Atrophy

Atrophy sets in when muscles haven’t been used for three days. The longer they lie idle the more they atrophy. Atrophy is defined more or less as wasting away or more primly as declining in effectiveness or use. Fascinating eh?  Like you, I never ever considered atrophy in my body parts before I landed on my back, broken, on Highway 1 after flying across the hood of the car that stopped in my path. These days I can hardly stop thinking about it. 

My sister-in-law the doctor was surprised when I described atrophy in my right leg as a stiffening of the muscle. She has only ever read about it I guess because she viewed atrophy as wasting away. In fact my right leg is swollen and for a long while was impossible to bend at  the knee. I had it in a brace to protect the two fractures in my thigh and also my broken kneecap. That was the good leg as my uninjured left was attached to the most broken part of my pelvis.  I am a mess. 

God I hated that scratchy itchy brace.  I described it as a dead sheep strapped to my leg. When I moved in the Hoyer Lift one person was dedicated to supporting my leg.  Dropping it even a little off level or twisting it caused me screaming pain. Burning pain across the thigh rendered me incoherent in agony. I was terrified of moving it incorrectly or knocking it. I lived in immobility with the dead sheep for weeks. Exercising the leg was exhausting. Once liberated you now understand, the bastard leg was completely atrophied. It’s still not ideal but I can bend it and stand on it without screaming in agony. Progress. 

Elias my Occupational Therapist has done more to cure the atrophy than anyone. He massages my leg using painful deep techniques that break up the muscle and the fibers surrounding the muscle. The best way I can describe the feeling of atrophy is as though my leg were encased in dried glue. The surface feels numb and against the glue you have a totally ineffectual muscle trying to move the leg. It’s not exactly painful but it is a sensation that produces a deep seated ache in the knee joint as I force the leg to bend. It is bizarre I tell you. I hope you never have to undergo atrophy.

The ever brilliant Elias deployed my gait belt usually used to support me while standing and stumbling to force my leg to stretch the knee joint. He pulled it up till I gasped in pain and then bent the leg back gently under my wheelchair while he sat on a stool and pulled gently but insistently to bend my atrophied leg back under the chair. The effect was immediate and my leg suddenly felt lighter and looser. Amazing. Painfully astonishing. 

I start my afternoon physical therapy sessions on the bicycle. It has a motor and in the early days I’d let the motor pedal my feet around loosening up the muscles and joints. Nowadays I pedal for twenty minutes as warm up to walking and climbing stairs. My right leg is still heavy and doesn’t move as easily or as fast as my left which is uninjured. But I can lift it till the right leg is straight and I can bend it and I am walking on both legs, only 50% weight bearing on my left as the pelvis above it is still healing from major fractures. But I am walking not hopping, even if my clumsy gait most closely resembles Frankenstein’s monster. Note no hands on my gait belt. 

It is a strange slow road to recovery and I probably have four to eight more months of work to regain my lost mobility they say.  I am aiming more at four months thanks as I need to get back to walking Rusty and exercising at Broga. I am planning on taking Rusty to empty back streets and letting him loose to walk the road even if I can’t keep up.  I want to see him out with me once again. 

Meanwhile I am working my legs here with Tahina practicing going up with my good (right) leg and going down with my bad leg:

I used to envy people I saw walking up and down those three steps.  Now at last, 48 days into rehab it’s my turn.  Now I climb and descend clutching the rails like my life depends on it, which it does. Three trips and I’m spent.  If you want a whole man I am not he but unlike a spinal chord break or an amputee I will get back to walking. To those who struggle with far less chance of that reward than myself, my hat is off to you. Whatever comes next in my life this tussle with atrophy I  shall never forget.  Never. 

Another Weekend

Another weekend this time cut short by a service at B’nai Zion synagogue in Key West. My wife had planned to leave in the evening but cut short her visit to attend the gathering. It was the right thing to do considering the unprecedented levels of terrorism breaking out across the country at places where people gather. 

Still I had a couple of nights to enjoy the company of my family. So I collected a few more Rusty pictures! 

Despite the brevity not a bad weekend. 

Bags of Time

Among the books given to me is a slim volume of poetry I can dip into as the mood strikes, The Rain in Portugal by Billy Collins. I enjoy poetry by an eclectic bunch of writers from Robert Browning to Wilfred Owen to Billy Collins and then I get sideswiped by a completely different voice like Wendell Berry, and my sister turned me on to Seamus Heaney. Anyway I was wandering through Google wondering and I came across another of Collins’ shaggy dog stories which struck a chord. The first dog poem of his I read was called Another Reason Why I Don’t Keep A Gun In The House and it made me laugh out loud in a bookstore so I felt obliged to buy the book.  I like to think that all the irritants listed here by the poet are spared my boy, seen here being walked by my wife on a visit to my rehab in the background. 

Anyway here’s Collins’ dog poem: 

The Revenant

I am the dog you put to sleep,

as you like to call the needle of oblivion,

come back to tell you this simple thing:

I never like you -- not even one bit.

