have some down time. Well, those who don’t assist with the scenes that is. The only time I see a regular patient on the weekend is if there is an emergency. And this weekend I’ve arranged for someone else to take care of anything that comes up unless it’s a super difficult case; then they’ll page me.”

“How often do you get an emergency?”

“More often than you might think, but they are usually pretty routine. Someone fell off a ladder, tripped on some steps, things like that most of the time.

“Okay. You go in to this room over here and get into the hospital gown there, and start putting on some of the braces you’ll find. Karen will come around in a few minutes to help you with getting them all on correctly like we want. Once you’re ready we’ll start the scenario rolling.”

“Getting right into it, I like that. I’ll see you in a few minutes ‘Dr. Brown’.” Susan grinned while using the movie name Steve would be using.

“That’s right ‘Mrs. Jones’, you have a very serious situation and we are going to have to take care of you.”

Walking into the exam room she had been directed to, Susan sees a cart beside the exam table with a pile of braces and bandages on it and the gown is laid on top of the table. Over on the counter to one side is a video camera and a second one is in the corner setup on a tripod.

Getting undressed she puts the clothes she is wearing into her bag and ties the pink and yellow gown on behind her neck and waist, leaving just her bra and panties on. Taking a look at the items on the cart she can see that some of the items are definitely going to require help to get on correctly, but several will be rather simple. She grabs a standard wrist brace and as she is pulling her hand through the sleeve there is a knock on the door and a woman dressed in nurses scrubs walks in.

“Hi, I’m Karen. Looks like I showed up at the right time.”

“Hello Karen, I’m Susan. Or I guess it’s ‘Mrs. Nancy Jones’ for today.”

“That it is. We need to get you into all of these so you look the part to start out with, then they’ll all come off when we move you in to do the casting.”

“Is all of this normal for a patient, or is it more made up for this scene?”

“Well it is a little bit extra, but based on what the scenario calls for all of these are possible.”

“Alright, let’s do this then.” Susan finishes tightening down the velcro on the long wrist brace and looks through the pile of braces. “Just one wrist brace?”

“Your other arm is going to get a backslab splint along with one knee. I think we’ll do those last.”

“Okay. So what’s next?”

“Take off that gown.”

For the next fifteen minutes the two women work on reducing the size of the pile on the cart while subsequently reducing Susan’s ability to move various parts of her body. Susan ends up in a rigid clamshell body brace with attached chin and occipital pads to support her head that includes a strap around her forehead, a thick neoprene elbow sleeve goes on the same arm that has the wrist brace along with a tight neoprene shoulder wrap added over top of that, a pair of elastic neoprene hip wraps encircle both hips and upper thighs tightly, her left leg gets a hinged ROM brace, and both ankles get put into leather braces with support stays in them and a pair socks. Finally the hospital gown is tied back on over top of all the braces.

“Well I definitely am starting to feel the part here. It’s a bit hard to move around with all of this plastic and elastic on me,” Susan states as she slowly moves around the room.

“It’s going to get just a bit harder too before we actually start the show. I have to get your right arm and knee in their splints now. Hop up on the table while I get the materials out for the splints.”

Susan carefully climbs up on the exam table and leans back to watch. Karen grabs a tape measure and measures Susan’s leg from the ankle up to just shy of her crotch. She then measures Susan’s arm from armpit to fingertips. Opening up a box Karen pulls out a length of wide silver foil which she cuts to the appropriate length and seals the cut end with a clip and does the same with a slightly less wide roll from another box. Several rolls of elastic bandages are pulled out from a drawer and set on the bed beside Susan, then the first foil package is opened up and the one piece padded splint is run under water to activate it.

Bringing it over to the table the splint is lined up under Susan’s leg and Karen start’s to wrap the first bandage around it to hold it in place and form it to the right shape. The splint is wide enough that it fully curves around slightly more than half the circumference of Susan’s upper thigh. By the time Karen is wrapping a third bandage around the splint on Susan’s lower leg the splint is actually touching together on top.

Setting Susan’s leg down Karen tells her, “Don’t move. The splint still needs to set up which takes a few minutes. It’ll start to heat up, but not enough to be worried about. I need to do your arm now.”

Opening and wetting the second splint this one goes on from a couple inches below the shoulder all the way out to past Susan’s fingertips. About the time that Karen finishes bandaging the splint on her arm Susan can feel the splint on her leg has gotten hot and is starting to cool down again. She tries to gently bend her knee only to find the splint has gone hard and she is unable to do so.

“Okay, how do those feel? Not too tight? Is the knee splint hard yet?”

“Well, besides being wet they are okay. The knee heated up while you were working on my arm and it feels hard. I just tried to lightly bend my knee and couldn’t.”

“Good. For the scene they want the splints to be extra thick, so I’m going to wrap some cotton batting like they use in comforters around your leg and arm, then wrap some more bandages around that to make it look like a big heavy splint.”

About ten minutes later Susan had extra thick looking bandages wrapped around her leg and arm. The fiberglass splints inside them were set hard and with the extra elastic bandages on she could hardly move her knee elbow or hand at all.

“Wow, these really restrict my movement. I can barely wiggle my arm or leg in them.”

Karen giggles, “You think that is restrictive? Just wait until we get you into the cast room. You’ll wonder what you got yourself into by the time we’re done.”

Susan smiles with a gleam in her eye, “That is exactly what I am hoping for Karen.”

“Well you’re definitely going to get it. Let me go tell everyone you’re ready and we’ll probably start the show here in a few.”

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

It took a little while before anyone came back into the exam room with Susan. A man walks in with what looks like a tackle box in hand.

“Hey there. I’m Fred. I run cameras, prompt for scripts when they get used, and do a bit of makeup work. They want you to look a bit more tired and worn down so I’m going to use a little makeup to play tricks with the lighting and shadows in here.”

“Oh, alright. Yea, I can see how that might help enhance the scene for this. Will it be heavy makeup?”

“Oh no, never. I hate those heavy stage makeup jobs, and we’re not up on a stage. I’ve got several tricks I’ve learned that I can use and still keep the makeup to a minimum. It’ll take me maybe five minutes. While I work we can go over the ‘script’ for this one even though most of the dialogue is going to be adlib.”

Fred opens up his case and starts pulling out what he wants to use to make Susan look a bit beat down.

“So, there’s no real script for this. We have a basic outline that I believe you and Steve worked up together for this one?”

“Yes. I had the basic idea some specific points I wanted to hit, and Steve filled in the outline with what we could do and how it could go. We’ve discussed it several times over the past week so I should be okay on the general direction it will take.”

“Works for me. Here, turn a little to the right please. Everyone else who will be on camera will take most of their cues from Steve, and probably one or two from you, and will mostly be along the lines of an actual patient receiving treatment. Now look to the left. It won’t be all that different from their normal work week job for them so nothing to really practice. Just go with what feels right in the moment and if it doesn’t work then we can back up and try a different approach.

“Okay, done. Try to slouch a lot, well as best as you can in those braces, and act tired and resigned then go with it from there. I’m going to take this camera with me and I’ll be using it to get different shots at various angles. Watch the camera in the corner over there, when you see the red record light come on get into character. We’ll be coming through the door thirty seconds later.”

Fred takes the camera from the counter and his makeup kit with him as he leaves the room. A couple minutes later Susan sees the red light and slumps back as best she can against the exam table and half closes her eyes.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

CA Day 1 - Launch

The door opens letting Steve walks in with a large folder in hand that is open while he is looking down at the papers inside and is followed in by Karen. As soon as he gets into the room he looks up.

“Mrs. Jones, How are you feeling at the moment?”

Susan opens her eyes more and struggles to sit up a little straighter. “I’m in a good bit of pain Henry as you can imagine, and please call me Nancy. You’ve been my doctor through all of this for too long to stand on formalities Dr. Brown.”

Steve chuckles lightly, “Of course Nancy. You know I can’t help slipping into my professional demeanor, but you’re right. We’ve been through a lot.”

“What are we looking at this time?”

“I’m afraid the news is not good Nancy. Your arm is injured far worse than a simple trip and fall should result in, and your knee is just as badly dislocated.”

“Of course it is. Just my bad luck again. I don’t suppose you’ve gotten any word back from those tests we did recently have you,” Susan said dejectedly.

“I have. I was just going over one of them in fact,” he replied while holding up the folder. “It’s as we feared. Your Ehlers-Danlos Syndrome has progressed at a much faster rate than we anticipated making you much more susceptible to dislocations and injuries. I also got the results of the other set of tests we did a month ago just yesterday.”

“And?” Susan asked, resigned to the answer.

“They confirm that you have adult onset of Osteogenesis imperfecta, and it’s aggressive. I’m sorry Nancy. I wish the news could have been better, but those are the facts.”

Susan closes her eyes and lays her head back as she sighs. A moment later she manages to get some tears to start falling while she begins to sob. Karen, who is not facing the camera at the moment, gets a brief surprised look on her face but covers it up quickly and steps in to comfort ‘Nancy’ who just received the bad news. A couple minutes later Susan stops the sobbing and looks up at Steve.

“So we’re talking about the worst case scenario here. My joints could pop out of place at the slightest bump, and or my bones could break for the same reason, and on top of that I’ve already got a broken arm and leg.”

“It’s not quite that bad Nancy, but it is close. It’s going to mean a lot of changes for you.”

“What about my treatment? How is that going to go now?”

“That’s something we need to talk about right now. Your EDS and O I combined make things a bit complicated. One option will be surgery to use rods and or plates with screws to both fix your current injuries as well as try to strengthen your larger bones, and some joint fusions would also be used. The O I makes this a bit risky due to the increased chances for fractures, but it is still doable.

“However. You’ve already had so many surgeries though that I’d like to go with a much more conservative approach. We’ve talked about this some in the past few weeks. We can try a non-surgical treatment to support and protect your body while still allowing you to do physical therapy to work on getting your body to strengthen and protect itself as best you can. If it doesn’t work out then we can fall back on the surgeries at a later date.”

“You mean the big body cast from head to toe.”

“More or less. Like I said, we’d construct it on you so that you would still be able to do PT, but you would not be able to easily dislocate joints or break bones because you’d essentially be in a full body armor suit custom fit to you. It has its drawbacks of course, but you’d avoid going under the knife again for the most part.”

At some point Fred had slipped into the room and was in a corner the stationary camera would not pick up. He was getting close ups of Susan while they talked.

“How long will I be in this cast thing?”

“I can’t be certain to be honest. Initially you’ll have to get used to the new restrictions. Then when we get started with the therapy we’ll have to take it easy and go slow so that we don’t injure you. I’ll hazard an initial educated guess of somewhere around eighteen months. Depending on how things go that could change and get longer, but I don’t particularly see it going shorter. It will take some time I’m afraid.”

“Okay. I don’t want to be cut open yet again if I can avoid it right now. Let’s try your Frankenstein cast. When will we do this?”

“Right now. If you were to go for the surgical route I’d be admitting you to the hospital today and scheduling the first round of surgery for the first available opening. I didn’t want to scare you, but I am that concerned about it.”

“Karen, if you would go get a wheelchair and some assistance and we can take Mrs. Jones to the casting room to get started with her new treatments.”

Karen goes out the door and a moment later Fred steps forwards and says, “Got it. Good work. We can get some stills now of ‘Nancy Jones’ in her braces and splints here then we’ll move over to the casting room for the next phase.”

“Nice trick with the tears Susan. I think you caught us all by surprise on that.”

Susan laughed. “Thanks Steve. I’ve been able to do that since I was a kid. Got my brother in trouble plenty of times until he figured it out.

“So we take some shots here then I get to go have my special cast put on?” Susan said excitedly.

“Yes,” Steve answers with a chuckle, “you are going to get your big cast like you wanted. I’m pretty sure I have it all figured out.”

“This is going to be so much fun!”

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Getting pictures on the exam table then several in the wheelchair and a short video of getting her moved from the exam room to the cast room takes longer than Susan can handle and she is squirming in her seat while they take more pictures of her being moved up on to the procedure table.

“Okay. We’re going to use the casting frame today for this. Technically we’ll be putting you into nine separate casts, but they will all get joined together as we go with special cast hinges.

“The ones for your knees and elbows are relatively standard and easy to work with for the most part. Your hips are going to be a bit odd since you wanted to restrict the lateral movement as much as possible so we can’t use the standard hip hinges. Instead I’m going to use some heavy duty I-ROM knee hinges turned around backwards. Those should stop most of the sideways movement while still being able to allow us to set restrictions on forward and backward movement.

“Putting hinges on the shoulders is not normally done, and nobody makes cast hinges for those. I’ve taken apart a couple of airplane splints to take the shoulder hinges out of those and the support struts should be long enough to suffice. I’ve add a couple of cross plates to the ends with screws to help set them in place in the plaster when we add them into the cast.

“Yes, we’re going with all plaster. It moulds better to your body shape, and it’s easier to secure the various hinge struts in place for the same reason. It does mean that the cast is going to be thicker and heavier over all, but I think that’s your goal, isn’t it Susan?”

Susan simply nods, the look on her face is like a child at Christmas being told all the presents under the tree are for her.

