The curriculum at Case Med is based heavily on the concept of problem-based learning (PBL). Which means we do a lot of work in small groups (roughly eight students per group, with one faculty facilitator). On Monday morning, we receive two cases. Each provides a narrative describing a particular fictional patient, their signs and symptoms, some imaging and potentially a diagnosis. We spend about an hour per case in our small groups working through the details, discussing elements we need to learn more about and how we will focus our individual research about the cases in question. On Wednesday, we reconvene and discuss the first case, Friday the second case. Small group is augmented by lectures that serve to provide some formal guidance as to the physiology and pathology with which we are presented, a sort of springboard for our small group research.

I think this is an incredible way to study medicine, as it forces us to learn how to learn, which will be infinitely more essential in our future careers as physicians than having memorized the entire list of signs of interstitial lung disease. To be sure, the ability to recognize common conditions and their presentation will be necessary to do our jobs. However with collective medical knowledge expanding at a phenomenal pace, even more important is the ability to quickly and thoroughly assimilate details about something with which we are unfamiliar. But I digress.

Recently, we had a case that was intended to guide our learning of the diaphragm and the accessory muscles of breathing, as well as the various phases and intricacies of the process. Because the diaphragm is innervated by spinal nerves C3-C5 via the phrenic nerve, but the accessory muscles are variously innervated by nerves at the thoracic and lumbar levels, the case we were presented with involved a patient with a spinal cord injury around the level of C4-C5. The idea behind this being that the patient would have at least moderate function of the diaphragm, but no use at all of the accessory muscles. Being able to discuss the topic in depth requires an understanding of all of the various muscles, what they each contribute to the process of respiration, and how they are impacted by a neural deficit.

However, during the course of the case, no mention was made of the classification of the patient’s SCI: complete or incomplete, or what the ASIA level was. Unfortunately, without this information, it becomes a lot more difficult to fully ascertain how the patient would fully be affected. As the case was not intended to be a neuro case, going into great detail on the ASIA scale or all of the other items impacted would be inappropriate. But without understanding at least that there can be tremendous variance in how patients are impacted by spinal cord injuries, it becomes impossible to really know this patient’s situation.

Of course, I’m in a unique position and am acutely aware of these differences. I’ve had to learn it as I’ve lived it, and as someone living with an incomplete SCI, I’ve learned just how bafflingly variant such an injury can be. Some muscles may function perfectly fine, while others that are controlled by nerves higher up the spine are more poorly innervated than those further down. It’s impossible to predict the items that will be affected in an incomplete SCI, which is why patients comparing functionality between ourselves can be nigh on useless.

During the course of discussing this case, I tried to mention a few times the concept of complete versus incomplete, and reinforce the idea that incomplete can be a vastly inconsistent diagnosis. And people in my group seemed to either already be aware, or they came across it in their research for this case. But in talking to friends, it was clear that other groups didn’t seem to be aware of the concept and some students were under the impression that such an injury is simply binary: all or nothing. You’ve either got full functionality, or none.

Nothing could be further from the truth.

Which got me thinking. If the extreme variability that is central to even scratching the surface of an SCI wasn’t covered, what about other conditions? And as I began to focus more on how other conditions are presented to us, I started to realize that many cases are presented as “here is syndrome X, and here are the associated symptoms.” No mention is made of how variable something may be, or the depth of different manifestations.

I discussed these thoughts with some classmates, and many of them shared the feeling that it seems medical education may be a bit lacking in regard to the spectrum with which various ailments appear. Perhaps this is considered an implied undertone to everything we learn. Perhaps it’s something we’re assumed to pick up in third and fourth year, when we’re immersed in the clinical aspect of medicine every day. Perhaps it’s something we’re assumed to learn at some other point in time.

Whatever the case, my own experiences have made me more acutely aware of such variance than I otherwise would have been when considering anything that we study, as have those experiences done for several classmates of mine. Which in the end, I think, makes us all more versatile and adaptable as a result.

But first, a much-needed progress update.

