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Of course he spoke of the injury as a bruise to the spinal cord and that doesn't mean anything to you.
Then after a while it starts to come through to you in various little ways.
And when it really hits, you fall into this bottomless pit.
This is the Rehabilitation Institute of Chicago in which I serve as a staff physician.
It is a hospital for the physical and emotional rehabilitation of physically handicapped people.
Its purpose is to help the disabled person regain the highest possible degree of independence in daily living.
When they took me from the hospital to the Rehabilitation Institute, well, before my accident I had no idea that it even existed.
I was a very optimistic person.
I didn't know what it meant to be paralyzed from the waist down.
And even if I had known what it meant, I didn't think that the idea of rehabilitation would have ever occurred to me.
When I finally entered the institute, I was very optimistic.
I had heard about some of the things they had done for people.
And I think that my family thought, and I guess maybe I did too, or at least I hoped that I'd walk out like I was before.
You just can't imagine yourself never walking again.
There are traces of quads and the hip flexor is stronger, a lot poorer than the hip extensors trace to hamstrings.
There's some trace, but I, in other words, but...
Scattered.
Scattered.
She didn't have any pain during the time that she did this evaluation, did she? No, but she was a little bit hesitant about sitting up and I had to do most of the support.
You don't have any pain in your back, do you? No.
Would you try sitting up for me and see if you have some abdominals? Try sitting up for me, would you? Tell me if you have pain.
That's good.
Gosh, that's very good.
She did better for you than me.
Fair plus.
At least, good.
I think you're going to do very well.
The problem is a long one.
The next patient we're going to discuss this afternoon is Audrey Peters.
This is a case of a 27 -year -old female who was involved in a car accident.
I discussed Audrey's case with the staff during her first week at the Institute.
Rehabilitation of any patient involves a coordinated effort.
During these meetings, we evaluate each person's handicap, determine realistic goals, and then plan the patient's therapy program.
Audrey has some scattered voluntary musculature in the lowers.
However, she's completely dependent.
When she first came in, Audrey's hospitalization was covered by...
Consideration and planning are provided not only for the physical rehabilitation, but for the social, emotional, and vocational needs of the patients.
The therapists, the nurses, the psychologists, vocational counselors, and the medical social workers are oriented in every aspect of rehabilitation so that an effective team approach can be carried out.
The family itself has been terribly frightened by this catastrophe to their daughter and really have not been able to give her any kind of emotional support.
Audrey came down for evaluation on the cart.
She was completely dependent as far as activities of daily living.
We did a muscle test and this showed her to have normal upper extremities, normal trunk muscles, some weakness due to disuse.
Our orders call for the tilt table.
First of all, we'll start her on that.
We'll get her up in a wheelchair.
We'll start on a mat program for range motion.
We'll do muscle reeducation to her lower extremities.
And Audrey looks like a very good prospect.
Rehabilitation Rehabilitation is a long and repetitious day -by -day affair.
It is a tedious, often painful process of regaining strength in the hand.
It is mastering the use of an artificial limb while facing the frustration of learning to do those things that were once so very simple.
Rehabilitation is speech therapy and learning to say the words that disease or accident have made so difficult.
At times, it can be something as simple as tying a shoe, or it can be as meaningful as a word of encouragement.
The measure of rehabilitation is not taken in days or weeks.
But in the succession of little physical and psychological victories, it is measured by the restoration of a sense of dignity that has been lost with the burden of a handicap.
It is counted in the seemingly small victory of a little boy with a head injury regaining his coordination.
It is the total of an endless number of times a stroke victim struggles from his wheelchair to stand in the parallel bars.
It is the young girl learning to walk on a new leg.
And for each of them, the victory is beyond any measure at all.
All right, lock your chair.
Now, I want you to lift your legs.
The physical therapy gym is one of the focal points of rehabilitation.
It is here that the patients are asked to perform very specific exercises to build up strength, power, and endurance in those muscles and limbs over which they still have control.
It is through the skill of the therapist and the use of hydrotherapy, exercise devices, heat treatments, and other special equipment that the patient begins to move again, whether it be in a wheelchair, on crutches and braces, or with artificial limbs.
I remember one of my first weekends home, we took my little sister to an amusement park.
They do that at the institute.
As soon as you're physically able, they like to get you home on weekends, so you get sort of used to the outside.
Or maybe it gets the outside used to you, I don't know.
Anyhow, it was really my first time out since my accident, and I remember very well how people reacted to me.
