Punishment

 This one might trigger some peoples queasiness about including children. It does describe what can be considered as child abuse with how the main character is treated.

It's something that has been floating around in my head for a while now and I decided to get it out and published all the same. If you don't like that kind of thing feel free to skip it.

Punishment

Elizabeth comes running down the stairs out the back door of the orphanage and jumps from the sixth step up down to the ground below. Unfortunately she didn’t see the stick on the ground. Her left foot lands on it and the stick rolls out from under her making her ankle twist unnaturally. She falls to the ground with her leg bent up underneath her butt and gets the breath knocked out of her for a second. When Elizabeth tries to stand up a sharp pain shoots up her leg and she falls back down grabbing at her left foot.

“Owww!”

One of the older children saw the accident and runs to get Mrs. Donahue, the house mother. After a quick assessment of the injury and seeing that Elizabeth could not put any pressure on her leg she is taken to the clinic the orphanage uses to treat the children who lived there.

“Okay Elizabeth,” the doctor says as he comes back into the exam room after having x-rays of her leg done. “It looks like there’s a small hairline fracture in your ankle here. I’m going to put you in a cast and give you some crutches so it can heal up.”

She watches in amazement as she gets her first cast ever. A thin sock with no toes on it is pulled up her leg to her knee. It is long enough that the end hangs off and hides her toes. He places her foot onto a flat metal bar attached to a frame that makes her foot sit at the right angle and is a bit uncomfortable. The bar is up inside the sock with her foot and is a bit cold. Several rolls of white bandages are wrapped around her foot ankle and lower leg up to just below her knee. The doctor calls the bandages cast padding and just having that around her ankle is already starting to make it feel better. He pulls over a bucket with water in it and dunks a rolled up white bandage in the water. The bandage looked stiff and a bit hard, but when he pulls it out of the water it’s turned soft and a little bit grey. He tells her he is using plaster bandages which are cheaper but also will form a tighter cast because they will shape to her leg and foot better.

More rolls of plaster are used than the soft padding and the cast gets thick by the time he is done and rubbing it smooth. The flat metal bar is finally pulled out of her cast and he turns her around sideways on the exam bed so he can put her foot up on a pillow.

“We need to let your cast dry for a bit before you can go,” he tells her.

The cast got really warm, almost hot, while he was putting it on and now it’s cooling down again. For the next hour she gets to watch TV until the doctor comes back again with a pair of wooden crutches. He checks the cast and decides it is dry enough she can leave. He helps her to turn and lower her leg down over the side of the bed.

“Now I don’t want you to put your foot on the ground at all. No standing on that leg and definitely no walking on it. You use these crutches all the time when you’re standing up and keep that foot elevated when you’re sitting down.”

“When does she need to come back again?” Mrs. Donahue asks as she walks in to the room.

“I want to see her in two weeks.”

A nurse shows Elizabeth how to use the crutches properly and again admonishes her to not put any weight at all on her cast or ankle.

“Make sure you follow the doctor’s instructions Lizzy. If you don’t then you may have to get a bigger cast next time.”

They return to the orphanage and Elizabeth becomes the new celebrity with her bright white cast. For a few days Elizabeth is very good about keeping her foot up on a chair and pillow while sitting in class or in her room. The other kids want to draw on her cast but she won’t let them, wanting to keep it clean and nice looking. They do play with her crutches, hopping around on them while she sits.

Her ankle stops hurting less than a week after she gets her cast, and she begins to be less careful since it doesn’t hurt anymore. She leaves her foot on the floor instead of putting it up on a chair and rocks it back and forth on the heel absent-mindedly while sitting in class. Or when she is standing up but not moving she will put her foot down and rest it on the end of the cast by her toes. By the second week she is hopping short distances to get something she wants instead of using her crutches. Her balance is not great so she puts her foot down frequently to catch herself when she does not have a crutch to lean on. By the time her first checkup is due she has even started walking on the cast a couple of times because someone was playing with her crutches and she had to chase them to get the crutches back.

A couple of the older kids frown and shake their heads when they see her walking on the cast.

“You shouldn’t do that,” they tell her. “You are going to get in trouble.”

Elizabeth walks into the clinic on her crutches keeping her foot off the ground. The cast is still mostly clean and white around her leg and on top of her foot, but there are definite wear marks and dirty spots all along the bottom of the cast.

The doctor inspects the cast and her ankle then has a short talk with her.

“It looks like you’ve been walking on this cast Elizabeth. I thought I told you to stay off of it. If you keep walking on your ankle it’s not going to heal correctly and take longer to get better. I’m afraid that because you’ve been non-compliant then I’m going to have to take this cast off and give you a new one.”

They cut the cast off with a really loud saw that splits the hard plaster with ease but does not cut the soft padding underneath or her skin. The cast is cut down both sides from top to bottom then some scissors are used to cut the padding underneath. Pulling the old cast off Elizabeth’s leg is still fairly clean except for around the toes where she kept putting her foot down. Her skin is a bit dry and flaky and her ankle feels pretty stiff.