I’m going to let you in on a little secret – it turns out doctor school is a lot of work. Now, I know that may come as a surprise, but it really is. After making the move to Cleveland in June in preparation to start school, I got caught up tying up some loose ends on technical projects I was involved in as well as transitioning my physical therapy to local resources, getting moved in, and getting ready to start school. Once school started, I had to basically learn how to be a full-time student all over again Suffice it to say, it has taken a while to really get on track managing my time efficiently again.

For the first month after moving to Cleveland, I started doing my PT at MetroHealth. They’re one of fourteen (or eighteen – hard to tell from the various online resources) centers in the US designated by the National Institute on Disability and Rehabilitation Research as a “Model Center” for SCI research and rehab. Sinai in NY is also one of them. My docs in NY had recommended I get in touch with a particularly qualified physiatrist based at Metro, Dr. Greg Nemunaitis. So I did.

Rehab there went well, but since Metro is on the other side of Cleveland, it wasn’t a practical solution once classes started. So under Dr. Nemunaitis’ guidance, I transferred my care to the rehab department of University Hospitals, one of our teaching hospitals. Since it’s on campus, it’s ideal.

When classes started, the focus of block one, our first six weeks, was on epidemiology and public health. As part of it, we were all given pedometers and told to keep track of how many steps we all take within a given day. There was a recently discussed recommendation that everybody try to take 10,000 steps each day for better health. So the faculty wanted us all to take the 10,000 step challenge as well, and they made a competition out of it.

Although 10,000 steps was more than just a bit overly-optimistic for me, I spoke to the people running the challenge and suggested that I keep track of my steps but be allowed to use a multiplier. I wasn’t expecting to break any records, but at the very least it would give me some guidance as to my progress. And knowing me, having a concrete metric to measure my progress by would make me push myself that much harder.

So for the past three months I’ve been keeping track of how many steps I can walk within a given day. So rather than describe it, here’s a picture:

The thicker line is actual steps at a given point of measurement, and the thin line is the five-day moving average.  The dip that occurs in September was due to some recurrent problems with my knee.  It seems I’m going to always have to be conscientious about it from this point on.   Regardless of that, I’ve moved from a max in the 500-600 range when I first started three months ago to a current best of 1200 steps in a given day within the past couple weeks.  So I’ve doubled my progress in that time.  Not bad, I don’t think.

Also, the moving-average has improved from around 600 in the beginning to around and above 900 recently.  Including the dip in September, I think that’s pretty good.  Both Cynthia (my PT back in NY) and my current PT didn’t feel there was any problem with me walking by myself at home, so I’ve been doing just that since July in addition to regular PT.  One of these days, I want to try walking to school in the morning, with a friend walking the chair.  PTs and doctor have all said that’s fine, and obviously I wouldn’t do anything crazy like try to walk across the street or through traffic, but it would be a good exercise.

Additionally, my steps have gotten more regular and more properly formed.  Although I’m far from walking normally at this point, I’m able to take a series of steps in succession without pausing between each one.  My current physical therapist has been putting a lot of emphasis on proper form, and I think this has a lot to do with it.  Both of my heels typically hit the ground first, as opposed to the balls of my feet (which has only started to happen consistently within the past few months).

I’ll continue to post updated versions of this graph from time to time, just to give an indication of my progress.  And maybe one of these days I’ll record a video.

So that’s where I’m at, recovery wise.  There probably won’t be any major milestones any time soon, since the process is slow.  But I figure as long as I can keep making that graph go in a generally upward direction, I’m in good shape.

Since the aisles in airplanes are so narrow and a regular wheelchair won’t fit down the aisles, airlines have what’s called a straightback chair that you transfer onto before getting on the plane.  It looks like this:

What the picture fails to convey is the width of the chair – the seat is probably about twelve inches wide.  Now, my butt is not twelve inches wide.  When I stop and think about it, I don’t think most people’s butts are twelve inches wide.  They had one of these at Sinai to practice with, so patients can learn about things they’ll need to use in the outside world.  I made a bet while there with Jason, the recreational therapist, that it was too small for me.  But sure enough, I transferred onto it and it was usable for a short period of time.  Although I’m sure I looked at least moderately silly on it.

