When the doctor finished the intake interview, Collin took me to my room and we said our goodbyes. I was expected to remain at St. Luke’s for four weeks.
“I think this is the right thing to do,” she said with conviction.
“I hope so. Something has to change.”
I was hopeful, yet also at the limit of hope. Collin and I needed the St. Luke’s program to work because it seemed everything else was working too slowly or not working at all. And it wasn’t that Cher and Peggy didn’t help me. They did. But there were limits as to how much family stress we could bear. At one point, Collin and I wondered if a nursing home might be more appropriate for a while. And in my own mind, I struggled with the ever-present and growing threat of losing my career in medicine.
“Tell the kids I’ll be all right,” I said. “Call me when you get home, but I might be in therapy, so keep calling.”
“I will. I Love you.” She did love me. I could tell. But I could also tell she was worn from therapy, just as I was.
“I love you too. Be careful going home.”
Our brief goodbyes reminded me of our goodbyes at Fort McCoy.
We embraced and then Collin left and I was alone in my room, in a hospital dedicated to stroke and head injury rehabilitation. My stroke had claimed parts of my body and brain and was threatening to take my career. I was trying to fight back with a grand scheme of inpatient therapy at St. Luke’s. And that was as daunting as the desert in Iraq, something larger and more frightening than I had imagined. It was a beast that could swallow me whole or take me piece by piece. Collin and I had put maximum leverage on four weeks of hospital-based therapy, a gamble with stakes so high I wondered if we had chosen wisely. I worried that I might fail or that the therapists would find me untreatable. I was cautiously optimistic because of the positive recommendations Collin and I had received, but just below the surface of that optimism lay the “what-if” questions about my future.
What if I spent the rest of my life zigzagging on the sidewalk, watching my feet in anticipation of falling to the ground? Would my stroke confine me to children’s books forever? Would I think no more complex thoughts than perhaps What’s for dinner? Would I become a burden and a chronic nuisance to my wife? At the core of those questions was the one that mattered the most: Would inpatient therapy allow me to continue as a physician?
—
Just after lunch a therapy assistant knocked on my door, which I left half-open. “I’m here to get you for therapy,” she said. She was matter-of-fact yet pleasant. No cajoling, no excess small talk.
This is the beginning, I think.
I respond to her with a single word: “Okay.” She helps me to the wheelchair and off we go, rolling down a well-lit hallway toward the therapy bay. As we roll, the hallway grows and elongates, like a scene from Alice in Wonderland. I am off to my first therapy session and in my head I am the perfect storm of anxiety and anticipation, bewilderment and excitement. I hope that hospital therapy will provide exactly what I need, yet fear it will provide nothing at all. I notice the doors of patients’ rooms as we pass them. Most are painted tan; some have bright colors. My wheelchair has a wheel that squeaks and I joke that I need oil and laugh a bit. She chuckles in return. As we come into the open therapy room, I am surprised that it is filled with so many patients and therapists. Fifty, I think, but the number is certainly fewer. Large brown therapy tables and blue mats cover half the room. The other half is covered with parallel bars and exercise equipment and a mock kitchen. She parks me just inside the room next to another patient and tells me that my therapist, Cindy, will be with me shortly.
The patient waiting by me is drooling. Her skin is pale. Her fists are tight and her arms contracted. She has an obvious head injury—a car accident, I assume. I study the room. It’s a lair, maybe a beehive. A patient near the opposite wall is screaming at her therapist. She refuses to get out of her wheelchair. The therapist is working at getting her to stand. The patient lets out a string of curses and the therapist says, “Stop! That won’t be tolerated.” Then the therapist rolls her over by me and my drooling companion and tells the screamer that she can cool down. The screamer yells, “You’re a whore!” The therapist says nothing and walks away.
Cindy comes to get me just as the screamer calms down. She introduces herself and tells me she is going to be my therapy team leader. She rolls me halfway through the room and helps me to a table where we sit and she goes over my schedule of exercises for the day. We will start with gait and balance and then do some shoulder work and finish with speech and language therapy.