When I licked your face,

I thought of biting off your nose.

When I watched you toweling yourself dry,

I wanted to leap up and unman you with one snap.

I resented the way you moved,

your lack of animal grace,

the way you would sit in a chair to eat,

a napkin in your lap, knife in your hand.

I would have run away,

but I was too weak, a trick you taught me

while I was learning to sit and heel,

and -- greatest of insults -- shake hands without a hand.

I admit the sight of the leash

would excite me

but only because it meant I was about

to smell things you had never touched.

You do not want to believe this,

but I have no reason to lie.
I hated the car, the rubber toys,

disliked your friends and, worse, your relatives.

The jingling of my tags drove me mad.

You always scratched me in the wrong place.

All I ever wanted from you

was food and fresh water in my metal bowls.

While you slept, I watched you breathe

as the moon rose in the sky.

It took all of my strength

not to raise my head and howl.

Now I am free of the collar,

the yellow raincoat, the monogrammed sweater,

the absurdity of your lawn,

and that is all you need to know about this place

except what you already supposed

and are glad it did not happen sooner --

that everyone here can read and write,

the dogs in poetry, the cats and the others in prose.

I would then thank you all for listening so politely and patiently. And I would profusely thank Billy Collins for the poems I love, but could not possibly have written.

Ambling

I walked yesterday. I climbed stairs yesterday. Yesterday I was a bipedal human being. To say I walked as you walk would be a distortion, dare I say a lie.  But I chased a walker frame down the corridor. Yanuel held my gait belt from behind and towed my emergency docking station behind us for those moments when Major Tom needed a rest and plunked his ass down in the midst of his exertions. Space exploration was never as tough as discovering the limits of your atrophied leg muscles.  I walked. “Walker, left foot, right foot (weight on hands), lock leg. Walker, left foot...” Stop hunching your shoulders Yanuel said gently, a tone far removed from the absent Eddy’s stertorian bark. Put weight on your left heel. You can do that now it’s weight bearing. 

When the surgeon checked my X-rays and said fifty percent weight bearing on Wednesday a new world of mobility opened up. No longer hopping, no longer toe tapping with my left, I could walk. I went back to bed utterly worn out by nine hours in the chair and worried to think a nine hour day destroyed me. Yes I walk, yes I’m up and about, but no it’s not like you the able bodied. It’s a facsimile. This was how I stumbled October 12th with two hands on my gait belt and two experienced therapists Elias (left) and Eddy (pink) poised to catch my lumpish body from my failing legs. 

Yesterday Yanuel put his hand on my gait belt as required by protocol but I walked, not smoothly, not fast but unaided. I was in a hot sweat after twenty minutes march from one gym down the corridor to the other. I met Donald along the way walking to the tune of his own drummer, white hair in his seventies and well back from near death like me. He said his neuro therapist told him to use word association to remember names. Michael Row Your Boat was his way of remembering mine. Donald Duck I said to him. Screw you he rasped I’m going to have to think of something else he said for word association.  He took off down the corridor far outpacing me. As he prepared to turn into the gym he called back “See how it’s done?”  “Quack” I replied. The therapists collapsed with laughter. Fuck you Mickey he called over his shoulder. October 4th learning to stay upright in the chair gait belt at the ready in case of slippage. 

Donald grinned at me as I stumbled into the gym and sank gratefully into my waiting chair behind me. Good job he said and I knew he meant it. We’ve been through hell and we know what it’s like.  But hell was far from over. Yanuel handed me over to Tahina. Steps she said.  I have spent weeks watching patients enviously as they climb the three steps of the hydraulic staircase in the middle of the gym. I’ve seen them stumble as they concentrate, I’ve seen them get stuck turning at the top. I’ve envied them.  My turn one day I said. 

Continuing the sack of potatoes theme here we have Major  Tom space walking back towards his wheeled seat docked alongside the mountain. But no, Tahina said, back up and around I went up and down five times. Good leg leads UP to heaven she said, bad leg leads DOWN to hell she added. And that’s how I did it. Not gracefully or with confidence but hauling myself like the cripple I am with strong shoulders and arms. I walked stairs.

The car next time. Walking and walking and pivoting and getting up and sitting down and building stamina and not falling. It’s my job. I am a lucky sack of potatoes. Spare me a thought as you get up, walk, stumble and keep going and get irritated as my friend Webb did when he forgot something on the far side of the supermarket and he had to walk back. Once he and I strolled together.  We shall again. 

Look at him go.  I should be so lucky.  I will be so lucky again one day. 

Stepping Out

I am closing in on the end of my time in rehab.  Next week I should have my departure date which I am guessing will be around November 12th. Yesterday I was in the surgeon’s office where Doctor Quinnan studied my X-rays and pronounced my bones are regenerating and healing nicely. 