But since these things are only designed to be used for ultra-short distances (to get you to your seat), it’s not too big an issue.  I had contacted the airline ahead of time to let them know that I’d need one of them getting on and off, and while on the phone they told me that disabled passengers are allowed to take the bulkhead seats (these are the seats in the first row of a section, with no seats in front and thus extra leg room).  The only case in which somebody can bump a wheelchair is a passenger with a service animal.

When boarding the outbound flight at JFK, I checked in with the desk and we began to pre-board.  But much to my surprise, when we were only about halfway down the jet bridge, I heard them announce general boarding.  Huh?  The plane was being boarded from the tarmac, so not only did I still have to get down there and transfer to the straightback chair, but we then had to get on a lift to get up to the plane itself.  The airline staff (Delta) clearly didn’t think this one through.  So even though we rushed down to the tarmac, the entire plane had to stand there in the freezing cold and watch while I dealt with getting on the plane.  Not too much fun, and really Delta, you seriously should have thought that one through better.  At least I know from now on to at least tell the people at the gate they should probably wait until after I’m boarded before calling all the other passengers.

The rest of the trip went off without a hitch, and when we arrived Sunday night we went out with a group of some of the current first year students at Case. Some I knew, some I’d just met for the first time.  It was an awesome group, and we had a great time.  Before the trip, I spoke to Dr. Mehta and she had arranged a few minutes for me to thank the first year class for the t-shirt they had sent me earlier in the year.  I’d wanted to just say something, although I still feel like I didn’t quite convey things properly.  Several students came up to say hi after, and I wish we’d had more time to chat with people.

The remainder of the trip was meeting with faculty and some key university  personnel to discuss logistics of when I get to campus – parking, getting around the facilities, making sure there won’t be any unnecessary burdens once I start.  I feel very confident about starting class this summer, and I’m really looking forward to it.  Travel home was uneventful, and I was back doing PT with Cynthia Wednesday night.

In the last update, I mentioned starting to walk on a walker with a maximum of about fifty feet.  That continues, and I’d pushed it to about sixty feet by the start of last week.  Then Monday afternoon while walking with some of the guys at Sinai, we got to the end of the fifty-foot hallway I usually walk in.  But this time instead of stopping, one of the guys opened the door and I just kept on going.  Made it about eighty-feet, then rested.  Upon standing up the next time, though, I walked what seemed about one hundred feet.  Then the third time, one hundred and twenty feet.  I was shocked, but I just felt more stable and didn’t feel a need to rest.  Needless to say, Tuesday my legs were a bit more shaky and fatigued than usual and I decided to not push them.  By Thursday, I did another lap of one hundred twenty feet and was raring for more.

I have high hopes for the progress I’ll be able to make over the next few months.  And while I don’t have any misconception that I’ll be jogging laps by the time I leave for school, I am hopeful that I’ll be able to start to walk short distances in my apartment by then.  But we’ll just have to wait and see.

I’ve been focusing a lot on vulnerability research, exploring new types of vulnerabilities and methods of exploitation, which is what drew me into the information security field to begin with.  Unfortunately, I wish I’d had more time to devote to pure research in the past.  Not that I regret any of the decisions I made or the client work that I’ve done.  Far from it.  I’ve had the chance to create and be involved in some pretty cool things, which was my goal before medical school.  It would have been nice to get into the more detailed nitty gritty of software exploitation that I’m doing now.  But hey, at least I’m doing it now.  I think I’ll be starting a separate blog sometime soon to chronicle the more technical things.  And I certainly plan to stay up-to-date with the field as a hobby, as it’s been something I’ve been crazy about since I was much younger.

Just this past weekend I went to DC for a security conference.  I mention it not to focus on the security side of things, but because it was the first trip I’ve taken since the accident on my own.  Over the past year I’ve taken several car trips with other people and stayed at a number of hotels, but never the train and never by myself.  Strange, a twenty-nine year-old man who’s traveled the world for clients in the past thinking about taking a trip alone for the first time.  Amtrak carried me from Penn Station to DC and back, and Marriott helped on the bedding side.  Fortunately enough, the conference was at the same hotel I stayed at, which made things a lot easier.  The trip was remarkably unremarkable.  Managed to get onto the train without issue, and transferred into a seat.  The gap getting out of the train was a bit too big for me to comfortable wheelie off of (especially with a heavy bag on the back of my chair throwing my balance off, a six-inch drop, and a gap that seemed about four-inches wide), so the conductor got a bridge plate.  It’s basically a small, foldable, three-foot long sheet of metal that acts as a ramp.