Some people would glance over and then try to act as if they hadn't seen me, and others would just plain stare.
That's when I first realized what it means to be handicapped.
The occupational therapy department complements the work in physical therapy through the use of various creative and manual activities such as weaving, printing, and woodworking.
Depending on the patient's specific needs, projects are devised to contribute to strengthening weak muscles or developing coordination or building up endurance.
This kind of therapy not only helps the patient physically, but gives him a sense of usefulness and the satisfaction of having something to show for his efforts.
Okay, let's try the other one.
Okay, I'll fix it there.
Okay? Now, standing up, I want you to pull with your arm, keep your head forward, and once your feet are on the floor, pull your hips forward, okay? Do you think all these exercises are really going to pay off? Yeah! You want to, uh, ready? Okay.
Now, pull.
Ready? Let's go.
One, two, up.
Come on, pull.
There.
Come on.
Now, get right.
This time, pull on your arms and keep your head down, okay? I'll tell you when to get it up.
One, two, up.
Come on.
There.
Now.
Get your hands forward.
Get your arms.
Slide your hand forward.
Come on.
Oh, my goodness! Oh, your feet are wide open.
Okay? Have you got...
Okay, just stand there one minute.
I feel better if you just hang on.
Well, we'll get your feet closer together, and just hold on.
There.
Just stand up one minute.
Okay, now lift your hips forward and get your head back.
I really think that the emotional motivation is one of the most important things in rehabilitation, because all the physical therapy and occupational therapy in the world aren't going to do you any good if you don't want to get better.
Also, you don't start making any progress until you begin to accept the reality of your handicap.
The first month, for instance, I was so sure I was going to walk out of there just like I was before, that I figured it was only a matter of time, and I worked like a demon.
I decided to fight this thing.
I wasn't going to let it beat me.
But what you come to realize is that for most people who have physical disabilities, no matter how hard you work, you're not going to be the way you were.
You might get a lot of return of function.
You might even be able to do a lot of things for yourself.
But the chances of being exactly the way you were really aren't very good.
So after a while, I decided to quit kidding myself, and I fell back into my depression, and for a long time I didn't care about anything.
It's hard for me to describe how I felt during that time.
All I can say is that as soon as you have a physical handicap, you have an emotional problem too.
And sometimes the emotional problem is really more of a handicap than the handicap itself.
When I think about the despair, the continuousness, sometimes I think to myself, if I could just get out of this, just be my old self for a weekend and get some release.
But there was no release.
It was just constantly with me.
One of the things that hurt the most was, well, before when you'd walk into a room where there were men, or pass them on the street, you'd get those glances, the look.
But when you're in a wheelchair, you get these piteous sort of, well, it's not the same.
And it hurts.
It really does.
I guess it must be even worse for a man.
I think I've seen this before.
I think I've seen this before.
I think I've seen this before.
I think I've seen this before.
I think I've seen this before.
I think I've seen this before.
I think I've seen this before.
I think I've seen this before.
I think I've seen this before.
I think I've seen this before.
I think I've seen this before.
I think I've seen this before.
I think I've seen this before.
I think I've seen this before.
I think I've seen this before.
I think I've seen this before.
I think I've seen this before.
I think I've seen this before.
You can't fight this thing alone.
I'm convinced of that.
You can't do it by yourself.
I had a lot of people pushing me, really.
Sometimes I'd wonder why they all bothered.
All this time, the effort.
When I felt so completely worthless.
I remember once I said to my OT, Look, I don't care.
I just don't care.
Apparently there's something missing in my personality, but I just don't care.
That's how I feel about it, so let's forget about it.
But she didn't.
She understood.
The general atmosphere and the institute helps, too.
It's very important to see people like yourself.
Because when you're alone in this thing, you think you're the only one.
And it's very depressing.
But when you see other people who were also independent once, It sort of relieves the feeling that you've been singled out somehow.
The thing that amazed me the most was everyone's attitude.
There were people there who were a lot worse off than I was.
Who somehow managed to live with themselves.
And to be happy in their way.
Under the circumstances, you'd expect a cloud of gloom to hang over the place, but it's really not like that.
In this respect, the human spirit is a remarkable thing.
People have their ups and downs, but everybody sort of jollies everybody else along.
And that becomes part of the therapy, really.
I mean, it's inspiring to see other people fight.
And it's a contagious thing.
To watch someone else make progress.
And it gives you a great incentive.