“I’m going to work from the bottom up on this with the assistance of Karen, Allie, Rebecca, and Jeff here. We’re going to do this just like a medically necessary cast people. I want all appropriate traction applied in the right places. The one item that will be done first though is the one I’m going to give you one last chance to back out on, Susan. Are you certain you want to do this?”

“Do you really have to ask that question again Steve? How many times have I said that I want this? I still do. No backing out.”

“Alright, I had to ask one last time. You’ll get what you want.

“Are all the cameras ready to go Fred?”

“All set. Video and stills primed and waiting. I’ve got the remotes for the still cameras on my vest here so I can snap shots at any time when I see a good shot line up.”

“Then let’s do this people. You know your jobs. Get in place to start the shoot then it’s nothing more than business as usual. Fred, give us the thirty second countdown.”

When Fred hits five seconds he stops talking and uses his fingers to count down the final seconds.

“Alright Nancy, this is what is going to happen. We need to protect your bones while still allowing you limited range of movement yet at the same time restricting your range of motion to try and stop dislocations. I said your arm is broken worse than it should be from a simple fall, but it’s still within reasonable limits to be able to manually reduce and cast it. Your knee is dislocated but not broken so early range of motion therapy should also be sufficient following a period of immobilization.

“To do this I and my team are going to put you into a modified full body cast. You’ll be held from head to toe once we’re done, and for the first week at least you’ll be admitted to a room in my long term patient care facility until we’re sure you can adapt to the restrictions.

“Now this is going to be the worst part of it. I’ve looked over your last set of x-rays and scans one more time, and I’m very concerned with your neck. I can see where several vertebrate are already trying to slip out of place as it is and it’s not going to take much for them to take that final slip. To stop this I’m going to put you in a Bremer Halo brace that will get attached to your body cast. It’s not going to be pleasant at all, and will be the hardest part of this for you. We’ll do our best to minimize the pain and discomfort, but there’s no getting around the fact that I’m going to screw four pins into your skull and it will hurt.

“Allie, bring me a tape measure please.

“Thank you.”

The strap around Susan’s head is removed and a paper tape measure is pulled around her forehead going just above the eyebrows and just above each ear.

“Okay, looks like twenty-two inches here. Get a small Halo crown out.”

While a box is pulled out and opened up the clamshell brace is completely removed, allowing Susan to breathe deeply for the first time in an hour. The hospital gown is left on to cover up her chest, but she knows that will go away soon enough once they begin the casting of her torso.

Steve come back over and slides the ring around her head and positions it where he wants. Rebecca then begins to screw the three positioning posts down so the suction cup like pads begin to press in against her head, one in the middle of her forehead and one each directly above each ear. Taking a blue felt tip marker pen Steve makes a dot underneath the pin holes he wants to use. There is one above each eye towards the outer end of the eyebrow, and one behind and just in line with each ear. He also makes a light circle around the center positioning cup to mark the location. Getting the marks in place the Halo ring is removed and set aside. The two pin sites behind the ears get shaved clean of any hair, then all four sites get an injection of anesthesia creating a round bubble under the skin at each place.

They wait a few minutes then Steve starts to poke Susan over the spots with the needle.

“Can you feel this Nancy?” he asks while poking the one behind the left ear.

“Um, no. Should I be feeling something?”

“How about here?” Steve queries when he pokes the site behind the right ear.

“Nope. Are you actually doing something?”

Steve moved up to Susan’s forehead where she can see him poking at her and tests the remaining two sites.

“Oh, is that what you were doing? No, I can’t feel that at all.”

“Good. Hand me the scalpel please Karen.”

Steve carefully makes a small vertical incision at each pin site that goes down deep, completely through the top several layers of skin and flesh and into the sub-layers. As each cut is made Karen takes a thick gauze pad and applies pressure until the bleeding stops. The Halo ring is brought back over and lined back up again using the ring Steve made on the center of her head and looking through the screw holes in the ring to make sure it is properly aligned. Four titanium screws have been threaded through the Halo and get manually turned down about half way. A small drop of a semi-greasy antibiotic gel is applied to the tip of each pin and all four are turned down by finger until the tips begin to penetrate the cuts on Susan’s head. A red plastic finger screw cap is fitted onto the end of the pins and they pause a moment.

“That was the easy part Nancy. The anesthesia kept you from feeling the incisions for the pins to go through. Now we are going to begin turning these pins two at a time about two turns each then two turns on the other two and back to the first ones again. We’ll keep turning them until these plastic screw heads break off. They are designed to hold out until they reach a specific pressure, about eight-inch pounds per square inch, then they break.

“When we first hit the bone you will probably not feel anything. But as we continue you’re going to start feeling the pressure build up, and you’ll probably hear something rubbing or grinding against your head. That will be the pins turning and rubbing against your skull while they penetrate and press on the outer layer of the bone. We won’t stop until all four are done and break off. The sound will probably be aggravating and the pressure is going to get painful.”

Nodding to Jeff, Steve begins to turn the front right pin down while using his other hand to gently spread the skin and let the pin enter the skin with out catching or pinching it. Jeff does the same thing on the back left pin and when they have made two full turns each they switch to the other pin on their side. Steve goes to the back right pin and Jeff to the front left and two turns are made then they switch pins again.

At first Susan does not feel much at all, just a bit of pressure. Soon though the pressure begins to increase and the grinding rubbing noise begins to echo though Susan’s head. The two men keep going, turning each pin two full turns before switching over and turning the other two over and over. It takes about ten minutes before the first plastic screw cap breaks off. By this time Susan is crying from the pain of the pins pressing in on her head, and the shock of the cap breaking off sends vibrations through her whole head which make her cry out. The other three quickly break off with no more than four additional turns at the most. Removing the leftover red plastic piece from the pins a Halo tool is used to quickly tighten down a locking nut on each pin securing it to the ring and stopping the pins from being able to loosen.

Steve pauses for a moment in place as does Jeff.

“Okay Susan, we’re taking a short break from filming for you. Are you alright?”

“Oh shit Steve. You warned me what this would be like, but the reality is something else. Damn this hurts. People really have to go through this when they break their necks?”

“Yes they do Susan. And it’s actually worse most of the time for them than it is for you. Usually they have actual broken bones in their neck that no matter how gentle we are will shift a little bit and cause them much greater pain. Are you going to be able to handle this?”

“Hell. I don’t know right now. You just screwed the thing into my head. Is it really fully attached to my head now?”

“Yep. Here, let me give you an example. Try to stop me.”

Steve takes hold of the Halo ring on each side and tilts Susan’s head around from side to side and up and down, all without her being able to stop him. Then he stops and holds it still.

“Now try to move your head around.”

Susan tries and can barely manage to move her head against his grip on the ring. The whole time Steve never touches her actual head. He only grips the Halo ring and has full control over how her head moves.

“Damn, that is a weird sensation. Okay, so it’s really in there. And it hurts like hell. You did say there would be an adjustment period over the next few days, right? I should get used to this and the pain will go away?”

“Mostly. You should adjust and the pain will lessen a good bit. But it has to stay at that eight-inch pounds which is a lot of pressure. That feeling of pressure will never go away as long as the ring is in place, and it will continue to be a constant low background pain that does not go away. And I’m going to adjust it just a little bit more to ten pounds like you asked for, but I’ll wait until tomorrow to do that to let you get used to this for now. I warned you it may be more than you can take.”

“Yea, you did. But I asked for it. I’ll tough it out for now and we’ll see how I do with it for today. Give me a couple more minutes off the camera and then let’s get going with the rest of it.”

A few minutes later the cameras are turned back on and the procedure moves on to the next step.

“Next thing is removing all of these splints and braces and then we can get the stockinette in place.”

The two backslab splints are removed by the expedient method of cutting through the bandages with scissors. The neoprene wraps and braces are removed without cutting and the two braces held with velcro are unstrapped and pulled off while the two ankle braces are unlaced and slid off. The hospital gown is finally removed along with Susan’s remaining panty and bra and set aside when the stockinette is brought over.

First a cotton shirt is pulled on over the Halo and down over Susan’s body that covers her from the neck to below the hips and has short sleeves that go over her shoulders and a couple of inches down her arms. A long john style pair of cotton briefs is pulled up over her legs that goes from her waistline down to just above the knees and gets tucked up under the end of the shirt. Tubes of cotton stockinette are pulled up over Susan’s arms that are twice as long a needed to go from past the finger tips to having a couple inches bunched up in the armpits. They are doubled over so that the loose ends of the stockinette meet in the middle and over lap at the elbow when pulled onto Susan’s arms. The same is done for Susan’s legs with double long lengths that extend from beyond the toes, have a couple of inches bunched up in the crotch, and the loose ends over lap in the middle at the knees.

“Jeff, lets get some traction applied to that Halo,” Steve calls out. “Rebecca and Allie, get the hip straps in place for the counter traction on the torso.”

Jeff pulls a traction bail out of the box for the Halo Crown and screws the ends into the attachment threads on each side of the ring. A hook from the traction winch at the end of the casting frame is attached to the center hook of the traction bail and just enough tension is pulled to keep it from falling off. Once the two straps are looped around Susan’s waist so they run down along the side of her hips they are pulled down to the opposite end of the frame where they are clamped off and tightened which causes Susan’s waistline to be pulled in over her hips.

Steve moves up next to Jeff and quietly whispers so only Jeff can hear him. “I want this really tight. See if you can get it up to sixty pounds of traction before she complains about it. Stop at forty if she complains sooner.”

Jeff nods and begins to tighten the ratchet watching the meter rise up with each click. He goes to twenty then stops. “Only part way there Nancy. I’m stopping for five minutes to give you a break and get used to it before going on.”

Susan nods, but the motion is restricted by the traction and Jeff only just catches it. The sensation of having her head pulled up from what is above the top of her head by just four screws imbedded in her skull is more disconcerting than it is painful. She can feel her back being stretched out along with her neck and after a minute it actually starts to feel good. When she nodded to acknowledge Jeff the feeling was truly odd and hard to describe.

Five minutes later Jeff begins to turn the ratchet again, applying more traction. Susan begins to squirm a little bit before he reaches forty pounds of traction, but does not call out or complain about it.

“Second tightening done there Nancy. Five minutes and one more time and we’ll be done.”

Susan tries to nod again, but this time can barely move her head so has to speak.

“That’s pretty tight Jeff. How much more are you going to go?”

“Just a little bit more, not much at all.”

“Okay. I think I can handle it.”

Jeff raises an eyebrow at Susan’s statement. Forty pounds is a lot, and usually the most they use. Looking down he can see the force of the traction is really pulling in on Susan’s hips causing very noticeable indents in her waist from the straps holding her tightly.

Five minutes later Jeff starts the final tightening and heading for the full sixty pounds Steve has asked for. He gets all the way to fifty-three pounds before Susan begins to moan from each click of the winch.

“Almost there Nancy, just a few more clicks.

“Hold out for just a little bit longer, your doing great.

“Almost there.

“And done.”

By the time Jeff hits sixty pounds on the gauge Susan is crying out softly and a couple of tears trickle down once again from the corner of her eyes. The force of the traction has pulled her waist in by a good ten inches, and the pressure on her head feels like a vice is trying to pull the top of her head off.

“We have reached the full amount doctor, as prescribed.”

“Very good. It looks like Nancy is in a bit of pain here. Karen, lets get her something to help take it down a few notches.”

“Yes Doctor.”

Karen goes out of the room and comes back a moment later pushing a small cart with a canister on it that has a valve and mask attached to the canister. She sets up the cart at the end of the frame and fits the mask over Susan’s nose and mouth.

Susan tries to push it away saying, “No gas. I don’t want to be loopy.”

“It’s just a pain reliever in gas form,” Karen tells her. “I’ll start it out really low and you can tell me how high to go with it.”

Karen gets the mask on and after a few adjustments Susan has her stop increasing the dosage.

“That’s good enough.”

The team moves down to the far end of the frame at Susan’s feet and she can feel them lift up both legs at once. She tries to look down to see what is happening but the traction is too strong and she can not bend her head forwards or backwards. She does find that she can turn her head side to side a bit, but the sensation is odd and when she relaxes her head returns to the neutral position which has her staring at the ceiling.

A slight tug on the stockinette by her big toes is felt then the toe is pulled through a hole that has been made in the cloth. A new tube of cloth is pulled down around each exposed toe and a moment later a soft cloth is being rolled around her ankles and wrapped down over the heels towards the toes. Susan realizes they have started with the cast padding and they are working on both legs at the same time, keeping relatively even on both sides. The padding is wrapped on down her feet to the toes, and the big toes get encircled separately from the other toes. Short strips of padding are pulled down between the rest of her toes, the ends being held down by another layer of padding being wrapped around the ball of the foot. They continue back up the feet and over the heels and ankles again adding a bit of extra padding over the malleoli and on up the shins to the knees. The padding stops rising about half way over the knee and they go back down again adding another layer to the lower leg and foot.

Feeling a new roll of padding being started just above her knees Susan looks down along her nose and is able to see the tops of a couple heads but little else. The padding is wrapped down to just the top of the knees then reverses and goes up the thighs to her hips and crotch. She can feel that they are attempting to wrap the padding higher up the outside of her thighs along the hips than on the inside of her thighs near her crotch. Two more layers are added over her thighs, but she can tell that they are leaving her knees uncovered for the most part.

