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Four Quads (Quadriplegics)
During a recent trauma shift I met John (name changed) (quad #1), a vibrant C5-6 quadriplegic with a wonderful new wife, a brand-new van (now totaled), and recent baby he had conceived in the “natural way.” Since his diving accident in high school John hadn’t missed a beat of the drum of life. His eyes and smile lit the room from the trauma gurney where he recounted the funniest story we had heard in some time in the ER.
C5-6 ‘quads’ (cervical transaction between the C5 and C6 vertebrate two levels below Christopher Reeve’s injury) can actually control part of their arm and shoulder, not a complete quad as we think it. The higher you transect, the more you lose. Christopher Reeve breaths with help of a ventilator. Two levels lower, at C8-T1, you can use your hands. Spinal injuries almost come in clubs because the deficit patterns are so specific, depending almost entirely spinal injury level.
In sum, at C5-6 one can pull but not push, with no finger movement. But if notched into a steering knob on the right hand, and a modified throttle and break on the left, a quadriplegic at C5-6 can, barely, but safely, drive an adapted car, usually a van.
Years ago, my uncle Ted (real name) (quad #2) let me drive his van in college when he wasn’t using it, so I am personally familiar with the controls. He had broken his neck being active too, as a helmeted motorcyclist enjoying the Oregon countryside where I grew up. Like John, my uncle Ted’s injury ignited his spirit and appreciation of life. Ted taught me medical lessons long before medical school, especially about spinal cord injuries.
For John, getting his new van was Christmas and a birthday rolled together. Freedom. An open road. Less dependence.
John was out for his second test-drive, on a local highway when his throttle jammed. 55, 65, 75, 85, 95mph. Quite a powerful engine, more so than the brake which shortly ground through after dropping the speed to 40. The engine overpowered the brake. Back up. 45, 55, 65, 75, 85…….
John is quite a storyteller, even from the gurney; his facial animation makes up for his lack of coordinated arm movement, even imitating the 8-cylinder engine noise accelerating back toward 100mph.
John’s wife gazed glowingly as he came to the climax of the story. “I figured I better get off the highway or I was going to die.” Sure enough.
Off-ramps can’t take those speeds, so John just jumped it. Through a perimeter fence, traversing an open area, piling an inner fence, smashing a barrier, over a curb. Each obstacle absorbing some speed. Down to zero, stalled in the dirt.
But the only reason to have such an open space in the crowded Bay area was that this was Lockheed’s military research wing. And all the security guards saw, or at least what they reported to the S.W.A.T. team, was that a white windowless van has just penetrated all their defenses at 80mph.
Helicopters. Sirens. M16’s. Laser sights. “I was lit up like a Christmas tree.”
“Step out of the car.” The megaphone boomed.
“Hands over your head.” Came the second request.
Neither of which is really possible with a C5-6 injury.
“If I still had my goatee, I think I would have been toast.” John proposed.
Certainly, the post 9/11 anxieties accented the whole affair.
Eventually, the laser sights lowered; an ambulance was called (just to be safe). This brought John’s pleasant story, and happy conclusion, to the tail of my long shift during which two others had died in unrelated illnesses.
I admitted John to the hospital just to be sure his sore neck was ok. It was -- CT scan negative -- and he went home today.
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I never learned the name of Quad #3; I will call her Julie. We briefly met in the hall one fresh Sunday morning near the spinal rehab which is in the same wing as the ER. Her injury was fresh, as evidenced by the back brace she wore. Hands flat, electric chair movement controlled with her chin -- a C4-5 injury at best.
Julie’s mischievous grin and presence in a main hallway made it clear she was playing hookie from the rehab unit. I enjoyed Julie’s smile so much that I circled back around a parallel hallway for the privilege of greeting her smile again.
A study on quadriplegia and happiness showed that, within 2-3 years, following the initial shock and regrouping, that quadriplegics usually return to their baseline levels of happiness. Julie didn’t seem to want to wait that long. Her smile radiated so deeply from within that it seemed to be formed more by her spirit than her lips.
Although I’m usually happy, Julie’s grin and playful laughter as she hid from the nurses and basked in the morning sun, made me wonder how long, with all this medical education, it had been since I had smiled and laughed like Julie did, so fully consumed in the moment.
Sometimes, people ask those who work in the trauma center and public hospital how they work around such pain and suffering. Good question. I think the acuity of events often stirs a sleeping authenticity we seldom get to enjoy from others.
I have come to enjoy helping trauma patients, not for the blood, nor even for the trauma at all, but because, for windows of brief lucidity, the entirety of humanity, decency, and compassion sometimes emerges. Priorities are set right. Bonds of family and friendship are polished and reinforced. I like medicine for this, emergency medicine in particular, because it reminds me, as it reminds the patients, of the echo of the meaning in their lives.
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Quad #4 was a lesson in assumptions. Drunks and drug addicts often arrive in cervical collars to protect against potential neck injury (as do about half the ambulance patients). Recently an ambulance arrived with a patient (I will call him Brian) for transfer to ‘rehab.’ He appeared disheveled. At first glance, this garnered a homeless appearance.
One of the ER nurses asked the paramedic “which drug,” which is a fair question as someone enters drug rehab. The sober patient piped in, “I just broke my neck at C6.”
Spinal rehab, not drug rehab. We all took a breath. For us, a little collective humility; for Brian, a new life trajectory.
I walked over, laying a hand on his shoulder, looked Brian directly in eyes and told him we would do everything we could, meaning that rehab would. I tucked a loose blanket in. My Uncle Ted had taught me long before my medical school that quadriplegics have problems with heat regulation; perhaps Brian was already too cold and didn’t know it. With complete lucidity, he just said “thank you.”
In the past hour since the injury, Brian had clearly lived a year -- obviously, visualizing his new life, or trying to. He stared straight up, watching the ceiling go by as the paramedics whisked him off to spinal rehab.
I hope he gets to work with Julie during therapy.
-Dr. Michael McCullough |