ONE STEP AT A TIME

CHAPTER 11

February 2007
The Wellness Center
Enumclaw, Washington

Take the first step in faith. You don't have to see the whole staircase, just take the first step. Martin Luther King Jr.

There are certain functions of the human body that are so automatic that most people rarely stop to think about them. Asthma sufferers or persons choking on a piece of food think about and appreciate breathing. The rest of us breathe so automatically that we are not mindful of the process. The same is true of a person’s heartbeat, of swallowing, of blinking and digestion. All these are functions automatically directed by the central nervous system. They happen hundreds of times each day; usually without any cognition by the person who occupies the body.

Another function that comes close to fitting this description is the process of walking. Though physiologically complex, a person walks without consciously reviewing the process with each step. Once a person has learned how to walk, the process occurs fairly naturally. Before learning how to control the process, toddlers take quite a few tumbles. They must learn how to use their feet in such a way to provide the balance and solid footing needed to remain upright.

The best way to describe walking is controlled falling. Each time a person takes a step, they basically lean forward and begin to fall forward slightly. At just the right moment the foot reflexively moves forward and plants itself on the ground and catches him. After the foot touches the ground, a body’s full weight is transferred to it and the knee bends to absorb the shock. The front leg then lifts the body and propels it forward as the rear leg swings up to catch them again, and the cycle repeats over and over and over.

Of course the process of walking is a much more complex combination of nerves, muscles and joints working in perfect concert to provide a smooth gait. The brain automatically sends a signal to the appropriate nerve telling it to “fire.” The nerve in turn enervates muscles in such a way that the correct joints are moved in just the right way. When the step has been taken the signal is sent back to the brain which in turn passes on the next message to an entirely different set of nerves, muscles and joints. Literally hundreds of individual signals and processes are required for a person to take one step.

Yet it happens without conscious thought hundreds, maybe thousands of times each day.

For an able-bodied person the only things that hinder the process are outside factors. Everyone has tripped over the corner of a turned up rug or stubbed their toe on the foot post of the bed. Sometimes the cat runs under foot; a step is higher than expected; a shoe or a roller-skate or a toy is left out in an unexpected place. Without expecting them or seeing them, a person’s walking could be drastically altered by these items. In most cases, when someone trips over such an obstacle a whole new set of signals and movements “kick” into effect and the person is able to self-correct so that the only damage is an embarrassing trip, a stubbed toe and perhaps, a mild oath.

Otherwise, once a person has mastered the balance and mechanics of taking one step after another, walking is a subconscious skill that, for most people, takes place automatically.

Because it is such a routine function, walking is also a benefit that most people take completely for granted. In some cases, people even complain about walking. I used to be guilty of such indifference. I used to look for the closest parking spot at the mall or the local sports arena. Able-bodied, I never fully appreciated what a wonderful gift it was to walk normally and without pain. Instead, if I had to take more than the least necessary steps I would complain – nothing serious, just mild annoyance or grumpiness.

I had forgotten what it meant to walk. Today, I am just getting ready to head up the stairs to the area of the gym where the lifting machines and free weights are kept. I have tired myself on a stationary bicycle and an elliptical trainer. Now I am standing at the foot of a staircase contemplating what it will take to walk up those steps. There in front of me is a little sign with the quote from Martin Luther King. Of course, the context in which he used the image of taking a step at a time had nothing to do with the physical act of walking. It had to do with conquering any seemingly impossible challenge; in his case the violent racism and discrimination that held our nation in paralysis for so many years. How do you ever see your way clear to change that? By taking one step at a time.

That is true of the task before me as I head up those stairs. One step at a time. It is also true of my life in general since the accident. I have learned that you can never take the process of walking for granted and that every day involves "one step at a time."

New parents’ proudest moments are often those when their children take their first teetering steps across the living room carpet or back yard lawn.. More photographs and home videos have been recorded of such momentous occasions than any other. Those first steps are preceded my weeks of coaxing, urging, prodding and assistance. Then the big day comes. Mysteriously, the child decides he/she doesn’t need the steadying hand of mom or dad or the security of holding onto a piece of furniture and they take off on their own. The pride and unbridled joy of that moment for parent and child is unparalleled.

Usually those very first steps end with a thump as the infant loses balance or heart or both and plumps down the short distance to where the ground meets with their overly padded backside. Undeterred, the awkward position of balance is once again attained and forward the child goes to the waiting arms of mom or dad.

On May 5th, Mark and Tina were with at our house to celebrate Judy’s birthday. They had brought their little daughter Allison who was just shy of her first birthday. Judy and I were like surrogate grandparents to Ally since her own grandparents lived in other parts of the country. We didn’t mind at all. We loved Ally. She had sparkling dark eyes that seemed to draw you into her soul. Most often she wore a winning, ear to ear grin. Even though it was Judy’s birthday, Ally was the star of the show that night. She was oh so close to being able to walk. She was brimming with energy, enthusiasm and glee that night.