The padding stops and for a minute there is nothing, then the sound of water running and slowly filling up a container is heard.

Steve comes into Susan’s line of sight.

“We are about to start with the first rolls of plaster Mrs. Jones, er sorry – Nancy.

“Since we are going to be using cast hinges to allow for movement, and have several joints we will be using them on, we are going to start working at several places at once. While we begin to cast your feet a couple of us are going to continue with adding padding to your torso and arms so that as we work upwards with the plaster we can also move right into getting the hinges in place while the plaster is still fresh and wet which will make for a stronger bond with the layers and hold the struts on the hinges in place better.

“Oh, we are also going to be adding walking heels onto the bottom of the casts on your feet. You won’t be walking on them right away, we need you to rest and take it easy at first, but this way the plaster holding them in place will also bond better for a stronger cast over all. By the time you start walking again the casts will be totally dry and quite strong and we shouldn’t have to worry about the foot portion collapsing from your weight as you walk.”

As Steve has been talking Susan can feel something new being wrapped around her feet. A few minutes later she can feel a sensation of wetness start to lightly soak through to her skin. The plaster bandages are wrapped quite firmly and get smoothed out as they go to help get as close a mould to her shape as possible. Susan’s big toes get wrapped in plaster separate from her other toes. Once her big toes are covered she feels them working on something along the bottom of the rest of her toes. Thinking about what she is feeling she realizes they are making toe plates that seem to extend a short bit out past the ends of her toes. The wrapping around her feet continues while more bandages start to work upwards over her heels and ankles to the lower legs. She can tell they are working at keeping her ankles held in a ninety-degree angle as best as they can. It also feels like the plaster is being wrapped quite far down over the top of her toes as well.

As her feet are being encased Rebecca and Allie appear and start to work on wrapping padding around her torso starting from just above the hips but below the waistline. Susan starts to find it confusing trying to split her concentration between the different areas that are being worked on at the same time so relaxes her mind a bit, just letting the sensations come to her attention as they will. When they start padding Susan’s hips and waist the stockinette brief they put on gets bunched up and pulled out of place so Steve has them just cut it off completely to get it out of the way.

About the time the casts on her lower legs reach up to just below the knees the padding has reached up to the top of Susan’s breastbone, her breasts being completely covered, and going around her torso high up in her armpits but not fully covering her shoulders. Bands of padding have been wrapped up over the top of each shoulder close to the neck, and have even encircled her neck a few times, but is seems to simply be a matter of how the padding is being wrapped so as to better hold it in place for now.

The plaster being worked on her legs now moves up to start encircling her thighs, leaving the knees free. Susan’s thighs are covered fairly quickly as there is little worry about needing to work over a bend for a joint. The plaster placed on the outside of the thighs follows the work done with the padding and goes up higher than it does on the inside of her thighs.

When they finish the padding for Susan’s body, Rebecca and Allie move on to working individually on Susan’s arms. Padding is wrapped around the upper arms from the armpits down to just above the elbows making about three layers. The elbows are left uncovered and padding starts to be wrapped on the forearms starting from the crook of the elbows down.

The plaster around Susan’s thighs appears to be finished and she can feel something being done with the stockinette around her toes. She feels fresh air blow across the ends of her toes as they are exposed with the exception of the big toes that only get the barest brush of air right at the tips. After that brief sensation she does not feel anything further on her toes, but her feet seem to get moved a little bit from side to side for a couple more minutes. Susan guess that they are finishing the casts on her feet by pulling back the stockinette and padding that was left hanging exposed past the ends and tying it down with another roll of plaster.

A few minutes later she actually feels a very slight pressure of something being pushed against the bottom of one foot then her foot wiggling side to side again as a walking heel is put in place and secured. While the heel is being added, someone is working on the opposite leg around her knee. Susan feels a layer of the stockinette get pulled out from underneath the cast on the calf and then the thigh. It is then pulled tight up over the outside of the cast and secured in place with more plaster. The first walking heel is finished about the same time the end of the casts on Susan’s opposite thigh and calf are finished and a moment later the process starts again with the opposite foot and knee.

What Susan has not been able to see is that Steve has been working on shaping and fitting the knee hinges to be used while the casts on her legs get brought to about ninety percent completed. Steve checks the positioning and spacing of the hinges, two per knee, and making marks with a grease pencil on the casts and bending the hinges as needed to get the proper fit.

While the hinges for her knees are being worked on the stress of the day so far along with the warmth of the plaster which is beginning to set combined with the light flow of gas lulls Susan into an exhausted place where she falls asleep.

The padding of Susan’s lower arms and hands works on down to the wrists where holes are cut to allow her thumbs to be pulled through with narrow tubes of stockinette being added over the thumbs. The padding covers her hands with the thumbs remaining out and being padded individually. More padding continues to go around her hands and on down over Susan’s fingers as well binding them together. Strips of padding are folded lengthwise twice to make a triple layer of padding that is placed in between the fingers.

With the casts above and below Susan’s knees prepped and marked for the hinges, Steve and Jeff work together on the same leg to place two hinges in the proper positions and Karen quickly wraps more plaster around the support struts to hold them in place then adds several rolls of plaster to firmly include the hinges in the cast, making sure to mold the plaster around the bars and cross pieces as tightly as possible to reduce any potential wiggling as close to none as she can. When the right leg is finished the three of them move around to the left leg and repeat the process to add two hinges into the cast on that side as well.

Having finished padding Susan’s upper body and arms Rebecca and Allie begin to apply the first rolls of plaster bandages around her waist and hips while the hinges at Susan’s knees are being completed. The plaster is wrapped so that it goes high enough over the top of the thighs so that Susan will be able to bend her hips forwards freely, comes down a little lower over the abdomen between her legs, and bends back down again around the sides of Susan’s hips so it is just a few inches away from the ends of the casts at the top of the thighs. Going around the back over the butt the plaster is wrapped low, the women doing their best to gauge approximately where the finished cast will still allow Susan to sit up comfortably without the bottom edge of the cast forcing her to lean forwards.

When the knee hinges are all finished Rebecca and Allie are about half way through the second layer of plaster on Susan’s torso, the body cast starting to take shape and showing that it will go up to just below the armpits to allow fairly free movement of the arms and rise up in front and back to just below the neck. The rest of the team joins in with encasing Susan’s torso and soon the body cast is about half finished. At this point they stop for a moment while Jeff and Steve get two plastic harnesses that have the attachments for the Halo on them and hold them in place on the front and back of the body cast. While they hold the harnesses in place Karen Allie and Rebecca quickly work together to wrap rolls of plaster around over the plastic pieces and incorporate them into the cast. With the Halo attachments added in the torso cast is finished up.

Steve Bends Susan’s left hip up while Jeff bends the right one so that Susan looks like she is sitting down while laying on her back, and they check the end of the cast around her butt and abdomen. Finding it to be a little long in the back they use plaster shears to trim it up a bit, then the stockinette at the top and bottom of the body cast is pulled around and the ends sealed down under more rolls of wet plaster bandages.

With the cast around Susan’s torso mostly completed Steve and Jeff go to work on adding in the hinges they are going to use for the hips. Marks are made for position, and some light bending is done to the support bars of the hinges. When they are ready to wrap the plaster to hold the hinges on Karen assists them, both with providing rolls of wet plaster and wrapping it in place.

Meanwhile Allie and Rebecca have begun to wrap wet plaster around Susan’s upper arms. They work quickly and the upper arm portion of the casts quickly take shape, going from just below the armpits to just above the elbows. Moving down to the lower arms and hands, they again work quickly forming the final part of the casts that Susan will be wearing. The casts begin just below the crook of the elbows and go down all the way over the hands and onto the fingers. Both thumbs are wrapped separately out to the tips in individual thumb spicas so that they are pointing at a gentle angle up and forwards away from the hand. The plaster wrapped over the fingers goes down to between the second and third knuckles of Susan’s fingers on the back of the hand while continuing all the way to just past the tips of all four fingers on the palm. Her wrists are bent upwards a little and her fingers are allowed to curve inwards a bit to form a natural resting position that should be comfortable for Susan’s hands.

The three groups finish up close to the same time, the hinges at the hips have been firmly set in place and the casts on the arms are ready for the elbow hinges to be added. Steve and Jeff take the lead on sizing and getting the hinges shaped and set in place while Rebecca takes charge of getting the rolls of plaster wet and handing them off to Karen and Allie who work on wrapping the bandages over the hinges to set them in place. Steve decides to use two hinges per elbow, and about ten minutes later they are fully incorporated in the cast.

“Nice work so far everyone,” Steve announces as the last roll of plaster is smoothed out over Susan’s left arm. “We’re almost to the home stretch now.

“This next part is going to be a bit difficult as we’ll be using hinges that are not really designed to be put into a cast like this, but they are the closest thing we can find to still allow Nancy movement at the shoulders while also giving them the support they need to protect them.

“We’ll work on one shoulder at a time for this, and hopefully what we figure out on the first one will make the second easier to apply.

“Looks like our patient has either passed out or fallen asleep on us at some point.”

Taking the gas mask off Susan’s face, Jeff turns off the gas and moves he cart with the gas canister off to the side.

The first hinge is brought over and Steve lines it up in a couple of different places until he finds a position that seems to allow for the right amount of support while still giving a decent amount of normal motion to the joint. Making marks on the body and upper arm casts Steve and Jeff then work on bending the support struts to make a good close fit to the casts. Getting it as close to good as they can, the rolls of plaster begin to be applied to secure it in place while Steve makes sure it does not move out of position. It takes about twenty minutes in all to get the first hinge added on the left shoulder. Taking what they learned on the first one the second hinge only takes about fifteen minutes to get positioned, bent, and incorporated into the plaster.

Looking down over Susan, Steve sees something he has not done before. The majority of Susan’s body is hidden from sight. Eight of her toes are peeking out from the ends of her casts resting on toe plates, but the cast comes down low with a gentle curve so only her toenails and the ends of the toes are exposed. The big toes are fully encased with a small hole at the tip where a bit of skin can be seen from the right angle. Susan’s knees are free of the cast and can bend within the restrictions enforced by the hinges, but the skin of her knees is covered by a layer of stockinette that comes up from below the knees and goes back under the casts over her thighs. Susan’s hips and crotch are cast free, and her skin can be seen in these areas. The body cast covers her entire torso leaving just the shoulders free and visible. Going down the arms Susan’s elbows are free to move, but are restricted and covered like her knees are. Finally Susan has what are short arm thumb spicas on each forearm with her fingers resting on finger plates that only expose the last joint of eight fingers. The spica on the thumbs is similar to the ones on the toes; both thumbs are fully covered with small openings at the tips to expose just the tip of the digit.

Steve nods and gives a low whistle. “And the over all cast is now done. Mrs. Jones is now essentially encased in a multiple hinged full body cast from her shoulders to the toes.

“Jeff, lock all of the hinges down to zero range of motion if you would. It’s time to see if the last item is ready to be completed.

“Karen, how does the body cast feel to you? Think we can get the bars for the Halo attached?”

Karen runs her hand over the torso cast and knocks on it in a few places.

“Seems ready to me. What do you think?”

Steve does the same and nods. “Yea. It’s ready. This is the home stretch people. Let’s get it done.”

The remaining parts for the Bremer Halo are brought over. First the horizontal rods that attach directly to the Halo crown itself are added in place and loosely tightened. Next the vertical upright rods are slipped in place on the body cast end and those connections are partially tightened. The attachment parts between the upright rods and horizontal rods are slipped on the top of the vertical rods then carefully slipped over the ends of the horizontal ones but not tightened down.

At this point Steve moves to stand above Susan’s head and carefully begins to move her head around. Karen stands at the far end by Susan’s feet while Rebecca and Allie take up position on either side next to Susan’s head. The three women give Steve directions to indicate where Susan’s head is looking and if it is held straight. Jeff watches the four loose attachments holding the rods together to make sure they do not fall off.

About the time they are getting her head aligned the way they want it, Susan wakes up. She slowly opens her eyes to see Steve standing above her and watches her line of sight shift in small increments.

“Okay, there. That’s it,” Karen says from the far end.

Steve stops moving and hold her head still. Jeff adjusts the loose uprights so that the ends of all six rods extend out past the connectors, and Rebecca and Allie start tightening down all of the bolts holding the frame together. In about five minutes the frame is locked down tight, and a gentle shake from Steve does not move Susan’s head at all.

“Hello there Nancy. We are just finishing up the last part here and tightening down the frame for your Halo brace. Karen, go ahead and take the straps off from Mrs. Jones’ hips while I loosen up and remove the traction on the Halo.”

Susan feels immediate relief around her hips and waist as the straps are pulled out and off. The cast around her lower torso still holds everything tightly giving her a noticeable hourglass shape, but the intense pulling from the straps is now gone. She hears the ratchet quickly clicking as Steve reverses it but she can not detect any change to the pulling sensation on her neck and head.

“Dr. Brown, is the ratchet broken and not loosening? I don’t feel any difference yet on my neck.”

