Miracles Take A Little Longer
"The Longest Journey Starts With A Single Step"
Lao Tze (Ancient Chinese Philosopher)
11.1 "....there are only three steps to heaven...."
I was collected one day, taken to the treatment room and helped out of the wheelchair by Sarah who, having settled me on the bench disappeared, returning a few minutes later with a walking stick.
"Right," she said. "Iím not absolutely certain you are ready for this but I am going on holiday for three weeks, youíre about to have your second weekend at home and I know you are very close to being ready so I want to be the one who is here when you take your first step. Do you think you can do it?"
"Not a problem, letís go for it." I said, planning how to fall gracefully in a way that that would ensure my head did not either hit any solid objects on the way down or bounce off the floor.
Sarah did the usual massage to coax some life into uncooperative muscles and then put me through the usual routine to work the knee, thigh and hip. We did practice steps with me leaning on the treatment bench and then came the big adventure.
What we had worked on was a rather peculiar adaptation of a bipedís method of walking. A person using a walking aid to overcome a weakness in the leg will usually hold the implement either in front or on the side of the body where the weakness lies. In this case there was no way that arm and shoulder were going to hold a stick or bear any weight. What I was going to do would look to the uninformed observer like somebody doing a very bad impression of Rolf Harrisí three legged man. I could not put my full weight on the left leg or hip and so would have to balance between dodgy left leg and a stick held in my right hand while the right leg lifted and swung forward. If Sarah was not confident I was the last person she was going to tell. I certainly was not confident but Sarah was the last person I was going to tell. Standing precariously in the middle of the treatment room floor, I was talked through the process walking by my physiotherapist seated in front of me on a wheeled office chair. We had an arrangement that in case of feeling myself falling I would drop the stick and grab her shoulder.
"Get the weight over your right hip. Now relax that left hip, let it go - let it drop. Near enough. Lift your knee and swing your thigh forward. Lift your knee, not your shoulder. KNEE." A tap reminded me where it was. "Heel down first, thatís your toe. allright, thatís almost your heel, and push your hip forward until it is over your foot. OK, good, but you did not push your hip forward, you held your spine stiff like a brush handle and moved that left leg forward by swivelling your right side back. Still, thatís half a step. Now the difficult bit. Shift your weight over to your left hip. Donít lean on the stick any more than you have to. Now relax the right hip, let it drop as you shift the weight across to your left leg, lift your knee and swing your leg forward." A full step, both legs.
"Now your weight should be over your right hip, release the left one again.
I tried to relax my hip. Nothing happened. I tried to lift my knee, nothing happened. Somehow that left foot had to get off the floor. Using the strength in my right side I held my body rigid, hoisted up everything on the left and with a turn of my body swung the leg forward. As weight fell on it, the knee snapped back as far as it could and locked but with help from the stick held me up as I repeated the right leg movement.
"Well, its a sort of step," Sarah said, but weíve a lot of work to do." We managed two more then the physio thought it was enough. She stood up and hugged me gently. "Your first steps."
"YYYYYEEEEESSSSSS." I leaped onto the treatment table and punched the air before jumping down, running out into the corridor and doing a lap of honour around the central quadrangle. Well, in my dreams I did. My true reaction was something like; "God, that hurt, but it was great."
I do not know if the any of the physios were taken in by my bravado or if they just humoured me. Honestly I was not physically ready for those steps, probably had not been ready to stand when I first wobbled to my feet a few weeks earlier. Determination and sheer bloody mindedness drove me to do those things because mentally it was necessary for me. The will, though it has no substance is the most powerful muscle we have but it burns a lot of energy and to fuel it we have to achieve goals and pass milestones to prove that progress is under way.
11.2 "....pick yourself up, dust yourself off...."
To anybody trying to get over such a major setback in the course of their life the achievement of goals is important and that is why I had to drive myself and blag my physio into doing those steps. We can only set our own goals and they must always be realistic and within (but near the limit of) our capabilities. And then we should reward ourselves by being visibly pleased with. This is what people do in everyday life when their goals may be to earn promotion or get a better job, they take a holiday or buy a new car as a reward. How many people have said "weíve decorated the sitting room so lets eat out." You have done well and so are entitled to feel pleased with yourself. Share the feeling, the world needs all the joy it can get. Do we not love more the athletes who, having won a gold medal or broken a record, caper around like crazy things, laughing, shouting and waving to everybody than the ones who just shrug and in an unbearably smug and self satisfied way say something like "I just went out and did what I came to do." Emotion is very human and joyful emotions make us more likeable.
Putting oneís own shirt on with one immobile arm is a big thing although it may not seem so to people who have not been there. For some people making a brew or a sandwich requires enormous effort. Speaking a simple sentence when the power if speech has been absent is huge progress. To say "can I have a drink please" can seem as exciting in those circumstances as scoring a winning goal or starring in a show in front of an audience of thousands..
