A good example of a catastrophic injury patient was a man who worked as a mechanic for a candle company. He had been at his job for years and was working the night shift just to help train a new mechanic, recalls Kathleen Fraser, MSN, MHA, RN-BC, CCM, CRRN, executive director for the Case Management Society of America (CMSA) of Little Rock, AR.

The experienced mechanic and the new employee received a call about machinery that had stopped working. The experienced worker checked it out and explained everything he was doing to the new worker.

“The mechanic unplugged the big candle cutter, explaining what he was doing to the new employee, who might not have been listening,” Fraser says.

“The new young employee thought he was helping and said, ‘Look, I think this is the problem,’ and he plugged in the machine just as the mechanic stuck his arm in there to feel for a clog,” she explains. “The machine turned on and cut his dominant right hand off at a slant, leaving a thumb dangling.”

The man was bleeding and injured so severely, they flew him to a regional hospital, where surgeons quickly worked to save his life. But there was an additional problem that made the medical team and the catastrophic case manager’s work more challenging: The man was a Jehovah’s Witness, and he refused blood transfusions, despite the risk this action posed for his survival and recovery.

“He had bled out badly and was anemic, and the surgery had problems,” Fraser says. “It got worse and worse because he was so in need of blood products.”

Surgeons tried to reattach the man’s appendage, and it would have had a greater success if he had allowed blood transfusions, she says.

“But none of his fingers could be saved, and all he had left was a thumb,” Fraser says. “That type of injury normally would stop someone from returning to work, but this man had such a great work ethic and a good view on life.”

With help from Fraser, who was his catastrophic case manager, the patient went through all of his medical treatment, and Fraser helped him stay in contact with his employer so he wouldn’t lose his job.

“The healing process was taking longer than it usually would,” she says. “We had a vocational case manager get involved earlier in the case than was usual, and we worked together to find all of the devices he could use.”

The man didn’t want a prosthetic hand, but they found him a prosthetic he could accept so it would enable him to return to work.

Fraser also educated the patient about how much more difficult it would be for him to improve his health if he was refusing transfusions and continuing to smoke, which affected his circulatory system.

“I was able to get smoking cessation treatment approved, along with patches, and I even worked with his wife, who didn’t want to stop smoking,” Fraser says. “When I closed the case, neither of them was smoking — they were amazing.”

The man did return to work as a mechanic and was able to stay there — and probably will stay through retirement, she notes.

“Yet, if he hadn’t had a case manager and with all of his issues, he never would have made it back to work,” Fraser says.