Steve reaches over with a tool to remove the traction bail from the Halo ring.

“No Nancy, the winch is just fine. The traction from it is off and I’m removing the traction bail from your Halo. You won’t notice any changes though I’m afraid. The Halo is taking over and maintaining the traction now that it has been tightened down and set in place.”

“It is? I didn’t know it would do that. It’s really tight and hurts.”

“You’ll have to get used to it. Your body should adjust over the next week or so and it won’t be so bad then.”

Steve puts the traction bail and screws back in the box then picks up a torque wrench and the Halo tool.

“We have one more adjustment to make here and then we can transport you to the care facility and your bed. I have to check the pins to make sure they are still set at the right torque.”

“Oh no. Is it going to hurt more?”

“It shouldn’t. The pins should still be set right for now. But you are going to feel a jarring shock from the torque wrench when it pops. I’m sorry, but that can’t be helped.”

Steve loosens the lock nut on the front left pin then inserts the flathead screwdriver tip on the wrench in the slot on the end of the pin. He twists the wrench without the pin turning at all, and when he is applying eight pounds of torque the wrench pops to indicate it is there. The vibration from the wrench popping goes right through the skull pin and into Susan’s head, and since the pin is screwed through the Halo ring the vibration gets transmitted around to the other three pins at the same time which increases the shock to Susan’s head all at once.

“AHH!” Susan cries out at the shock. “I felt that from all around my head!”

“It wasn’t painful was it?”

“Well, not exactly. But that’s not fun to experience. It rattled my entire head.”

“I’m sorry. I have to do three more. I’ll try to be quick.”

Steve tightens the lock nut back down and moves to the back right skull pin next. He moves efficiently and gets through with checking all four pins in about ten minutes. Only the back left pin actually had to be tightened down by a quarter turn. Susan does her best and only whimpers as the torque wrench pops each time, and winces some as the one pin turns.

“All done. I apologize for that Nancy. It is necessary with a Halo and can’t be avoided. We’ll need to do that every two, or maybe three, weeks for as long as you’re wearing it I’m afraid.

“Now, let’s get you up off of this frame and out to the transport van so we can get you someplace where you can be a little bit more comfortable and get some food.”

Susan tries to nod but her head doesn’t move. The Halo completely stops her head from moving in any way. All she can feel is her neck muscles tense up while her head fails to move. As several of the people in the room start to move a gurney over to get Susan on, she attempts to move her arms so she can shift over a bit. The only thing that happens is Susan feels the casts on her arms pressing back against her movement and her arms remain where they are. She tries to move her legs and gets the same feeling of the cast stopping her from moving. The hinges in the cast are apparently locked in to a zero range of motion right now.

“Hey. What’s up with this? Why can’t I move? Why are the hinges all locked? I’m supposed to be able to move around some so I can do PT.”

“Um, eventually, yes Nancy,” Steve responds. “But right now since this is all fresh and new, and because the plaster is still technically wet and needs to fully dry to achieve full strength, I am keeping the hinges locked at no movement. This is to let your body get used to the situation it is now in as well as letting the plaster cure and dry.”

“Well dammit all. Fine. How long?”

“Since the cast is in several pieces it should dry a bit quicker than if it were all one big cast. We’ll use some space heaters and fans to help dry the plaster out. Give it about four or five days and your cast should be dry. To be on the safe side in about a week we can start allowing some range of motion again.”

Susan has been struggling against the cast while Steve explained and she noticed that all of her fingers were confined and barely able to move as well. She can just barely lift her fingertips up by maybe a quarter inch off the plaster shelf they are resting on.

“Looks like it doesn’t matter much when you do,” Susan huffs. “My hands are useless with these casts covering them like they are. I can’t move at all, and when you finally let me move some I won’t be able to do anything for myself. I’ll need help for even the most basic of things. I’m beginning to think you should have just put me in a solid cast from top to bottom anyways.”

“Now Mrs. Jones,” Steve says softly, “I know things look a bit dim right now. That’s understandable. But it will get better. Once we get you moving again we can see how well you do with the full body cast brace you’re in. The plan is to get you up to where you can have full range of motion within the limits of the hinges, and we can cut down the casts over your fingers when the time is right so you can start doing things for yourself again. I promise, it won’t be so bad and it should not take all that long.

“Now just relax for us while we get you onto this transport gurney and get you ready to travel.”

Susan just snorts through her nose and gives Steve a glare when he looks down at her.

The team carefully moves Susan off the casting frame onto the gurney. Once centered on the bed, an adult undergarment is brought over and placed over Susan’s privates and taped shut around her waist. Karen and Rebecca take several minutes to go from head to toe and wipe off any flecks or smears of plaster from the exposed parts of Susan’s skin with wet washcloths. After she is clean they take a couple of blankets and drape them over her cast and gently strap her down so she won’t fall off from an errant bump or sudden shift.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

CA Day 1 – Flying High

While Susan is being cleaned the lighting in the room goes a bit dimmer and the record lights on the various cameras go off.

Fred walks up and tells everyone, “Now that was one heck of a scene. I’m sure I got everything from one angle or another in either video or stills. I have to say that was really awesome!”

“Thanks Fred,” Steve replies. “How long did we take on this? In fact, what time is it anyone?”

“You guys were going almost non-stop for just under two hours. With the different cameras I probably have around six hours worth of video to go through for editing.”

Jeff pops in with, “It’s eleven forty-nine.”

Fred turns to address Susan. “That little argument at the end with Steve was pure genius Susan. The surprise and shocked reactions to your situation looked genuine. Very well done.”

“Yea, well, that was mostly real there Fred,” Susan says dourly. “I really was and am shocked and in a good bit of pain from all this crap.”

“Oh. I’m sorry.”

“Not your fault Fred. It’s Steve’s fault. You’re just the technical camera guy. Isn’t that right Steve?” Susan finishes with a low growl.

“Um, yea. I guess it is. But we talked about how you wanted this to go Susan and I kept to it. Well mostly kept to it,” he amends when Susan growls at him again. “Most of the alterations actually are for medical reasons. I swear.”

“All except one Doc,” Jeff interjects. “You had me take the traction on the Halo up to a full sixty pounds. That’s a lot of pull for anyone to take. I’m surprised I was able to get it that high actually.”

“Thanks for throwing me under the buss there Jeff,” Steve says quietly as Susan starts to get louder.

“Sixty pounds of traction?!? Good god, no wonder I’m hurting! It’s a damn good thing I have a high pain tolerance or I’d probably be crying or passed out from the pain right now! Sixty pounds. Good grief.”

Susan calms down slightly and gets a thoughtful look, “Really? You applied sixty pounds of traction to my neck through the Halo?”

‘Yep. I sure did.”

“Dang. And I took it all. I thought you were only going between five and ten at each step, but you did twenty pounds each time.”

“That’s right. I paused at twenty and forty pounds, and you didn’t really start to complain or struggle until I hit about fifty-three pounds at the end. I only increased the traction by seven when I was telling you it was almost over.”

“Huh. Well. So, can we get moving here? I’m feeling like I got run over by a Mack truck and I’m hungry. It would be nice to get some pain killers in me too.”

“Right. Okay Jeff, you and Rebecca take Susan out to the van and get her over to our long term care facility. We should have a bed already set aside for her. The staff there assumes Susan is a real patient so be aware. The rest of us will clean up.”

Jeff and Rebecca wheel Susan through the clinic and out the back to the waiting van. The gurney is a part of the equipment for the van so it easily loads in from the back and locks down in place. They climb in and start up the vehicle with Rebecca driving. About twenty minutes later Susan is being wheeled into the care facility where Jeff informs the receptionist they have a patient of Doctor Weiss’ to admit.

“We’ve got Susan McCallen here. I believe a room should already be prepared?”

“Let me check. Yes, here she is. Room fifteen B. That’s up one floor and to the right from the elevator. I’ll have a couple of duty nurses meet you there.”

“Got it. Any chance you can add in some drugs for pain there? Susan has had a pretty rough morning.”

“Um, actually I can. The doctor apparently anticipated the need and has an order and prescription already entered to be administered on arrival. I’ll highlight it for immediate notice.”

“Thanks Jenn. See you later.”

Susan is taken up one floor in the elevator. A nurse meets them as the elevator doors open up and leads them to the room where a second nurse is turning down the bed and preparing it to transfer Susan over. The four of them get Susan into her bed with relative ease then Jeff and Rebecca leave.

“Okay Mrs. McCallen, Doctor Weiss has a few orders for when you arrive here, but I think the first one you’ll like the best. I understand you’ve had a rough time this morning so we’ll give you a shot for pain relief first thing. Then we can work on the other things.

“Hm. Hey Gail, there’s not much body available here with this cast. Where should I do the shot?”

“Ummm,” Gail looks over Susan contemplating, “let’s see if we can get her over enough to do an injection in the buttocks. That looks like a possible location. If we can get her to tilt enough, we should go ahead and get the extra support pads under her to create an air space for the fans.”

The nurses tilt Susan up just enough on one side to untape the undergarment and expose a butt cheek. A quick jab later and the medicine begins to course through Susan’s veins and the garment is taped closed again. Around ten minutes later the drug takes full affect giving Susan some needed relief and bringing the pain down to a dull roar. Following the injection they lower Susan onto her back again temporarily before tilting her up on one side then the other. While they have Susan tilted plastic covered foam pads are pushed under her at several points to lift Susan up off the bed several inches. Once they are done there is enough room underneath Susan to make a fist and fit it sideways between her cast and the bed from head to heel.

“These next couple items are going to be a little uncomfortable. We need to insert a urinary catheter and a nasal feeding tube. The feeding tube will be first. With the Halo you won’t be able to tilt your head back like we normally do so it’ll be a little bit harder to get started. Just follow our instructions and it’ll be over quickly.”

A short spray of anesthetic goes up Susan’s right nostril to numb the sinus while Gail takes the tube and measures the length from approximately where her xyphoid process would be, up to behind her ear, around to the tip of her nose, and makes a small mark on the tube with a black marker. A generous dollop of lubricant is put on the tip of the tube prior to inserting it up Susan’s nose and Gail starts to push it in. With a cup of water and a straw they have Susan swallow several times while the tube goes in and down to her stomach, stopping when the mark Gail made is at the opening of her nostril. The external portion of the tube is tapped down to Susan’s cheek to hold it in place.

“One down, one to go and only one tear. I know getting that in is not fun, but it’s done and you will barely notice it’s there in no time. The catheter will not be nearly as bad and you will get used to it even quicker.”

The undergarment is untapped on both sides and Susan’s groin is exposed.

“Oh, shoot. These hinges are locked. We won’t be able to spread her legs for this.”

“There’s just enough room for what we need. We can do it.”

Susan’s privates are cleaned with a couple of baby wipes and Gail holds Susan’s skin out of the way while the catheter is inserted. The tube is well lubricated going in so it is not painful but definitely uncomfortable for Susan, especially when they reach the bladder sphincter and have to push slightly harder to get through. Susan feels like she is urinating and a moment later actually hears the tinkling of fluid in a plastic bottle. The balloon on the end of the catheter is inflated inside her bladder and a gentle tug from the outside confirms the catheter is in place and not coming out. It takes a moment for the tinkling to stop but Susan still feels like she is peeing due to the tube remaining in her urethra. The absorbent undergarment is pulled back up and taped down again with the catheter tube getting laid along the top of Susan’s left thigh where it connects to the drainage tube that continues over the side of the bed.

“Betty will be back soon with some food for you,” Gail tells Susan. “We’ll be checking on you regularly and frequently since you are unable to move right now and can’t use a call button. The nurse’s station is right outside your door so holler if you need to and someone should be right in.”

Susan hears a couple of clicks from two different areas of the room and warm air begins to blow across her.

“There. That should keep you a little warmer and help the plaster to dry a little faster without cracking the casts.”

A short while later Susan is watching the bag of formula slowly emptying into her belly. Betty had returned with a small bowl of soup that she carefully fed to Susan then moistened her lips with Vasoline to keep them from drying out. Just before leaving again Betty hooked up the bag of liquid formula to Susan’s nasal tube and Susan can feel her belly slowly expand against the cast as it fills with the fluid.

Betty returns not too long after the bag is empty and flushes Susan’s feeding tube with water. A little while later the warm air and full stomach again lulls Susan to sleep and she does not notice when a nurse enters the room later to check on her and administers a couple of drugs through the nasal tube to help Susan remain asleep through the night.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

CA Day 2 – Initial Cruising Altitude

Susan finally wakes up the next morning after the sun has already risen. Initially she is confused by her situation. She is in pain from the Halo pins embedded in her skull and the amount of traction being applied to her head and neck. She is also barely able to move any part of her body, only able to get a bit of wiggle from her shoulders and hips while her elbows wrists knees and ankles are held in place by the unusual plaster cast encasing her.

“Hey! What’s going on here!” she calls out. “Someone help!”

Susan struggles against her restraints for a couple of minutes, getting louder and more agitated. A nurse quickly enters the room to calm her.

“Mrs. McCallen, please calm down. You’re a patient here in our long term facility. You have a very serious condition you are being treated for and need to stop struggling or you could hurt yourself or even damage your cast. Don’t you remember being brought in yesterday?”

