A Broken Man Who is Hard to Forget

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.

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.

HELLO BEAUTIFUL

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.”