After visiting for awhile and letting Judy open presents, we had birthday cake and ice cream. As usual, Allison crawled up to my lap where she knew that the “honey man” would indulge her sweet tooth with a bite or two of ice cream or some other delicacy. Then, almost as if on cue, it was time to practice her faltering walking steps while holding tightly to Judy’s or my hands.

I remember commenting that evening how amazing it was that a child ever learned to walk. It seemed so complicated as I watched her struggle. But she was persistent and determined. We all knew it wouldn’t be long before she was toddling around on her own. With her determination, Mark and Tina would soon have to really watch her carefully because she would be walking – even running – everywhere.

Three days later, in the trauma room at Memorial Medical Center, I remember hearing someone say (I don’t remember who) “We don’t know if Fred will ever be able to walk again.” Given the extent of other injuries, walking may have been the least of the worries at that moment. But those words rang in my ears with a stark harshness. They sent a wave of dread and discouragement through me. “Not walk? How could that be?” Something I had done naturally and repeatedly for nearly 47 years was now a doubtful prognosis. It was crushing news.

Of course there were other matters to worry about first. My injuries had to be repaired and heal enough before they would know if their dire prediction was true. Because I was so sick, the necessary surgeries to fuse my spine and to rebuild my hips and pelvis had to be postponed. The dual threats of infection and pneumonia were too great. My body was too traumatized to risk surgery.

It was 28 days later before I was able to realize the full extent of what I had been through. I had been kept immobile in bed with traction until those procedures could be done. Once they were behind, they began to wean me from the mind-numbing effects of morphine. After these two major surgeries had occurred, I was finally able to be in a normal hospital bed and enjoy limited movement.

I will never forget getting the first look at my emaciated legs. Completely inactive for 28 days, these legs which had before been able to walk, run, mountain bike, and ski now looked like some hideous anomaly that surely didn’t belong to me. All the flesh sagged flatly on the mattress and the bones protruded up in a ghastly, unreal fashion. They looked like two sticks laying in a puddled mass of skin and flaccid fat cells. I was horrified.

Even if there had been no spinal cord damage or broken bones, after 28 days of total inactivity, I doubted my legs would ever be able to work again. For the first time, the reality of life in a wheel chair began to occupy my thoughts.

Finally I was well enough to undergo surgery. First, a twelve hour operation was performed to fuse my cervical spine. Using a titanium plate and a fibular graft, the threat of further damage or injury to the spinal cord was minimized.

Several days after that, my pelvis was set and fixated with an external device that looked like something made from a child’s erector set. Of course it was state-of-the-art. But until the bones in my pelvis and hips could knit together strongly enough, it represented one more reminder of the possibility that I might never walk. Until those bones and joints healed sufficiently, I could not bear any weight on my legs. Walking was not a certainty.

On June 6th, I was finally moved from the ICU ward to a regular floor at the hospital. That in itself seemed like a huge accomplishment. It was a joyous day in many respects. From my vantage point on the sixth floor of Memorial Medical Center, I could partially raise my bed, allowing me to look out my south-facing window toward the University Golf Course. I could also see out the door to the hallway.

The sixth floor was the floor where patients with orthopedic problems were housed. As I would look out the door, I would see young children pass my room under the watchful eye of a nurse or a physical therapist as they learned how to get along on crutches. There were also older patients walking under the assistance of walkers and under the same supervision. I was envious of them all. I secretly wondered if I would ever walk again.

The extent of my therapy to this point had been the exercise of my arms. Though affected by my cord injury, they were not as profoundly weakened as my legs had been. Everyday, twice a day, Brian or one of the other PTs would come in with dumbbells and elastic straps to supervise my exercise. They told me the whole point of these exercises was to build up enough upper body strength so that, in case I had to, I could propel myself wherever I needed to go in a wheelchair. Having this upper body strength would also enable me to shift my weight in the chair, make transfers to car seats, beds and furniture. The assumption was obvious: there didn’t seem to be much hope of my independent walking.

To that point, I had lain in a supine position and had not even been seated upright. The next step in any recovery was to correct that situation. Saturday, June 7th, at around 2:00 p.m. a cadre of nurses and therapists strode into my room and announced that it was time I sat up on the edge of the bed. Filled with fear and excitement at the same time, my legs were removed from traction, a collar was put around my neck to keep it stable. A gait belt was cinched around my waist, and I was surrounded with helpers. One therapist began to gingerly move my legs over the edge of the bed. Two strong men took me by the shoulders and began to reposition me. My legs went over the side, bending at the knee for the first time in over a month. The pain was excruciating as joints frozen from inactivity were forced into an unfamiliar and unwilling position..