When pursuing our goals it is always important to keep a sense of proportion, to leave ourselves room to fail and to find something to congratulate ourselves for even in failure.
"I didnít make it this time but I did better than most people thought I could," is fine. Be prepared to work at something a little longer or set your sights a little lower. Many time I said to my physio, "OK, we are going to walk across the room," (or later "to the end of the corridor") and then had to say "well we ARE going to do it but not today." Sometimes in going further than ever before my walk would still not be as far as I had hoped. Setting myself an unattainable goal helped me go beyond any previous achievement. Other times you just have to put problems down to the fact that youíre having a bad day. Failure can be turned into triumph just by looking at things from a slightly different angle so laugh at it, find success within it but never use it to beat yourself up.
The right attitude is a great tool in life, either for overcoming illness and coming to terms with it after effects, for dealing with loss or trauma and simply for getting to where you want to be. We must be careful however not to cross that faint line beyond which positive thinking becomes self delusion. Your positive thoughts should always come from yourself, donít buy into the pre - packed self help techniques peddled by so many pseudo - psychologists. Their promises are nothing but a cynical marketing ploy. Stick with me, I might be rubbish as a self - help guru but the most this book will cost is the price of materials to print it. And if you can read it on a computer screen it can be had free. (But please, if you enjoy the book and can afford to do so, send Different Strokes a contribution. Payment deatails are included in the Introduction.
11.3 "Öícos youíve touched her perfect body with your mindÖ"
With Sarah away on holiday Iíd been told my treatment would continue with another physiotherapist. Nobody mentioned who would work with me and I was not aware there was a queue.
(This was not because I was a sex symbol as Senior wind - up merchant Kathy might tell you, but because Sarah had told her colleagues that my "go for it" attitude made me rewarding to work with. Well, thatís my story and Iím sticking to it. The nurses and other female staff had decided I was "hot totty" or the nearest they were going to get to it in the Rehab unit. Uncharacteristically I was a little offended by this at first, it felt as if people were making fun. Still itís difficult to get a life while working in a hospital so if they wanted me to be hot totty on wheels I could try to indulge them.)
One day in early September, Catherine, a very pretty girl with magnificent red hair and a body that would have done credit to a Rodin sculpture, (This is Cathy with a C we are talking about, not to be confused with Kathy with a K who is equally beautiful but in a more Junoesque way; - confused? It gets worse; as well as those two and a Cath there were three Dianes a Jane and a Jayne on the nursing team, two Maxines in the unit, definitely more than one Barbara and so on.. Duplication of names seemed to be an integral part of Human Resources policy. Perhaps it helped assess the state of our memory) After a couple of sessions getting familiar with my problems, Cathy - with - a - C took me to a treatment room one day, helped me onto the bench and explained why the muscles in my back and left leg were so tight. I will not attempt a technical explanation but basically muscle tissue not communicating with the mother ship (brain) becomes lazy and shortens itself in the expectation that without regular instructions from the central nervous system, it can sit back and have an easy life. Cathy had other ideas.
We had a quick run through the way all the muscles linked together from neck to ankle and how this shortening effect was causing many problems. The main one, the one preventing the progression from taking faltering steps while holding onto something to being able to support myself and move using a walking stick, was that my left foot turned inwards. At that time I had little control in hip or knee, and no sensation in the leg to indicate my foot had contacted the floor. Walking involved getting the right leg into position, putting weight on it and then hoisting up the left hip, twisting to swing the leg forward and carefully putting the foot down, shifting weight on the leg and locking my knee only when I could see that my sole was flat on the ground. This meant looking at the ground constantly. In terms of ability to get anywhere my walking action made a lazy snail look like Benny the Dip.
Once we reached an understanding about what we were going to do, Cathy helped me to stand and made sure some of my weight was on my left leg and the knee was slightly flexed. The she stood next to me, right leg draped over my buttocks, her pelvis pressed against the hip, left arm on my shoulder and her right hand pushing firmly up the length of my back.
"Iím trying to promote some elongation in these big muscles," she said.
She was promoting elongation alright but it was not in my back. To avoid embarrassment I tried to focus my thoughts elsewhere by remembering all of Hamletís soliloquy but the only piece of Shakespeare that came to mind was "Oh, that this too, too solid flesh would melt." I changed tack and thought about a cricket match that was being played. The problem was solved in seconds and we had brought something back to life even if it was not quite what we had been aiming for. It would be many more months however before there was much progress in loosening muscles that were blocking my walking action.
11.4 "....tea for two...."
