Dr. Clark is the local specialist in spinal cord injury and I’ve been seeing him since the month I got out of rehab. Usually when I roll into a room, I’m the only guy in a wheelchair, but in Dr. Clark’s waiting room, I’m never alone (although to be fair, I’m usually the most disabled guy even there). When Cathy and I enter the waiting room today, I recognize one of my buddies from rehab, Tony. Tony is about five years younger than me and got hurt riding an ATV.
Looking at Tony makes me feel like I’m looking into a mirror. He’s got the same skinny arms and legs strapped down to his chair, and I can see he’s also put on some weight in the midsection region. He’s even got an identical strap across his chest. It’s almost hard to look at him, because of how severely impaired he looks—if that’s how I look, it’s no surprise Cathy and I have been having trouble making friends. His mother, who I recall became his caregiver after he was discharged from rehab, is accompanying him and she looks as exhausted as Cathy probably looks.
One thing that’s new on Tony that surprises me is the trach jutting out of his throat, tied around his neck with a blue cushion. Both of us had trachs in rehab, but we both managed to get them out. Somehow Tony’s has reappeared, although I can see the red cap on top of it, indicating he’s not actively using it.
“Hey, Jamie,” Tony calls to me as I pull up my wheelchair beside his. There isn’t a lot of room and I knock into him slightly, jolting both of our bodies.
“Hey, Tony,” I say. “Long time no see. What’s going on?”
“Notice my new addition?” Tony wags his eyebrows at me.
“Oh my gosh!” Cathy exclaims. “What happened?”
“He got pneumonia last year,” Tony’s mother explains to us as she touches her son’s shoulder gently. “It was touch and go for a while. He recovered, but they weren’t able to entirely wean him off the trach.”
“She puts me on the vent only at night,” Tony tells me. “During the day, I’m fine.”
“Usually,” his mother adds.
I shiver slightly. I hated having that stupid trach and it’s unsettling to think that I’m one pneumonia bout away from getting it back.
“What are you here for?” Tony asks me.
“Just a check-up,” I lie.
Tony and I never confided in each other about that sort of stuff, although maybe we should have. I’m sure he has a suprapubic catheter like I have, or something like that. I’m sure his mother is trained to help him evacuate his bowels, the way Cathy is. He knows what it’s like to have someone helping you with something so personal. He’d get it.
I cast a quick glance at his groin area, wondering if I detect a bulge of a diaper. Tony wouldn’t have told me if he had to wear one, and I never told him. But there was one time when I very obviously shit myself during a group therapy session, to the point where someone had to immediately take me away to be changed. Later, Tony caught up with me and said, “Don’t feel bad—it happens to all of us.”
Maybe I should have done a better job keeping in touch with Tony and the other guys from rehab. But it just brought back too many bad memories.
I wonder if Tony is thinking the same thing, because he says to me, “You and Cathy should come by for dinner sometime.”
“We wouldn’t want to impose,” Cathy says to his mother.
“Not at all,” she says quickly. “We would love to have you over.”
Tony rolls his eyes. “If I can squeeze you into my social calendar. It’s pretty much nonstop dates these days.”
He laughs at himself, and for the millionth time, I feel incredibly grateful to have Cathy. If I’d been single at the time of my injury, like Tony was, I’d probably be living with my parents the same way he is, and I can’t begin to imagine how I’d meet women. Well, I wouldn’t.
A nurse calls our name and we follow her to the examining room. Once we’re safe inside the room with the door closed, she says, “This is about a bowel-related issue?”
I nod, not really wanting to provide details more times than I have to.
“We’d like you to transfer to the examining table then,” she tells me.
I look at the examining table then back at the nurse. “That’s not going to happen.”
“Dr. Clark will want to perform a rectal exam,” she tells me. She frowns. “We can find a staff member to help with the transfer.”
“That sounds fine,” Cathy says before I can protest again.
A male nurse comes in to assist Cathy in transferring me to the examining table. When I see the muscles in his arms, I at least feel comfortable that he’s going to be able to transfer me without any difficulty. Cathy undoes all my straps, and immediately my body tilts to the right due to my complete lack of trunk control. The nurse leans me against his chest, grabs me by my pants and shifts me over to the table in one swift movement. Then Cathy gets behind me to help ease my body down onto the table.
“Wow, you’re good at that,” Cathy tells the nurse.
“It gets me a good workout,” he laughs as he flexes his biceps. I try my best not to be pissed off that this guy is flirting with my wife while showing off his muscles.
“Should I get him undressed?” Cathy asks him.
He looks me over. “From the waist-down.”
So while we’re waiting for Dr. Clark, Cathy takes off my sweatpants and shoes. I’m left in my T-shirt and diaper, and I can’t help but wish they’d given us a sheet to cover me with. Wouldn’t that have been a reasonable thing to do for my privacy? But fuck it. Nobody seems to give a shit about my privacy anymore.
Cathy shifts the head of the examining table up just in time for Dr. Clark to enter the room. So I’m able to look at the doctor instead of staring up at the ceiling.