Even though the room was air-conditioned, I was sweating as though I had been out working in the sun for three hours. I felt lightheaded as the men behind my shoulders began to gently coax my upper body into a sitting position. I couldn’t support my own weight or hold myself upright and so they stayed behind me. I was encouraged to try and stay in this position for a minute. When the minute was up, I was exhausted. I was elated as well. It seemed a whole new world was beginning to open up once again: a world that could be experienced from a seated rather than prone position. We sobbed with tears of happiness and accomplishment.

That was the beginning of further, longer sitting experiences. By the sixth day on the orthopedic ward I was strong enough for staff to lift me into a heavily padded, specially designed wheel chair. I was wheeled into a conference room across the hall where I could receive visitors, have a different view and even take a meal or two.

This room would be the perfect room for Judy and I to celebrate our anniversary on June 17th. We had made other special plans before the accident but those weren’t going to happen. When my mind had begun to clear after the last of my surgeries, I had come to realize that I had been in ICU for 28 days and that Judy had been by my side for everyone of those days. I was overwhelmed at her love and devotion and I knew there was no way I could ever repay it or fully convey my love and gratitude. I did the first thing that came into my mind. I asked her if she would marry me over again. Restating our vows and having a special ceremony seemed like the perfect way to begin this new phase in our life. We began asking all the proper people if we could use this conference room to hold our “remarriage.”

A week after I had been moved upstairs though, I was well enough to be transferred to a rehabilitation hospital. Several options were discussed and finally it was decided that I would be transferred to Rio Vista Hospital in El Paso, Texas. It was a relatively new hospital and was said to be the best in the region. They specialized in brain and neurological injuries. Our case workers and Doctors felt this would be the best place for me to go for Rehabilitation.

On Friday, June 13, I said goodbye to the doctors and staff at Memorial Medical Center in Las Cruces. They had become like family to us in many ways. I was transferred to a gurney and wheeled downstairs to a waiting ambulance for the 45 minute drive to my new home away from home. This ride was much more relaxed than my first ambulance ride. But I was filled with a fear and uncertainty of what might lay ahead.

It was at Rio Vista however, that a roomful of friends and family gathered on June 17th to witness Judy’s and my second wedding. It took six staff to get me into the wheelchair that would take me to my wedding. I remember humming to myself the old tune “I’m Getting Married in the Morning” from “My Fair Lady.” Judy brought a freshly starched and ironed white dress shirt and my favorite Tommy Hilfiger tie. I didn’t bother trying to put on slacks or shoes. They simply covered that part of me with a blanket. Judy looked stunning that night; more beautiful even than the day we first were married. I was proud and excited to give her the silver ring that Mark and Tina had helped me purchase to surprise her. That night was one of many moments that made the time at Rio Vista endurable.

It was there at Rio Vista that I truly began to see that learning to walk was a long, tedious and complex process. It began with many small steps; not the least of which was a positive attitude. “Mr. Davis, we are going to help you get as well as possible. If there is a chance you might be able to walk again, we are going to help you get to that place.”

That kind of attitude is so important in every area of life. Often, a person’s accomplishments are limited only by an attitude or outlook that says something can’t be done. The staff at Rio Vista began to establish an outlook that was positive. If there was any chance I might be able to walk at all, the staff there convinced me that if I worked as hard as I could, the possibility of walking was more likely than if I chose to give up. So I worked – as hard as I could.

Unlike the miracles of the New Testament however, I could not simply pick up my bed and walk. In fact, my hip and pelvis were so badly damaged that I would not be allowed to bear weight on them for the next two to three months. For the time being I was relegated to a wheel chair. Before I could learn to walk again I had to learn how to use it.

In the meantime, the therapists began working with me to help reestablish a sense of balance; an important prerequisite to walking. At first I had a hard time sitting up on the edge of the therapy mats. My brain and body had been so conditioned to being horizontal that they resisted this effort at first. After that, they began trying to get me to play basketball or catch from this seated position. I needed to be able to maintain balance without the aid or support of my hands.

Gradually, the program progressed to the point where I was strapped into what is called a tilt table. This enabled them to raise my body to a completely upright, standing position without forcing me to bear weight on my legs. Then it was on to the standing rails.

Most people used this device to help them walk a short distance by holding on to two parallel handrails. My right hip was still to fragile to bear weight. So I would stand with all my weight on my left leg while gripping the handrails tightly. At first, I could only endure 5 minutes. Before long I was standing for 30 and 40 minutes at a time.

