When Something is Lost...

He was Black as his rage. He crouched alone in the far corner of the room while all about, throughout the long rows of treatment tables, therapists, and patients were stuck in stilted postures and caricatured talk, staring near desperate into each other’s eyes, trying to pretend he wasn’t there, clinging for anything seemingly sane they could imagine themselves clinging to by the same denial that instinctively freezes whatever perceives itself as instantly and overwhelmingly confronted by its destroyer, because that was the reality.

In the wilds, or not, it is the same. From eons below the beginnings of conscious thought the too tame do not want to know, and they absolutely do not want to know that they don’t know because knowing would wrench them from their ordinary into naked terror, and so they relinquish consciousness to oblivion. It has a name. It is called Negative Knowing, and it is always on-line waiting.

I entered the surreal, and from near a hundred feet away, I saw his face full-crazed with hate. From my first step through the door, I knew he knew I was the man. Without breaking stride I had to hold his stare and move to him through the others and the drab drapes as if he were just another consultation, all the while praying that whatever thread still held him would hold just a little longer.

We were on the crumpling crust of hell, yet my only fear was that it would be my laughter that would collapse it if I couldn’t suppress its insistently playing in my head. I forced my concentration to my eyes, and then there were just the few yards between us, and each instant would measure if it might work, or that it didn’t.

I stopped an arm length away. He tensed towards me, his fists and jaws clenching, the vessels swelling along his neck, his chest heaving synchronized to his wide flaring nostrils as streams of sweat poured through the corrugated crevices of his ravaged face and ran down his neck into his soaked white T-shirt revealing the rippling of his powerfully sculptured muscles. Except for his left shoulder, he was physically magnificent.

Only moments before, I had been casually conversing in the crowded corridor, facing the door to the treatment area, maybe forty feet away, when it had suddenly flown open, and the therapist had bolted through it wild-eyed, lurching spastically among the others incidentally there who were now also suddenly intensely distracted from the reality that had exploded among them. She was still jerking her head back towards the door stammering that he was about to kill as she came close, and I held out my arms.

Through her terrified sobs I discerned the basics. He was a barber from Watts. It was all he wanted to be. But for the previous six months, awake and in his tortured dreams, every instant had condemned him to be the agonized witness to his withering left arm flopping about, taunting its normally functioning hand that could only hang there helplessly.

His girl friend had caught him straying, and before the gunshots faded she’d had her wretched revenge. He’d only been hit once, and it was “only a .22,” but, in all the complexity of his neck, it had selectively severed his fifth cervical nerve root, his total power supply to his entire shoulder. Never again would he be able to raise his left arm to ply his trade, or for anything else.

The therapists had done what they could, all the while realizing there were no odds for any return. They had explained that shattered nerve roots don’t heal and that reparative surgery isn’t possible. They had offered him assistive devices - splints and pulleys –that had only compounded his anguish. They were for cripples! His stifled screams were for what was hopelessly limp, and finally the terribly wounded panther, his back literally to the wall, was daring the last insult.

He had to let me touch him! Touch is the primal communicator, the first sense of even microscopic creatures. If there was any chance to succeed, I had to touch, and I absolutely had to convince him of the truth that nothing then was more important to me than him, and that no matter what had happened before, I was there. I knew, and I cared.

His breath was on my face, and I smelled his sweat and heard his gnashing teeth, and we stood that close, looking at each other and nothing perceptible changed. Then, for the first time, I lowered my gaze to his neck.

The wound was almost invisible. As I started to slowly raise my hand towards it, he spun away, viciously dropping back deeper into his crouch, simultaneously whirling his face back at me just enough to keep me in the sidewise fire of his left eye. All I could do was stand motionless with my hand outstretched near where he had been, and quietly wait, and fight not to feed what couldn’t stop dancing in my head because it had to be tethered until its time.

Time. Dear Almighty, give me time. Again my gaze deliberately left his eye, and I looked down to where I wanted to touch, gently asking him to please turn his head. Nothing --- then, hesitantly, reluctantly, he turned, just barely, and for a quiet moment I gently palpated the quivering area with a few fingers… and very slowly he stood erect.

I glanced at his chart because I knew he expected it, but at Los Angeles County/USC Medical Center, one of the world’s largest and busiest, I knew that what I wanted wouldn’t be there, but it gave me priceless time. We could just stand there while he was unchallenged to take my measure me and begin to decide.

Besides, expediting a consultation by first reading what others have written is easily a snare because it might not state what someone actually decided. Ideas are powerful, and especially in the press of the County load it is easy to prematurely conclude and hardly realize it is happening. A typographical error or a slip of a pen has more than once become immutable in its cascading damage through too long a string of too-busy consultations.

Examine everything. Commence with his neck and then his normal right arm. It was safer and showed him what I would want when I examined his injury. There is no rigid protocol for such an examination. The flow that is valuable cannot be precisely predetermined. Each requires attention to the individual issues, like hunting or investigating a crime.

The muscular structures are capable of an almost infinite diversity of expressivity, both in function and dysfunction. They are the actors, the sole means for all movement, the final repository of the emotions. In his case, there was no spectrum, and he would have to undeniably understand that. When I did confront him --- and I would have to --- he had to be completely convinced that it was from irrefutable knowledge of him, to which both of us agreed. He must have no other alternative.

Time! The longer he allowed me to examine him, the more authority he invested in me. And I knew I would need it all.