“I’m ready to go,” I say, anxious to get started, yet also intimidated by all I see, by the lair and its imaginary wolves. Cindy instructs her therapy assistant to grab a gait belt. I tell her I don’t need one. She says I do if I want to do therapy. I can tell she takes no prisoners. Gait belt on my waist, they help me to my feet.
“Okay, let’s just take a short walk down the hall,” Cindy says. “Tighten your stance, look up. Breathe. You’re tensing up. We need you to relax.”
I bring my feet together and ataxic gyrations take control of my body. I am a wobbling toy top at the end of its spin. The therapist and assistant each take hold of my belt. I take one step. Shit. I make a wild gyration that twists me 45 degrees off-center. “That’s okay,” Cindy offers. “Let’s try again.” I make a concerted effort to watch my feet and think of every step. Cindy puts two fingers under my chin and pushes it up. “Look up,” she says. “Your feet know where to go.”
“I need to watch my feet,” I counter.
“You need to trust your feet,” she counters back.
I think she is using a cute little mantra she learned in physical therapy school. Trust my feet. Whoever heard of that? We start again and I manage to walk maybe twenty feet with the therapists holding on. I weave and stutter-step as Cindy encourages me to keep my head up and breathe. I turn to look across the room and crash, but my gait belt saves me. “Concentrate,” Cindy says.
I am concentrating—on all the activity going on around me. On the screaming patient and her therapist, on the drooling head injury patient, on the others working their limbs and their hands. The lair, the hive, the therapists. I’ve never seen anything like it. More screamers emerge whom I hadn’t noticed at first. They’re more reserved, polite, but still in agony over something in their therapy. Other patients, like me, walk to the rhythm of their therapist. Some do quite well; others, not so much. One patient with ataxia cannot walk a single step. Another is hooked up to a computerized treadmill. He has one prosthetic leg. I think he might be a soldier too, but I don’t ask. The therapists look like they don’t take crap; they keep pushing. They might pause but they don’t stop. And as I take my first walk in my first hour of therapy at St Luke’s, I wonder about the kind of patient I will become. Will I crash to the floor, scream at my therapist, weep in shame? Will I fail therapy? Will it fail me? I sense that I want to run or hide, but I cannot; the therapist knows my room number, my case file—my name.
Cindy walks me slalom-style through a set of orange cones on the floor, just as Peggy had done in outpatient therapy. We walk slowly, then fast, in a circle and then on a line; on carpet and on linoleum, and up and down a set of practice stairs. I walk with and without my cane. I step over a fake curb, a line, a crack, over or around tiny obstacles on the floor: a shoe, a piece of paper, a spill of water. I wobble and weave up and down a ramp like a boxer on the ropes. I walk until I think walking is overrated. After thirty minutes Cindy says it’s time for some balance routines.
“I thought we were doing balance,” I say, slightly puzzled.
“That was gait training. Balance is different.”
We do five minutes on a large blue exercise ball. I fall to the sides and Cindy catches me. We repeat. I fall again. It’s like being drunk without the booze. I say “Shit” more than is necessary. It doesn’t help.
From the ball, I graduate to the balance beam—a gymnast’s b
alance beam, only fixed to the floor with a double set of mats on either side. No way can I walk on a balance beam. No way.
“Am I supposed to walk on that?” I squeal, my voice up nearly an octave.
“We use it for balance. Don’t worry, we’re here to hold you up. We’re going to start with one step. Your left foot first, then your right.”
She has me stand on the right side of the beam with my feet together as close as I can get them. She and her assistant hold me with the gait belt. My left foot goes first. It’s my good foot. They tighten their grip on my gait belt and lift. And as quick as I am on, I am off.
“That’s good,” Cindy says. “Try it again. This time, remember to breathe.”
I start again by standing and breathing. When I am ready, I am supposed to lift my right foot onto the beam. I will never be ready. Never. I pause longer than is apparently allowed. Cindy and her assistant start putting pressure on my belt. That’s the sign. Pressure. It’s time to move.
