June 30, 2006

First up today was the OT, and first task was for Gary to transfer from his wheelchair to the mat. As I watched him take so much time to get his feet off the footrest of his chair in preparation for the transfer, and as I watched him a short time later try and try but remain unsuccessful in getting himself rolled over from his back to his side on the mat, I couldn’t help thinking that he’s got so far to go to get this basic stuff down second-nature; I can’t imagine he’ll have it down smoothly in a month. But he is confident he will.

In any case, I certainly don’t share such thoughts with him. After all, in his beginning days here sitting himself upright on the mat from a side position seemed such a daunting task for him – now he can do it every time he needs to, though not without effort.

The main thing the OT had him do was practice arm circles with weights while on his side, to increase the endurance of his shoulder muscles. After his session with her, he supposedly had an hour’s break. “Do you want to stay on the mat and work by yourselves?” she asked when her hour with him was through. “Sure,” we said. She gave some suggestions for what to do, but Gary asked her if he could sit on the edge of the mat and practice little hops along the mat – after watching me do my transfer, he’d come up with some ideas for improving his own transfer and wanted to try them out and get more practice at the skills involved. At first she wasn’t going to let him do it because he still loses his balance and it would just be us on our own with no supervision, but after he showed her what he wanted to do, she gave her okay under three conditions. First of all, I had to sit right in front of him on a stool. Second of all, he couldn’t sit too far forward on the mat (and she showed him how far he was allowed to go). Third of all, if I left for any reason, he couldn’t do anything that might lead to something bad happening (she gave the example that if he was sitting on the edge of mat, he couldn’t move at all until I got back).

She left, and he stayed sitting without moving until I brought from his room the protein drink he’d requested. I automatically started to hand it to him, but of course he didn’t automatically take it – doing so required balance. So this simple act became our first practice task. He figured out where to put his left hand on the mat for best balance and took the cup with his right. I had kneeled in front of him before passing him the drink and when he took it, I held my hands just below the cup in case he lost his balance. If he went forward, I would save him; if he went backwards onto the mat, I wouldn’t be able to get him in time anyway, so I would save the cup. Fortunately, neither of those happened. He gave me the cup, took a breather, then took the cup for another drink. That accomplished, he practiced sideways hops down one side of the mat then back. He said he could definitely do them better now that he’d incorporated the ideas he’d gotten after watching me :-) After a while his arms were too tired to get him any height, so he stopped this skill practice, not wanting to be sliding on his flap instead of hopping. Since he had another session coming up that was going to involve strength exercises, he decided to stretch. So his next task was to get himself in the middle of the mat. Since he’s not allowed to go into a deep bending position, he laid down on his side and I got his legs up on the mat. He again tried to roll from his back to his side with the goal of getting to the middle of the mat, but for some reason he couldn’t get himself rolled over. It still remains a mystery why sometimes he does it so easily and sometimes he can’t do it at all. We'd noticed some things that he sometimes forgets to do. Sometimes his movements in swinging his arms from side to side are not big and fast enough. Sometimes he doesn't lift his head and swing it along with his arms. Sometimes he doesn't remember to punch forward with his top arm at the end. But sometimes it seems like he’s doing all that but still can’t get over.

So after he gave up on getting over himself, I lifted and bent one of his knees toward the other leg and gave his hip a little push as he swung with his arms. This got him over. I gave him his chain loops, which the OT had just given him this morning (one person at Shepherd sews them for all the patients and she somehow had never received the email from the OT placing the order for Gary’s), and he went through his series of stretches while I went to the car and got our hometown phone book. When I got back, Gary had finished stretching one leg. Before starting to stretch the other, he used the phone book and my cell phone to call our bank to make sure there was enough money in our account to cover the check we were about to send off – the required 50% down payment for the garage.

After the call and after he finished stretching, Gary asked the tech, who was working with someone nearby, what she was going to have him do. She told him, and since he would have to be in the chair for it, his final task with me was to get to the edge of the mat and sit up. Somehow in trying to figure out how to do this (again, limited by what he is allowed to do because of his flap) we ended up with him having his head curled up against the wall at the top of the mat. He was stuck there. Because of my back I didn’t dare chance lifting him to an upright position; fortunately it was time for the tech to have her session with him. She came over, saying, “Gary, what are you doing way up there?” We gave ironic laughs and briefly explained. She grabbed onto trunk on one side and I helped push on the other and we got him upright. (And we’re going to be ready to go home in one more month? The therapists claim he’ll see more and more rapid improvement as the weeks go on. They’d better be right!)

