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Richey rolled himself in a manual wheelchair into the exam room of the spinal cord clinic for the first time on a warm spring day in April. He managed to lift his quivering right arm to shake my hand. I was the new nurse practitioner in charge of his care. He had some ability to walk but he used the wheelchair to maneuver the halls of the VA. Luckily, he could schedule a hospital van to drive him back and forth to appointments. Having a spinal cord injury proved to be an advantage in the system.

Richey’s dirty blond hair stood in tuffs on his head. Dressed in jeans and a T-shirt, he could have passed for eighteen but in reality he just turned thirty, had an ex-wife, two preteen girls, and a few years of homelessness under his belt.

“What are all these scars on your abdomen?” I had asked.

“All the fights I had growing up,” he said. “Always in fights.”

When I met him he was living with his brother, his brother’s wife, and their young daughter. His brother was planning to leave for Iraq and his wife would move in with her family, so Richey decided to move back with his mother.

“Don’t do that, you’re crazy,” Richey’s brother told him. But Richey figured that his mother tried her best when they were growing up. He would give her a second chance. Plus, he said he would be near his ex-wife. He wanted to reunite with his girls.

Richey couldn’t get out of his own way to avoid trouble. He had a long history of drug abuse and alcoholism. He saw evil intent in everyone he dealt with. He could worm his way into a confrontation by just looking at a person. No one respected him. Not one person was supportive.

Richey hated our physician but he seemed to tolerate me. Most of the spinal cord patients flattered me because I had the prescription pad. They had pain and needed medication. Like all my patients, Richey signed a contact to submit to random urine testing. The first sample tested positive for marijuana along with cocaine.

“Knock off the cocaine,” I told him and added that I would look the other way with weed. Most of the spinal cord patients liked marijuana because it helped with spasms and improved their appetites.

Richey wasn’t too different than the spinal cord guys I cared for—“broken men” I called them. They had no incentive to look back and try to figure out what happened to turn them into the non-functioning adults they had become. They had no insight, no imagination, and no drive to make changes.

Most of Richey’s problems revolved around his perception of not getting any respect. The receptionist in the x-ray department didn’t respect him so he didn’t get the x-ray I had ordered. The night nurse didn’t respect him so he left the rehab center I had worked so hard to get him into. Maybe she was mad that he broke the rules by wandering outside after hours, peeing in the bushes, falling down afterwards, and unable to get himself up until he was found in the morning. His mother didn’t respect him so he left her and went to Florida to live with an estranged sister who didn’t respect him so he went back to live with his mother who I found out used drugs and let him drive her car that he was physically challenged to drive in the first place. I suspect that if a policeman had stopped him, that policeman wouldn’t respect him for driving without a license.

His ex-wife didn’t respect him for having an affair. Nor did she respect him when he drove home with his ladylove in the front seat on the day she, his wife, was in the hospital giving birth to their first daughter. During that drive Richey flipped the truck over, his girlfriend was fine but he fractured his spine.

I have long forgiven myself for not being able to help Richey recognize that his actions caused most of his problems but I still think about him after all these years.

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