They have her lay back on the bed without doing more than clean off the dirt on the bottom of her toes and a new long sock is pulled up over her leg. This time the sock goes all the way up to the top of her leg and a nurse is holding her leg up in the air while the doctor starts to unroll the cast padding onto her leg. He goes from her toes all the way up to her hip with numerous rolls, making the padding tight and conform to the shape of her leg the best he can. A bucket of fresh water and rolls of plaster bandages get pulled out and the nurse continues to hold her leg up as the doctor starts wrapping a wet squishy roll around her foot.

Her ankle is kept at the same angle as before but she has to try and hold it there herself with a little help from the nurse. Elizabeth’s knee is held bent a bit and the doctor tells the nurse to keep her leg at a forty-five degree angle. A lot of wet plaster bandages are used to cover her whole leg from the base of her toes all the way up to her crotch. When the doctor finally pulls down the ends of the sock over her toes at the bottom and the edge at the top the cast is quite thick and hot. They rub the plaster for several minutes while it feels like it heats up even more and they make the outside of the cast nice and smooth. Her leg is set down on several pillows to keep it held up so it can dry. It takes two hours before the doctor says it is dry enough for her to be able to move it again.

The nurse helps Elizabeth to stand up, supporting her new cast as she turns around and puts her good foot on the floor. She finds that she can’t move her knee at all. The cast makes it impossible to do more than put her toes on the floor and to do even that she has to partially shift her hip, although the weight of the cast pulls her leg down fairly easily.

“Now Liz, don’t try to walk on this cast at all. You can’t bend your knee now to keep you from walking but you can still put your toes down to take the weight of the cast. Don’t come back in two weeks with a cast that is damaged on the end or looks like you’ve walked on it. The doctor won’t like it.”

Elizabeth is good and makes sure to use her crutches for everything for an entire week. The cast goes up high enough and immobilizes her knee so that she can’t really walk anyways which helps, which is what the doctor intended by extending the cast so high. She makes sure that she puts the cast up on a pillow on a chair when she is sitting down. This time she lets the other kids draw a little bit on her cast and does some herself out of boredom. With this cast she is much less able to get around and she misses out on playing with the other kids a bit more, sitting on the sidelines while they run around. Some of the older children tease Elizabeth and run away with her crutches several times so she can’t get up.

“Hey, give me back my crutches,” she yells at them. “I need to go to the bathroom.”

A few of the other older kids take the crutches away from the ones causing trouble and return them to Elizabeth, but they can’t be around all the time.

“Don’t walk on that cast,” they warn her. “The doctor doesn’t like kids who don’t listen to him and will punish them. A boy hurt his leg a few years ago before you got here. He didn’t listen and got a bigger cast like you did. He still didn’t do what the doctor told him and he got an even bigger cast the next time. He got mad and started doing things to his cast to try and break it. The next time he went in for a checkup he never came back. Nobody knows for sure what happened to him, but we heard that he ended up in a super big cast and couldn’t move at all.”

Elizabeth tries to be good, but the meaner kids leave her crutches across the room or run off with them several times when the nicer kids aren’t around and she has to try and hop on one leg to go get her crutches. With the cast being both bigger and heavier, she has to walk on her toes more than once to get around. It doesn’t hurt her ankle so she thinks that maybe it’s just the adults being paranoid. In the privacy of her own room where nobody can see her she starts limping heavily on her leg to get up and grab a book or some clothes. To try and hide the damage to the end of the cast she gets some younger kids to draw all around her foot by her toes and uses shoe polish to make the bottom white again.

Her next appointment rolls around and she sits up on the exam bed quietly watching the doctor take a look at her cast.

“You have some pretty drawings on your cast this time. Did you do any of them?”

Elizabeth just nods.

“Vey nice,” he says. “Some good artists in the orphanage. Unfortunately I can see that you’ve disobeyed me again, haven’t you? You’ve been walking on this cast.”

She just looks down at the floor and nods in shame, her attempt to hide the damage having failed.

“We’ll have to take this cast off and put you in a new one in that case. Your ankle will never heal if you don’t stay off of it.”

The saw makes short work of removing the cast and she gets to see her leg only briefly before they have her laid back and are pulling up a fresh sock onto her leg again. The sock and padding go all they way up from her toes to her hip again like last time. She does not notice but the padding also goes out past the end of her toes too. The nurse is holding her leg up again and this time she is keeping Elizabeth’s knee bent up a lot more than last time which is very uncomfortable because her knee is tight and stiff.

When the end of the sock is pulled down at the top the cast is right up against her crotch and even feels like it goes up to her hip on the outside. When the end down around her toes gets pulled back she is surprised to see that she can barely see her toes at all. There is an extended part of the cast that goes up under her toes and out past the ends now and holds them out straight so she can’t curl her toes around the end of the cast anymore. Her knee is also held bent a lot more so it forms a right angle from the upper leg to the lower leg, and the cast is quite thick.

It takes a lot longer for the cast to cool down and she waits for two hours again before it is dry enough to move. When the nurse helps her get up off the bed and lowers her leg down for the first time in the new cast Elizabeth can not put her foot down on the floor. The bend at her knee makes her leg short enough that her foot hangs in the air several inches above the floor now and she can actually swing her leg front and back with out scraping on the floor at all.

