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I woke up in the morning feeling like I had hardly slept. Between the constant interruptions from the nursing staff and the discomfort caused by my breathing tube and neck brace, the last two nights had been restless. I was already missing the sedatives that had knocked me out for the first three.

It was a relief when Dr. Bone arrived for her morning rounds and, after examining me, announced that I was ready to be extubated. She had the respiratory therapist, Christopher, come in to remove my breathing tube. He replaced it with a nasal cannula, which was better because at least it allowed me to talk, although my voice was weak and hoarse.

“Your throat may be a little sore for the next few days, but it’ll get better with time,” he told me, as he listened to my lungs with his stethoscope. “The important thing is to take deep breaths. Because of your spinal cord injury, you’ve lost control of the intercostal muscles between your ribs, which help your chest expand when you inhale. Your lung capacity has been reduced to less than forty percent of what it should be, so you’ll want to keep your lungs clear and fill them with as much air as you can. If you were to develop any respiratory complications, like a collapsed lung or pneumonia, you’d probably have to be put back on the vent. I know you don’t want that.”

“Definitely not,” I whispered, feeling a flicker of fear.

“Yeah… the problem with that is, your abdominal muscles are also paralyzed, so you can’t cough effectively enough to clear the mucus from your lungs,” Christopher went on explaining. “What we have to do to help you out with that is called an assisted cough. There’s a couple ways we can do it. There’s a manual way, which involves someone else pushing down on your abdomen while you exhale to simulate a cough - I’ll teach you and your caregiver how to do that sometime before you’re discharged - but here in the ICU, we use a machine called the Cough Assist.”

My head was spinning. Caregiver? Cough Assist? This was all new information to me, and I felt overwhelmed as it dawned on me just how different my life was going to be, even after I left the hospital. I had been so focused on the past and present, I hadn’t thought that far ahead into the future. There was a part of me that had assumed I would regain the feeling and function in the rest of my body, that I would be able to walk out of here on my own two feet after a few weeks of rehabilitation. But now I wondered if I was being overly optimistic, hoping for something that was never going to happen. Would I be in a wheelchair for the rest of my life? Would I have to rely on other people to help take care of me? No one had told me what to expect one way or the other.

The anxiety must have shown in my face because Christopher suddenly put his hand on my shoulder. “Don’t worry,” he said reassuringly. “It’s basically just an oxygen mask attached to a machine that uses positive and negative pressure to make you take a deep breath and then suck the air and mucus out of your lungs, like a cough. Here, I’ll show you.”

It wasn’t the machine itself I was worried about, but I didn’t bother to correct him. I let him hook me up to the cough assist machine by placing a clear mask over my mouth and nose. When he turned the machine on, I felt air flowing forcefully through the mask. After a few seconds, I heard a loud whooshing sound, almost like a vacuum cleaner, and the sides of my face were sucked against the edges of the mask as the air was expelled from my lungs. It was a strange sensation, much different from normal coughing, but it must have worked because after a few rounds, I felt phlegm in the back of my throat. Christopher removed the mask and stuck a suctioning wand inside my mouth to get rid of it. The rattling sound it made reminded me of the dentist’s office, and I found myself wishing, for the first time in my life, that I was there instead. I would rather be anywhere but here.

“How does that feel?” he asked me, listening to my chest again afterwards. “Better?”

“A little bit, yeah.”

“Your lungs sound clear, and your oxygen level is right where we want it to be. All good signs. You’re doing great.” He smiled down at me as he draped the stethoscope around his neck. “I’m going to see some other patients now, but I’ll be back to check on you later. In the meantime, let your nurse know if you feel congested or short of breath, okay?”

“Okay. Thanks.”

After Christopher left, I tried to go back to sleep, but I couldn’t. My mouth felt as dry as the Sahara desert, and my throat burned. “Can I have some water?” I croaked to my nurse, Stephanie.

She gave me a sympathetic look and shook her head. “Sorry, but you’re NPO - nothing by mouth until you’re cleared to start eating and drinking again.”

“Can’t you just give me some ice chips?” I begged. “Just something to wet my mouth? I’m dying here.”

“I’m sorry, but I can’t. Doctor’s orders,” said Stephanie. “Don’t worry - you’re getting fluids through your IV, so you’re not really dehydrated. It just feels that way because your throat’s irritated from the tube.”

That didn’t help. Frustrated, I closed my eyes again to block out the fluorescent light and pictured myself in a cool, dark cave. The faint blipping of my heart monitor became the sound of water dripping down from stalactites. I would have happily licked the water droplets off the cave walls just to feel moisture on my sandpaper tongue. I tried to work up some saliva instead, but my mouth was so dry, I couldn’t even spit.

I had barely closed my eyes when Dr. Bone breezed back in. Lying flat on my back, I couldn’t see the door, but I recognized the sound of her dress shoes clicking on the tiled floor. They were different from the rubbery squeak the nurses’ Crocs and sneakers made. “How are you doing, Kevin?” the doctor asked as she came up alongside my bed.

“I’m thirsty,” I answered immediately. “Can I please have some water?”

