Re-edit #5502
Dawn found more people out and about. Sabine and Emilia were in the Hyena down at Larrissa’s place. Emilia was the designated driver and baggage handler taking her down to check on Penny and meet Larrissa and the kids.
Penny was recovering slowly but steadily. Sabine talked Emilia through the thought process of the neuro exam she was doing, explaining each step as she went. She added other elements like how the one she was using was based on a dive injury neuro examination.
“OK, the first thing we look at is what we call ‘orientation’.” Sabine said as they started.
This wasn’t the first time Penny went through this with Sabine but she understood she was teaching Emilia as she went.
“We want to know if the patient knows their own name and age? For this to be valid, we need to know the right answers as well, otherwise they could tell us anything.”
“We follow this with do they know the present location, what time, day and year it is?”
She turns and looks at Emilia.
“Remember, even though she appears alert, the answers to these questions may reveal confusion. Do not skip this step.”
Sabine turned back to Penny as she continued the exam. She was talking to Emilia the whole time.
“Next, we have her count the number of fingers you hold up, using two or three different numbers. Don’t get into a rush. Check each eye separately and then together. Then we have her identify a distant object.”
Sabine points to a picture she placed on the dresser earlier when they first walked in.
“A sail boat” Penny said, correctly identifying the object.
“Good!” Sabine said.
“Now, we tell her to hold her head still, or you can gently hold it still, while placing your other hand about 18 inches in front of their face.” Sabine took Penny’s head in her hands to demonstrate.
“Now, we have her follow your hand with her eyes. Move your hand up and down, then side to side. Her eyes should follow your hand and should not jerk to one side and return.” Sabine looked over at Emilia, saw she was keeping up with writing all the notes as they went.
“Good, next, we check her pupils to make sure they are the right size and react to light properly and accurately.” Sabine used a small penlight to check the pupil’ response.
“The next element is the rest of the of the cranial nerves. We ask her to purse lips like puckering up for a kiss. Look carefully to see that both sides of the face have the same expression. They should match. Anything that doesn’t make note and ask if it’s normal or preexisting.”
“Moving on, we ask her to grit her teeth. Feel her jaw muscles to confirm that they are contracted equally. To test the sensation of the face, we have her close her eyes while you lightly touch your fingertips across the forehead and face to be sure sensation is present and the same everywhere.”
“To check her hearing, hold your hand about 2 feet from her ear and rubbing your thumb and finger together. Check both ears separately, moving your hand closer until she hears it.”
“We want to check her swallowing reflex. We have her swallow as we watch. For some it’s hard to see the ‘adams apple’ move. We can lightly feel the throat on those people.”
“Since we are right there, we have her stick out her tongue. It should come out straight in the middle of the mouth without deviating to either side.”
Emilia was seriously impressed with the thoroughness of this exam. She was a little overwhelmed and trying to keep up as Sabine just kept going.
“We test her muscle strength by telling her to shrug her shoulders while you push down on them to observe for equal muscle strength. Check her arms by bringing the elbows up level with the shoulders, hands level with the arms and touching the chest. Tell her to resist while you pull the arms away, push them back, up and down. The strength should be approximately equal in both arms in each direction. Check leg strength by having her lie flat and raise and lower the legs while you resist the movement.”
“One of the last ones is balance and coordination. Remember, if she fails, you need to be prepared to protect her from injury when performing this test. First, have her walk heel to toe along a straight line while looking straight ahead. Then walk both forward and backward for 10 feet or so. Pay attention to whether her movements are smooth and if she can maintain balance without having to look down or hold onto something.”
“Next, have her stand up with feet together and close eyes and hold the arms straight out in front with her palms up. She should be able to maintain balance if the surface she is standing on is stable. Your arms should be around, but not touching, her in case she starts to fall.”
“We check coordination by having her move an index finger back and forth rapidly between her nose and your finger held approximately 18 inches from her face. She should be able to do this, even if you move your finger to different positions.”
“Now, we have her lie down and tell her to slide the heel of one foot down the shin of the other leg, while keeping her eyes closed. She should be able to move their foot smoothly along the shin, without jagged, side-to-side movements. Do this on both right and left sides and observe carefully for unusual clumsiness on either side.
Emilia loved Sabine’s smooth and steady style of assessing. It seemed more thorough and polished compared to Doug or Kara’s but she realized it was a much different environment they were in.
Sabine was forcing herself to take things slow and gentle. Her biggest worry was reinjuring herself and setting things backwards in her recovery. She noticed out of the corner of her eye Isadora watching her examine Penny and how she was teaching Emilia the process.
Sabine was quickly distracted by this, trying to force herself to continue.
Sabine felt uncomfortable with Isadora watching. She was not sure why but it was not the first time Isadora made her self-conscious. It not like she didn’t like her, in fact she really was fond of her but around her left Sabine feeling intimidated. She hated it when someone made her feel that way. It took away some of her power, her sense of control.
It wasn’t a feeling Isadora was questioning or judging her medicine. Sabine knew her medicine inside and out. The part she was worried about was parenting. She saw in Isadora all the things she didn’t know about being a parent or raising a kid.
“It’s not like I had good examples of parenting growing up. Damn it, Amber either get here or get out of my head!”
Brody met them when they arrived at the farm. Brody was always happy to hear the Hyena coming. If Brody was surprised by the new person with Tenshi, he didn’t show it right away.
“Morning Tenshi, Someone new with you I see.”
“This is Sabine.” Emilia said as she walked around the front of the Hyena.
When she told Sabine about the verbal subterfuge the group had with the farm members, Sabine told her she understood. Well, it was a little more than that, actually.
“Emilia, you have to be careful with such personas. If it is something you may have to live with, make it one you can respect, someone you can be, or want to be. Otherwise, it becomes someone you hate, someone you resent. It’s also a way to embody someone new, someone you want to be, need to be. Someday, you may have to be Tenshi forever. Make her someone you won’t mind being a part of you. With them, I will go by Sabine.”
Brody watched Tenshi help Sabine out of the Hyena. Sabine seemed to be moving slow. He wondered why. Some of those thoughts, along with almost all the others fled from his head as Sabine turned her gaze towards him.
The only time he remembered such a gaze was the one time he saw a wolf or coyote in the lower pasture. It was eating something and he surprised it. The level of intensity struck him then like a physical force. It was similar now when she locked eyes with him.
“Good morning, Ma’am. Pleased to meet you. How can we help you today?”
Brody went with the common courtesies to cover his nervousness.
“Good morning, Brody. I’m here to talk with your mother for a little bit while Tenshi has a chance to help you and Ruby with some of your morning chores.”
Brody was surprised at her voice. It was very precise, but weak. It reminded her of Sissy’s voice when she was hurting.
“I’ll go get her. Ruby and Ashley are already down with the goats.”
Brody didn’t wait for a response. He turned and bolted inside.
...... yet. Probably doable and considering that part of PNW is/was a hotbed of dope growing, there could be something black market in that area.