“You come back in two weeks so I can check on that ankle and cast and we’ll see how things are going. You shouldn’t be able to walk in it at all now, so I expect to see a good clean cast next time,” the doctor tells her.

Elizabeth nods and promises to be good.

The kids at the orphanage and at school are intrigued by how the new cast forces Elizabeth’s leg to stay up off the ground. Sitting down is difficult too because of how far her knee is bent. The cast is heavy enough that she has to lay her leg down on the side when elevated which takes up a lot more room out beside her when she is sitting. Because she still is not feeling any pain Elizabeth starts putting her foot and heel on the floor again in the classroom due to her hip getting sore from being turn out to the side so much. The nice older children are surprised she only got a bigger bend in her knee and a little extension under her toes this time. They warn her again to be careful and do their best to keep the other kids from making Elizabeth have to hop around without her crutches.

There are still a few instances when Elizabeth is stuck without her crutches, but this time she is unable to even walk on her toes and has to scoot herself on her butt along the floor with her cast dragging on the ground. She does not let anyone sign or draw on her cast this time, and only makes a few random small doodles of her own at the top of her thigh from sheer boredom.

By the time her next appointment is due Elizabeth’s leg has been in a cast for six weeks. Two weeks in a short cast below her knee, and four weeks in a cast up to the top of her thigh. The cast is still in good shape and holds her leg immobile without fail. There are a few marks and stains on the bottom of the heel with several scrape marks up the side, and she hopes her explanations for why will be accepted.

“Doctor, I have a few marks on my cast again, but it’s not my fault,” she tells him as soon as he walks into the room.

“Is that so? Why is that Elizabeth?” has asks.

“My knee is bent so much that my hip was uncomfortable trying to keep my leg up on a chair. I had to put my foot down on the ground so it wouldn’t hurt so it got a just a little bit dirty.”

“I see. What about these scrape marks I’m seeing up the side?” he questions her as he looks over the cast.

“Those are because some of the other kids took my crutches away and wouldn’t bring them back. I had to crawl on the floor to get my crutches back again.”

“Mhm. Well that would also explain this soft spot under your toes there. I assume you leaned on the cast when you tried to get up off the ground again, didn’t you?”

“Um, yea. I’m sorry,” Elizabeth says quietly.

“Unfortunately this still puts your healing time back again and this cast is going to have to be removed for a new one. Since you can’t seem to be careful enough with it then I am forced to have to put you in an even bigger cast this time.”

Elizabeth is afraid of what is going to happen next and starts to quietly cry.

She isn’t given any say or choice in what happens. They take her to a different room where she is told to strip and take all of her clothes off. Her crutches are taken away from her and she is put up on a frame that holds her up. There is a pad for her head and shoulders to rest on with a long flat metal bar going all the way down her back to another very small pad and bar. She can barely keep her butt on the lower pad and the bar comes right up between her legs and the doctor pulls her hips down so she is right up against it. Another pair of bars with little plates for her feet to rest on comes up from below at the far end. Her right foot is wrapped to the foot plate with elastic bandages but her injured left foot is left free and the plate there gets removed.

Two nurses assist the doctor this time. One holds her left leg up while the second one works with the doctor wrapping her up in cast padding. The long sock goes up her leg like the times before, and a new sock goes over her right leg from the hip to just below her knee. A shirt of the same material is pulled on over her body and the bar she is laying on gets covered on the inside as well. Padding starts down at her toes on the left and goes all the way up her leg and keeps going on up over her hip. They wrap more around her other thigh too and the doctor keeps pulling her down against the bar and wraps more padding around it as well which holds her in place. The padding continues to go on right up over her belly and up her chest to practically her armpits.

The sound of dripping water heralds the start of the plaster being soaked and soon her legs and body begin to disappear under the many layers of cast bandages that get wrapped around her body. When they stop adding more bandages and begin to rub the cast smooth Elizabeth is surprised to see them bring over a wooden dowel rod. It gets measured between the middle of her right thing and down to the middle of her left shin then they hold it in place while more plaster is wrapped around the rod and her legs to hold it in place and it gets added into her new cast.

She is left up on the frame for about half an hour while the cast gets hot then starts to just cool off before they pull her off it. The entire bar up between her legs and the flat one along her back comes off with her and she wonders how they are going to get them out of the cast. The cast saw comes out and an opening is made around the bar that has been casted into her crotch. When they pull it free the padding underneath is cut open as well exposing her privates. The bar that is up her back slides out from the top. The ends of the cast around her toes, around her other thigh just above her knee, and around the top just below her armpits are finished off with rolls of plaster holding the loose ends of the stocking down. The padding around the opening that shows her private bits gets pulled back and more plaster bandages catch and hold that down too.

Elizabeth gets embarrassed to have her naughty parts showing and tries to close her legs but the cast keeps her from moving at all and she is unable to cover herself. She tries to reach down with her hands but the cast goes up too high and she can’t bend her back anywhere near enough to get her hands over her privates. She is put onto a padded table and left there so her cast can continue to dry for about four or five hours. All that she is given to cover up her crotch is a small towel. Eventually the doctor comes in to check on her cast.