“I’m not ready,” I protest.
“Raise your right leg to the beam and let it rest there,” Cindy insists.
She’s not stern, just clinically pushy. I raise my right foot onto the beam and let it rest. All my weight is on my left leg. Cindy and the assistant guide me with pressure on the belt. I am on the beam and Cindy holds me steady and starts to count. She gets to three and a half before I fall and they catch me. After one more trial she has me practice the balance beam routine on a line on the floor. It’s not any easier for my balance but not nearly as threatening as the beam.
Cindy finishes my gait and balance session and walks me back to my wheelchair. My next session starts in about ten minutes. I drink water and watch the other patients. The screamer has gone back to her room. I’m glad. She made me nervous. I am nervous. I think my gait and balance training have gone poorly. I want a redo, but I can’t have one. I feel like a temporary interruption in the massive machinery of therapy, and when I am finished with the days and the weeks before me, I shall walk out the door of this hospital and onto the thin mantle of a tenuous life.
Somebody calls my name. I answer, “Yup,” and raise my left arm. Another therapy assistant comes to my side and says we’re off to an occupational therapist, Charlotte, for some hand and shoulder work. I simply nod. At a table next to the wall where the screaming patient started out, I sit on a chair and the therapist sits next to me on her chair. She is older than the other therapists, older than me. Her hair shows hints of gray, but she is trim and fit. She tells me she has been at St. Luke’s for fifteen years. As she begins the session, we talk about my motor deficits from the stroke and my recent shoulder surgery. I am comforted to learn she has had years of experience in recovering fine motor skills and shoulder mobility “Well,” Charlotte says, “you have several issues that we can work on at the same time. Do you have much shoulder pain?”
“Yes, every time I move it,” I answer. “I have a catch that always hits a nerve when I do my arm circles or lift it to the side.”
“We’ll work on that,” she replies. She sounds clinical and objective as she gives a little smile. “Okay, let’s have you stand and do some small circles with your arm. Just pretend you’re stirring a pot, only let your arm dangle in front of you. Balance yourself with your feet.”
I start the motion. My arm swings loose like a pendulum. I am making eggs instead of circles and Charlotte tells me to let my arm swing round to my front. If I do that, I know electricity will surge down my arm. She gently pushes on my upper back so I’m more parallel to the floor and my arm is swinging directly under my shoulder joint. It is more aggressive than I wanted, more dangerous for eliciting pain. “Small, round circles,” she encourages.
My arm rotates slowly. Round and round. The tiniest of circles, no larger than the diameter of a softball. There is no pain, but there is no real effort at pushing the edges. I’m doing well, I think.
“Good,” Charlotte says. “Now make a larger circle. Use your body to swing your arm. Make sure to breathe.”
“I thought I was breathing.”
“You tend to hold your breath.”
I take two big breaths and swing my body. As I begin, I lose my balance just enough to throw me off. My arm swings wide in an arc that almost reaches the table and the pain shoots down from my armpit to my fingers and into my back. It’s a combination of electricity and tearing and burning. I hear my joint snap and rip. It makes that sucking, tearing-cartilage sound a drumstick makes when pulled from a roasted chicken. I scream and yelp both, simultaneously, then I hyperventilate as a tsunami flattens everything in its path. I grab my right arm with my left and hold it steady so it doesn’t dislocate, even though it won’t. I taste the salt of bile at the base of my tongue. I retch the dry retch of pain. Charlotte grabs hold and sits me in my chair. “Breathe slow, controlled breaths,” she says as she massages my arm.
I have no control over how I breathe, no real control over the heat that rises within me. I cannot fight the pain that bores unrestrained into my arm and through my joints. I am gored by a bull in Pamplona, hit by a bullet in Iraq. I am down and trampled and bleeding. I think the pain will mark the end of the session.
