A Letter From The Spinal Cord Injury Unit

Dear Darren,

Your new puppy was with you in the car crash where you sustained your spinal cord injury. He was miraculously uninjured and is now staying with a friend while you’re here. You talk about him frequently—about how he’s named after a character from Star Wars, about how he’s going to grow so much bigger than the vet predicted, about how he looks like St. Bernard but he’s really a boxer mix.

On the first day you arrived, I went into your room to make you custom resting hand splints and explain why you need to wear them at night. I told you, “Since right now you don’t have any movement below your shoulders, these will help you position your hands to protect the length of the tissues. That way if you regain movement, you will still be able to have full motion in your hands.” You responded, “When.” And I said, “What?” You repeated yourself, “When. When I regain movement.” I looked at you—twenty-seven, messy dark hair, and five o’ clock shadow growing in. I didn’t know what to say.

Some patients regain a lot of movement. Some don’t. Some patients come in unable to do anything besides bend their elbows and leave able to lift each individual toe. Others leave the hospital without new movement. I couldn’t predict which category you would fall into. I wanted you to be hopeful, but I also didn’t want to promise you something I couldn’t guarantee, so I just smiled hesitantly at you and affirmed, “When.”

Then, you were unable to move your fingers or open or close your hands at all.  Now, your physical therapist and I are astonished every day about how you’ve been steadily regaining movement and function. I remember the day you told me, “I have a surprise for you,” and you showed me a thumbs up as I ooh-ed and ahh-ed. “I’m just waiting for the day when I can give my mom the middle finger,” you told me mischievously. It’s been a joy celebrating the little achievements with you.

We’ve worked on all sorts of aspects of life that were interrupted by your injury—accessing your phone, brushing your teeth, getting dressed, toileting, participating in hobbies, etc. We focused just on compensatory techniques at first, adapting your environment or the way you did things to suit your abilities at the time. Then, as you got more movement back, we added in practicing activities the way you used to do them and increasing your strength and endurance. I’ve seen you go from relying on someone else to feed you, to using a universal cuff, to using adaptive silverware, to feeding yourself with typical silverware. You’ve made so much progress.

Today, your friend brought your dog to visit and of course, we incorporated him into our treatment session. At that time, you were just starting to get some finger function, so we went outside and played fetch to practice coordinated arm movement and grasp and release patterns. I noticed that even though you were throwing the ball, he kept bringing the ball back to your friend because she’s been the one caring for him for the last six weeks. I’m sure you noticed too, and I’m sure it hurt—a tangible reminder that the world is moving on without you while your life is on pause here. I can only imagine how frustrating it must be to feel as though you’re sprinting and fighting just to return back to your starting point, where you used to be. I wonder if every victory comes with the glum realization that the things you’ve been working so hard to do again are the things that came easily and without thought.

I’m sorry that this happened to you. I can’t do anything to change your circumstance, and I can’t return to you what has been lost. I can only cheer you on, assure you that you have the whole medical team working together to provide you the best care, tell you I’m proud of how far you’ve come, and continue to work with you on things you want and need to do. I want so badly for you to be able to stand up and leave the hospital right now, but regardless of your level of function, know I will be fighting alongside you to maximize your independence and quality of life. We’ll take it one day at a time.  


Your occupational therapist

*Disclaimer: Details of the story changed to protect privacy of the patient

Stacey Lau is an Occupational Therapist and just graduated from UTMB.

Stacey Lau is an Occupational Therapist and just graduated from UTMB.