He said I can have fifty percent weight bearing on my left foot which means I can walk properly now with a walker supporting my left leg using my considerable upper body strength. No more hopping thank God. Now I learn how to manage increasing the strength in my legs which have been inert for months and then I learn how to handle myself, my wheelchair, and my walker in banal daily activities.  A great deal of handling going on here. 

I spent all day in the wheelchair and got back to my room grumpy ready for a nap. I was exhausted which in turn forced me to ask myself how will I cope with daily demands if this is all the stamina I have?  However the sensible voice in my head told me to take it one day at a time. Yesterday was also my birthday and I was flooded with cards and electronic messages. It was delightful and moving to turn 61. Many of you have appeared not in person but as personalities in my life through this crisis and it is one of the great good things near death has brought me. I try not to think too hard about how important this page is to so many of you because if I do I start down that route I will suffer analysis paralysis. 

I have to say I really like Publix bakery and they make a mean chocolate cake but I felt like carrot cake for some reason so my wife, and Publix, came through. Apparently the nurse’s station agreed it was delicious as they weighed in and polished it off. I am lucky to be served by a bunch of really nice people in this place. I am astounded by the joy and compassion displayed by the staff everyday. I feel cocooned by them.

I was hoping to drive Sosa crazy with a Rubik’s cube I was sent. I scrambled my brains on it  for a while and then offered it to him. He went mildly nuts wandering the halls fiddling with it between rooms and came back a couple of hours later defeated. Keep it I said, until you get it done. He flashed a glare at me and went outside to smoke and calm his nerves.

My wife brought me birthday greetings from her class. Apparently she “sure does miss me” so I wonder how much time the students can score deviating her mind from the class subject matter in hand to pondering my situation. We used that technique when I was a student: get the teacher off course wasting time on a favorite subject of hers to avoid giving the rest of us a test...glad to be of service students! 

The details of what I work on next in therapy, when I leave this place, how I cope in Key West and what work will feel like when I go back part time December 1st...all of that is uncertain. But I am not concerning myself with all the uncertainty at this point.  I am here, I am alive, and I am learning and all that feels great. As you all have shown me in this process, it will all come out in the end. Thanks for following along. 

A PS to Andrew from Seattle who sent a card recalling our chance meeting in the Dry Tortugas years ago. It was lovely to hear from you and yes I still recall that time fondly as does Layne. Thank you for the card. Much appreciated. 

Laughter

I was given a compendium of funny stories from the Reader’s Digest and if you are as old as I you will remember the words “Laughter-The Best Medecine.”  I have found lots to laugh at in rehab but lately I have found myself the old timer in the gyms. People who were here previously are gone and I see new faces and a new set of challenges to start conversations. Sitting at the table yesterday I saw one dude I knew and we fell to talking.  The guy on my right I didn’t know but he seemed affable enough. 

In rehab conversation follows predictable paths. Where are you from what are you in for, asked with circumspection or hinted at as not everyone wants to reveal all.  Yesterday the guy said he was in rehab following a kidney transplant. Whoa! Weird! Apparently a nerve to his leg got severed and he needs to learn to walk again. Not very funny so far, right?  So I asked does a transplant hurt? ( I like to know this stuff and rehab generally is a great opportunity to ask). No he said.  Not being able to piss hurt like a...and dialysis sucked. The transplant didn’t. They have all those drugs. Oh yes I said remembering my own surgeries. I love Dilaudid, fantastic stuff. Yeah he said until it blocks your gut. 

Now it is said, and I know this from experience that if you put two sailors in a bar sooner or later the conversation turns to toilets. In my new experience here I have found patients in rehab frequently weave the same course. The kidney transplant and I both got the dreaded Ileus (“ill-eh-ooss”) when the painkillers after surgery paralyze the bowel. We compared notes on our blocked bowels shaking our heads sadly.  My sister in law the doctor I said,  recommended prune juice. I tried it and at two in the morning the dam burst and I went into details which got all three of us laughing our heads off. Trust me, part of the relief from misery is knowing it is shared. Floating helpless in a bed of diarrhea is only part of the joke. 

That’s nothing the kidney transplant said. I got a rubber hose up my butt and a second guy in the corridor pumping a water barrel. Every time my nurse yelled “now!” I got hosed. By now all three of us were thumping the table with tears running down our faces. Did it work?  I gasped straining to catch my breath. Not entirely he said and I shall spare you the details. We frantically sucked air trying to compose ourselves. What a shitty day the transplant patient said shaking his head at the memory then he realized what he had said which set us all off again. 

You’ve had enough fun Elias said as he broke up the trio by pulling my chair back and wheeling me off to the rowing machine. Later I was sitting opposite a grumpy looking guy lifting his weights.  You’re the one from Key West he said. Yes I said wondering what rumor  the  mill had started. You’re all weird down there he said. Guilty as charged I replied but the great thing is if I’m weird I’m as nothing compared to the guy roller skating down the street behind me in a pink tutu and fairy wings. He looked about ready to choke. There’s always a bright side I said. And he stayed grumpy even though I never mentioned fecal matter once.  Some people are just like that.