The Marriott was great.  Their accessible rooms truly are accessible, unlike the Westin I stayed in a few months ago for a wedding.  While the Marriott had a roll-in shower, angled floor with a drain and a fold-down bench to sit on, the Westin had this ridiculous “bench” at the end of the tub.  It was really just a normal bathtub with a four-foot by four-foot tile platform at the end of it.  There was no tub bench to sit on, so the only place for someone disabled to sit on is the flat platform at the head of the tub.  Now, I’m no physicist.  But when you have somebody sitting on something that’s vertically higher than the tub, do you think all the water is just going to preferentially drain into the bathtub when there is no slope?  Let me tell you that, no, it does not.  So the bathroom floor at the Westin was a lake for the weekend.  Lest you think I’m just bathroomly inept, the hand-held showerhead in the Westin, which had its own water control, was mounted right at the end of the tub by the platform.  Whoever designed that “accessible” bathroom clearly doesn’t understand what accessibility really means.  The Marriott even had a cut-out under the sink, to allow clearance for someone’s legs while in a wheelchair.  And so did one of the sinks in each of their public bathrooms.  Everybody responsible for designing spaces to be used for disabled people should have to actually sit in a wheelchair and try their spaces so they can learn from their mistakes.  Of course there’s no way for them to try them beforehand (although CAD software really should be able to model this kind of thing), at least they can explore different spaces and see what it’s really like.

Coming up this weekend will be the first airplane trip.  Kristina and I are heading to Cleveland to meet with faculty and administration at Case to do some planning for starting medical school in July.  While there I’m hoping to also scout out a few possible places to live and make some contacts that will be helpful when it comes time to sign a lease or mortgage in a few months.  And I’ll also get to see how another hotel chain handles accessible rooms – this one has already told me they have a roll-in shower, so hopefully we won’t create a miniature Lake Erie on their floor.  With any luck, I won’t have to put the snow chains on the chair tires.

Over Christmas I went to visit some family I’ve got in Maine.  Now, there I needed snow tires.  It’s an annual trip for me, and I love spending time with family that I’ve always been close to.  My uncle built a makeshift ramp from the first floor to the second floor of their house, using wood to create two tracks on the stairs that fit the wheels of my chair properly. Since the tracks were only approximately the width of the chair, everybody else could still walk up and down the stairs relatively normally (albeit with a small width).  He then rigged up several heavy-duty sailing pulleys to the beams of the house at the top of the stairs, and we used the pulleys to basically pull me up and down the stairs.  It was quite a creation, but it worked every time and was safe at the same time.  I spent a full week up there (up in Maine, not up at the top of the stairs), and it was really great to spend time with family, get away from the city and unwind a bit.  I also took a walker with me and made an effort to stand just about every day while there.

For some reason after getting back from that trip, though, I was really feeling down.  For the first week or two, I was feeling a bit detached and more moody than usual.  I think part of it was having to return to reality.  Although I certainly can’t ever forget the disability I have to live every minute of every day with, it’s easier to ignore it when you’re in a different surrounding doing different things.  My legs were also understandably stiff when I returned.

But the bigger part of it, I suspect, was that I was quickly approaching one year since the date of my injury.  It’s hard to believe that as of this past January 27th, 2009, it’s been a whole year since that awful night.  Looking back on it, I’ve been through so much and it makes the year seem so long.  But it has absolutely flown by while it’s been happening. Somewhat in a daze, of course.  When I look back at the original blog posts from when I was still hospitalized, it blows my mind to remember just how functionally impaired I was.  The weakened grip strength (which, by the way, about a month or two ago I grabbed the grip strength tester and was pulling 120 psi with both hands), the inability to roll over in bed, heck, I couldn’t even sit up on my own back then.  I’ve come so far in the past twelve months that it’s hard to even remember how impaired I used to be.  And I remember in the past, I haven’t been able to remember life before the injury. Funny, those memories seem to be slowly coming back.  I’m glad to now how the old blog posts to read over and help me to remember where I’ve come from.  It’s humbling, to say the least, to compare to where I’m at now.