When we move our own parts, it is called “active” movement; when others do the moving, it is called “passive.” Both need to be studied. Each involved joint and its associated structures need to be observed - for position, tenderness, temperature, contour, flexibility (too much or too little), tone, range and strength.

It was time to examine his left arm. I urged him to try to move his shoulder, and he tried, and the intensity of it shook him, and his whole torso strained from his effort. I urged, and he labored even harder. The sweat flowed from his forehead, and we searched the paralyzed fibrotic atrophy for the faintest flicker, but there was nothing, and we both knew it.

Examining for sensation is completely subjective. What the patient says is. So, it requires clear communication, patience and mutual attention. A trustworthy examination takes the dedicated time of two. Testing for pain perception is more than just reporting the stick of a pin. Too often, a device called a Whartenburg Wheel, similar to a dressmaker’s pinwheel, is expediently rolled along the skin while the patient is asked if it was “felt” or was it “sharp.” But perception of sharpness and perception of pain have different significance. In his case, it was the level of pain appreciation that needed to be elicited and compared to the opposite side and whether it was more or less and which was normal. In contrast to particulate pain appreciation using a pin, a sudden series of sticks from a wheel of pins causes a summation effect that destroys precision. So the patient can become confused and intimidated by an examination wasted by haste. With the sensory examination, now, for the first time, he had to speak to me.

I finished. Then, I gave us both another respite by returning scrupulously to his thick chart. When I finally looked up, and our eyes met again, his long buried fear had finally seeped through and was pitifully pleading with me. But there was no time left for me to respond with the sympathy he deserved because time had run out. Concentrating totally on him and his examination had kept my composure, but, now, there was nothing more to sustain it, nor could there have been. Wish it or not, the crazy bubbles in my head from percolating pressure that had finally forced the fissure and exploded with my first few sentences.

“There is no way on this earth you will ever get back the use of your shoulder… When something is lost, you have limited choices: You can run, and try to hide --- and you can’t --- and it will only be noticed --- more --- and you’ll make ------ yourself into a miserable -- and foolish ---failure ---- Or you can --- use --- it! --Find a way --- to take advantage of it! Make it unique ------ to you!”

His brow furrowed as he listened intently but with increasing alarm at what his disbelieving eyes were beholding. My composure was gone. My professional demeanor disappeared into doubled over hysterical laughter, my crossed arms trying vainly to splint my sides as I painfully gasped for sufficient air to survive.

The all-consuming metamorphosis shocked him beyond comprehension as I was reduced to erratic garbling, struggling for intelligibility, near exploding with fun (that I hoped I’d live through) as the long smothered craziness that had flashed through my head in the corridor had to reach him because, from the first, it was the only real ammunition I had. I was almost collapsed, bent over almost to the floor, trying to ignore the pain in my belly, twisting hard to keep his eyes, near desperate to get the words out.

He couldn’t take any more. With a sudden almost grotesque thrust, he bent low and wide-legged, his head quizzically, comically tilting close over me only inches away. His mouth continued to gape wider and wider, eyes bulging even larger, eyebrows arched almost to his hairline. Then he was clawing at the air with his hands at a total loss what to do with himself, or me as a matter of fact, while all the while he frantically searched my face for the faintest hint of ridicule. But there wasn’t any. I couldn’t fault him at all for what was happening to him. In fact, I depended on it.

At last, I was able to catch a breath and began sputtering pure and wondrous in once-only-in-a-lifetime congruence when the stakes were everything, and we both knew it. And he clung to his last thread. And he listened! And I knew we would win!

“Instead of pushing your chair --- and your life ----into the back of your shop--- put it right in the middle of the floor! ---You can’t get along without using something --- to get your arm up. ----- So really get it up! -- Chrome the pulleys! ------ Make the ropes ring bells --- and whistles! --- Make them fly birds around! -- Do anything that makes it --- fun! --- that everyone can see and makes people laugh! ----- You could name your shop -------’The Hang-up!’-----

You are the only man in the entire world who could legitimately advertise himself in the Yellow Pages as -------- ‘The Best Hung Barber in Town!’”

The mind is most mutable in maximal crisis. That is where I intended him and where he was, and my words began to make sense to him. Slowly, he stood erect, and thus began the most amazing transformation as his face became a kaleidoscope of the most incredible array of expressions as the deep crevices of his long torment thawed and melted and flowed away in the streams of his sweat, and all the residues of his ordeal washed away with them

He threw back his head and roared, and when he looked at me again, he was beyond jubilant. He grabbed me up to him, and we hugged each other and rocked, almost falling as his laughter boomed with mine.

Then, without a word, with glorious smile, his white teeth flashing, and his strong right arm swinging, he marched triumphantly out straight and tall. He was whole again, as he had not imagined he ever again would be.

Incredibly, all about, it was as if nothing had happened. I don’t know if even one person paid attention to what had transpired. No one approached me. The price of running from reality is heavy. The physical therapist who had feared for her life never even asked me what had happened.

In the end, it had been our time, only his and mine. His chart faded into the files, and eventually I forgot his name. But, every now and then, I would think about driving into Watts and looking for The Hang Up.

“When something is lost, you are never the same.

But, if you refuse to be less, then you must be more.”

Jean Pierre Hallet

____________

(Chapter One of Goodley Stories of a Medical Maverick by Paul H. Goodley, M.D.)