“You won’t be walking on that leg now, I’m certain. You won’t even be able to stand up on your own in this cast. This will also take care of the pain you were having in your hip at the same time.”

The cast holds Elizabeth’s inured leg from the ends of her toes up to her torso. Her ankle is relaxed this time and held pointing down a little bit instead of at a right angle. The left knee is still bent but not as much as the cast that just got removed. Instead it is closer to how the first long cast held the knee bent, but seems to be between that one and a right angle. The bar plastered between her legs goes diagonally up to her right thigh where she can see her knee that is held up just as high as the left knee that is fully covered in the cast. Her legs are immobilized with her knees spread out in a wide vee shape leaving her crotch fully exposed without something to cover it up. She realizes she can’t get pants or even a panty up over the cast due to the bar between her legs. Her hips are bent up so that she is laying on her back with her knees up in the air and her heels, one covers in plaster and the other free, rest on the table. The cast fully encloses her body all the way up to her armpits with no other openings.

“I don’t want to see any damage to this cast the next time you come in for a check up in two weeks young lady. Go ahead and put her in a diaper nurse, the cast is sufficiently dry now to send her back to the orphanage.”

The one nurse who has been there for all of her cast changes frowns at Elizabeth.

“I tried to warn you about listening to the doctor. He does not like to see damaged casts due to noncompliance. Now you’re going to be in a hip spica cast until he decides that your leg has healed to his liking. Even if you pass his inspections every two weeks, this means that you’re going to be in a cast for a long time. The doctor believes that the bigger the cast the longer it needs to be left on.”

“How long do you think I’m going to be in this cast?” Elizabeth asks quietly with obvious fear in her voice.

“At the very least three months. And that’s not from the time of your first cast either. The past six weeks don’t count for this. It’ll be three months starting from today.”

Several tears escape to roll down Elizabeth’s cheeks when she hears that. The nurse rolls Elizabeth onto her side with her good leg up in the air and tells her to hold herself up. A moment later and she can feel the nurse poking something up into the opening around her butt. She does it again quite a few more times working around the opening before she lets Elizabeth roll onto her back again. Looking down she watches as the nurse adds a wide strip of shiny plastic tape onto the edge of her cast then adds more so they all over lap all the way around the opening down there.

“This is to help protect your cast from getting wet or soiled in case there are any accidents. Try to keep from having any if you can. The next step is unpleasant otherwise.”

A small baby diaper is pushed up against her crotch and into the cast so it covers her butt and privates then a larger light pink diaper with baby designs is secured around the outside to hold it in place and cover her modesty.

“Mrs. Donahue and a couple of the other people at the orphanage are familiar with taking care of a child in this type of cast. They’ve done it before so you should be in good hands for now when you go back.”

A wheelchair with a high backrest tilted way back is brought in and Elizabeth is taken back to the orphanage and put in her room. It is still the middle of the day so most of the other kids are in school and Elizabeth is alone. She explores her new cast to see how much she can move in it.

Her left leg is completely immobilized now and she can’t move it at all. The cast comes down over the end of her toes this time completely covering them and the doctor had even pressed the cast down tight so she can’t even wiggle her toes. Her entire left leg is completely useless now. The right leg is able to bend at the knee and her right foot is free to move around, but she can’t move her right thigh from the position the cast has it in. Her chest and back are held in a tight embrace from her hips all the away up to just below her armpits. The edge of the cast is high enough that her flesh bulges over it when she puts her arms down by her sides. This restricts her ability to bend front or back or side to side a great amount. Trying to reach down with her hands Elizabeth is unable to get her fingers to the opening between her legs at all. She is able to touch the top of the diaper she has been put in and can possibly pull the tabs free that hold it closed but she would be unable to grab them and close it back again. Trying to sit up is an effort in frustration and if not for the pillows that have been put behind her to elevate her head some she would be stuck lying flat on her back.

Over the next two weeks Elizabeth learns how to shift herself sideways a bit by rotating around on her butt, and she is allowed to go to school in her wheelchair with a long thick sock over her good foot and lower leg. She wears a sweater over her arms and shoulders to stay warm, but otherwise her cast and diaper are left fully exposed and visible to anyone around. The cast stays in good shape over all, and gains several signatures and drawings on it. Elizabeth is not happy to be stuck in her cast and complains verbally about it but does the best she can to not do anything to damage the cast.

Elizabeth does have trouble with going to the bathroom. She has to use a special bed pan since she can’t fit on the toilet in her cast, and there are a few accidents that occur. They manage to clean her up pretty well, but it is embarrassing for everyone when it happens. The checkup goes well and Elizabeth remains in the same cast this time and for the checkup after that one as well.

Four weeks in her hip-spica cast have gone by. She has settled into a routine with her cast and had started to give up on trying to hold back her pee when she needs to go. She simply lets her muscles relax when she starts to feel the tiniest urge to go and she needs to have frequent changes of the small inner diaper to keep her dry. Despite the lack of control the cast remains mostly dry and free of stains thanks to attentive care takers and good taping around the cast opening that gets changed every week. Bowel accidents only occur twice from waiting too long to let someone know she needs to go, and the releases are small and firm which make them easy to clean up.