Now on to the good stuff.  About four months ago, I took my first steps on the parallel bars in physical therapy.  Then in early November, I also started to do some walking on a walker with full-leg braces.  Well three weeks ago at Cynthia’s direction, just before the one year anniversary of my injury, I’m happy to say I shed the leg braces and finally took steps on a walker with no assistance.  Because of some of the past difficulty I’ve had with leg spasticity, we’ve been cautious about getting onto a walker without braces too soon.  The concern, of course, is that my legs will spasm and give out from under me, and I’ll wind up on the ground.  So we have proceeded very cautiously, and the first time standing up without braces I had one therapist on either side of me, and another person behind me to hold on to my belt just in case something went wrong.

But up and off I went.  And these weren’t the sloppy, barely steps that I had first taken on the parallel bars a few months ago.  Both legs were able to support my weight independently, and although the right leg is still weaker than the left, I was able to move them both independently.  So now no walking in parallel bars, no walking with braces, just walking with a walker under my own strength.  Since then, I walk in every PT session (4-5 days a week), and try to stand at least one of the two days I’m not in some form of PT.  I can walk about fifty feet before needing to rest when things are going well, and I generally walk three to four times each session.  And I continue to stand in the standing frame and in the parallel bars each of those days to help build strength.  I’m generally at Sinai for three and a half hours for PT, and I put in as much extra time as I can.

There are still some accessory muscles that are extremely weak, barely measuring a one out of five on the ASIA impairment scale.  At this point there are only a couple that are still that weak, but just one or two months ago they were still a big fat zero.  I can stand for several minutes now without getting tired, only needing to occasionally lightly touch a walker for balance.  Once those accessory muscles get a bit stronger, I hopefully won’t need to use the walker for balance when standing.  Cynthia (PT) has indicated that her goal for me is to be able to use a walker for mobility around my apartment by the time I leave for Case in three to four months.  I would be ecstatic to be at that point by then, but if there’s anything I’ve learned through this ordeal it’s to not set arbitrary deadlines.  Granted her timeline is probably much more realistic than mine, but I’ll just take each day as it comes.

So while I’ve still got a long way to go, I’ve come incredibly far in the past year.  And I’ve got no intention of stopping any time soon.

I’m thankful for my health and current physical abilities.  I know this may seem counter-intuitive, but I have to consider how much worse things could have been.  I’m lucky to be alive.  If my injury had been a mere one or two inches higher up my spine, the injury could have killed me.  My fall could have resulted in a traumatic brain injury that would have changed the very core of who I am – but it did not, and for this I am grateful.  I could have wound up with a complete spinal cord injury with little to no prospect of ever even feeling touch below the level of injury.  The damage could have been so severe as to render my fingers and hands completely useless, thus decimating any hope of fulfilling my goal of becoming a surgeon.  But it was none of those things.  For the simple fact that I’m still here living, I am thankful for every new day I have to live.

My injury was catastrophic.  The type of catastrophe that nearly every doctor and physical therapist I spoke with originally thought I would not come back from.  Now, I’ve always been persistent when I want something.  And while professionals have a wealth of experience that cannot be underestimated, faith and persistance may just be that certain unexplainable set of factors that cannot be quantified.  I’ve never given up hope that I will walk again, and I’ve never stopped trying to get more function back.  Most thought I would not regain functionality below the level of injury, and even if so, that it wouldn’t be enough to be considered useful.  Since then, however, the doctors and therapists I work with have all agreed that my prospects are vastly better than they were in the first few months after I was injured.  I’ve surprised everybody who saw me at the time of my injury with what I’ve gotten back.

