Friday, January 22, 2010

A Tale of Two Neurologies

My friend Cass is the daughter of one of my best work pals, Mary. She's about 4, and as you can see, has a all the exuberant, uncomplicated joy of most people who are 4. She's outspoken, confident and fun to be around just about all the time, although she has put me in my place once or twice when we disagreed about something. (Just imagine. Her mother would never do such a thing. Ahem.) Cass had surgery around Thanksgiving. She has CP, and a certain amount of spasticity which has kept her from walking without a walker, so far. In a quietly miraculous sequence of events during the holidays in which planets aligned and the heavens parted, Cass was accepted as a candidate for a highly specialized surgery, and it was done. The doctor guaranteed - guaranteed, mind you, the reduction of the chronic spastic state of some of the nerves preventing her from walking, and said that Cass would have no limits, once she re-learned things: no limits. Surgery done, post-op recovery well underway, Cass was a bit like a noodle.

Well, think about it. If you didn't have to hold your head upright because a contraction of muscles in your neck and back did it for you, your brain wouldn't think it needed to allocate brain-cell-resources to that function. And if the muscle contraction stopped one day, your head would flop over. If you were a kid whose brain had never needed to work on learning to hold up your head, your brain would have to say, "Hold on a damn minute. We gotta re-allocate some brain cell resources here, and tell those muscles to hold up our head. Stand by, stand by." This is what happened to Cass, in a gross oversimplification. Her brain had to step in, build the connections and bridges between itself and the appropriate nerves and muscles, and allow her to learn how to do things like hold up her head. Some of this happens fast, and some comes in time, with encouragement and physical therapy and boundless love from two people who are as committed to this success as they are to waking up every morning. And as Mary and I talked about it the other day, it dawned on me that Cass and my dear Rodney are, in some ways, on different ends of a certain continuum.

Rodney has something called neuropathy. It occurs in people who are severely diabetic or alcoholic, but it also in occurs sometimes for no reason anyone can understand. He has neither of those afflictions. And neither his family doctor nor a range of other consulting doctors, like neurologists, can put their fingers on a cause; he just has it. One night a year or two ago, he said, "Do my toes look swollen?" and I said, more or less, no indeed. But from that point forward, he began to experience both numbness and excruciating pain, and testing revealed that he has an almost complete lack of nerve conductivity between his toes and his brain. Doctors expressed astonishment at his pain tolerance and stoicism; apparently they could send an amount of electical current intolerable to you or me through his nervous system but the vital connections took no notice. He takes rather alot of medication to try and manage his pain, he suffers, I think, more than he says, and we do some things that help him dissociate from it. We walk on the beach. He takes a metal detector, because that combination of brain functions removes him from the pain for a bit. But he can't walk too close to the lapping waves down close to the shoreline, because his toes don't really work any more and his balance is unreliable. We don't care. I walk closer to the water and find sharks' teeth in the gleaming water lit by the sun . He walks higher up on the beach, where purchase is easier to come by, and if he teeters a bit or should fall, he'll recover his balance, and stay dry.

So Mary and I were catching up at work this week, and I asked about Cass's reduction in spasticity (yes, it is much removed, perhaps even gone) and how's she's doing, re-learning some things her brain had probably begun to take for granted. Physical therapy, the natural recuperative powers of childhood, and a bottomless well of love are helping her move forward, helping her determine how far she wants to take this virtually unlimited set of new possibilities. "Her TOES are starting to move," Mary said, "I never thought about it much before, but you know, you use your toes to help you walk, and Cass's toes really didn't move before the surgery..."

For a tiny second I lost the sound of Mary's voice, realizing that Cass has toes that are waking up, coming to life, discovering and figuring out how to do the job of helping her walk. One of these days, Cass will be able to walk, or run, or scoop up a baby sister or brother on her hip, or walk across a room physically with the same confidence she moves now, the same beauty, the same certainty. Rodney will be moving differently on his feet, finding new ways to move, just as Cass did. Perhaps he will need to rely more on his conscious brain, do more work to figure it out, but he will find his way. And while he can't rely on the recuperative powers of childhood, he does have a similarly deep well of love from which to draw. He might have to work a little harder but he won't work alone.

And finally, because it's Friday and there's a bank of fog off to the east that could befuddle the nimblest of brains, a clear, blue-sky sunset seemed like a fine closing note. It was one of those sunsets we get in early January, when the days have begun to grow noticeably longer and we are humbled with gratitude. Tonight is one of those nights, for though it's damp and cool and foggy and faintly wintry, the light has returned. And when the light returns, robins land in our yards and hope settles in right beside them, warmed by the sun and promising everything.


  1. Angie- I just loved this post. I am so sorry for Rodney but I know he is strong and has, yes, a deep well of love to draw on.

  2. Thank you so much, Ms. Moon. I love sharing some of our troubles and woes in this format more than I can tell, along with the joys and beauties. You continue to inspire me.


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