A holiday event is planned for the orphanage where a semi famous personality from TV will come in for the kids to meet along with a couple of her co-stars. The children are excited as the show is popular among the kids and everyone has extra energy leading up to the visit. A tent gets setup in the backyard to the orphanage where some chairs and a refreshment table is setup on the day of the event.

Elizabeth is wheeled into the tent where she is left while the other children participate in the activities outside. This depresses the poor girl and she becomes grumpy and complains out loud again about how unfair it is that she is stuck in her cast. When the star of the hour comes into the tent she sees Elizabeth for the first time and is shocked to see how disabled the young girl is.

They talk about what happened to Elizabeth and she tells the woman that she is being punished for not behaving like the doctor told her to with her first few casts. The celebrity is upset to hear how Elizabeth is being treated and vows to see what she can do about it. Several other children hear what is said including some of the ones who have been trying to make it harder on Elizabeth.

Later in the day the celebrity returns to the tent with the doctor beside her. She is questioning the doctor as to the treatment Elizabeth is enduring and he is reassuring her that not only is it appropriate, Elizabeth’s injuries are actually more involved than the star was led to believe. Feeling a bit chagrined she apologizes and gives Elizabeth a hug.

“I get it,” she says to Elizabeth. “Being in a big cast like that is not fun. You want to get out and play with the others. I would too. But you need to do as the doctor tells you so you can get better. From the sounds of it you’re in good hands. Do what they say and you’ll be up and running around in no time.”

The visit ends and the celebrities all leave. The doctor takes a moment with Elizabeth alone. He walks over and frowns down at her in disappointment.

“It’s a good thing the other children warned me about what you told that woman. I would have been very unhappy to have been caught unawares by her questions like that. As it is I think that you need to be punished for the trouble you made for me. I’ll have to think of something for your next appointment next week.”

Elizabeth frowns and kicks out at the doctor with her good leg. He is almost too far away and the angle is bad so while her foot does strike the side of his leg it is weak and no more than a light tap.

For the rest of the weekend and into the first part of the following week things continue as they have been for the most part. The children who have been mean to Elizabeth pick up their actions and actually begin to strike her cast in several places causing damage several times. This upsets her and she has an accident due to stress which is bit harder to clean up because she has been drinking more water the last few days and her cast is visibly soiled.

Going into the doctor appointment Elizabeth is scared of what is going to take place. She is already in trouble because of what she told the visitor and now her cast is nearly broken in one place and dirty from an accident. The doctor notes the changes to her cast and shows he is displeased with her.

“It seems that not only are you defiant and violent, you still can’t keep your cast from being damaged. It will have to be changed once again, and this time we will need to restrain those offending parts that have too much freedom.”

A mask is held over Elizabeth’s mouth and nose forcing her to breathe a fruity smelling gas while her wrists are tied down with patient restraints. She tries to struggle but she is only a young girl and small for her age. In a few minutes the gas does its job and Elizabeth calms down to where she stops fighting. Her cast is cut off and although she had been in it for over a month and her skin is dry and dirty they only do the minimum necessary to clean off her nether region to keep any possible infection from getting started. The thick, dry, scaly skin on her leg and foot are left alone. The mask gets removed and when the gas starts to wear off Elizabeth gives up fighting as the new cast is made.

New stocking gets pulled on going from her chest on down both legs this time to the ends of all ten of her toes. She is put up on the same frame again and both feet get bandaged down to the plates at the far end to hold her legs up where the doctor wants them. He keeps her knees bent somewhere between forty-five and ninety degrees while pointing her toes down as far as they will comfortably go this time. Her legs get spread out a little further than the last cast held them and Elizabeth moans at the discomfort which does make the doctor bring them in some a bit. Cast padding covers her from the armpits down once again and includes all of her right leg. Plaster is still used to form the hard shell of her cast and when they get down to her feet the bandages holding them down are removed so her feet can be included in the cast. In about two hours she is pulled off the frame with two wooden rods having been incorporated into the cast this time. One over the ankles and one over the thighs just above the knees.

The ends of the cast are finished and all of Elizabeth’s toes are completely hidden inside the cast which has been pressed down to hold them firmly. With the cast finished the doctor pulls out a sealed package.

“Since you can’t control your bodily functions I am going to add in a catheter,” he tells her.

Not knowing what that is Elizabeth watches in confusion as a thin tube is prepared and a clear gel is rubbed along the length of it. Reaching between her legs the doctor pokes the end of the tube between her legs and finds the opening where she pees from and the tube is pushed up inside. It slides in easily with the gel on it, but it still feels wrong and Elizabeth sobs openly and loudly.

“No! No! Stop!” she cries. “I’m sorry! I’ll be good I promise!”

The doctor does not listen and the tube goes deep inside her belly until she feels like she has to pee and she hears the tinkle of something liquid falling into a bucket. Something expands inside of her body slightly and there is a tug that confirms the tube is not going to come out on its own. The tinkling stops and she can see the doctor connect a clear tube to a bag that collects a little bit of her pee in it and she still feels like she is going although only a few drops are caught.

