How do you tell an undefeated patient that there perhaps might never be a road to recovery?
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Will I be able to walk again?” Ronald asked me, peering deeply into my eyes as I stood next to his hospital bed. Three months ago, in another country, he was waiting at a red light on his bike when a truck lost control and thrust into him from behind, transecting his spinal cord and leaving him paralysed below the waist. He had surgery back home to realign the spine, which they did with some screws and rods to stabilise the broken fragments, but, as expected, with an injury of this nature, there was no gain of function in his lower limbs. He was transferred to our hospital for extensive rehabilitation.
The short answer to his question was “no”. The long answer was also “no”. But how do you tell that to a 45-year-old father of two sprightly children, an image of whom I could see on the screensaver on his phone. He had left them behind with his parents and had travelled here with his wife, promising them that he would come home walking in two months. “My hands are fine,” he said, raising them up and opening and clenching his fists. He had rounded biceps and chiselled forearms, probably from using them to move his torso around. “But I can’t feel anything below my chest,” he mourned with a listless anguish. “I don’t even get an erection.” He pointed to the urine bag that his catheter drained into. It had flaky sediments that made the urine appear hazy; a consequence of prolonged catheterisation.
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I gently lifted the blanket off him to examine his legs. He had no power. He couldn’t move at the hip, knee, or ankle, even though the grimace on his face showed that he was trying. He couldn’t even wiggle his toes. He had no sensation from below his chest to the soles of his feet. “And yet, everything below feels so heavy,” he said, miserable.
I helped him onto his side as he wanted to show me his bed sore. Like an asteroid had landed on his planet, he had a crater on his buttock, with dying skin of varying hues sloughing away and tracking down to bone. “This is what we need to fix first,” I told him. “Without this, we can’t do any physiotherapy. We’ll get a plastic surgeon to clean it up and rotate a muscle flap over it.” His melancholic expression told me that he wasn’t interested in the technicality of any of it. “I just want to be able to walk,” was his doleful one-liner. “We’ll get there,” interjected his wife, who was standing beside him. She was half his size, but was astonishingly able to transfer him off the bed onto a wheelchair all by herself. “What doesn’t kill you makes you stronger,” she reminded him, summarising the story of their togetherness.
I ordered some investigations and explained to them a plan for what we should do over the course of the next few months, which they agreed to. I walked out of the room and stared at my feet for a full minute. I stood on my toes, on my heels, and did a squat. I thanked God. As neurosurgeons, even though we treat patients with spinal cord injuries all the time, this man’s pain felt unbearable. The heartbreak in his eyes was as tangible as the dysphoria in his voice. However hard we try, we can never fathom what these patients must be going through. I sometimes wonder what’s worse—to have an
active mind in a paralysed body or a functional form with loss of insight, judgment, and creativity?
About half a million people globally sustain a spinal cord injury, annually. A majority of these are young adults. The social, cultural, and economic burden of this is unconceivable. Its impact on the immediate caregiver is beyond belief. The assault on their emotional and sexual needs is just as devastating as the damage to their sensory and motor function. Physical barriers to basic mobility result in their exclusion from society, ensuing in a plethora of mental health issues. Billions of dollars are pumped into research to enhance recovery of spinal cord function with no promising results that could be universally applied.
“Why am I still not walking?” Ronald questioned me after a month. His bed sore had healed and his rehabilitation was in progress. “We’re building strength in your upper body so that it’s strong enough to support your crutches when you stand,” I deflected. Every time we chatted, he spoke in the same monotone without blinking his eyes. Day after day, I went into his room and we talked for about 20 minutes or more. On some days, I took him down to the cafeteria and we spoke there. I got him a book to read. We cut a cake on his birthday and got all the hospital staff to sing for him, but it barely turned the corners of his mouth upward. “How about we watch a raunchy film?” I tried, willing to sound inappropriate. He didn’t concede.
I recalled lines from a poem by Australian author Erin Hanson. It starts with “They say happiness will find you/ But I think sadness will find you too” and goes on to say, “You can’t remember how it started/ And you don’t know when it will end/ But you know that you’d give anything/ To stand up on your feet again/ Sadness is that feeling/ When the falling doesn’t stop/ And it saps your life of meaning/ And of the good things that you’ve got.”
Every day, I would pause before entering his room. I would close my eyes and take a deep breath, then enter sounding loud and chirpy, but he looked at me with those brooding eyes and a tediousness in his voice, as though he could see through the facade. “When will I walk?” his grief questioned me, almost making it seem that I was the one responsible for his infliction. The physiotherapist showed him videos of his improvement, but he refused to acknowledge those. From being unable to sit, he was now standing with calipers and holding onto a monkey bar, but he was nowhere close to walking, even with any kind of support.
On my rounds one morning, I saw all my patients on his floor but didn’t enter his room. As I was heading to the next ward, the nurse reminded me that we hadn’t seen Ronald yet. “I can’t,” I told her, defeated. “It exhausts me completely and I have nothing to offer that makes any kind of difference to him,” I conceded. We had failed him. His wistful eyes and his despondent voice told me so.
It’s been three months and Ronald is still at the hospital. He does his physiotherapy religiously and is making progress. He still cannot walk. Maybe he never will. But he hopes. As do I.
The writer is practicing neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals.
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