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The guy on the motorcycle looked like Jeff. My heart did a flip. His muscular arms jutting from his T-shirt were tan. Of course not like the arms of the guy I knew as Jeff. His were thin and weak. But I imagined this is what Jeff would have looked like before his accident. I felt my eyes water and if my husband wasn’t next to me at the wheel of our aging BMW, I would have let myself cry.

I first met Jeff in the four-bed hospital room at the Veterans Administration Hospital a few years prior. He was there for his monthly catheter change. The nurse practitioner that I was going to replace was planning to introduce me. The doctor who worked in the Spinal Cord department was there too. Just in case. As was one of the clinic nurses. A simple procedure like changing a Foley catheter was a possible death sentence for Jeff.

He could have been my son with his dark hair, lopsided smile and an irreverent sense of humor. I wondered what he thought of me, an older nurse, grey hair and, as some folks have told me, an off-putting air of reserve.

Jeff was told he wouldn’t live to see his fortieth birthday after he survived a motorcycle accident in his late teens. When he came to the clinic, he rolled down the hall steering his electric wheelchair by shoving his shaky right wrist against the joystick.electric wheelchair Jogging pants covered his withered legs. A black cord secured his sneakers to the footrest and a water bottle clung to his left hand with a Velcro strap. “Hello beautiful,” he said when he maneuvered into the exam room. I eventually learned this was his universal greeting to women of all ages. Even as a die-hard feminist, his beguiling brown eyes and appealing grin charmed me.

Jeff lived with his cat in a trailer not far from the hospital. The nurses who visited his home a few hours daily didn’t change his catheter even though this was a routine procedure because Jeff had autonomic dysreflexia (AD). Any trauma or irritation, like the Foley change or a fecal impaction or even the beginning of a bed sore, could cause Jeff’s blood vessels to constrict, which, in turn, would trigger a rapid rise in blood pressure. The normal mechanism to dampen this affect was blocked by Jeff’s spinal cord injury. Without immediate medical attention, Jeff could have a stroke and die. It was safer to change the catheter in a hospital where emergency backup was available. Plus, Jeff liked to get out of his trailer and socialize.

Jeff’s fortieth birthday fell on the day he had to have his catheter changed. The clinic staff surprised him with a birthday cake. After the appointment, I watched him roll down the hall with a large black balloon bobbing from the back of his wheelchair: 40 and over the hill.

Over the next year, Jeff developed a urethral stricture. Now, threading the tube through the narrow urethra caused trauma that set Jeff’s blood pressure skyrocketing. I began doing the procedure in the emergency room. Finally, Jeff agreed to have the catheter inserted through the abdominal wall directly into his bladder, which would side step the episodes of AD.

No longer hampered with a tube in his penis, Jeff requested a prescription for Viagra. The Spinal Cord Team discussed Jeff’s request at our weekly conference. Because there was evidence that sexual activity increases the risk of AD, we denied his request.

Jeff had been chatting over the Internet with a woman who lived in Michigan. He paid for a round trip ticket for her and her five-year-old daughter to spend the weekend with him. After the second visit Jeff confided he had managed to obtain Viagra. And it worked. No complications. And he was in love. Not just with the woman but with her little girl. His eyes grew soft as he told me “She climbs onto my lap, wraps her arms around my neck and kisses me on the cheek.”

Jeff could not be dissuaded of his plans to fly to Michigan. He boarded the plane with documentation of his medications and medical problems along with an automatic blood pressure monitor, a tube of nitro paste (in case his blood pressure started to rise to frightening heights), four catheter insertion kits with extra catheters, a few pamphlets on AD to pass out to the flight attendants or anyone else, and a special present for his girl friend: an expensive silver necklace.

Jeff returned smug and nostalgic—his lady friend and he made love, he partied with her friends and she even hired a van to take him to a rock concert. He also returned with a broken wheelchair. The airline paid for the repairs on the chair. But no one could repair Jeff’s heart when he received the let’s be friends e-mail.

“It was the necklace,” he said. “It scared her off.”

When I left the VA, I gave Jeff my e-mail address. He sent silly jokes, sappy poems and updates on his health. At some point I realized I hadn’t heard from him in a while. The e-mail I shot off came back undeliverable. I called a friend, a nurse who worked at the VA. “I’m so sorry to tell you,” she said, “Jeff died of AD while he was in the hospital getting treatment for a kidney ailment.” He died five years after his fortieth birthday.

After a long career in nursing, I’ve collected many patients who wander around in my memory. Some stomp and growl, others tread softly. Jeff glides toward me in his wheelchair. His dark hair pokes out from under the baseball cap. He smiles.

“Hello beautiful.”

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