“Not yet,” Dr. Bone said apologetically. “We need to make sure you can swallow safely first. When you have surgery on your neck, everything gets shifted around to make room for the hardware that’s holding your spine together. Sometimes swallowing is difficult or feels different in the days afterward. And since you can’t cough very well to clear your airway, you’re at a higher risk of choking or aspiration if food or water were to go down the wrong pipe.”

“Well, how will you know if I can swallow safely if you won’t let me try?” I asked, annoyed. It was bad enough feeling like an infant, incapable of doing anything for myself, but now I was being treated like one, too. Don’t give the baby solid food for the first four months, or he might choke. All I wanted was a sip of water!

“I’ll have a speech pathologist come in to evaluate you sometime this week. Once you’re cleared to begin eating and drinking again, we’ll be able to take out your NG tube.”

I wasn’t happy with her answer, but no amount of arguing or complaining would change her mind.

“How are you doing otherwise?” Dr. Bone pressed, finally forcing me to move on.

I didn’t know how to answer that, so I decided to be direct. “You tell me, Doc. Do you think I’ll be able to use my arms and legs again, or am I gonna be like this for the rest of my life?”

She pursed her lips as she looked down at me. “That’s why I came back to talk to you. It’s been five days since your surgery, so the swelling in your spinal cord should have gone down. Now that you’re able to speak again, I’d like to do a more thorough neurological exam to assess the level and grade of your spinal cord injury. That will give me a better idea of what kind of recovery you can expect moving forward.”

I didn’t think it was possible for my mouth to feel any drier, but somehow, it did. With difficulty, I swallowed and said, “Okay. Let’s do it.”

Dr. Bone washed her hands and snapped on a pair of gloves. “For the first part of the assessment, I need to do a quick rectal exam.”

I immediately regretted agreeing so quickly. “Uh… what? Why?”

“To see if a certain reflex is present. After a severe spinal cord injury, there’s a period of complete paralysis below the level of injury. It’s called spinal shock. It can last anywhere from a day to several weeks, but typically it resolves in a few days. If you’re still in spinal shock, there’s no point in doing the full assessment now because the findings could be completely different once it resolves. But if it already has, this assessment will determine your prognosis.”

I sighed. “All right… do whatever you have to do, I guess.”

With the help of my nurse, she rolled me over onto my left side and removed my hospital gown. For the first time, I was thankful I couldn’t feel her touching me. She must have found what she was looking for, though, because after a few minutes she announced, “The reflex is present, so we can proceed with the full exam.”

I took that as a positive sign, although I couldn’t remember if it was really a good thing or not.

“While I have you in this position, I need to check for a couple of other things,” said Dr. Bone as she stood behind me. “First I’m going to insert my finger into your anus, and I want you to tell me when you feel any pressure.”

I felt my face flush, as all the old “Backdoor Boys” jokes I used to hear flooded back into my brain. Don’t be embarrassed, I tried to tell myself. It’s not a big deal. She’s just a doctor doing her job. But it was hard not to be. I braced myself for the physical discomfort I was anticipating, but I didn’t feel anything down there.

“Okay Kevin, now I want to see if you can clench your sphincter muscles, like you’re holding in a bowel movement.”

I bit my lip to hold back the burst of laughter that almost came out when I heard her say the word “sphincter.” Of course, I couldn’t help but picture myself and the boys wearing wigs and spandex on the set of our music video for “Just Want You to Know,” in which we had portrayed a fictional eighties hair band called “Sphynkter.” It was a good thing none of the other guys walked in at that moment. I could only imagine how much they would have been cracking up. We had always talked about dressing up like Sphynkter again for a show, but we hadn’t done it. Now we never would - or at least I wouldn’t. I supposed the other guys could always do it without me.

“Kevin?” Dr. Bone asked, bringing me back to the present. “Do you understand?”

“Yeah.” Straightening my face, I tried to follow her directions, but I didn’t know if I was doing it or not. I still couldn’t feel a thing.

“All right,” she finally said. “Let’s move on to the next part of the exam.”

I frowned. “How’d I do?”

“I’ll go over your results once we finish the full exam,” she replied, which led me to believe I had failed the first part.

They repositioned me so I was lying flat on my back again. Then Dr. Bone showed me a safety pin and said, “Next I need to assess your sensory level. I’m going to poke different parts of your body with one end of this pin, and I want you to tell me if you feel a light touch or a pinprick. The light touch will feel like this.” She stroked the side of my face with the rounded end of the pin. “The pinprick will feel like this.” She stuck my cheek with the pointed end, making me flinch. “Got it?”

“Got it,” I replied, grimacing.

She told me to close my eyes so I couldn’t see what she was doing. A few seconds later, I felt something smooth brush the skin behind my right ear. “Light touch,” I said. This was followed by a sharp poke in the same place. “Pinprick.”

“And does it feel the same as it did on your face?” Dr. Bone asked.


She worked her way down the right side of my body first, jabbing me just above the collarbone, on the shoulder, and near the inside of my elbow with both ends of the safety pin. I felt everything to that point, although the sensation seemed duller further down my arm. Below it, I felt nothing. She could have cut off the bottom half of my arm, and I wouldn’t have noticed. My forearm, hand, and fingers were completely numb.