Big achievements like walking can be a long time coming but if they are the major milestones on the way to recovery we can be just as pleased with small achievements as illustrated by my second weekend at home
On the second home visit I had awakened early. It was late summer and a warm sunny morning. My bed was in the front ground - floor room of our terraced house. Teri had wanted to sleep on the couch but had let herself be persuaded that I would be fine alone and was upstairs. My first adventure was to raise the blind which meant wriggling around the bed until I could reach the cord.. The front of our house looked out over a wide valley towards Pendle Hill and it was pleasant to spend some time admiring the view. Then, as the clock had passed eight, I worked out a plan to surprise my wife with early morning tea. Sliding myself down the length of the bed and manoeuvring the wheelchair into an accessible position I transferred and scooted through to the kitchen, making a few chips in the paintwork on the way. Kettle, teabags, cups and saucers were no problem but getting milk from the fridge was a struggle. I managed it, poured out the tea and arranged cups saucers and a freshly filled milk jug on a tray. Getting this to the worksurface was going to be decidedly iffy but removing the tea things and replacing them when the tray was on the floor enabled me to propel it with the tip of my toe inch by inch to the living room. Problem. Bending to pick up the tray caused the chair to start tipping forward. Solution. Wedge one of the dining chairs against the table and wedge my non - operational foot against the chair thus enabling me to pick up the tray with my right hand and place it on the table.
For business reasons we had two telephone numbers so using the business (downstairs only) line I phoned Teri and invited her to join me for early morning tea. This effort made me so proud of myself that Gabby was dispatched later to buy champagne for a celebratory drink. I had set myself a challenge and succeeded, solving a problem along the way.
11.5 "Ösome machine is doing it for youÖ"
Taken those first steps with Sarah had encouraged my mind to get ahead of my body and build up the expectation that I would just progress smoothly, three steps today, six tomorrow, twelve, twenty - four and so on. It does no work like that of course and the steps were just a symbolic achievement, in terms of actually being able to get anywhere they meant nothing. The way my left leg had locked at the knee to make a pillar of bone rendered it no more use than a crutch. It would help me hobble around very slowly and painfully(20) but never get very far. Cathy had explained as she was lifting my leg through the step pattern that we had to retrain my brain to move muscles in a proper walking pattern by sending the correct signals. I still knew how to walk of course, but when the neuro motor responded to a request to walk somewhere by sending out a "walk" request, only one leg was listening.
A computer programme will link a condition to an action (IF A = 5 THEN DO CALCULATIONS) The computer executes instructions or "thinks" by moving static electricity from one location to another in its memory. If data is not put in the right location to create the trigger condition, nothing will happen. A brain is similar but much more complex and its code is chemical rather than electronic; for example the code might be IF DRINK = OVER THERE THEN TELL ARMS & LEGS "GO AND GET IT" We never consciously think through that line of code but the instruction is executed somewhere in the depths of intelligence. If the brain area where it should be executed is damaged however the data that is formed by the desire to walk cannot be moved to the right location where it will tell your feet to get going so nothing happens.
(Do you have a clue what Iím talking about? You do! Oh good because I think Iíve lost myself.)
OK, so I had lost the ability to transform the desire to walk or hold things into the muscle actions that would make possible the things I wanted to do. The links or nerve pathways in my brain had to be rebuilt or rewired through undamaged tissue. That was the task the physiotherapists had taken on.
Cathy with a C was a hands - on sort of girl as has been suggested and got right into the problem. First we tried to get the leg going on its own. With my right arm on the treatment bench to prevent falls, I took dummy steps, moving the paralysed leg back and forward. Cheating was easy and again my fit right side enabled me to hoist up my hip and swing the leg through. Few of us ever think how complex a series of actions is involved in walking so I recommend you get a better qualified person to explain it.
The redhead took me into the corridor and set about teaching me to walk properly.
It can be quite disheartening to learn that one has been walking since the age of one - and - a - half and forty - eight years later still have not a clue how it is done but Cathy was determined I was going to learn. First, standing behind, she took hold of my hips and showed me how to transfer my weight from right to left and back again.
"Now, lift your knee," she instructed. I hoisted up everything from my shoulder. The movement was doubly wrong. Not only should my left shoulder not have lifted everything underneath it but in doing it like that I should not have made my left shoulder move up by stiffening my entire torso and pushing the right shoulder down. What idiot coined the phrase "itís as easy as putting one foot in front of the other?"
Cathy did not know me quite as well as Sarah but was learning as quickly as I was finding out that learning to walk is not childís play, that in my case being capable of doing something and finding a way of doing it are not necessarily the same thing.
We ended up in one session with the physio crawling backwards on her knees along the corridor, lifting my knee and positioning the foot which still had a severe tendency to turn inwards. Those of you with bad minds may be thinking the picture it made resembled another image of a pretty young woman on her knees in front of a middle aged man in a corridor in Washington D.C. that was occurring around the same time - well close, but no cigar.
Actually it was a good job Sarah came back. By the end of my second week with Cathy I was finding it hard to concentrate on physiotherapy.