New Life, No Instructions

by Gail Caldwell

  19.

  The bad times were at night, when fatigue felled me like a tree. God knows I had plenty of rescues: drive-by cheeseburgers and shower spotters and food drops that saved me, body and soul. But I longed to be able to do the simplest things: to cook a meal or empty the trash or (most of all) stride across a room. I was getting a crash course in what it felt like to grow old or infirm, and I kept thinking of my parents, of moments past when I realized what they could no longer do: my father’s inability to get up from a chair but refusal to succumb to a walker, my mother using one arm to lift the other on her bad days from arthritis. I had viewed them as stubborn during these times, when I tried to help and they soldiered on. Now I applauded them, and regretted my impatience.

  My solitary meals were valiant and pathetic efforts. It took me forty-five minutes to manage a plate with heated food, ice compresses for my leg, a fork, water, a phone, and crutches, all in one place. I couldn’t lean or bend more than ninety degrees, so I had a ladle for dog food and a pitcher to pour water toward the bowl on the floor. I learned to throw things at the sink from my post at the counter: avocado pits or banana peels or seltzer bottles. Despair was too often a partner at these dinners, at least in the first six weeks, when I had been told to use two crutches with every step and I was too weak to break the rules even if I’d wanted to. My goals had never been so measured: to get to the counter, get to the couch, get to the end of the day.

  This bleak corridor did not go on forever, though at the time I felt, beyond all rational thought, that it would. Humbled by how weak I was, I had neither the patience nor the faith to believe I would be strong again: might lift a boat or even carry a bag of groceries. Once I got to my bedroom, upstairs at the back of the house, I felt a relief bordering on bliss: crutches tucked nearby, safe for another day, nowhere else to go.

  When I was strong enough, I climbed the stairs on crutches with my laptop in a backpack. The first few weeks my heart raced with exertion when I reached the top of the stairs, no matter how slowly I went, and I stopped there until I was sure I wasn’t dizzy. Then I’d go a little farther—as far as the middle room, where the thermostat and lights were—and one night I stood there in the semi-dark, my hand on the wall, and said aloud, “You can do this.”

  It was the same voice I used for the dogs, for Clemmie and then Tula and Shiloh and every other dog I’d known, when they were scared or sick or trying to make a jump. “You’re OK. You can do it.” A reassurance from someone stronger, someone who knew. The voice a mother uses on the playground.

  I didn’t think much about this, that I was talking to myself and what a voice of consolation it was, until later. One afternoon a good friend had come to visit, and we were talking in the kitchen, with Peter nearby on a phone call. Lane asked me how I was, really and truly, and so I told her that I was all right but that sometimes it was awful, and then I told her about standing there in the dark until I was ready to keep going. Only when I finished did I realize that Peter, who always got the tough version of how-I-really-was, was no longer on the phone and had been listening behind me. And he said, quietly, “You are walking across Kansas.”

  In the medical dramas and miracle resurrections of popular culture, rehabilitation—the patient’s incremental march toward well-being—is usually put on fast-forward. The triple bypass is performed; the man is seen shooting hoops with his son. High drama doesn’t much lend itself to rehab, where the glories are micro-measured and repetition is the overriding story. Leg lifts? OK, do that ten thousand times and we’ll reassess.

  And yet it was here, on the living room floor or on a yoga mat by the pool or lying prone on a physical therapy table, that my real story unfolded, its thrills and crevasses exaggerated by the desertlike sameness of the work itself. The things I longed to do became the things I believed I would never do again, and this fear was so complete that I would hurl myself at the challenge with not a little desperation, then overshoot it and have to readjust. My surgeon cleared me to swim at six or seven weeks, and the first time I swam I went to the gym with the goal of putting my suit on, nothing more. Navigating on crutches from car to locker room and managing a swimsuit change took about twenty minutes. But then I made it to the wide steps of the pool and a lifetime of watery memories reached up for me, and I fell in like a drunken mermaid. I was so happy—so enveloped and no longer precarious—that I had to force myself to leave. When I got home, I went to sleep sitting up in a chair.

  Time is a vast place when you are standing still. It was three months before I walked without crutches or cane, six months before I moved through the world with a shred of confidence. The first several weeks of winter I lay on the couch with my leg elevated and watched the walkers outside the window on my street—thoughtless bipeds on their way to someplace else, their limbs moving in seemingly perfect symmetry. I spied on everyone I knew, too: Peter’s loping stride, Pat’s easy marathoner’s pace, Nancy’s tireless gait. All of them seemed to possess the grace of dancers. At night, when the window show was over, I went to websites on walking and online orthopedic journals to read about how normal bodies achieved this vital, gliding phenomenon. “I hear it’s a miracle surgery,” people sometimes said, when hearing what I’d been through. Generally I smiled and appeased them. Yah, I thought to myself, still waiting here for the miracle.