To my horror though, he isn’t alone.
“Hi, Jamie, Cathy,” Dr. Clark says to me. “This is a medical student who’s been shadowing me. Her name is Maddie.”
Maddie is twenty-something with a pert little nose and blond hair tied back in a ponytail. She’s really cute, and absolutely the last person I want to discuss this around. On her part, she seems incredibly uncomfortable to have walked in on me half-naked.
“Jamie has a C3 complete spinal cord injury,” Dr. Clark tells Maddie. “He has no movement or sensation below his shoulders. One thing we do for him here is work on issues with his bowel and bladder program.” He smiles at me. “Jamie, would you mind if I showed Maddie your suprapubic catheter?”
Yeah, I do mind. But what the hell. It’s not like I’ll ever see this girl again. “Sure.”
The tube is already jutting out of my diaper, but Dr. Clark tugs down the diaper to show where it enters my abdomen. There are several drops of piss hovering in the tubing, and they shift and make their way down to my leg bag as he moves the tube.
“A suprapubic catheter is a better option than a Foley catheter that goes through the penis,” Dr. Clark explains to Maddie, “because it decreases the risk of infection.”
Maddie nods solemnly.
“Now, Jamie,” Dr. Clark says, “Cathy says that you’ve been unsatisfied with your bowel program. That you’d like to try to eliminate the accidents. Now, how often do you have accidents.”
I glance at Maddie. “Once a week.”
Cathy snorts. “No, more like three times a week.”
That’s… okay, it might be true.
“You’re using magic bullet daily now?” he asks me.
“Magic bullet is a suppository that stimulates a bowel movement,” Dr. Clark tells Maddie. “Cathy inserts it and then they wait for him to get emptied out. I looked through the documentation, and it looks like we’ve tried quite a few things before arriving at this particular bowel program.”
“But it doesn’t work,” I say. “Obviously.”
“One issue that we’re facing is that you don’t have a lot of rectal tone,” he says. “Or at least, you didn’t last time. We’d like to test you again.”
I know what that means.
Cathy rolls me onto my side in anticipation of a rectal exam. She does it by rolling my right leg over my left, then putting my right arm across my body, then slides me over onto my side. I hear Dr. Clark undoing the Velcro on my diaper and pulling it down to do a rectal exam. I hold my breath.
“No change from last time,” he announces.
“Jamie,” he says, “would you be okay with Maddie taking a feel? I’m trying to teach her about rectal tone.”
Jesus Christ, absolutely not.
“Sure,” I mumble.
Maddie uncertain shadow hovers over me as I hear her gloves snapping into place. I can’t feel what she’s doing, but I hear her gasp followed by a familiar smell and I know exactly what just happened.
“Oh my God, he…” she manages.
“It’s okay, I’ll get him cleaned up,” Cathy says quickly.
I’m afraid to know how badly I shit the examining table. It takes about ten minutes before everything gets cleaned up, and Dr. Clark excuses himself in the meantime. When he returns, I’m in a fresh diaper and Maddie is conspicuously absent.
“After reviewing your records and feeling your rectal tone,” Dr. Clark says, “I’d say that the chance of maintaining bowel continence is extremely small.”
Great. So I really am stuck with the diaper forever.
“However,” he continues, “there are surgical options available to you.”
Cathy frowns. “Surgical options?”
Dr. Clark nods. “Some of my patient who have had difficulty with wound management in the sacral area have had diverting colostomies. That way they don’t have to worry about incontinence.”
“A colostomy?” I blurt out. “You mean I’d have a bag on my belly?”
He nods again. “As I said, it’s not a terrible option. It would involve a significant abdominal surgery, but it would be a simpler way to manage your bowel. Your stool would collect in a bag and you’d just have to have the bag emptied periodically, which would be easier than cleaning up an episode of incontinence.”
I don’t know what to say to that. As much as I hate wearing a diaper, I don’t know if having a bag of shit on my belly at all times would be preferable to that. I imagine Cathy and I having sex and her having to look down at that bag while we’re doing it. That can’t be sexy.
Plus the idea of going through a surgery is scary. I’ve been hospitalized a couple of times for urinary tract infections since my injury, and I hated it. I spent most of the time stuck in bed, relying on the slowest nurses on the planet for all my needs. And what if after I was intubated for the surgery, they couldn’t get me off the ventilator and I ended up like Tony?
“I need to think about it,” I say.
“I don’t think it’s a good idea,” Cathy says.
Dr. Clark shrugs. “Jamie, your wife is the one who does your bowel program. Is this is her preference, I’d say you don’t have a problem.”
I bite my tongue, not wanting to tell the doctor about my son’s horrible proclamation the night the Rosenthals came for dinner. About how my baby was getting out of diapers and I wanted to do the same. I know he’d tell me I’m being ridiculous, and he’d be right.
But I can’t help but think that maybe the colostomy isn’t the worst idea.
To be continued....