Sal was known to work hard, play hard, and he believed in the importance of family. He was married with children in the prime of life. In the course of his activities he managed to break an arm. It was a simple fracture, and was set successfully shortly after the accident. On follow-up examination a bone fragment was discovered at the site of the earlier fracture. It was cleanly separated from its surroundings. Because of the possibility of later complications, a simple office procedure was suggested to remove the fragment.
At the appointed time, a local anesthesia was administered, the bone fragment was removed, and the small incision was closed. The Sal everybody knew did not wake up from surgery. The Sal who woke up was blind, deaf, unable to talk, unable to walk, had difficulty sitting, and the movements he displayed appeared to be more random than deliberate. Whether he grunted in response to prompts was never determined with confidence. He was unable to care for any of his personal needs, requiring complete care for survival.
It was believed that Sal had a reaction to the anesthetic agent used for surgery. This reaction produced the broad assortment of impairments to brain function. Sal was referred to and moved almost immediately from his home in Topeka to the Hadley Memorial Hospital and Rehabilitation Center in Hays for evaluation and treatment as indicated. While Hadley was built with the goal of serving more severely impaired individuals, Sal showed no ability to perform useful functions for himself or others. All communication, mobility, and self-care was missing.
Rehabilitation with any likelihood of success with job-related objectives was clearly out of the question with Sal’s current state of function. Field and facility counselors may expect to spend a block of time processing referrals of individuals whose circumstances, like Sal’s, are beyond help.
It is shocking when a life is virtually terminated following a simple surgery, leading to the conclusion that there is no such thing as a simple surgery when the complications may be life threatening. Any possibility of success with Sal would necessarily follow many months of medical and psychological restoration, at which time Sal could be reconsidered for service based upon his level of function at that time.
Each district office in most state rehabilitation programs have physician consultants who are available to provide relevant projections and prognoses given the presenting findings. Shortly after an acute brain trauma the return of function is a seriously problematic prediction. As the brain heals, spontaneous recovery of function is often not well distinguishable from that which follows treatment. At some point in the first year and a half the bulk of the consequences have changed from acute to chronic residuals, and little further improvement in function may be expected. This is a harsh projection for the individual and the families involved.
A similar dilemma follows injury to peripheral nerves. Motor nerves, unlike sensory nerves in the extremities, are capable of regenerating at a painfully slow, but highly predictable rate. This possibility complicates serious rehabilitation planning. If the return of function is a possibility, rational folks want to “wait and see” until after that regeneration window has closed. After an extended window has closed, complications to function often follow, and full recovery is rare. At that point the “wait and see” period is over.
Individuals with spinal cord injuries, which do not regenerate, often have a perverse belief that their recovery is certain. This belief is understandable as the consequences require a complete makeover of life. For those with limited adaptability the fairy tale of complete recovery may be the best. Social security’s disability listings allow for automatic findings of disability and the payment of benefits for persons with most spinal cord injuries. At the same time vast numbers of folks with spinal cord injuries choose to adjust to their impairments and work very successfully in spite of serious obstacles. Their road is arduous, but their drive and achievement may be spectacular.