  My surgeon’s discharge instructions were to “walk 4–6X a day, for 5 to 10 minutes. Walk outside if possible.” The point was to get the patient moving, and trips to the microwave didn’t count. But at the time I interpreted the advice as four to six real treks a day, and my heart sank at my anticipated defeat. Most people recover from hip replacement with the same leg they started with, but mine was on its maiden voyage, longer now but unschooled, and I couldn’t go far without muscle spasm or fatigue. I was crutching around the house most of the day, so I aimed for one or two walks outside. The first time I emerged, blinking in the sun like the men in Plato’s cave, my neighbor Rita came onto her porch and cheered.

  Off I’d go, at first with a partner who could spot me, eventually alone, the stopwatch running on my cell phone. New England was having the mildest winter in a decade, and I headed down the front steps in gym shorts and compression stockings and running shoes and a down jacket. I cannot imagine how odd I looked, though people forgive a lot when you are on crutches. Two houses, then three. Five houses, then turning around and seeing the ocean of distance back to my front porch. Finally to the little park halfway down the street—populated most days by me and a couple of stalwart mothers with their preschoolers.

  One afternoon I saw a toddler at the park who was entranced by my crutches, and, with his mother hovering, he came toward me—step, lurch, step, lurch—with his arms out and a big smile on his face. He was fifteen months old, his mother said. “You’re better at this than I am,” I told him, and in a way I was in earnest, watching his every move. Spying on a toddler to learn the body’s genius, to learn how to do it right. All moxie, he thrust himself into space, certain that it would receive him; his arms and torso took him forward while his legs figured out the mechanics. It was an amazing sight, that cold sunny day in December, and the image stayed in my mind’s eye for months, as my body followed suit.

  Walking, it turns out, is a mansion of complexity, and I know this mostly because I did it crookedly for so long. My lengthened leg now reached the ground without a built-in drag; it was as though two horses harnessed together, one smaller and slower, had finally been started from even gates. Every muscle from my toes to my rib cage hollered out in protest. Most of them were being stretched and torn as I reached that new distance; a few may never have been engaged at all.

  The first several months I suffered shin splints and back pain and calf cramps and iliotibial band syndrome; if my foot landed in the wrong way while I was reinventing myself, I felt it later in my knee. I found a note that I wrote myself in winter that describes my state of mind. “I am frustrated and sick of it,” I wrote, “aware that it is muc
h much worse than people said it would be—and about precisely what i thought it would be. The weakness of my leg has made this a brutal rehab.”

  Occasionally I experienced the fundamental shift of my body as a visual hiccup while the world righted itself. Even in pain and in training, I could walk faster and better than I had in years. The first time I took a familiar walk at the reservoir, around a little peninsula, I looked out over the water and it seemed, just for a second, as though I were in a slow-moving car. That was when I knew—one of the times I knew—that the physics of my being in the world had changed. It was as though God kept throwing me a bone once in a while, just so I would keep going.

  Thus did Kansas reveal itself, with endless plains and then dips and rises. The milestones I worried over came on their own: first swim, first walk in the woods with the dogs (I had Nancy, and one crutch), first trip to the store. For outpatient physical therapy I found a wry, lanky man who coached high school girls’ basketball when he wasn’t working on people like me. He was the perfect fit for me, kind and a bit of a wiseass, and he spent most of his energy convincing me to slow down and accept where I was. “They never tell you how bad it is,” he said about joint replacement. “They’re afraid you won’t do it.” I held on to his wrists and tried to walk on my heels, the same way I had with my mom when I was four. I cursed and complained; he put weights on my ankles and, later, slabs of icy gel packs on my leg. By the time he booted me, I half-worshiped him, because he had shown me the hallway to my own strength.

  My micro-victories were how I survived months of uncertainty. On a Monday in May I said to my friend Morgan, “I’m afraid I’ll never row again,” and the words, typically melodramatic, so scared me that I drove to the boathouse the next day to see if I could lift the boat, and did. “You gotta have the want-to,” a famous rodeo guy said about how he kept winning, and sometimes I think that was all I had, the want-to. I made it to the locker room, the boat bay, the first upstream bridge. That’s good—now do that ten thousand times. My world became so focused that Jean began referring to it over the summer as Camp Gail. “So what happened at Camp Gail today?” Pleased to be recognized as my own zealous director, I named her honorary camp counselor.

  With uncemented hip replacement, the first three to six months are critical, because the bone is growing into the prosthesis. After the early months of rehab, Dr. Mattingly told me I could do anything except run (no worries there) or leap from a high table (ditto). As I worked and fretted my way toward getting stronger, I kept being reminded that the body has its own intelligence, an elegant circuitry that all but bypasses conscious thought. Sometimes no matter how fierce my want, my leg would falter, or muscles would spasm, or fatigue would level me, and on those days I wanted to weep over my limited return. Walking was still harder than anything else; my muscles and tendons were trying to catch up to my smooth-gliding joint.

  I was plodding along a path one afternoon, frustrated with how labored and unnatural my movements felt, and I thought, OK, pay attention to the good leg, and then I realized how obvious this simple instruction was. I had been trying to dictate the mechanics of my right leg, without much luck, and so I gave a new instruction: Don’t pay attention to me, meaning my brain and my will and my effort to drive the chariot. Just do what the other leg is doing.