The nurse’s words get through to Susan and the memories of what took place the day before come flooding back to her. She stops trying to force her limbs to move and tries to relax again.

“Oh goodness. I’m so sorry. I woke up and I was hurting and couldn’t move. I didn’t remember anything from yesterday and just reacted.”

“It’s okay. That’s not unusual for a patient who is in such a large cast. It can take a few days for their situation to start to feel normal to them, and waking up restrained like you did can be unnerving. You’ll be alright Mrs. McCallen.”

“Thank you.”

“Since you are apparently awake, you said you were in a bit of pain?”

“Yes. My head and neck are really painful right now.”

“Well I can do something for that right now. Give me just a couple of minutes and I’ll be right back.”

The nurse left and in a few minutes returned with a small tray in hand. Taking the nasal tube she opens the side port on it, inserts the plastic tip of a small syringe, and injects the contents down into Susan’s stomach.

“There. Some pain medication for you. Now to flush the tube out with water.”

She repeats the injection with a larger syringe filled with water and caps the port again.

“It’s not quite as ideal as administering medications through an IV, but with your cast it’s a bit hard to find a viable place to insert an intravenous line. We really only have open access to your neck, and that is preferably reserved as a last option location and only on the order of the attending physician.

“Would you like to try eating a bit of breakfast this morning, or just go with a tube feeding instead?”

“Thank you. Um, I think I want to try and rest as much as possible. Can we just do the tube all day today?”

“I’m sure that will be fine. I’ll let the kitchen know to give you the full nutritional formula instead of the supplemental one.

“Do you feel any need to go to the bathroom this morning?”

“No. I don’t think so.”

“Okay. Again it’s not unusual for a new patient to have changes or temporary stops in their normal functions. We’ll be checking on you frequently, so just let us know as soon as you do feel the need. It may become necessary to give you something to assist with a movement, but that won’t happen unless you go several days without having one.

I’ll be back shortly to do your first skull pin cleaning.”

“Oh. Alright.”

The nurse applies a fresh layer of Vasoline to Susan’s lips, checks and empties the drainage bottle, then tends to some of her other duties before coming back with the supplies to clean Susan’s Halo pins. The cleaning is simple and done fairly easily despite Susan essentially being prone on her back. The pins are cleaned using a solution of hydrogen peroxide and sterile saline with two clean double ended cotton swabs used per pin. Susan learns the cleaning will be done twice daily; one soon after she awakes and the second in the early evening. While the skin around the pins is tender, the cleaning is done with the minimum amount of firmness to properly clean the area and keep the skin from sticking. She is told this will keep any infection from getting in to the open wounds around the pins and help prevent her skin from adhering to either the pins or her skull. After a couple of days Susan begins to get used to the twice daily minor torture of having her skin pulled around the pins and cleaned, keeping in mind this will keep infections out.

Susan spends the rest of morning in relative quiet. The nurses check on her at least every thirty minutes if not sooner, and she gets her first full tube fed meal for the day around nine AM. Between the times when someone comes in to see how she is doing Susan relaxes and manages to take short little naps here and there.

When she is not napping or being checked on, Susan does test the limits of her hinged full body cast. Her head is completely immobilized in the Halo. No matter what she tries she cannot get the tiniest bit of movement from her head. The restriction is odd and not how she expected it to be. Her wrists, ankles, thumbs and big toes are also immobilized but those joints have just the slightest bit move movement when she presses against the padding inside her cast. As well, when she tries to move those joints she feels her muscles tense up and cause pressure against the hard shell of the cast restraining her movements. However when she tries to move her head not only does it not move even the slightest, when she tenses up her neck muscles there is no sensation of something hard resisting the movement. Her head simply does not move.

Testing the various hinges gets some slightly different results. The ones at her elbows and knees have almost no give in them. Susan guesses that there is maybe a millimeter or two of movement before she hits the stops on the elbow hinges, and the knees have about the same amount of give too. Her knees are held straight out while her elbows are locked at a ninety degree angle; although due to the Halo she is still not able to see even the tips of her fingers. The hinges at her knees differ from the ones at her elbows. The elbow hinges are standard range-of-motion or ROM cast hinges that can be adjusted in ten degree increments to allow limited movement or locked rigid into any of the available positions. But, per a request from Susan, the hinges at her knees however are normally used with KAFO braces and have a spring assisted drop lock on them. When her knees are extended to fully straight the locks automatically engage.

The hinges at her shoulders allow maybe a quarter of an inch movement in a couple of directions. Susan is just barely able to lift her arms forwards, although even that is not enough to bring her fingers into view, and she is able to spread her elbows out to the side the same amount.

The hinges at her hips are not standard hip hinges which would usually allow both forward and sideways movements. This was another of the changes that Susan requested with this cast. She did not want to be able to spread her legs out sideways once the hinges were in place. Steve used some heavier duty hinges he took out of some ROM knee braces instead and turned them around backwards to allow forward motion with no lateral movement. With the hinges locked down Susan is unable to lift her legs, but she finds that even with these hinges she is able to slide her legs apart more than she thought she would be able to. Recognizing that the plaster is still technically wet and in the process of drying Susan does not push the limits for both her shoulders and hips so she will not damage the cast.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

CA Day 2 – Request For Higher Flight Pattern

Steve stops by to see how Susan is doing around mid-afternoon. Checking in with the nurses first he is told that Susan has been in some pain from the Halo which was expected and is being given pain relievers to manage it. She has also requested to be fed by formula only which they went along with. Besides that she has been relatively quiet and napping on and off so far.

“Good afternoon Mrs. McCallen,” Steve says as he closes the door to the room.

“Steve? Is that you?”

“It is. I’ve closed the door so we can have some privacy. How are you doing Susan?”

“Oh Steve! I’m loving it! This is almost everything I had hoped it would be! Well, except for the Halo. This thing hurts.”

“I did warn you about that. Are you going to be able to handle it?”

“I’m not sure to be honest. You applied a lot of traction to my neck with this thing. How long does it normally take for a patient to get used to a Halo?”

“Hm, I normally hear from my patients that it takes a week or so to really start getting used to it. But they also tell me that after the first two or three days the initial pain drops down to a lesser, background, annoying pain.”

“I see. Well I’ll try to stick it out for now. Just how long will this cast really take to dry out? I want to get some movement back again before the week is up you know. I need to try out getting around like this before it has to come off again.”

“Alright. We’ll see how the Halo goes.

“The cast should actually be fully dry by tomorrow morning. Like I mentioned during the scene, the cast is in multiple parts and with the heated fans here blowing on you all the time it should dry out and take on its final hardness by then. You’ll be able to get up and walk before the week is out.

“I’m glad to hear that the rest is what you wanted though. Really enjoying that part then are you?”

“Almost.”

“Almost?”

“Yea. I can move my shoulders and hips too much, especially my hips. I mean, watch this.”

Susan spreads her legs out a little bit and pulls them back in again.

“And I’m sure I can go further than that, I just don’t want to damage the cast any.”

“Yes, I see.” Steve takes a closer look around Susan’s hips. “Don’t do that any more. You’ve already damaged the cast a little bit. I can see tiny gaps around the edges of the hinge struts.

“Well the shoulders are probably the best we can do with that short of just casting them solid. They just don’t make cast hinges for that joint.”

“I kinda figured that would be the case. What about the hips? Can we do something about not spreading them? I can’t bend my knees at all right now with them locked and I want to keep my hips from moving too.”

“Well, I suppose that we could add in an abduction bar or two between your legs. That would tie them together so your hips can’t move laterally while still letting the knees and hips move anterior and posterior. In other words, forwards and backwards.”

“Oh! That sounds good. Let’s do that!”

“We can. But, that will mean your legs won’t be able to move independently any more. You will not be able to walk normally. Once we get you up and moving again you’ll need some form of crutches or walker to help you ambulate.”

“I don’t care. Add in two spreader bars.”

“Okay. I did tell the nurses that I was going to do an assessment on how the cast was doing, so doing a revision all of a sudden would not be out of the ordinary.”

“Good. And what about my fingers? When will you give those back to me again?”

Steve chuckles, “Well I don’t know about that. I need to get a little something out of this too. And having you helplessly in need of assistance all the time is my little price for you to pay I think. I may cut the finger casts back on the last day or two if you behave.”

“Oh alright. Fine. Be that way,” Susan giggles. “I suppose I will just have to deal with it,” she says with a grin.

“Now, I’ve been thinking. What about the wires? I decided I want to try that too. I’ve already got them feeding me solely through the feeding tube today.”

“They did mention that. I can tell them that I examined your jaw and am ordering an MRI for later this afternoon. Tomorrow or the next day I should be able to get someone in to start the process of having your jaw wired shut.

“If you’re really sure that is. You’re already pretty disabled here right now. Once your jaw is wired you won’t be able to talk at all at first. And if there is an emergency, like say with a problem breathing, it is possible an emergency tracheotomy will have to be done. If we do then you’ll have a hole in your neck and we can’t close that up right away. It usually takes a good week minimum before a trach can be reversed.”

“Oh. Well, what’s the chances of such an emergency happening?”

“Well, I suppose the odds are pretty slim on that. You don’t have any of the additional conditions which would potentially increase that type of risk.

“Okay. If you really want it we can wire your jaw shut as well.”

“As long as you don’t think a trach is a risk, then yes I want it.”

“One thought here Susan. If you do manage the week with the Halo still in place and decide to go the distance with that ... well, there is a possibility to consider here.”

“And that is?”

“Hear me out first now.

“With me needing to submit some type of medical records for you to show that you have been injured and require that Halo for the next several months, there is quite often a need for a tracheotomy to be in place for a decent portion of that time as well. The typical neck injury does have a tendency to include a problem with ventilation at first. What do you think?”

“No. I don’t want to deal with a trach even short term, let alone as long as you are suggesting. While it is tempting, and I admit that I am very curious how that would feel to not be able to breathe on my own and have a machine doing it for me, and it would add another layer of authenticity, I’m going to try and stay somewhat sane here and not go for it. Thanks, but no.”

“Alright. Just thought I’d throw it out there.

“I’ll go tell the nurses to prepare for an MRI on your jaw and that your cast is not sufficient and we will be adding in two abduction bars. One between your thighs and one between your calves. I should be back to do the addition to the cast in a little bit before they take you out to have the MRI.”

Steve returns around an hour later with Rebecca and a cast cart. They temporarily unlock both the hip and knee hinges to give them room to work, and in about twenty minutes there are two wooden bars fully encased in plaster and joined into the cast. Both bars go over the front of the cast with one in the middle of the thighs and the other in the middle of the shins. The end of the bars are trimmed so that they are an inch shorter than the outside face of the casts and do not protrude while still being completely covered with plaster bandages. Once they are done the hinges are again locked so Susan’s legs are held straight down from her torso.

Susan discretely tries to spread her legs and even with the new additions barely being in the ‘green’ set stage she is no longer able to spread her legs at all which gives Susan a smile of contentment. The people for the MRI show up thirty minutes later and wheel her entire bed out and take her away. An hour and a half later she is returned to her room to receive a later dinner of formula.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The third day of Susan’s fantasy cast adventure went both quickly and slowly at the same time for Susan. She did wake up with a bit of confusion again, but quickly remembered her situation and stopped fighting her restrictions before causing a nurse to have to come into the room.

The day was slow because she had hoped to have someone show up to begin the process of getting her jaw wired shut but nobody arrived to do that. Steve did show up late in the afternoon and let her know that the doctor he contacted was not able to get away until the next day to get her jaw prepared.

Other than the early morning confusion and her anticipation mounting through the day, day three went fairly quietly with nothing of great interest happening otherwise. Her twice daily pin cleanings happened with little fuss. Susan napped when she could, which was frequently, and she requested that she continue to receive only formula through her nasal tube as he jaw was reportedly hurting her. This also gave her the excuse to not talk much at all ‘to keep from straining her jaw’.

The fans continued to blow warm air around her cast through the day, with the foam pads elevating Susan up being moved to different positions several times. By the evening the nurses stated the cast was probably fully dry already, but they would keep the fans going through the night to be sure.

Unbeknownst to anyone, on the same day as day three of Susan’s grand cast adventure, a man made a wish somewhere in the middle of the United States. A wish that was granted. It forever changed the way that the medical profession would utilize plaster and fiberglass casts. How it would affect those who used casts in a recreational manner had yet to be considered.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

CA Day 4 – Changes To The Flight Plan

Day four of Susan’s cast adventure began with her hearing the door to her room close quite early in the morning which broke the lazy early morning half-awake and still waking-up dream she was having.

“Good morning Susan,” Steve says as he comes into Susan’s range of view.

“Hi Steve,” she replies as Steve is checking the various sections of her cast. “Is it dry enough?”

Steve knocks on the cast over her chest, “Yes it is. Completely dry as far as I can tell. Does it feel wet or clammy anywhere on the inside to you?”

“Nope, not at all. In fact it’s gotten to be pretty comfy in here.”

“Then I declare this cast dry.”

Steve goes over and turns off the fans.

“How is the head doing?”

“Still hurts a good bit. But not as bad as yesterday did.”