Last week while discussing things with Melissa, my physical therapist, she stated with caution that while she thought I was capable of getting up on a walker and potentially walking with no assistive devices whatsoever, she couldn’t possibly begin to estimate when that might be possible. She said it would be likely that I will be able to walk on a walker by the time I leave for Case, but it’s not likely that I will be able to use a walker as a mode of transportation by then.  Which is fine with me – progress is progress.  But she also followed that up by saying that when she first evaluated me four months ago in late July, she thought that at some point in the future walking might be a possibility, but she never would have expected me to be where I’m currently at within our first four months of working together.  I’ve surprised her too.

I’m thankful for all those excellent doctors and therapists that have helped me over the past ten months. There have already been so many, and I know there will be more before this ordeal is not the primary focus of my life, and there is no chance I would be anywhere near where I am without them.

I’m thankful for you – everybody who has been there and provided support, thoughts, prayers and assistance along the way.  This is not the type of experience anybody should ever have to go through alone (well, it’s not the type of experience anybody should ever have to go though, period), and fortunately I haven’t had to.  My family and friends have truly been a blessing, especially the love and support Kristina has given me since the very beginning.  She’s faced this challenge with me with more strength than I could ever ask of anyone, and the accomplishments are every bit as much ours as they are mine.

Now, I don’t mean for this to sound like a cornball acceptance speech or like I’m writing the introduction to a book.  But when I reflected on things this Thanksgiving, these were the things that dominated my thoughts – not how horrible it is that I’ve had to deal with a spinal cord injury.

I’m thankful that I will be going to medical school next year at Case.  Since childhood, I’ve wanted to become a doctor.  Running a business and working in the information security and technology world was a pleasant detour on the way and security will always be a passion of mine, but my goal has always been medicine.  Although I was originally to start this year, deferring was a smart decision and I look forward to starting next summer.  And I couldn’t be starting at a better place for me than Case.  It’s funny, I had heard of it before I started planning which schools I would apply to, but not much more than that.  Then somebody I randomly crossed paths with suggested that it might be a good fit for me.  So I gave it a closer look, and it turned out to be an incredible fit.  I fell in love with the school on interview day, and had decided on it pretty much at that point – before I was even accepted.

Since then, dealing with the faculty has been an amazing experience and they’ve gone out of their way to help me make sure all the critical pieces will be in place before I start school in the summer.  And that doesn’t even begin to consider how thoughtful the students are.  I’m thankful that the place I’ve chosen to spend the next four years at is the right place for me, and has the right kind of people.  And for everybody who’s helped to make the dream into reality.

So I do have a lot to be thankful for this year, despite what the obvious may suggest.   And what would my overly-effusive thoughts be without an update.  After my recent seeming setback, I’ve come back stronger than before.  I have since walked on a walker with braces again.  While I could previously walk ten to fifteen feet before needing to rest, I was able to walk more like thirty feet before having to rest.  And I increased the number of times walking from two to three at the same time – and then some.  During those trips, my legs also felt a lot stronger.  Although the braces keep them from bending at the knee, I can feel the vast difference in how much the muscles in my legs are contracting to help me stay upright.

The strength has translated to walking on the parallel bars without braces as well.  My steps have recently become a lot more controlled and proper, rather than just moderately jerky movement in a forward direction. Then a week-and-a-half ago, at the end of a trip down the bars, I decided to try letting go of one of the bars while standing.  My balance and trunk control felt a significantly improved, so I told Melissa I was going to let go with both hands.  She was in front of me in case anything went wrong, and my chair was immediately behind me – and it’s not like I threw my hands in the air, they were only an inch from the bars.  So I let go.  And stood upright, completely unassisted, for at least five seconds before my trunk started to slowly lean in one direction.

I caught and re-steadied myself, and then did it again.  And again.  I’ve since made this a routine part of every trip walking down the bars, continually trying to improve my free-standing time.  Funny, the more I do, the more my endurance continues to improve and my recovery time before the next trip down the bars decreases.

Then last Wednesday in the pool, I shared this experience with Cynthia and she suggested trying the same thing in the pool.  She had been working with me to slowly use my arms less and less, so she was excited at the possibility of free-standing in the pool.  Now, mind you, when I discuss pool therapy, we’re only in water that is between three and four feet deep.  So it really only goes to my waist.