“No more peeing into a diaper and getting your cast wet. I’ll have to think about the other end and stopping you from soiling your cast. Now for that voice of yours. I can’t have you telling people that you’re being punished. That won’t do at all.”

The face mask comes back again but this time the air is clear of any smells and seems to be even more rich. A nurse pokes a needle into the back of Elizabeth’s hand and tapes it in place for intravenous access. A syringe with while milky fluid is connected to the IV and the medicine is pushed into her veins. In just a minute she feels weak and finds that she can barely move on her own anymore. The mask is pulled away and a thin tube with a nozzle on the end is stuck into the back of her mouth where something is sprayed. They do it again a moment later and wait a few seconds before going deeper and spraying down the back of her throat a few times.

Elizabeth feels the back of her tongue and the upper parts of her throat go a bit numb from the spray. Next a curved flat metal instrument with a bright light on the tip is pushed into her mouth and down the back while the doctor pulls her jaw open wide and forwards at the same time forcing her head to tilt back a bit. Looking down inside he takes a long tube from the nurse and shoves it down deep in her throat which makes Elizabeth gag slightly. She feels it slide down inside her neck then the nurse attaches an empty syringe to a tiny tube on the side of the tube in her throat and presses the plunger down pushing air into it. Something inflates inside her throat and suddenly Elizabeth is only able to breathe through the tube, no air is able to go in or out of her lungs through her mouth or nose. The tube gets secured in place with a plastic device that has sticky pads that glue to her cheeks and a strap gets pulled around the back of her neck to hold it even tighter.

“There, no more worries about you telling people things you shouldn’t. Now you can’t talk at all and can only breathe through the ET tube. Don’t make more trouble or that might have to be made a bit more permanent.”

A hose gets connected to the outside of the tube in her mouth and a machine starts to gently give her air through the tube as she breathes normally.

“Since she’s now on life support we’ll have to admit her to the inpatient clinic. Take her up to a room and get her set up to stay for the next two weeks. We’ll need to add in a feeding tube with the endotracheal in place. Include IV medications to provide a little pain relief due to the tubes she now has. I also want a daily enema schedule setup and started as of today.”

He looks back down at Elizabeth and smirks.

“Misbehave and cause trouble and you see what happens. You end up like this. Keep it up and it’ll just get worse from here, I promise.”

The nurses and doctor struggle a bit with the weight and awkward size of her new cast to get Elizabeth moved off the table and onto a gurney so she can be taken to a different part of the clinic. The hose is disconnected from the tube in her throat and a big blue bag is hooked up that a nurse squeezes a couple of times a minute while she is moved to a room. Once in the room they get her immobile body into the bed and get her setup to stay.

Having a tube shoved up her nose is extremely unpleasant and Elizabeth struggles against the nurses while they push it in. They have to forcibly restrain her arms because she fights against them and then someone has to hold her head down when she tries to turn it side to side so they can’t get the tube in. It takes twenty minutes to do a five minute job but eventually she feels the tube go all the way down her throat to end up in her tummy. Tape goes around the external end of the tube and onto her nose to hold it in place and more tape holds the long tube down against her cheek to help keep it out of the way. A bag gets hung up on a pole at the head of her bed with a thin tube going down to a box with lights, buttons, and a screen on it then another tube comes out and down to where it is connected to the needle in her hand. A machine gets wheeled into her room and setup with an air hose connected to the tube going into her lungs and it gives her assisted breaths of air a couple times a minute.

A little later in the afternoon a nurse shows up with a couple of packages. Elizabeth can’t see everything she is doing but she can hear the packages get opened up down by her legs or feet. The towel that has been placed over her crotch gets removed and a fracture pan is slid up underneath her cast. She can feel something plastic get pushed up into her cast around her butt then a cold gel is smeared between her cheeks down there. A moment later she feels a tube get pushed up inside her butt and something inflates on the inside. Elizabeth sees a large rubber bag get hung up on a moveable pole with a rubber tube going down between her legs then warm water begins to flow up into her belly and fill her up. The nurse reaches up into the opening of her cast and gently massages her belly from the front which makes her relax some more and the water goes even farther up inside. It takes a few minutes to stop and Elizabeth feels very full and slightly cramped from all the water that goes in and the nurse does something so that she can’t let it out again. The bag and tube disappear and she is made to hold all of the water for ten minutes. The nurse continues to gently rub her belly the best she can which helps make it better and finally she removes the tube in Elizabeth’s butt.

“Go ahead and let it go dear. The medicine has had enough time to work now and you can evacuate. The bed pan will catch it all then I’ll do a second quick rinse to get it all out.”