Charlotte tells the assistant to get me a cool cloth so we can recover and start again. Again. I hear the word, but I think she is mad, a mad scientist or just mad in general. I cannot start again. I am spent. Samson has lost his strength at the hands of Delilah. The wet cloth on my forehead provides a tiny distraction, but when Charlotte stands me up again, the pain is too much to bear. “Let’s just stand and breathe and let your arm rest at your side. You need to relax your whole body. Your tension adds to your pain.”
I protest loudly. “It hurts, dammit!” The three words come out angrier than I want them to. And I don’t know if anger is what I feel. Maybe it’s the surge of natural hormones in response to pain. Maybe it is anger; if it is, I think I might be angry with myself for having a stroke and that’s confusing and pain is confusing.
“I know it hurts,” Charlotte responds. She sounds factual, neither challenging me nor comforting me, just informing me that she knows the facts about pain and therapy. “I want you to bend at the waist and let your arm move forward naturally. Don’t force it; no circles. Just let gravity take it where it naturally wants to go. Let’s do that for a count of ten.”
“I can’t,” I plead. I think that ten is the same as infinity. I hate gravity. I hate my arm. I hate my therapist.
“Bend forward slowly. You’re in control. Remember to breathe.”
Charlotte puts slight pressure on my neck to inch me forward. I do not respond. She puts her other hand in front of me to indicate how far I need to bend—four inches, maybe six. If I can move that minuscule distance, I have a chance at healing. I take a breath and hold it, getting myself ready to bend. “You’re holding your breath again,” she reminds me.
“I think I need to stop,” I beg. “My shoulder hurts too much.”
“Let’s do five more minutes. An inch at a time. You’re doing fine,” she insists.
I am not doing fine. That’s doctor talk or therapy talk for “This is going to hurt like hell, but we’re going to ignore you and push through it anyway.” That five minutes will become the Hundred Years War. I rest; then I bend, one inch, no more. The pain edges forward with me, ready to pounce and twist me into submission. Charlotte tells me how well I am doing and to bend just a little more. “A few more inches,” she says. I listen to her voice, her assurance. I feel her hand on my neck, the supposed hand of experience, and for one unredeemable second I decide to trust her. I am still a soldier. I suck it up and push back the pain. I bend the full remaining distance to her hand. The bull thrashes its head, the inquisitor turns the wheel on a rack, and I see the gray darkness of unconsciousness mixed with pinpoint sparks of light. “Jesus!” I scream. “Stop!”
I know that other patients are watching me the same way I watched the screaming woman in my first hour. And I am ashamed and embarrassed
. I see that I am broken and gored and racked and weak. I have failed the test. I cannot master pain. My life is diminished.
—
By week two I had assigned my therapists secret names: Attila the Hun, Charlotte the Barbarian, Julia the Inquisitor. I even fantasized that one of them was a dominatrix, whip in hand, black fishnet stockings revealing muscular thighs, her spiked heels digging into my chest as she pinned me against the therapy mat. “You’re not screaming,” she snarled in an Eastern European accent. Then she wrenched my arm or leg and I screamed, not because I wanted her but because she hurt me. I let her continue, because in some bizarre way pain became the equivalent of healing. I would yield—one millimeter per session, one twitch of a toe, a single step.
The same exercises and routines continued daily over the following three weeks. Some days crushed me; others made me feel like an artist with a new palette of oils. My therapists advanced my therapy in increments that challenged my mind and body and resolve. I solved puzzles and word games and wrote basic sentences. The speech therapist made me read out loud from a book, like a child in kindergarten; it was kindergarten in some ways. I put blocks on top of blocks and matched colored tiles to colored tiles. I added numbers and subtracted numbers, and memorized lists of objects and didn’t repeat them back in order. I read stories and told the therapist what they meant and then I repeated the process. Different day—Different story. I learned to walk and talk at the same time, and did them both reasonably well. To retrain my hand-eye and limb coordination, I played one-on-one “volleyball” with a brightly colored inflatable beach ball. My feet stuck to one spot on the floor while my arms swung at the ball. Down I would go, therapy assistant attached at the gait belt.
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