She had him work on the rickshaw first. Then came his most difficult strengthening exercise yet. At the parallel bars, he was supposed to press himself straight up, hold for five seconds, then lower himself (no plopping down allowed) – fifty times! He was to do it in five sets of ten. After the third set, it was time for him to do a weight shift, so he used the parallel bars for a depression weight shift, holding himself up for a minute. He said that was the longest minute he’d ever experienced. He and I thought that would count for at least one set of the “dips” but the tech would have none of that. He forged ahead and triumphantly finished all fifty dips, noting that when he’d first come here he wouldn’t have been able to do even one dip. I told him that his upper arms were about twice the size around as they were back then, and it’s true.

The tech wasn’t through with him yet – he did ten minutes on the hand cycle, stopping for rests as he did last time. He was very glad when the clock struck noon and after lunch said that since he’d had three tough sessions with his therapists – the OT, the tech and me :-) – he deserved some ice cream as a reward. I gave him the eye ;-) but brought him some Hagen Daz.

After that we went back out to the gym for his PT session. She wanted to take him outside to try out these other power-assisted wheels (again, they don't do all the work, but provide an assist so he only has to push the wheels about half as much as he would with a completely manual chair). She suggested we go to Chick Filet, which was in the opposite direction as Fresh Market and not quite as far. I thought maybe we should go to Fresh Market so he could really compare the difference between using these wheels and his regular chair. He said he’d prefer to go somewhere different. I suspect that the fact that the trip to Chick Filet would be uphill on the way there, and therefore down on the way back (the opposite of Fresh Market), played a role in his decision.

He liked the wheels a lot; they have only one speed, not the two the other power-assisted wheels he’d tried had had, but he found the chair much more controllable. Strangely, though, a couple of times when he turned the power off, like to go down curbs, it didn’t always turn back on right away after he pressed the power button. The PT would jiggle the cord from the battery to the wheels and press the power button several times and eventually the wheels would turn back on, but we never figured out just what the problem was. Unfortunately one time they wouldn’t work was when we were crossing an intersection, and the PT had me wheel him across it because we were in danger of the light changing on us. I was already sore from wheeling him back from Fresh Market, and this didn’t improve that state.

At Chick Filet, Gary negotiated the door (we had to tell the customer who came and opened the door for him that we didn't want help, that Gary was practicing opening doors by himself). Then he got himself a lemonade, remembering to ask for a lid for it since he was going to have to carry it between his legs (though that isn’t allowed with hot drinks). Even with this precaution, he spilled some on him when he flicked the straw. Fortunately it was only a little bit, so we didn’t need to head back so he could put on other pants (he is not supposed to ever be in wet clothing for any length of time). This incident taught us the value of him carrying along a change of clothes on any excursion.

We checked out the heights of the tables, and they were high enough that he could roll his chair under them. We went to a booth, and the PT told him that when he had his transfers down, if he wanted to when he was in restaurants, he could transfer from his chair to the booth and vice versa; some people did that, others preferred to remain in their wheelchairs.

On the way back to Shepherd, since we were now on the opposite side of the street from it, the PT showed us how to get to the tunnel that goes under Peachtree and leads to Shepherd. She pointed out that we can use the tunnel on a trip to Fresh Market, for instance, in order to avoid crossing Peachtree, as it is a very busy – and narrow – street (on our way to Fresh Market I had made Gary travel on the inside of the sidewalk, to try to avoid any mishap of his chair veering into the street, hoping that he wouldn’t veer and knock *me* into the street).

Upon our return to Shepherd, Gary told the PT he really liked these power-assisted wheels, so now is thinking of getting them for use in getting about campus (but not at home or in the math building). He'll have another week to try them before making a decision. One thing of which I want to make sure is that he is going to be able to lift the wheels and get them on and off his chair without much difficulty – they weigh twenty pounds apiece.

Back in the gym, the PT helped him transfer to the mat. Then she had him practice moving his seat cushion from the chair with the power wheels to the chair he’s been using – once again this was a reminder of how every little thing he has to do has now become something that has to be thought through. He got the cushion over to the other chair, but since he'd used a “fling it and hope it lands in the right place” technique, she had him do it again, giving him tips of how to balance to get the cushion where he wanted. He wasn’t quite successful, falling backwards onto the mat in the process. The PT pointed out that once again he hadn’t flung his hands backwards to stop his fall, but rather he’d tried to reach forward and grab at the mat, which hadn’t worked yet. She warned him that on Monday they were going to go through an exercise where he would sit on the mat and she would push him backwards, trying to make him fall over. She said it had to become second-nature for him to fling his hands backwards.