“What do you think? Will you make it to go full term like you wanted?”

“The jury is still out on that one. I’m not sure if I’ll make it yet.

“Will I be seeing your jaw doctor friend soon?”

“You will definitely see him today, and I am thinking it will be sometime this morning. Until he shows up and does the initial work I’m going to keep you completely motionless.”

“Okay. I’m getting used to just laying here. I can keep it up I suppose. Not like I have much choice though. I kinda have to wait for someone else to come unlock these hinges before I can even try to move,” Susan giggles.

Steve grins, “There is that.

“When the Doc shows up he is going to have some choices for you to think about with having your jaw wired. We’re not going to go the surgical route, so no posts cut through the gums and screwed into the jaw bones.”

“That’s good to know.”

“He’s going to use Erich Arch Bars. They kind of look like braces a little bit. They are solid bars that will be bent to fit around the outside of your teeth all the way around from the back molar on one side to the back molar on the other side. Top and bottom. The bars have smooth round hooks on them all pointing in one direction, so when he puts them in he’ll position them so the hooks on top point up and the hooks on the bottom point down, or basically away from the other side. The bars are held in place with wires individually looped around each tooth, and each wire is twisted closed with a part of the bar inside the loop and tightened down.”

“Alright, I’m with you so far I think. That’s going to hurt a bit, isn’t it?”

“A little. And there might be a little bit of bleeding too. Getting the wires in place around each tooth can be a little tricky sometimes.

“But here’s where you’ll have a choice to make. He’s going to offer you the option of having a bite plate included in the deal. The bite plate will essentially make sure that your teeth do not get pulled out of position for as long as the jaw remains wired shut. As far as he know this is to be a long term deal here. If you go with the bite plate, I can guarantee that you will not be able to talk. Period.”

“I won’t? Not even after a while?”

“Nope. It’s not possible with this. The bite plate is a solid one piece construction. It’s going to cover the front and back of all of your teeth and have a plate for added stability that goes across your tongue which will hold it down. He’s going to have to take and impression of your teeth to have it made. I’ve kinda given him the impression that this is a minor emergency so if you choose to have one then he’s going to get it done today.

“You’ll have the impressions made then the arch bars put in, and later this afternoon he should come back and check the fit of the bite plate. If the fit it’s good he’ll use a temporary glue to hold it in place overnight to allow you to see how it will feel. If you do good with the bite plate in place over night and think you can handle it then he will wire your jaw completely shut the next day.”

“And if I don’t like the bite plate?”

“Then he will use a gentle solvent for the glue, take out the bite plate, and finish wiring your jaw without it in place.”

“I see. Interesting choice.”

“I figured I’d give you all the facts before hand so you could think about it. With your cast adventure as it is going now, I can take out the wires and bite plate at the same time we remove the majority of your cast. Taking them out is easy enough, I just don’t normally put them in myself.”

“I could keep the wires though, if I wanted?”

“It would mean keeping the feeding tube too, and if you keep it long enough then we’ll have to do regular tube changes. Those nasal-gastric tubes are really only good for about four weeks tops. I like to have my patients come in every two to three weeks to get them changed if they have one.”

“I see. Something more to think about.”

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

“Hello Mrs. McCallen, I am Doctor Irwin Yates. You can call me Doc for short.”

“Hi Doc. Please, call me Susan. Are you the jaw doctor?”

“That I am. Doctor Weiss tells me that you are having some rather serious troubles with an unfortunate combination of issues, as I can see. It is even affecting your jaw and causing you some pain and problems there as well and he has prescribed a duration of having your jaw wired shut.”

“Yes, I am afraid so. I’m going to be like this for some time to come it seems and I am already being tube fed because of my jaw.”

“Yes, I see that. Well, we have a few things to discuss before I get started here. I will explain just what is about to be done, and give you a choice of some treatment options.”

For the next forty-five minutes they talk. Doctor Yates shows Susan exactly what the wires and bars look like, explains how they will be fixed in place, and shows her an example of the bite plate that he can make for her. He makes quite clear that with a bite plate Susan will no longer be able to talk as long as it is in place, but it will also be certain to protect her teeth from moving. During the discussion Doctor Yates tries to direct Susan towards having the additional bite plate included, but by the end of their talk Susan is still uncertain.

“I just don’t know Doc. I do understand your concern about my teeth, but is the risk of having them move out of place that bad? I mean, I won’t be able to talk at all with that and I’m already pretty helpless here as it is. Losing my ability to communicate clearly with others might be too much.”

“I can understand your hesitancy Susan. But if what Doctor Weiss is indicating is true, then you’re going to have to retain a wired jaw for some time. The risk to your teeth increases the longer you go like that.

“I’ll tell you what. Let me make the impressions, we’ll get the arch bars in place, and I’ll go back to my office and get the bite plate made. Just as soon as it’s ready I’ll run it over here and show you how it feels. You can think about it until then and we’ll talk some more once you’ve had time to think. No more talking about it for now.”

“Okay Doc. That’s fair. I can go with that. Let’s get started then.”

Doctor Yates goes to the equipment he brought with him. Pulling out two impression trays he mixes the paste, fills the trays, and has Susan bite down into them and hold it until the paste has set. He makes sure to tell Susan the actual bite plate will not be anything like the impression trays, it will be much smaller and be form fit to just go over her teeth. Setting the impressions aside, the next step is to get the Erich Arch Bars measured and fixed in place.

Lip spreaders are slid into Susan’s mouth to hold her lips open and give Doctor Yates clear access to her jaws and teeth. Measuring is done using a thin plastic strip initially, with separate measurements done for the top and bottom jaw. Two bars are cut from a spool, checked for fit, trimmed to the correct length, and the potentially sharp ends filed down some. Over the next two hours Doctor Yates carefully inserts a metal wire between each of Susan’s teeth, bends it around the back on the inside of her mouth, and pulls the wire back through to the front through the gap between her teeth on the other side. The ends of the wire are kept long enough so that they extend far enough out that she can see them by looking down along her nose. He does this for every single tooth in Susan’s mouth. By the time he is done with the last one it looks like a wire brush exploded and is trying to come out between her teeth and lips.

“You’re doing well Susan. I apologize for those few times I stuck you. I’m about to add in and secure the arch bars now. This is when you’ll start to feel the tension of having the wires tightened that I told you about. It won’t be too bad.”

Susan tries to respond, but with the lip spreaders and all of the wires in the way all she can do is make unintelligible noises.

“I know, you can’t say much right now and it’s probably getting pretty uncomfortable for you lips at this point too. I’m sorry about that, but we’re only half way there. At least the next part tends to be much quicker.”

Taking the upper arch bar, Doctor Yates threads it down through all of the wires around Susan’s top teeth and places it flat along the gum line with the round hooks pointing up. Starting at the front in the middle he uses a pair of wire forceps to twist the wire and capture the bar against the tooth. Checking the arch bar is in good position he does the same thing with the wire right next to it in the front, then switches from side to side as he twists the wires down tight until all of the wires looped around Susan’s top row of teeth have been tightly secured. Taking a wire cutter he snips the extra length of each wire off leaving about half an inch length that he twists around so the sharp end is lying against the enamel of the tooth. It takes Doctor Yates slightly over thirty minutes to wire the upper arch bar in place.

“There, that’s the top one in place and secure. And I didn’t even break a wire. It’s pretty easy to break these wires, they’re so thin. Time to get the bottom arch bar done now.”

Doctor Yates repeats the process on Susan’s lower jaw, this time making sure the hooks on the arch bar are pointing downwards. Another thirty plus minutes go by and he finally removed the lip spreaders.

“Oh. Ah. My lips will never feel the same again Doc.”

“I’m sorry Susan. That does get rough. Here, let me help.”

He gently massages Susan’s lips for a moment then rubs in some Vasoline and gives Susan a couple of drinks of water.

“Better dear?”

“Yes. Thank you. Oh. These wires feel strange.”

“Have you ever had braces before?”

“I have. Back when I was a young teenager. This feels similar but at the same time a bit different from then.”

“It would. The usual braces go across the front of the teeth in the middle of each tooth. These arch bars are actually pulled up tight against the teeth right at the gum line which is higher, or lower, than braces go. The natural narrow part of the tooth is what we use to keep these arch bars in place and then tie the jaw shut against that. It is very effective.”

“I imagine so. And one way or another I’ll be finding out tomorrow won’t I. My teeth actually hurt I think.”

“Yes, they will be a bit tender for a few hours. Do you feel any place that is sharp?”

Susan moves her lips around over the metal in her mouth then her tongue.

“I don’t think so, no.”

“Good. Now I’m going to gently press in on your lips and I want you to do that again to check for sharp spots.”

They do the test and Susan reports nothing is poking her anywhere.

“Excellent. We are done for now. I’ll get this bite plate done and come back this afternoon. We can see what you think then.”

“Alright Doc. Thank you. I appreciate what you are doing for me.”

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Susan does not see anyone other than the nurses the rest of the morning and for several hours of the afternoon. Late in the day Doctor Yates returns with Susan’s new bite plate. He checks the fit in her mouth and how well it fits in against the arch bars. He makes some adjustments to trim off some of the plastic along the front of Susan’s teeth and allow a little room between the plastic and the arch bars so that when he uses the wire to hold her mouth shut the bite plate will not interfere.

The two of them talk for another half hour about how Susan feels and how Doctor Yates thinks this can affect her teeth and jaw health.

“Truly Susan, I think going with the bite plate will be best in the long run.”

“I see your point, and I am almost convinced. But that thing really feels like it is trying to gag me. I’m not sure I can handle that all the time for as long as I may end up wearing it.”

“Okay then. Let’s give it a test. I promise that all of my other patients who use this indicate they get used to it and the gag reflex goes away by the next day most of the time. I’ve only had three patients who were not able to handle a bite plate, and all of them had mouths much smaller than yours.”

“Oh thanks Doc, now you’re telling me I have a big mouth,” Susan jokes.

“Well, if the shoe fits ...” Doctor Yates shoots back with a chuckle.

“Let’s glue this bite plate in and give it one hour. If you’re okay that long then I’ll leave it in for the night and come back in the morning to see how you did. I’ll leave an application of the solvent with the nurses just in case.”

Susan moans but relents. “Alright Doc, we’ll do it your way. But if I throw up it’s all your fault.”

“You’ll be fine. I promise.

“Now this glue is temporary, but it is still strong. It will hold your mouth shut and keep it that way over night. It takes about three or four days without the solvent for the glue to start breaking down. Come tomorrow if all goes like I think it will then I’ll use the solvent and take it out, clean it, then coat the bite plate with a gel that will help prevent decay and plaque. After that I’ll put it back in place and do the final wiring to immobilize your jaw.”

“Okay, okay. Let’s just do this and get it over with. I hope you’re right. I don’t fancy drowning in my own vomit here.”

The glue is applied, Susan’s teeth are dried front and back, and she bites down into the grooves for her teeth. Doctor Yates tightly holds her jaw shut for about ten minutes. When he lets go Susan tries to open her mouth again. Her jaw does not move, the glue is set and holds firm. Next she tries to say something to the doctor, but with the plastic going over her tongue and holding it down all she can get out is a low grunt and moan.

“There we go. And one hour starts now,” Doctor Yates says as he sets a timer on his watch.

The time goes by smoothly and by the end of the hour Susan realizes she is already starting to get used to having the bite plate in her mouth. With blinks and grunts Doctor Yates is able to communicate with Susan to confirm that she is okay.

“See, I told you that it would be okay. I’ll let the nurses know that you’re jaw is set for the night and to call me at any time if there is a problem. I honestly don’t expect there to be one though. You’re doing well. I will see you tomorrow and we can get this finished up.”

Doctor Yates presses the call button and Nurse Gail arrives a minute later. He informs her that Susan’s jaw is glued shut for the night, places a single application size bottle of the solvent on the counter in Susan’s room as a precaution and waves as he leaves Susan’s sight.

The rest of the day and through the night the nurses check on Susan a bit more frequently as she is now unable to call out or make a loud enough noise for them to hear.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Steve arrives late in the evening to check on Susan and find out what she has decided.

“Hi Susan, how are you doing? Did you let Irwin talk you into the bite plate?”

Susan waits until Steve is standing over her then grunts and spreads her lips open.

“OH, well, I guess he did. Nice bit if work there as usual.

“I did say that I was going to keep you fully immobile until he got your jaw started. And, I also promised you that I would let you get some movement in while you are in this cast. So, Jeff should be arriving in a minute or two with some ambulatory aids, and we are going to at least get you up and walking around your room for a little bit.”

Susan gives a happy little squeal at that pronouncement which gets a smile from Steve. He begins to unlock some of the hinges while they wait for Jeff to arrive. Jeff comes in and closes the door behind him. He carries in a walker and platform crutches, and a box containing platform attachments for the walker. Helping Steve finish with unlocking the rest of the hinges Susan is finally able to lay her hands down on the bed for the first time, even is she is unable to twist her wrists to lay them flat.