All the while I was getting pretty good in the wheel chair as well. I could transfer independently to my bed, to a restroom chair, and even into a car seat. I was independent enough to go with family of friends to the cafeteria for a bowl of ice cream or a coke. It was a much more pleasant place to entertain. I was able to wheel myself out into the courtyard. We celebrated the 4th of July there as well as our daughter Melissa’s 22 birthday. My beloved dog Brandon, who I had not seen for over 3 months was even allowed to come meet me there in the courtyard. I felt a sense of freedom being able to get around independently. Walking again still seemed a remote possibility, but I was determined to do everything I could to make it happen.

Eventually, I had progressed as far as they thought possible. We all decided I could return home and continue my rehabilitation as an outpatient in Las Cruces. What a momentous day it was when I left Rio Vista Hospital after 8 weeks. I left with many mixed emotions. For 8 weeks I had grown very close with the staff of Doctors, Nurses, Aides, Therapists and even the woman who came each day to clean the room. She always greeted me with a friendly, warm “Hello Mr. Davis and how are you today?”

After returning to Las Cruces an appointment was made at CORE, a local outpatient Therapy clinic associated with Rio Vista’s parent company. Greg, my new Physical Therapist was an athlete and I think he saw I had been somewhat athletic as well. He pushed me hard. He wouldn’t take no for an answer. When I thought I could not do one more pelvic squeeze or more repetition with a dumbbell, somehow he would coax, urge, cajole and force me into doing more.

Once I had been given clearance to begin weight bearing on both legs, he really began to push me. He made me get on the floor and figure out how to pull myself back to the mat or wheelchair. He made me stand in the rails even longer than I had before. He got me on machines that began to start building muscles back into my legs.

The good news was that everything down as far as my knees seemed to work well. I could flex the hips and the knees. I could push my feet down and move them to the outside. I could not pull them up or turn them inward. But it began to appear as though I would be able to walk again; albeit with braces and crutches.

During this time, a friend from Young Life who owned a clinic of her own had volunteered to work with me on the days I was not going to CORE. She bravely got me on a treadmill and a life cycle. One day, she brought a walker to the side of the mat and much to my surprise told me that I was going to learn how to walk with that walker. Imagine Judy’s surprise and joy when she came home from work that night and I demonstrated my newly found “trick.”

Eventually I progressed from the walker to forearm crutches. I was fitted with some heavy plastic devices called Ankle Foot Orthotics (AFOs). They mechanically forced the front of the foot to raise after each step and thus prevented my toes from dragging on the ground. We found a Doctor who was able to measure my leg lengths and build up several sets of shoes to a prescribed height and thus diminish the effects of a two inch difference in length between my right leg and my left.

My goal had been to walk my daughters down the aisle at their upcoming weddings. It appeared that might actually happen – even if assisted with braces and/or crutches or canes.

On August 31 – just three and one half months since my accident – I took my first steps with a walker. Two weeks after that I decided on my own I would try walking without the walker. I chose a place at home with a smooth surface (even if hard should I fall) and I placed the walker where I knew I could get to it and I took five independent steps.

I felt like my little friend Ally, who by this time, had already begun walking. I was every bit as proud and elated as she could have been. It was a huge accomplishment for me. But I realized it wasn’t my accomplishment. It had happened only by the persistant grace and healing touch of God. It had been possible only because people around the world were praying. I walked because a slew of Doctors, Nurses, and Therapists were well enough trained to take me ahead one step at a time. It happened because of the encouragement and love of my wife and children. It happened because all these things had begun to instill in me a deeper sense of trust and faith.

Since my childhood, I had read but not really appreciated the stories of Jesus’ healing ministry. What an incredible miracle it truly was to have touched a person who had been crippled for life and by simply telling them to get up and walk, they did. It was more than a miracle of healing a crippled joint or repairing a damaged muscle or nerve. It was a complex compilation of many different steps – all happening in an instant. Balance, nerve function, stiff joints, mental attitude, muscle tone were all touched in such a way to make possible what had taken me several months to learn and do.

Yet I considered God’s touch in my life no less miraculous. When I had first heard the ominous words that suggested I might never walk again, I was crushed. I believed it would take nothing short of a miracle for that to happen. As time progressed and evidence began to show I might walk again, it didn’t happen overnight. It was a slow, laborious and frustrating experience. Like a small infant the process of walking had to be learned anew one small step at a time. Along the way there were more than a few tumbles. There still are.

As I was relearning the process, it occurred to me that this experience was an important metaphor to help me better understand my walk of faith. Living the Christian life is much like walking. By faith a person first comes to trust in Christ. In those early stages of faith, there is so much to learn and often the new Christian has to hang on to something solid. Hopefully there is a more mature believer holding their hand while they take the first faltering steps. Such reassurance and support is essential. The “spiritual muscles” in a new or immature believer are often weak and unable to support much weight.

One step at a time. Day by day, I have found that I have choices. I can't see the future or the end of the stairway. But then I don't really need to. All in need to do is take a step; then another; and another; and another - rusting God every step along the way.