As he and I went back to his room after that session, a nurse stopped us and told us that our team nurse, OT, and PT had cleared us for a push pass, and all was needed now was the okay of Gary’s doctor or the resident who worked with the doctor. We asked when we could get that, and she said she would put in a call to the resident. She did so, and before we’d even gotten to his room she yelled that she’d gotten the resident’s okay and we were now all clear for a push pass! So we can now take any little trips around here that Gary feels up to (as “pedestrians,” I mean). Gary said he wants to go to the nearby Mexican restaurant soon. This caused him to recall that only a relatively short time ago, he’d somehow gotten it into his mind that he was going to have to "eat" through that tube in his stomach forever. More dismaying, he’d thought he was going to have to be on the ventilator for the rest of his life, that perhaps there were people with his level of injury who couldn’t be weaned off it. Progress had seemed so slow at the beginning of his recovery.

So I guess when I’m thinking how slow things are proceeding now, I should recall what things were like just two months ago.

We went back to his room, and I planned to leave for my walk/meditation/cooking dinner break about a half-hour early. It was not to be. Earlier I had overheard Gary’s new roommate talking on the phone with his sister (as I indicated, it is impossible not to hear every word of both ends of the guy's conversations), her saying how she was having difficulty in finding a place to stay here, so I’d gone to his part of the room and told him I had done some investigating of the possibilities, that I'd checked out the hotels on the list Shepherd had given me and had also found some promising hotels via the internet. Evidently he'd passed that information on to his sister when she'd arrived in his room (in his quarter of the shared room, that is), because she stopped me as I was leaving and asked to know what I’d found out. So I got out my notes containing that information and went over my discoveries with her. Then I headed to the elevators, only to find they weren’t working because Shepherd was having a fire drill. Even after the drill ended, the elevators didn’t work. A nurse walked by and told me and the other person who was waiting for the elevator that they were broken and that we needed to walk down the passageway to the Marcus building and take those elevators. I headed that way. I had a brief twinge of conscience as I tried to leave the other person in the dust, rationalizing that Shepherd wanted their patients to be as independent as possible. This patient was lying on her stomach in a bed and the way she was getting around was to push the big wheels at the front of the bed – a wheelchair bed. I had done enough pushing lately and I feared for my back if I tried to push an occupied big bed. But when I was about half a hallway ahead of her, I heard her calling me. Sure enough, she wanted me to push her. How could I refuse? So I pushed her to the Marcus elevator, dragging my rolling suitcase behind me, and then we went down to first floor. It turned out she wanted to go all the way back to where the Shepherd elevators were, make a left, and go out the door there to the outside. So I began pushing her in that direction. As we approached our destination, she told me that the purpose of this trip was so she could have a smoke. I felt like pushing her bed, her in it, out the nearest window ;-).

I had to go to the grocery store after that, and upon my return to the hotel, I balanced my bag of zucchini on my roller suitcase. As I got to my stairs, a worker at the hotel asked me if I wanted assistance. I said sure, and he took the suitcase. I started up the stairs then turned to tell him the handle on the suitcase could be pushed down and it might be easier to carry that way. “It would be,” he said, continuing to carry it with the handle fully extended, “but you know us men, always having to do things the hard way.” We had a good laugh at that.

While driving back to Shepherd in the evening, I stopped at a red light behind a car that had a dog in the back seat. The dog had a little routine. He would run to the passenger side, make a U-turn, run to the driver’s side, stick his head out the window and look all around, the repeat this procedure again and again, all at dizzying speed. Why do dogs do things like that?

Back at Shepherd it was obvious that Gary’s roommate had been given his pain pill again – they’d evidently tried to make him go cold turkey, which IMHO seemed rather extreme, going from a pill every four hours to nothing. All evening he was in a really good, talky mood, calling various people on the phone or talking through the curtain to Gary – basically, the man was flying. I’m not sure what he and/or his medical team have decided to do about his pain. He and his wife had told us that they’d talked to his doctor about it, his doctor being the same as Gary’s. His doctor had said that he himself still has pain (and I think it’s been at least fifteen years since his accident), and that in fact right then as they spoke he was having strong burning pain (which was situated nowhere near where his injury was – the pain can be anywhere). But, the doctor had continued, rather than live on medication he chose to not take any and to just cope with the pain.

Back to us. Gary and I went through our nighttime routine – personal care stuff, stretching him, and once again me taking care of his skin wound. I cleaned it, put the various medications on it, and covered it; when I was nearly through he asked how much longer it would be. I said I was almost done and asked why he’d wanted to know. He said because it took the nurses about two minutes to do it, and it had taken me over twenty. I said they’d had a lot more practice and if he preferred the nurses to do it, then that was fine with me. He said he trusted me to do it right more than he trusted the nurses. I sure hope that trust is well-placed.

We again had a hard time carrying on a conversation during the evening visit because of you-know-who’s speaker phone. Gary joked that the two of us should get megaphones, maybe give the guy a taste of his own medicine, with the added benefit that Gary and I would be able to hear each other ;-)

All for now.