  And it worked. Haltingly, but more smoothly than any effort of will could have achieved, my leg started moving in tandem with its partner. Like two dogs in harness, each of whom has to figure out what the other is doing. It was a moment in which I felt stunned and humbled and smart, smart in the sense that I had gotten out of my own way, and if it seemed a bit psycho—woman walking alone, talking to leg—well, at least my audience of muscles seemed to be listening. The mind-body dyad had revealed itself as the fragile, sometimes beautiful collaboration it is.

  The polio virus destroys neurons, which carry signals from the brain to muscles to make them fire. Once the wires are down, the signal reroutes to another muscle—an efficient mechanism that can have unfortunate long-term side effects. The muscles that take over keep working and getting stronger and eventually overtaxed; the weaker one loses what feeble ability it had. There were lots of times in my life, most acutely in physical therapy, when I had been made achingly aware of this neurological shutdown: moments when I tried with all my might to isolate a muscle and it simply wouldn’t fire, or was too weak for me to feel its effort. It was like being paralyzed, though on a smaller scale. I remember staring at my leg, feeling everything around the targeted muscle trying to help, and getting nothing back.

  Now I had a different place to start from. The additional length Dr. Mattingly had given me had partly leveled the playing field—and had sent my right leg to the gym just by my walking across the room. The act of weight-bearing that was now possible engaged muscles from my waist to my toes that hadn’t worked in years. I had months of this careful testing ground ahead of me, miles garnered and muscles emerging and protesting, but I couldn’t know that yet; I had to bank on what little I had and the belief that I had a fighting chance.

  About six months after surgery, I was sprawled in my usual place on the living room floor, trying to stretch and work individual muscles while Tula rolled a tennis ball my way. My routine was to do the easy, gratifying exercises at the beginning and end, so that the ones I hated—the ones that hurt, or, worse, where nothing happened—were buried in the middle. In this way did I trick myself from getting too discouraged.

  That evening I wiggled a couple of toes—I was strengthening my foot as well—and I felt the movement all the way up to my hip. I looked at my leg and tried the motion again, and I saw something move on the outside of my lower leg. It was the tibialis anterior muscle, and I’d never seen its definition before. My muscle’s Rip Van Winkle moment. I wiggled my toes and it fired and moved and my heart soared. I was teaching my leg to walk again, except this time it was nearly two centimeters longer and I was sixty-one years old, and my first coach had been dead for six years.

  20.

  In the last year of my mother’s life, in 2005, I flew to Texas seven times; three of those trips I was convinced it was the end. After my father died in 2003, she had stayed put in the brick colonial where they’d lived for forty years. She cooked a ham for herself on Easter Sunday and had a woman in to help her several times a week, with two daughters hovering by long-distance, and though she was ninety-one and barely weighed a hundred pounds, she insisted she was fine and could live on her own. My sister had long called her Little Mother as an endearment, and one winter day I walked into the house—I had driven from Santa Fe, New Mexico, where Pam lived—and Mom was standing in the kitchen, smiling in greeting and holding on to the table, so I wouldn’t see that she was unsteady on her feet.

  “Tiny Mother, where are you going?” I said, because she had clearly lost weight, and without a pause she pointed her cane skyward and said, “Up to heaven, I hope, to be with Bill.”

  I was there for a three-day visit, and the next afternoon when I had gone for a swim, she called me on my cell and said, “Come home—something isn’t right.” When I got there she was sitting on the brick hearth by the fireplace, trying to talk but having trouble finding words. I called my father’s former neurologist and told the office assistant that I thought my mother was having a TIA, or transient is-chemic attack, which is what they call the little strokes that afflict the elderly. The woman put me on hold and when she came back in a few seconds, she said the doctor could see my mom in two weeks. I swallowed my rage and dialed my therapist, a psychiatrist, two thousand miles away. Within moments, on his instruction, I had given my mother an aspirin and told her we were going to the hospital to have her checked out. Halfway there she said, “I’m scared,” which may be the only time I heard her say that in more than fifty years.

  Her blood pressure was skyrocketing—220 over 120—and by the time we got her admitted, she was going in and out of lucidity. She was convinced that my father was in the room, which seem
ed to make her happy. The cardiologist took me in the hall and shook his head, and so I sat on the bed with her for hours, and finally, because I couldn’t think of anything else to do, I started reciting Scripture, which I knew she loved. I got all the way through the Twenty-Third Psalm, to my surprise, and then I said, out of nowhere, “I shall lift up mine eyes to the hills, from whence cometh the Lord.” It was a misquote from another psalm, but that was the best I could do, and we stayed there together until she nodded off.

  Two days later, she was stable and seemed lucid but still couldn’t talk, and after several planning sessions with my sister, I flew back to Boston to take care of things at home, with the idea that Pam and I would start the arrangements for assisted living. Monday morning my phone rang and I saw the hospital number and grabbed the phone, assuming it was the nurses’ station.

  “Hi, Gail!” my mother said brightly. “What are you doing?”

  Her speech was normal, and she sounded about seventy years old. I tried to hide my amazement and so asked her questions that were fashioned to gauge her clarity. “Do you remember my being there?”

  “Of course!” she countered.

  “Do you remember my saying the Twenty-Third Psalm?” I asked.