The hinges at her knees have a lever to keep them unlocked which are engaged and Susan works at bending her hips and knees for a few minutes while still lying in bed. She finds that the abduction bars between her legs do a superb job and she is completely unable to get her legs to spread out to either side, nor inwards together in the slightest. Her feet remain perfectly aligned about six inches apart between the casts on them and do not budge. To move either leg Susan must move both at the same time now.

Steve and Jeff first raise the head of the bed to forty-five degrees and stop to give Susan some time to adjust to being semi-upright again after four days of laying on her back. Susan’s head swims and she is dizzy for several minutes before it goes away and she indicates she is ready to go further. They get her sitting all the way up straight and pause again while she takes another moment to adjust. Once she is able to see straight again they get the walker setup in front of her with the platform attachments first and carefully get Susan standing. Releasing the catches on her knees the locks engage and provide extra support to help Susan stay in place while the walker and platforms are adjusted to the correct heights to accommodate the height of her walking heels and the height her arms are held at in the cast.

They allow Susan over an hour to get used to being up again and moving around. With some trial and error Susan learns that the platform crutches are actually easier for her to move around with than the walker despite, and possibly even because of, the walker having four points of contact with the floor. She has to use a swing through gait since her legs are locked together side-by-side and the crutches allow her more freedom to move forwards easily. Susan does find that the casts over her hands are just as debilitating as she thought they would be. Because the plaster edge of the casts extend out beyond her fingers all the way around where they are exposed she is not able to grasp anything at all between her fingers and the cast despite being able to lift her fingers enough to create a small gap.

Still, Susan goes to bed happy that she is able to move again, and manages to communicate with Steve and Jeff well enough using ‘twenty questions’ to get them to leave the hinges unlocked for the night. As she lies in bed, she decides that the bite plate is going to be too much and will have Doctor Yates remove it when he shows up before he finishes wiring her jaw shut on a more permanent basis.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

CA Day 5 – Crash And Burn or Rocket To The Moon?

Susan wakes up the next morning and while annoyed that she can’t yawn, does not experience the post cast confinement confusion she had the first few days of her cast adventure. She lay in her cast reveling in the feeling of it surrounding the majority of her body while still allowing the major joints some freedom of movement. The nurses come in and find Susan awake, so they get her situated for another day and hook up her morning meal bag on the bedside pole while doing her morning pin cleaning.

The morning passes with nobody else arriving to visit or check on her, and the nurses on duty hook up Susan’s noon time feeding bag which they have warmed up some since it was stored in a refrigerator all morning. The formula is thicker this time as it has extra fiber included in it to try and help Susan to have a bowel movement that has yet to take place since she was brought in.

Susan chooses to lay down flat in bed with the curtains over the window wide open to let the sunlight fall over her. The heat from the sun soaks into her cast and body which feels good and the warm formula slowly filling her tummy just adds to the warm content feeling Susan is experiencing. She begins to daydream about her cast adventure while she lay there, envisioning in her mind how it might be if she took it all the way to the utmost levels, eventually drifting off to sleep with her fantasy running at high speed.

While Susan slept, the growing area of effect from a wish crept across the building in which she lay. The first noticeable result is the defects and blemishes in Susan’s cast are corrected. The outer surface of the plaster becomes smooth, none of the cloth in the plaster is visible any longer. The gaps created where Susan had both tested her limits and struggled in confusion were made tight and firm. The walking heels straighten out and shift to be perfectly aligned and flat to the floor when she stands up straight.

The next change to take place is all of the hinges in Susan’s cast lock tight at zero range of movement in the position she is currently in. This keeps her legs held straight down and her arms held down with her hands by her hips. Subtle changes occur to the hinges making them tighter in their function; even the hinges used at Susan’s shoulders alter so that they will fully immobilize her arms while locked.

Susan is awakened by someone entering her room. She tries to raise her arm to at least greet the person with a semi wave only to find her arm will not move. She tries the other side with no better result. Trying to move her hips or knees is just as useless.

“Hello Susan,” Doctor Yates greets her as he comes into Susan’s line of sight. “I see they were kind enough to lower your hands for you. Shall we get that bite plate out and finish getting your jaw immobilized?”

Unable to move, and realizing that Doc was under the impression that she was not supposed to be able to move yet, Susan just grunts with a positive noise.

Doctor Yates takes the glue solvent and carefully applies it around the bite plate.

“This is not going to taste very good I’m afraid, but it is safe. Just try not to swallow too much and I’ll suction out as much as I can quickly.”

A few minutes later and a suction tube is in Susan’s mouth sucking up water that Doctor Yates is gently pouring in to help rinse out the last of the solvent.

“Thank you Doc. That really is foul tasting. Yuck.

“So, I realize I made it through the night and part of today with the bite plate, and I even got used to it with no gagging long before I went to bed, but I decided I don’t want it in there. It’s just too much.”

“Susan, you adjusted to the bite plate perfectly like I said you would. It is really important that you use it now or your teeth are going to suffer.”

“I know what you’ve told me Doc, but it’s just too much. Having it in there is just one step too far to making me completely helpless in my opinion. I can’t.”

“Susan, you don’t realize what can happen. If you end up with these wires in place for a long time your teeth are going to get moved around. All that dental work you did as a teenager will be undone. You’ll end up back in braces again as an adult. That’s much harder to correct and will take longer. It can be that bad.”

Susan sighs, “I get it Doc. Really. But I had a really hard time trying to communicate with the nurses and Steve, Doctor Weiss, when he came by. It’s just too much. I don’t think I can do it.”

“I understand Susan. It’s really important, but I can see how your situation can make it worse. Look, do this. For me, please. We’ll leave the bite plate out and I’ll do a semi wire of your jaw right now. Talk to Steve about this. I’ll come back tomorrow, and if you still don’t want the bite plate I’ll leave it out and finish the job without it. But please really think about this. It really is a matter of not talking now for however long your jaw is wired shut versus years of braces to realign your teeth again.”

“Okay Doc. I’ll think about it. And I’ll talk to Steve. I promise.”

“Very good Susan. Thank you.”

Doc pulls out his needle nose forceps and a spool of wire. He puts the lip spreaders in Susan’s mouth and has her close her jaw tightly. He quickly starts to connect the top arch bar to the bottom one using three loops of wire. One on each side and one in front. After the first loop is in place on the side Susan is no longer able to open her jaw at all, and the second and third loop simply make it firmer.

“There. That is not how I usually wire a jaw shut in this situation. A few snips and it will come out in seconds.”

Susan tries to respond but it comes out garbled.

“Take your time and try to talk slowly. You won’t be able to pronounce certain sounds right away. Most people eventually learn how to talk fairly well with their jaw wired shut, although a few never get it. Hopefully you won’t be one of the few.”

Susan tries again slowly like Doc suggests.

“Wow. ‘is is rea’y ahhs. Ods. I han’t moff I ‘aw ah ahl.”

“There you go, that’s the idea. Keep at it and you should be able to talk mostly normal soon enough. I’ll see you tomorrow.”

Once Doc has gone, Susan tries to move again and is still unable to move.

‘Dammit all. I know I could move earlier when I got fed,’ she thinks quietly to herself. ‘What happened? Wait. I bet I know. Doc woke me up when he came in. I bet Steve came by while I was asleep and locked me rigid again knowing that Doc was coming,’ she reasoned. ‘Guess I’ll have to wait for him to come back and release me again.’

Susan rests in the sunlight, still enjoying the warmth it provides and considers what Doc has been saying. She feels that Doc is genuine in his concern for her, that he feels certain that her teeth are at a definite risk. He doesn’t know that this whole cast is just a week long adventure for her and most of it will be coming off. The chances of her actually needing the bite plate are so miniscule that it’s not worth putting the plate in so that she can actually talk to people instead. She does realize though that if she were to have her jaw wired shut like Doc thinks will happen then the bite plate might actually be the way to go. Keeping her teeth straight for the long haul makes good sense.

While she thinks about the bite plate situation Susan absentmindedly pushes against her cast, casually testing the limits of her confinement and the hinges. As she is testing the hinges, she notices some differences.

‘Hang on. That little loose spot on my right foot isn’t there anymore. The cast is perfectly tight now. Did my leg swell or something?

‘It doesn’t feel swollen, and the cast doesn’t seem to be getting too tight around my foot either.

‘Now that I think about it, there were a few tiny spots that were starting to rub or poke me a bit and be annoying on the inside. Those spots are gone. All of them.

‘And why can’t I move my shoulders? These hinges aren’t the right kind and had some wiggle room in them. Now I can’t move my arms at all from anywhere. What is going on here?’

About this time Susan hears someone walk into the room and Steve comes into view.

“Hey there. How is the head feeling today? Did Doc give you the final tie down on the jaw?”

The first question catches Susan off guard and she takes a moment realizing her head is not hurting nearly as much.

“Uh, ‘ea muh hea’ is fsee’in mush ‘ette’.”

“Oh, dang, wired jaw speak I see. Okay. So your head is better?”

“ eYes.”

“Good. And from the talking I guess you went without the bite plate then?”

“ ‘ot esah’ee. ‘is is ‘emoraree ‘ire.”

“Oh? Temporary? Let me see.”

Susan spreads her lips and Steve pokes at them a bit more.

“I see. Just a few little loops right now. What’s up?”

“I ‘on ‘hinc I ‘an ‘ake ee ‘ite ‘ate. Is ‘oo ‘uch.”

“Well, I can see that. Especially if you go and keep the wires in your mouth past this little adventure like you thought about. Or is it just because the adventure is so short. Is that it?”

“ ‘ea.”

“Oh, okay.”

“ ‘heve. Homhing is kanged wi’ he ast. Kast. ‘ake a ‘ook ah i’ eese.”

“What? What’s wrong?”

“I han’ mooff. ‘he hin’es r ‘okked. An’ I han’ mooff I ho’ders. ‘hey were ‘oose hefore but ‘ow I han’ mooff ah ahhl.”

“Didn’t we lock the hinges down again last night before we left?”

“O. Ngo.”

“So you’ve been able to move all day but now you can’t?”

“Yeeah.”

“When did you stop moving again?”

“ ‘ust beesore ‘oc howed uh. I hell aseef uring ah unch. I oke uh an k‘oud nah mooff.”

“Okay. Give me a second. I want to go check with the nurses.”

Steve leaves and come back a couple minutes later.

“I asked and none of the nurses say that any adjustments were made to your hinges today that they are aware of. This is strange.”

“ ‘heve. Okk ah ee kass. I’ heels smoosser. ‘high’er. Ak’uahee heel behher.”

“Really? Alright, let’s take a looks see here. You know, you may be right. The whole cast really does look smoother and better shaped. And hang on. Look here. The cast around the hinges where they are held is perfectly tight. You had made some tiny gaps in the plaster trying to move around and now they’re gone. What the hell? And what’s this? This shouldn’t be like this. The stockinette. We left your middle section open and uncovered around your waist so we could see your skin. We couldn’t really do your waist and hips like we did the elbows and knees, it just wasn’t doable that way. But look at this. The stockinette is completely covering your side from leg cast to body cast just like it does at your knees and elbows. Let me look under here. I’ll be damned. The same thing here under the adsorbent brief. The stockinette has covered you up except for what looks like a properly formed and sewn opening around your genitals. The opening looks like it continues on around to your butt too. How the hell did this get here?

“Wait a minute here. That can’t be. It’s just not possible. It can’t be true.

“Susan. There have been some rumors starting to go around. Crazy rumors. Things about casts coming alive and making themselves perfect. Absolutely no blemishes or defects in any way. Casts that actually grown on their own even. The patients can’t feel anything wrong on the inside and the casts are perfectly comfortable and form fitting to them.

“This can’t be. I have to get you out of there right now!”

While Steve was talking about the rumor of living casts, Susan began to feel something moving in her mouth around her teeth. The strange sensation in her mouth combined with what Steve was saying scared her a lot and she yelled as best as she could when Steve turned around and began to run out of the room.

“SEEVE! SEEVE! SOPP!”

Steve stops and turns around again.

“HEEVE! AH MOWSS! OOK AH AH MOWSS EESE!”

Steve quickly comes back to Susan’s side and pries her lips apart with his fingers. What he see’s makes him gasp in shock but he can’t stop watching.

“Oh. My. God. That’s not possible.

“Susan.

“Susan, your jaw. Your jaw is being wired shut right before my eyes! The wires are shifting and growing on their own! How is this happening?!?”

Susan gave an inarticulate scream of fear, but couldn’t move or do anything to stop what was happening or even attempt to reach up and feel her own mouth.

It took about fifteen minutes before Steve reported it was finished.

“It’s done. Your jaw is completely wired shut. It’s the best job I’ve ever seen. I dare say it’s perfect. Can you still talk?”

“Seeve, ah sarred. Hat is goong on?”

“This scares me too Susan. I have no idea. All I’ve heard are what I thought were unsubstantiated rumors. Until I saw this. And inspecting your cast, Susan, it’s perfect too. I bet it feels pretty good for you on the inside, doesn’t it?”

“Eeah, eh hus.”

“I have to try. I’m going to get a cast saw and cut you out.”

“Hut oo meen, hry?”

“Susan. One of those rumors says the casts can’t be cut off anymore no matter how hard they try. I am afraid you may be stuck in there, but I still have to try. I’ll be back in a few minutes.”

