Scale

Yesterday I emailed a friend and made a joke about already being up and riding my bike, and he sent back a sweet response congratulating me and saying how liberating it must be to be out of the hospital and feeling the wind at my back.  The truth is that progress has been constant, but I am still in the hospital and nowhere near being able to hop on a bike.  And the email exchange made me realize how hard it is to understand what could possibly require two months in the hospital if I am improving as much as I claim I am.

The answer is that the distance between a partially paralyzed state and being able to ride a bike is both incredibly long and incredibly short.  Time-wise, I am astounded at how quickly that distance can be covered under the right circumstances, but I am equally amazed at all of the tiny changes that must take place to arrive there.

Take my legs for instance. When I first arrived in rehab three weeks ago, I could either lie in bed or sit in my wheelchair with my feet held up by leg rests.  I couldn't lift my legs off the foot pedals or put them back on; unable to bear weight on my legs all I could do was hold on when someone lifted me from where I sat on the edge of my bed to pivot me into my wheelchair; I often nearly screamed with frustration when I was left on the toilet and could not lift my legs enough to shift on the plastic seat; and once I was tucked into my bed for the night, I could not move my legs to adjust my weight or turn on my side.

In the first week of physical therapy, the daily regimen of exercises consisted of placing my legs over a bolster then trying to use my quads to lift my foot a few inches off the mat, as well as working at pulling my feet towards my butt to raise my knees into the air, and turning on my side with one leg raised up on a powder board -- a smooth, low table -- with a leg skate to eliminate gravity and allow me to begin relearning movements while my legs gained strength.

When this is your starting point, small but significant victories can occur every day before you even begin to think of triumphs like standing up alone.  One day it is waking up to find that while you were sleeping on your side, your leg straightened itself out on its own.  (You have to ask someone for help if you want it returned to its previous position, but still it is progress.)  Another day it is feeling your heel suddenly kick back on the powder board after several sessions that nearly pushed you to tears because you could not will it to move even a half centimeter no matter how hard you tensed.  And when on Saturday my heels suddenly pushed my knees into the air while I was waiting for my therapist to track down a piece of equipment, I got the kind of thrill you'd expect if I had just leapt to my feet and walked home.

This past week the many small changes in isolated muscles -- lifting a knee, raising a foot, moving my ankles like windshield wipers, straightening a leg -- have suddenly come together to produce the kind of recognizable progress that we are accustomed to using to measure improvement. I can push myself up from my chair and steady myself enough to barely need the help of a handrail. I can walk 50 feet with a walker. I can transfer myself from my wheelchair to another chair or my bed. and I can step up on a four-inch step.

And I admit that even I start to wonder what's left to be done that can possibly require another three to five weeks in inpatient therapy and then outpatient, but then I remember this morning's PT session when I was told to try walking sideways and nearly came crashing to the floor as my knees and my hips went shooting out in twelve directions at once, and I can only imagine the steps, both large and small, yet to be taken in the weeks and months ahead.