A brief review of the folks who do incredibly stupid things must include the tree trimmer who sawed himself off the limb he was sitting on, the truck driver with epilepsy, and Arnold who dived headfirst into a strange body of water. One high school football player decided he would water ski with his artificial leg. He skied fine, but the wood attached to the socket soaked up a pound of so of water, and the player thought he was getting weaker. The solution was a new, waterproof artificial leg. The others were not so lucky.
Adolescents often do stupid things serially and may be excused. Arnold was almost 30 years old, and more than likely had survived other incidents without serious consequence. He was single, built like a bull, and worked construction when he worked. He was an accident waiting to happen. On this occasion he dove headfirst into two feet of muddy water and severed his spinal cord at the lumbar level. A friend had to drag him out of the water before he drowned. His injury completely paralyzed both legs with zero chance of restoration of function.
Arnold’s lifestyle was over. While he remained strong as a bull from the waist up, he was a basket case in several respects. Walking short distances is still possible after a fashion, when equipped with braces on both legs, locking knee joints, forearm crutches, good proprioception, gait training, and half a brain. Arnold had all these except the last. Going any distance to speak of is better performed in a wheel chair. While the braces may allow standing in parallel bars, the world does not come ready-made with such things, and the braces are often seen as excess baggage.
A serious dilemma for many folks with spinal cord injuries is the notion that after the injury heals, they will be able to walk again. Because walking is such a vital activity to normal life, it is rarely given up without a fight. Accepting the injury as permanent is a vital step to adapting to a new lifestyle, and doing the things needed to live with a serious and complicated cluster of impairments. In many respects one must be born again, and start over from scratch.
All the medical treatment, physical therapy, care and concern the new patient receives may well convey the thought that recovery is possible. At some level it may be essential to keep the hope alive in order to keep each person working on those tasks that will mean a better quality of life down the road. It was easy to believe that those folks who received such injuries and did well were treated somewhere else in the state, while those referred to the medical center were the leftovers with more severe injuries and fewer resources to work with. Most of the well educated folks with responsive grey matter did not make it to the university’s medical center.
Arnold was provided with braces and crutches and a wheel chair and lots of instruction via physical therapy. Arnold rejected any thought that his impairments were permanent. Certain complicating issues compound the problems of many paraplegics. Bowell and bladder function is no longer on semi-automatic, as these survival needs are not sensed normally. Their functions must be re-learned and facilitated manually.
Circulation of blood receives no boost from muscle function, and pain served at or below the nerve distribution level is missing. In the absence of muscle and sensory function sitting in a wheelchair and laying in bed may be hazardous to your health. Wheelchair pushups and frequent turning in bed are necessary to avoid the complications which may follow the lack of attention. One must worry about the attending skills of an individual who dives into strange water headfirst.
During Arnold’s first admission he was able to master the wheelchair balancing act. This includes jerking the front wheels into the air and balancing on the rear wheels. The competition then is to time how long one may remain balanced on the rear wheels. In this competition it is important that one return to earth on the front wheels, the only safe landing. Failing in this the other option is to go over backwards, landing on ones head. Exactly how many times Arnold fell over backward on his wheelchair is not known. When it happens the individual requires the assistance of one or more persons to set the world upright again, wheelchair and half lifeless paraplegic person. Arnold was reluctant to learn this lesson.
Several months after his initial outfitting Arnold was back again. On this second visit he had developed serious decubitus ulcers (pressure sores) over both hips. Careful cleaning and treatment was provided for several weeks until the situation was stabilized, and it was believed Arnold had received adequate care for a second discharge. Discussions at the time involved hyperbaric chambers in which it was thought the healing process might be shortened. Skin grafting and healing of deep wounds, when successful, often require weeks or months of comprehensive care. Some believed that Arnold might not be the best candidate for teaching clinics, except as an example of what happens when things go wrong.
After another period of absence, Arnold returned to the center for his third visit. On this occasion his ulcers had advanced well beyond both hips. The extensive wound sites had become infected, and fly larvae had taken up residence in Arnold’s extra openings. Arnold was wheeled through the Physical Medicine and Rehabilitation Department on a gurney, leaving a trail of stench that required defumigation before the resident staff could return to work. As the standard treatment had progressed as far as it could go both legs were surgically removed. This process retained enough flesh to close the wounds. While this is an extreme procedure, the removal of two useless legs lowers total body weight, and allows body movement with far less effort. This lessens the load on the arms for mobility and transfer.
To facilitate as normal function as possible, a form-fitting, padded, plastic-laminate bucket was tailored to what remained of Arnold. It was fitted with the necessary openings and fasteners so it could be put on and removed with some difficulty. With Arnold’s new bucket, he was able to sit upright in his wheelchair, transfer with little trouble, and perform his wheelies almost effortlessly.
It is surprising what can be accomplished with two good arms and a small brain.