When a few seconds went by without feeling another poke, I snuck a peek, wondering why she had stopped. Opening my eyes into narrow slits, I was stunned to see her stick a spot near my right nipple with the sharp end of the safety pin. It should have hurt, or at least made me flinch, but I felt no pain, not even the slightest bit of pressure. I opened my eyes wider and watched as her hand repeatedly raised and lowered the pin, stabbing me in a straight line along my torso like I was some kind of voo-doo doll. I still didn’t feel a thing.

“Doing okay, Kevin?” Dr. Bone called out as she continued down to my waist. I quickly closed my eyes again so she couldn’t see the tears that were welling up in them.

“Uh-huh,” I heard myself say, but it wasn’t true. I was far from okay.

When she was done testing the right side of my body, the doctor went around to the other side of the bed and repeated the same procedure on my left side. The results were no different: I was numb from the chest down.

“Now I’m going to ask you to try moving some of your muscles so I can assess your motor function,” she said next. “We’ll start with your arms and work our way down, okay? You can open your eyes for this part.”

“What’s the point?” I muttered, keeping my eyes shut. “I already know I can’t move my arms or legs. Trust me - I’ve tried. Many times.”

“Well, I want you to try again so I can document how much muscle strength and range of motion you have,” replied Dr. Bone. “We need to get a baseline now so we’ll know if you make any improvements down the road.”

Her explanation made sense, so I reluctantly opened my eyes and agreed to give it my best effort.

She picked up my right hand and held it by the wrist, where I could see it. “All right, Kevin, I want you to bend your elbow and bring your hand up to your nose.”

I sucked in a deep breath as I stared at my hand. I couldn’t feel the bottom half of my arm, but I attempted to bring it toward my face anyway, hoping maybe muscle memory would kick in and help me out. But my hand didn’t even twitch. “I can’t,” I whispered, letting out my breath in defeat.

“That’s all right,” Dr. Bone said reassuringly, resting her hand on my shoulder. “Let’s try it a different way.” She wrapped her hand around my upper arm, still supporting my wrist with her other hand. “Can you touch your nose now?”

I tried again, but still, nothing happened. “No… I can’t!” I cried in frustration, fresh tears filling my eyes. I took short, shuddering breaths as I tried to hold myself together. I didn’t want to break down in front of her, but inside, I was falling apart. I had never felt so weak.

“It’s okay, Kevin,” said Dr. Bone, her voice softer than before. “We can stop for now. I think I have enough information.”

What information? I wondered, as the tears rolled down my cheeks. Information that told her I would never walk again? Never play the piano? Or sign my name to a piece of paper? Or push my son on a swing?

When Brian and my mom arrived at the hospital, fresh from church and still dressed in their Sunday best, Dr. Bone sat them both down in my room and delivered her verdict.

“As you know, Kevin broke both his C5 and C6 cervical vertebrae in the accident last week,” she began, showing us a series of X-rays taken before and after my surgery. She pointed to the bones that were out of place in the first set of pictures, then ran her finger over the metal rod she had used to put them back together in the second set. Seeing the hardware that had been installed inside my neck reinforced to me just how serious my injury was. “We were able to repair the fractures with internal fixation and a spinal fusion, but we’ve been waiting for the swelling to go down to assess the severity of the damage to his spinal cord.”

I watched Brian’s face as the doctor spoke. There wasn’t a trace of his usual humor in it. He was frowning, his lips pressed together in a thin line, his forehead creased with an expression of deep concentration as he kept his eyes fixed on her. I could only think of a handful of times I had ever seen my cousin look so serious. I almost wished he would crack a joke, just to ease the tension in the room.

“I was able to do a more thorough neurological assessment this morning,” Dr. Bone continued, now turning her attention back to me. “It showed you have a complete injury, Kevin, which means your spinal cord was fully compressed at the C6 level. No messages can make it past that point. The damage from the swelling after your initial injury extends up to C4, affecting your arm muscles and weakening your diaphragm.”

I could hear my own heartbeat drumming like a timpani inside my head. The sound of blood rushing behind my ears was almost deafening, drowning out the doctor’s words. “So what does that mean exactly?” I asked, my own voice sounding distorted, like I was trying to talk underwater. “Will I ever walk again?” I held my breath as I waited for her answer.

She shook her head. “You’re a quadriplegic, Kevin,” she said, looking me directly in the eye. “With extensive rehabilitation, you may regain the use of your arms and wrists, but not your fingers and nothing below the waist. Until science discovers a way to reverse spinal cord injuries, you’ll be permanently paralyzed from the chest down. So, no… you will probably never walk again.”

As I let out my breath, I felt deflated, like all the wind had gone out of my sails, leaving me as I was: limp and useless.

“What other questions do you have?”

Once the initial shock had worn off, my mom and Brian both started asking Dr. Bone about rehabilitation centers and other treatment options, everything from physical therapy to stem cell research. I just lay there, only half-listening to what they were saying. Their words barely made sense to me. In that moment, all I could comprehend was that my life, as I’d known it, was over.