I stood up in the pool, moved my hands from the edge of the pool to holding on the Cynthia for support, and then slowly lowering them and letting go of her completely.  Again, I was standing fully upright.  But this felt a lot more steady than a week before that on the bars.  She started watching a clock, and when a spasm in my left calf muscle threw my balance off, and my time was up.  But not before reaching a full minute of standing time.  With no assistance, other than the force imparted upon my body by the water.

So there you have it.  I do have a lot to be thankful for.  Now maybe if I’m lucky, I’ll get to start walking on a walker for Christmas…  ;)

Don’t get me wrong, it’s not like I don’t have a significant goal to reach for and focus on.  Far from it.  In fact, I’ve got a goal much more challenging and difficult to achieve than any I’ve been faced with before.  More difficult than losing a parent, more difficult than working full-time while in college (which really isn’t too hard, unless you over-extend yourself the way I did one year – good thing I learned from that),  more difficult even than getting into medical school.  But there’s a big difference in how those challenges have forced me to grow, and how the current challenge’s physical orientation leaves my mind with a lot of time to wander while pushing myself in therapy or the gym.

And don’t let me give you the idea that the rest of me is just lying stagnant while I push the body to grow and strengthen.  The Greeks would be proud, as I daily nurture my mind and soul.  I’ve been doing my own information security vulnerability research (the field in which I worked prior to medical school), learning things to the depth and breadth that I had always wished I could while I was too busy running a company and providing services to clients.  I’d go into depth about what I’m researching here, but it’s not that type of blog.  :)  Although I may start writing a second one soon… but I digress.

I’ve also been nurturing my artistic side by spending a lot more time with photography and music than I had been immediately prior to my injury.  Prior to returning to school to complete the academic work necessary to apply to medical school and preparing for the MCAT, I used to broadcast two weekly Internet-radio shows: one on a Sydney-based station, another on a New York-based station.  Due to time constraints, I had to give up both shows and put my music pursuits on hold.  Studying for the MCAT while taking twelve credits and working fifty hours per week was the straw that broke the DJ’s back, as it were.  Finally again I am able to dedicate the time and energy I used to, and it feels incredible to have that outlet once again.  I’m entertaining the idea of starting a weekly show again, which I had intended to do upon reaching medical school.

It sounds like I’m doing a lot, but I used to do these things while working full-time and going to school.  Looking back on it, I have no idea how.   People told me back then they didn’t know how I did it, but it all felt natural to me.  Now my days are filled with physical therapy, exercise, typical daily tasks (which take a lot longer than they used to, and are thus a significant source of frustration), security research, music and spending time with those who are important to me.  Time-wise, I’ve merely replaced school and work with physical therapy.  But it feels odd not to have some major milestone that I’m pursuing.  Again, I realize that walking is a huge milestone.  But it feels different, because it doesn’t mentally exhaust me.  Emotional exhaustion is a whole other story (and a whole other blog post).

And thus, the weeks seem to be passing me by insanely quickly.  I realize how long it’s been since I last posted something, but it seems so recent in my mind.  Just about a month.  It’s already been three-and-a-half months since I was discharged from the hospital.  The whole summer has rushed me by and it feels like I just got home.  When I came home, I had set the completely arbitrary goal of taking my first steps in a walker within three-to-four months.  There was absolutely zero medical basis for that goal, it was just something that felt like a good goal to set for myself.  That time is almost here, and I’m *almost* at that point.  Melissa, my therapist, today said she’s even feeling frustrated that I haven’t been able to start taking steps on the parallel bars.  She agrees that it’s all because of the significantly lagging right leg, and that the left is more than ready to move on to taking steps.  Despite my prior fears (geez, even that was over two months ago), the right quadriceps are finally starting to fire, as I’d mentioned before.  They’re getting stronger, and now when I dangle my legs and try to kick, the right one does move between four and six inches.  Progress is progress, but progress is slow.  Four months might be just a bit out of my reach (but thankfully, it doesn’t seem to be entirely too far off).