Elizabeth tries to go potty but the unusual position of lying on her back makes it hard for her to let go. It takes her several minutes to relax enough that she finally starts to get a trickle of water coming out. Once it starts she is able to relax more and the flow grows larger until it comes rushing out and carries all of her poo with it. The nurse waits for a couple of minutes for it to stop then wipes off Elizabeth’s backside to clean her. She takes the bed pan away and Elizabeth can hear her dump it into a toilet and flush then water runs in a sink to rinse the pan out. She comes back with the bed pan and another full bag of water. The new bag is warm and all of it gets drained up into Elizabeth’s bowels but this time the nurse pulls the tube out of her butt right away and encourages her to let it go. It still takes her a few minutes again to release but eventually the water comes out and Elizabeth is wiped off leaving her clean on the outside and inside.

Elizabeth is in shock for the rest of the day and just lies in her bed not knowing how to take what is being done to her. The days start to pass and she quickly becomes surly and difficult. The enemas are done every day and she begins to fight the nurses when they come in to perform the internal cleansings. She gets mad and tries several times to remove the IV line in her hand and the endotracheal and nasogastric tubes in her throat. She causes herself to bleed a lot with one attempt to pull out the IV needle which requires moving the IV line to her other hand and heavily bandaging the injured one. She gets her feeding tube out several times, and despite the pain is able to pull out the breathing tube once as well. The only reason she does not pull out her catheter tube is because she cannot reach it. Although she can’t move her legs with the cast covering over half of her body, she does manage to pull herself around in bed and try to crawl out. The nurses catch her several times with the bed rails lowered and half way over the side of the bed trying to fall down to the floor.

The nurses eventually have to use patient restraints to strap her wrists down to the bed at her sides. Even restrained she still manages to cause problems by not cooperating with her enemas and trying to force out the water even while it is going in. She manages to make herself vomit several times when she is fed her liquid formula through the feeding tube, and although she is getting cleaned out daily with the enemas she manages to hold back and have accidents that have to be cleaned up and soil her cast.

Two weeks go by and the doctor makes several visits during that time to check on Elizabeth or to deal with another problem she has caused for the nurses or injury to herself. When she managed to pull the tube up out of her windpipe he had to use a special camera to check and see if she damaged her airway and then get a new tube put back in. He did warn her that pulling the tube out had hurt her throat and she could end up having serious problems because of what she did. The warning along with the pain of what she had done did keep her from pulling on the tube after that, although she did start biting on the tube frequently which made the alarms on it go off at all hours of the day and night.

The doctor comes in one morning and has a clipboard in his hands.

“You have been very difficult these past two weeks Elizabeth. You have disobeyed us practically every day, made quite a lot of messes that require a good bit of work to clean up both yourself and the bed, and you’ve even injured yourself,” he says checking the bandages around her hand. “I am tired of having to deal with your attitude and the problems you are causing, and I am certain my nurses are tired of it too. I had hoped that you would settle down and be good after a few days but instead we’ve had to add restraints to keep you from doing more damage. And you still manage to be trouble. I have no choice but to punish you. You will have to get a new cast put on because this one is dirty. I am going to put you to sleep after your cast gets cut off and you will just have to find out what your new punishments are going to be when you wake up. And to get you ready for your long day, let’s just add in a bit to your air now. I suspect that you will be rather difficult otherwise with your hands freed.”

The doctor turns and makes a change to the machine that gives Elizabeth air. The assisted breaths get turned up so they happen every time Elizabeth breathes in and out and soon the gas he adds in makes Elizabeth feel weak and tired. Nurses come into the room a few minutes later and her whole bed is rolled out along with the breathing machine. They take her to the room where she got put into her big cast and the saw is brought over to cut her out. It takes twenty minutes for the cast to get removed. They wipe down her body only a little bit and Elizabeth is surprised to see how thin her left leg has become. The right leg is also noticeably thinner but not quite as much. She tries to move but with the gas making her weaker and how stiff her legs have become from being immobilized in her cast she does not manage to do much at all and can’t stop the nurses from doing their jobs.

The tube in Elizabeth’s airway gets deflated and removed safely then a mask is placed over her nose and mouth and she can smell something funny in the air coming from it. Her eyes roll up and close a minute later and she is put to sleep.

Elizabeth wakes up to pain in several places on her body. The worst of it is centered around her head, but she can feel pain in her neck again and lower down on her belly somewhere. She tries to reach up so she can rub her head and maybe relieve the ache she is feeling but her arm won’t move. Something is holding it still. She tries with her other hand only to find it too is being immobilized. Opening her eyes she tries to look down to see what is stopping her arms from moving and she can’t even move her head. Her mouth opens to call out but no sound is made.

Her eyes roll around trying to look at what has been done to her. She can see something white poking up down in front of her to one side and it takes her a moment of wiggling and staring to realize it is her hand. Looking to the other side she sees a second white object and a test wiggle confirms it to be her other hand as well. Both hands are stuck up in the air in front of and to the sides of her chest and encased in plaster so that none of her fingers are visible and she can’t move them at all. Trying to wiggle or move fingers, hands, and arms just gets the feeling of hard plaster holding her immobile all the way up to and including her shoulders.

Elizabeth tries to wiggle her body and the familiar feeling of having a cast firmly hold her chest is her only reward. With minimal effort she is able to feel that she is back in a cast that still goes down both legs all the way past the ends of her toes so she can’t even wiggle them. The attempts to move her hips or butt leave her confused though because she does not seem to feel an opening down around her crotch anymore. There is something soft pressing right up against her privates with the hard feeling of a cast on the outside. Her attempts to move her lower body do reveal that there is something on the side of her belly which is where the pain is coming from.

