Making plans for the future

euhm alyssa mellorOrthopaedic social worker Alyssa Mellor helped work out a plan when one of the needed antibiotics was not covered by Medicaid.

Day 2: Emory University Hospital Midtown

Cleaning the family's second-story gutters, earphones blasting, teenager Terry Smith missed the ladder rung and landed hard on a metal fence below.

The damage caused inflammation across his spinal cord, first weakening and then paralyzing his legs. It also caused an infection that refused to respond to antibiotic infusions. Surgeons cut away bone and tissue around the affected area, but the infection was relentless. Stopping it would require more specialized expertise. Smith was referred to Emory University Hospital Midtown and orthopaedic oncology surgeon Nickolas Reimer.

Reimer performed a hemipelvectomy, which required removing the affected pelvic bones and one leg. He used the patient's thigh tissue as a pedicle flap to cover the defect created by the infection and sealed the wound with a vacuum-assisted closure device that drew out fluid, irrigated the wound with antibiotics, and encouraged blood flow and healing.

After three weeks in the hospital, Smith was eager to go home. Planning for his discharge, social worker Alyssa Mellor helped connect the family with local home health care nurses and a local infusion doctor to continue antibiotics for five more weeks. But there was a problem. Medicaid wouldn't cover the more expensive of the two antibiotics that his doctors insisted he needed. Having spent almost every night at the hospital with her son, his mother had lost her job and the family's health insurance. With her husband disabled, paying her son's medical bills was impossible. The hospital used its charity funds to cover the needed medicine.

Before his aggressive surgery and antibiotic treatment, Smith had been mostly confined to his home after his injury. At his most recent return visit to Emory Midtown, he told doctors proudly that he was making plans to go back to school. There was a diploma in his future, he said, and maybe even a party or two with old friends.

In his experience with damage caused by tumors in the musculoskeletal system, the surgeon had dealt with problems like this teenager's before.