My best friend’s wedding was this weekend.  We’ve known each other for fifteen years already, and we’ve been through so much.  We grew up together, and have seen each other through a lot.  We’ve watched each other grow and change, all the while never losing who we were.  He taught me the meaning of brotherhood, and it’s fun to think about where we thought our lives were going back then and where they’re at now.  Surprisingly, we were both pretty accurate.  It still felt weird to make him say “my wife” for the first time after the wedding, though.  He said it a few more times, and it still feels really weird.  I’d never been anyone’s best man before and I’d never given a speech at a wedding before, so I wasn’t sure exactly what kind of thing to say, but I thought of a few important things and just nervously went with the flow.  It seems to have been well-received.  They’ve been together for what must be close to five years now, and I wish them both the best.  I think they’re really perfect for each other.

I saw a lot of old friends this weekend, a few for the first time since the injury.  I was surprised with how well I dealt with seeing so many people and talking in front of over one hundred people – I thought I was going to feel a lot more uncomfortable.  It helped that I knew a good number of those present, and I also realized that I’m only nervous or uncomfortable the first time I talk to somebody.  After that, it’s completely fine.  I think I’m always nervous that people will think there is something mentally wrong with me because I’m in the chair.  I’ve heard stories from others to that effect – waiters asking people what an individual in a chair would like, as if they are incapable of ordering food just because they’re in a wheelchair, or other such nonsense.  It still surprises me when people I don’t know treat me perfectly normally, which is far more often than not.  It’s as though I expect everybody to treat me differently, and I still carry that fear with me.

A year seems like such a long time, but exactly one year ago now I was arriving in Cleveland for my first medical school interview, at Case Western.  I had prepared myself intensely: written and reviewed all my notes, re-read my primary and secondary applications, done several mock interviews, and thoroughly read over the school’s web site.  Additionally, I had gotten in touch with a friend of a friend who was a first-year at the time.  He agreed to let me stay with him while I was in town, and to let me attend classes with him the day before my interview.  For some reason, Case felt like the right choice, so I arrived three days before my interview and stayed at a hotel in downtown Cleveland so I could check the city out.  It was a Saturday night, September 8th, before a Browns vs. Steelers game, and I quickly learned how much that takes over a city like Cleveland.  I found some good restaurants downtown, walked around a lot and explored the neighborhoods in the small downtown area.  Then I headed out near Case to meet up with my host and see the area more closely.  It’s strange to think that one year ago, I was so wrapped up in the medical school admissions process and had no idea where I would wind up when it all came to completion.  Even stranger to think that one year later, my life has taken such a strange turn of events.  Case is well-known for attracting and admitting “bent arrows,” students who have had other careers before pursuing medicine, and my life has certainly become even more bent than it was before.

It’s hard to believe that it’s already been nearly eight months since I was injured.  I get scared sometimes that I’m not moving fast enough, that I’m not progressing enough within the allotted time.  Deep down I’m sure that’s a huge part of why time seems to be passing me so quickly.  Just over a week ago, Melissa did a re-eval necessitated by my insurance company for approval of more visits.  During the eval, she assessed my functionality below the level of injury and assigned numerical values to muscle strength.  It was encouraging to see that some of those numbers have changed a fair amount within only a month of working with her, and knowing that helps me to stay positive that therapy is working and that I’m moving forward regularly.

The eight months since my injury have all flown by me so fast, and yet it all seems so distant.  My memories of daily life prior to my injury are non-existent.   All the little insignificant things I used to do every day are the hardest things to remember.  I have no idea what it feels like to be able to easily move my legs without thinking about it.  I have no idea what it feels like to shower standing up.  I have no idea what it feels like to only have to spend fifteen minutes getting ready in the morning.  Those are only some of the things I can’t comprehend anymore.  Strange that the things we do every day can be so hard to remember, but given their immemorable nature, it makes sense.  Life without a spinal cord injury really is just a distant memory to me at this point.  And yet it also is held in my hope for the future.  Some day I hope daily life with a spinal cord injury is but a distant memory.