Trying to look around some more Elizabeth realizes she is not seeing the air hose or plastic tube going into her mouth, yet she still can’t breathe through her nose or mouth despite being able to breathe normally it seems. She waits a moment and hears the machine pump air into her lungs when she inhales and can feel it make her lungs press up against the inside of her cast. It seems to be assisting her with breathing more often than it was before too. Squinting her eyes she can still see the tape holding the feeding tube in her nose and can feel it taped onto her cheek as well.

Looking down at her nose and trying to look at the tube which feeds her gets Elizabeth looking to the sides and up to see if there are any new bags of medicine hanging up. Instead she notices a black bar going up the side of her head on the left. Looking to the right there is one there too. Rolling her eyes up as far as she can she is just able to see another black band crossing around above her eyebrows. She can’t figure out what she is seeing, but it almost feels like what ever it is she sees is responsible for both the pain in her head and keeping her head from being able to move. She guesses that what ever is making her neck hurt might be connected with how she is still able to breathe but not let her make any noise.

Elizabeth hears someone walking into the room but gets frustrated when she can’t turn her head at all when she tries to look. Suddenly a nurse appears where she can see her and she looks down to see that Elizabeth is awake.

“Good afternoon sleepyhead,” the nurse says.

Elizabeth tries to say something and although her mouth opens she can’t even make a squeak or quiet moan.

“Don’t bother trying to talk Liz. You won’t get any air to go through your vocal cords. You have a tube in your neck now called a tracheotomy so you can breathe but not talk. A hole has been cut through the lower part of your neck and into your windpipe and a much shorter tube has been inserted and the cuff inflated so you only breathe through the tube. No air will go in or out any other way. A cloth strap is tied around your neck to help hold it in place.

“Because you have been so much trouble the doctor has put casts on both of your arms now that are connected to your body cast. No more moving around or fighting us anymore which is a lot easier for us to deal with. Of course you are still in a full dual hip-spica cast immobilizing both legs so they can’t move either. Because you managed to badly soil your old cast and make such a mess with the enemas and accidents the doctor decided to do an ostomy. You will be glad to know that you will not be getting daily enemas anymore. Of course you also will not be able to poop normally anymore either. You no longer have poop coming out of your butt. Instead there is a hole in the lower side of your belly where the poop comes out all on its own now. Because there is no way to stop it we have to glue a bag to your side to catch the poo in. Thankfully with your total liquid diet the poo is pretty runny and easy to collect. We have to empty out the bag several times a day, but that is much easier than having to deal with the enemas every day. We’ll change your poo bag for a new one every three days and to check the stoma is healthy.

“You still have a catheter in your bladder to drain your pee through, but now it also come out through your lower belly instead of between your legs so it’s a little easier for us to reach and work with. That means that there is no reason to leave an opening on your cast between your legs anymore. There is a small hole under your butt so that we can give you a very small enema once a week now because it still needs to be cleaned out every once in a while. Just because you don’t poop through there doesn’t mean your body will stop making mucus and it needs to be cleaned out still.

“All of that is to make things easier for us nurses to take care of you. No more messes and no more fighting with you unable to move your arms or legs anymore. Now let’s talk about this thing,” she says as she taps the black bar on the right side of Elizabeth’s head.

Elizabeth can actually feel the tapping on the bar in her head and it seems to echo some.

“This is called a Halo. There is a ring going around your head that has screws in it which have sharp tips that are embedded into the bones of your skull now. Those screws are basically external fixation that will keep you from being able to move your head in any direction at all. They are very, very good at this. The screws and Halo ring are attached to these bars on either side and they go down to where they have been included into your body cast so the whole thing is one big piece.

“The doctor had you put into this halo purely as a punishment for misbehaving. We are going to have to come in here three times a day to clean the screws in your head and the tube in your neck. We also have to use a suction tube to suck out more mucus from your trach tube several times a day as well. The cleanings and suctioning are not pleasant for you, but there’s not much you can do about it. We’ve kept you asleep for a few days and your new cast is fully dried now.

“Because you were so bad for us, the doctor decided that all of your new cast and halo and tubes and bags will start over the timer for when they can come off. The start time for you to ‘heal’ and get out of all of this only began a few days ago when it all went on. You’re going to be in all of this for several months at least, maybe longer. There is almost nothing you can do at this point to cause trouble, but don’t try being difficult or I can guarantee that you will be like this for even longer.

“It’s going to be hard enough recovering from being confined in your cast and halo. If you stay in it even longer that will just make the recovery even harder so don’t be a problem for us. As it is, you really damaged your trachea with that little stunt pulling it out like you did. The doctor took a better look at the inside of your neck while you were out and you’re probably going to have some long term difficulty because of what you did. Be good and you’ll get through this and eventually back to normal for the most part. Keep misbehaving and I don’t know what will happen next, but it won’t be good for you and probably permanent next time.”