You feel, if they can do it, so can I.
One of the hardest things to do is to forget yourself.
I saw myself not as me, but as a cripple.
Of course, that's past now.
I don't think of myself as being different anymore.
In other words, the consciousness of me is not the consciousness of me the paraplegic, but of me, Audrey.
But me the paraplegic lasted for a long time, and I only lost it very slowly.
In fact, I still remember the first time I really forgot myself.
One of my roommates was a quadriplegic.
And when Peggy first came in, she had no control over anything below her shoulders.
And of course, she had to be fed.
Well, we always talked about the time when she'd get enough muscle return so that OT could make her a splint and she could feed herself.
Well, it might not seem like much to someone on the outside, but for Peggy, it was a step on the way back.
She was able to do something for herself.
And I remember that I suddenly realized that I'd forgotten I was me standing there in my braces.
That was the beginning of forgetting me, the handicapped person.
In essence, I feel we can think of rehabilitation as the restitution of the feeling of personal dignity.
This only comes with being able to do things for yourself.
From the time a patient enters the Institute, he is encouraged to do as much for himself as possible.
It may seem a small thing to push a tray through a cafeteria line, select your food, and to eat with other people.
But this allows a patient to resume as near normal a situation as can be created in a hospital.
Various social and recreational activities and the mere presence of other patients, staff and volunteer aides, are part of the total effort to bring a patient out of himself.
Audrey has shown very good progress in physical therapy.
Her grades have gone up to fair plus and better on the right side, particularly the right side, right lower extremity.
And we are considering cutting down that brace to a short leg brace.
Activity of daily living is perhaps one of the most important areas of treatment and rehabilitation.
Its purpose is to help the patients overcome the feeling of dependency by giving them a chance to practice routine daily activities.
Along with this program, a series of pre -vocational examinations are conducted.
We try to simulate on -the -job tasks, which are used to determine the level of complexity of work that can be performed as well as the physical demands that can be tolerated.
Patients who have been less seriously handicapped or who are able to regain a great deal of function often are able to take over the household chores again.
Some patients who have been upgraded very significantly can go back to their old jobs and in many instances can go home again with the prospects of leading an almost completely normal life.
I think there are two things on the outside that always remind a disabled person of his handicap.
One is doors that are too small to push a wheelchair through and the other is stairs.
Well, in the PT gym there were four practice steps and I knew that if I was really going to make it back, I was going to have to be able to climb those steps.
Before my accident, I don't think I ever thought about how many places there are that you just can't get into unless you walk up a few steps.
Maybe it's only a curb, but for a person in a wheelchair or a person in braces, it becomes a mountain.
I remember saying to myself, you've always wanted to climb mountains, so here's your chance.
And that's exactly what I felt like I was doing.
I think this patient has done extremely well.
I think her ambulation is quite efficient.
Her efficiency can be improved with further practice.
However, at this point, I think she has essentially reached a plateau and has tapped our resources for the most part and is ready for discharge.
A physical handicap is something you never get away from completely.
And I knew before I left the institute that I'd never be able to do the things I really love to do.
Tennis, swimming, walking in the sand.
These are things I've told myself don't matter, yet I know they really do.
But you find other things and you begin to have longer and longer periods of happiness.
The first summer after I left the institute, I went back to finish my master's degree at Illinois, and I think that was my first period of any sustained happiness.
There were other handicapped people there and I started meeting fellows and I was going out on dates and I really felt like a girl again.
You know, I didn't feel like a parrot.
I felt like a girl.
And from there it became longer periods of happiness.
You learn to do things for yourself.
You learn to drive.
You get your own apartment.
And finally when you get a job, well, this is really it.
You're doing something.
You've really made it back.
I'm going to go to the gym.
I'm going to go to the gym.
I'm going to go to the gym.
I'm going to go to the gym.
I'm going to go to the gym.
I'm going to go to the gym.
I'm going to go to the gym.
I'm going to go to the gym.
I'm going to go to the gym.
I'm going to go to the gym.
I'm going to go to the gym.
I'm going to go to the gym.
I'm going to go to the gym.
I'm going to go to the gym.
I'm going to go to the gym.
I'm going to go to the gym.
I'm going to go to the gym.
I'm going to go to the gym.
I'm going to go to the gym.
I'm going to go to the gym.
I'm going to go to the gym.
I'm going to go to the gym.
I'm going to go to the gym.
I'm going to go to the gym.
I'm going to go to the gym.