Steve runs out of the room in a rush to find a cast saw he can bring back.

Less than a minute after Steve runs out, Susan feels something in her mouth again. This time it is on the inside over her tongue instead of the outside around her lips like the last time. She starts to gag a little bit but the feeling does not go down her throat. It spreads out to the sides pinning her tongue down and up against the insides of her teeth. It takes a couple minutes for Susan to realize that it is starting to feel just like the bite plate, and it is growing to fill her mouth. It is already to the point where she is no longer able to make intelligible speech and will soon render her almost mute once again. By the time Steve returns with a portable saw Susan can feel the plastic spreading between her teeth and curling out around them. The wire immobilizing her jaw feeling like it is moving and shifting to accommodate the almost complete bite plate.

Susan grunts at Steve to get his attention before he turns on the saw and does her best to spread her lips apart.

“What? What is it Susan? Something with ... oh no. What is that? Is that your bite plate growing in place there?”

Susan grunts an affirmative as best she can, no longer able to talk. Steve watches for the next two minutes as the bite plate finishes growing in place. The wire shifts and appears to grow a little to give it room. When any movement looks to have stopped Steve tries to pry Susan’s jaws apart with no success. Her jaw is firmly wired closed and will not open.

Shifting gears Steve grabs up the cast saw.

“I’ll deal with that in a minute. Let’s see if I can get this damn cast off you.”

He powers up the saw with a reassuring whine and immediately begins to cut through the plaster encasing Susan’s upper right arm. Making a successful cut through the length of the cast on her upper arm, Steve moves down and begins to cut through the cast on her lower arm as well.

Susan could feel a slight difference when the cast on her upper arm became loose from Steve’s cut. As he is cutting through the lower arm cast Susan can feel the upper arm begin to quickly tighten up again until it is just as tight and comfortably form fitting as before Steve cut it. Susan tries to grunt to get Steve’s attention but the saw is too loud and Steve is too involved to notice.

Getting a cut down the side of the lower arm cast Steve grabs a cast spreader out of his pocket and turns to Susan’s upper arm only to find there is no cut for him to further open up. The cut he made just a couple minutes ago is gone.

Susan can feel the cast on her lower arm getting tighter again and grunts. Steve looks up at her so she rolls her eyes down. Steve looks at her lower arm and watches as the cast repairs itself, the cut over the back of Susan’s hand sealing shut as he watches.

“Oh no. It’s true. I can’t cut this thing off. You’re stuck in there. But that’s the cast. Nothing was said about a wired jaw! Maybe I can free up your jaw!”

Steve opens a drawer on the counter and finds the emergency tools Doctor Yates had left behind. Taking the wire cutters Steve carefully spreads Susan’s lips and begins to snips the wires at the front of her mouth. With only three snips Steve stops again.

“It’s no use. The wire is healing almost as fast as I am cutting it.”

Susan sighs in resignation. She had felt the wires and plastic grow in place inside her mouth so she suspected that would be the result.

Steve is staring at Susan with a desperate look in his eyes.

“There has to be something I can do here. Something. I have to try. The Halo. I’ve got to try.”

Going over the drawers again Steve comes back with a couple of tools in hand. Karen runs into the room as Steve approaches the bed.

“Oh god. Steve. Is it true? Susan! Are you okay?”

“Help me do this Karen. Now. Please. Take this. We have to try. Take the frame apart if you can but don’t touch the skull pins or Halo Crown. We don’t want to hurt Susan.”

Steve hands Karen one of the tools to the Halo and together they attempt to loosen and unscrew several parts of the frame to remove it. They are barely able to get a few of the bolts to loosen up before they begin to retighten on their own again. Trying again they are unable to even get the same bolts to come loose anymore, let alone any of the other ones.

“Just one more thing to try,” Steve says quietly. “Karen, find a scalpel if you would please.”

“Um, right. Here’s one.”

Steve takes the scalpel and exposes the blade on it. Reaching down between Susan’s legs he grabs the catheter tube and cuts it in two. Water and urine begin to drip out of the end of the part that is still inside Susan while Steve continues to hold the other end. A moment later the end Steve is holding disappears out of his hand and two moments later the tube is whole again and still inserted into Susan’s bladder. Giving it a hard tug only causes Susan to grunt in discomfort.

“Of course.”

Steve falls down dejectedly into the chair beside Susan’s bed.

“It’s no use. We can’t get anything to come off. Not the cast. Not the Halo. Not even the wires on your jaw. The catheter. Nothing.”

“You tried everything else Steve?” Karen asks.

“Yep. Everything just heals the cuts or retightens in a minute or two. And that’s at the slowest. It seems to be getting faster the more we try.

“Oh my god Susan.” Steve cries, “I am so sorry. We’ve trapped you in that thing. It’s our fault. I have no idea how to get you out of there.”

Susan grunts several times until finally Karen comes over where Susan can see her. Blinking her eyes and grunting she gets Karen to play twenty questions with her, the only way she can communicate right now. Through grunts and blinks Susan reminds them that it was her that came to them and asked for this. She made the rules for how the cast she was now trapped inside of would look. Yes, they participated in what has happened, but in no way does Susan hold them to blame.

Near the end Steve had stood back up and was also participating in the semi one-sided conversation. Shifting a bit on his feet he bumps into a medical machine.

“What the heck? What is this doing here? I don’t recall ordering a respirator to be brought in here.”

“Wait a moment,” Karen breaks in. “There wasn’t a respirator in here the last time I was here, and I am pretty sure it was not here when I came in a short bit ago so where did it come from?”

Susan’s eyes begin to get very big and she starts to grunt at the two of them. She has an idea of where it came from and is getting very scared. They begin a new round of questions, but a minute later Susan lets out a muffled scream.

Karen and Steve watch in horror as Susan’s throat suddenly begins to split open right above the junction of her neck and breastbone. Right in the exact spot where a tracheotomy would be performed. Susan stops grunting or screaming as a tracheotomy tube seems to grown up out of her neck taking the air away from moving over her vocal chords. It takes just one more minute and Susan is fully hooked up to the respirator, the machine now pumping away and regulating Susan’s ability to breathe, completely taking over that function for her.

“Holy Christ! Did that really just happen?!?” Karen exclaims.

“Yes, it really did,” Steve answers. “Susan just got a tracheotomy and looking at the settings here her breathing is totally under control of this respirator.”

“How? Why?”

“I have no idea.”

By this point the two medical professional are at a complete loss and not even paying attention to the person most affected by this. For her part tears are streaming down Susan’s face. She is completely helpless. Unable to move. Unable to feed herself. Unable to even breathe on her own. Her urine is being removed by a tube that can’t be cut. And she now has a pretty good idea what will happen to her and for how long.

A few minutes pass by and for Susan the final confirmation occurs. There is the sound of something being released with a small amount of force. At the same time Susan can feel her bowels letting go and filling her adult diaper. The incontinence that she dreaded has made itself known. It takes a couple of minutes for the other two in the room to realize what just happened. When they do Steve slowly walks out to see if a nurse is available while Karen begins to look for supplies to clean Susan up and replace the incontinence brief. A nurse shows up and between Karen and the nurse they get Susan clean and taken care of.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

* Epilogue *

Cast Adventure(Curse) Day 25 – Realizations And Truths

Susan thinks back to the day when her life got very complicated and yet extremely simple at the same time. Three days into her own personal cast adventure an unknown man was brought into a hospital in Texas in a cast. Supposedly the cast had started out as two separate short leg casts on just his feet and lower legs. By the time he was brought to the hospital where doctors could attend to him the casts has grown up both legs, merged into one cast, and continued to grow up his body and started down his arms. In a relatively short amount of time the cast had eventually grown to completely cover the man from head to toe, no openings and nothing to be seen of the man outside of small holes just big to allow some wires and tubes through to monitor his health, feed him, give him air, and remove bodily wastes.

Nothing they could do would cut open that cast; it would just repair itself from any damage. And the cast was perfectly formed. Not a single flaw or blemish to be seen in it. All they were able to do was to put the man in his cast in a room of the hospital and watch.

From there any cast in the hospital began to show the same effects of being perfect. On their own, existing casts fixed any flaws in them and also were unable to be removed at that time. It wasn’t until some time later when the world began to figure out that once the normal duration to heal a broken bone was reached that a cast could be removed. There was even a tale of one cast that had dropped off on its own somewhere.

Two days after that event in Texas a wave or circle that carried and expanded the ‘living cast effect’ as it was being called flowed past and through the facility where Susan was enjoying her own unique cast for what was supposed to be a short week long adventure. The effect on her cast was quite similar to most others, but at the same time turned Susan’s life upside down.

From what had happened Susan was able to figure out a good portion of how some casts were being affected.

On the day that her own cast became alive and she endured the addition of yet more medical procedures, Susan had been daydreaming when she fell asleep. Those daydreams ruled the dreams in her sleep and took on the utmost extreme of her fantasy. Extremes which were visited upon her shortly after waking up and the effect of the living casts took hold. She also knew from this how long she would most likely remain like she now was.

Susan’s extreme fantasy revolved around her supposed genetic diseases taking a strong grip on her body and making things quickly happen to place her into a very dependant and helpless position. In Susan’s fantasy the plaster cast with numerous hinges was only the first stage, shortly adding in a Halo device for her head. The fetish scene she had agreed to and filmed took care of those parts at the same time. On the day that her cast evolved she was in the process of having the next part included into her short adventure. Namely having her jaw wired shut. The bite plate was not originally a part of her fantasy as she did not know about them. But the doctor who wired her jaw was quite convinced it was necessary and should be used for the long term and Susan had subconsciously agreed, therefore it got included in to her fantasy. When her cast responded to what ever made it come alive, it was also responding to her own fantasy that she had been dreaming about while she slept. In that fantasy Susan’s diseases had been very aggressive, requiring her jaw to be fully wired shut, her body to be held still in her special cast for an extended period of time, her breathing badly affected and needing to be taken over by a machine, even her bladder and bowels losing control and requiring some form of medical intervention with a catheter for the bladder and incontinence pants to contain the random bowel movements when they happened.

The time frame they had stated in the scene that was filmed was only around eighteen months as long as things did not get worse. In her fantasy dreams the ‘worse’ had happened. She was to be in her special cast for no less than three years with the potential for it to go longer. At a minimum, for the first twenty months of that Susan would be kept completely immobile. The respirator would also be fully in control of her breathing for those same twenty months. It would then be necessary on a part time basis, primarily used full time through the nights, with relapses of full time twenty-four hour use randomly occurring. The tracheotomy tube would remain in her throat indefinitely as long as the cast also remained and possibly beyond. She would eventually get to move her arms and legs again while still restrained by the limits of the cast and hinges. At some point which was not clearly defined she would eventually also regain the use of her eight fingers again along the way. The urinary catheter was to be permanent for the rest of her life while her bowel incontinence would only be able to be regulated and managed over time so that she would be able to perform a regular bowel movement at the same time each day as long as she was able to be in a prepared bathroom; otherwise she would still have an accident.

Susan had tried her best to get the message across to the people who were taking care of her, but they were slow to understand. At the moment Susan was only twenty-five days into almost two years of being completely immobile and helpless. Her caretakers, Karen Rebecca and Allie actually, had not yet figured out a workable method of communication that would allow Susan to fully express herself.

Steve was the best one with the twenty questions when he came around daily to see her. In fact she had just gotten through a session of questions with him a short while ago.

“So let me see if I get this. As best as I can tell you believe that you have done this to yourself, right?”

Yes

“And you think that you’ll be stuck in that cast and get up for up to three years?”

Yes – no

“Damn. I don’t quite have it.”

Yes

“Alright. But am I getting closer?”

Yes

“Well at least I’m getting there.”

And that was pretty much how her last attempt to explain had ended.

Susan relaxed into her cast, finding it to be quite comfortable at least. The extreme traction on her neck and the eight pins in her skull did cause a bit of discomfort all the time, but it had become just another part of her daily life now and she could usually manage to ignore the pain for the most part. A new bag of formula was currently filling her belly with her dinner and they had warmed it for her which was always nice.

Eight pins in her skull you ask? Well, when Susan had fallen asleep that first night her dreams were still centered around the fantasy and how it had now terribly affected her reality. The thought of the sixty pounds of traction had crept in and caused a near nightmare with her head almost splitting open and the top popping right off. That was until her subconscious had latched onto having more pins screwed into her head to distribute the forces more evenly. When Susan had woken up the next morning she could feel something had changed but she could not tell what. When a nurse came in to check on her they found four new pins had been added and embedded into Susan’s skull. All eight were evenly spaced out around her head, and nothing could be done to remove even one of them.

Susan knew that her Halo and cast was medically incorrect and unnecessary in a logical sense, but she had already figured out that since when were fantasy and subconscious logical? With no choice available to get her free of her enforced situation Susan took some solace in the fact that she was indeed living out her fantasy, however much it hurt and caused her issues. Susan could do no more and no less. All she could do was to lay in her cast and let others take care of her for the time being.

She did hope though that once she was able to get rid of some of the devices surrounding her and keeping her alive, that some of her fantasies would prove to not be true and leave her with a more normal life afterwards.