Chapter 7
Six months later
“I’m really sorry you had to bring me today,” Mary said for the third time as Bert pulled into the parking lot of the Montana Rehabilitation Center. “I could have changed the appointment.”
“I know I don’t have to,” Bert replied, putting the SUV in park. “I want to. I can wait in the car if you’d prefer.”
Mary hesitated, her hands resting on her lap.
The truth was, she’d never brought anyone to one of these appointments before, other than her parents, and lately, she’d come by herself, wanting to hold on to every ounce of independence she could grasp.
The quarterly checkups she had with her doctor and physical therapist were intimate in a way that had everything to do with the vulnerability of her body that no longer worked the way it should.
“You can come in,” Mary said finally. “But fair warning: these appointments are long and probably boring for anyone not directly involved.”
“I brought a book,” Bert said, patting his jacket pocket with a small smile.
The rehabilitation center was familiar territory for Mary.
She’d been coming here every three months since she’d moved back to Montana, seeing Dr. Marla Casteel, a physiatrist who specialized in spinal cord injuries.
The staff knew her by name, and the receptionist waved them through with a warm greeting.
“You can wait here,” Mary said, gesturing to the comfortable waiting area with its magazines and large windows overlooking the mountains. “I’ll text you when I’m done.”
“Take your time,” Bert said, already settling into a chair and pulling out his book.
Mary rolled toward the examination rooms, checking in with the nurse who took her vitals and updated her chart. Within minutes, she was moving from her wheelchair to the examination table with the assistance of the nurse and a transfer board.
Dr. Casteel arrived moments later, her warm smile and competent manner immediately putting Mary at ease. “Mary, good to see you. How have you been feeling?”
“Pretty good, actually,” Mary said. “No major issues since the last visit.”
“Excellent. Let’s start with the basics, and then we’ll get into specifics.”
They went through the clinical questions…
the unglamorous realities of living with an incomplete spinal cord injury.
Bladder function, bowel routines, skin integrity, muscle tone, and spasticity management.
Mary answered each question matter-of-factly, long past the embarrassment she’d felt in those early months after the accident.
“I’m going to check your hip flexors and see how your muscle tone is doing,” Dr. Casteel said, moving to examine Mary’s legs. She lifted Mary’s right leg, bending it at the knee and hip to test the range of motion and muscle resistance. “Any increase in spasticity?”
“Some,” Mary admitted. “Mostly at night. My legs will sometimes spasm when I’m trying to sleep.”
“That’s not uncommon. We can adjust your prescription dosage if it’s becoming problematic.” Dr. Casteel continued her examination, moving to the left leg, testing sensation with light touches and pinpricks at various points.
Mary answered each question. “Yes, feel pressure, not sharp, though.”
“Your injury is still classified as incomplete, which means there’s potential for some recovery of function, though at this point, almost three years post-injury, we’re unlikely to see dramatic changes.
However, maintaining your current level of function and preventing secondary complications is crucial. ”
“I understand,” Mary said, hiding the sigh threatening to escape.
She’d heard variations of this speech before, and while there had been a time when the word “unlikely” had devastated her, she’d made peace with her reality.
She wasn’t going to walk again. But she could live a full, meaningful life anyway.
She was taken to the physical therapy gym where her PT, Marcus, was waiting. Marcus was in his forties, built like a former athlete, with the kind of practical, no-nonsense approach that Mary appreciated.
“Hey! Ready to work?” Marcus asked with a grin.
“As ready as I’ll ever be,” Mary replied, unable to keep from smiling.
The PT session was more physically demanding than the doctor’s examination. Marcus had her transfer to a mat table where he put her through a series of exercises designed to maintain her upper-body strength, core stability, and flexibility.
“Let’s check your hamstring flexibility,” Marcus said, positioning Mary on her back and lifting her leg. He slowly raised it, watching for the angle at which her muscle tightness would limit the movement. “Good. You’ve been doing your stretches.”
“Most days,” Mary admitted. “Sometimes I skip when I’m tired.”
“I’d rather you do five minutes of stretching every day than thirty minutes twice a week,” Marcus said, lowering her leg and moving to check the other side. “Consistency is key for preventing contractures.”
They moved through the routine of hip flexor stretches, trunk rotations, and scapular-strengthening exercises. Marcus checked her transfer technique, making small suggestions to improve her efficiency and reduce strain on her shoulders.
“Your upper body strength is excellent,” Marcus noted as Mary performed a series of wheelchair push-ups, lifting her body weight off the seat to relieve pressure. “How often are you doing pressure reliefs throughout the day?”
“Every thirty minutes or so when I’m sitting for long periods,” Mary said. “More frequently if I’m wearing jeans or anything with seams that might cause pressure points.”
“Perfect. And skin checks? Any areas of concern?”
“I check every night before bed. No pressure sores, no redness that doesn’t fade within twenty minutes.”
Marcus nodded approvingly. “You’re doing everything right, Mary. A lot of people with spinal cord injuries develop secondary complications because they don’t stay on top of the daily management. But you’re vigilant, and it shows.”
The praise warmed Mary’s chest. She’d worked hard to learn how to take care of herself, to understand her body’s new limitations and needs.
Hearing that her efforts were paying off validated all those nights of careful skin checks, all those mornings of stretching routines, and all the times she’d done pressure reliefs even when she was tired or busy.
After the PT session, Mary transferred back to her wheelchair and made her way to the waiting room. She spotted Bert immediately, and his gaze landed on her. His book was open in his lap, but his attention had been on the door she rolled through.
“All done,” Mary said, rolling up beside him.
Bert’s gaze roamed over her face as though to see deep inside her. “How’d it go?”
“Good. The doc said everything looks stable, no complications. Marcus tried to kill me with exercises, but that’s pretty standard.” Mary started toward the exit, and Bert fell into step beside her. “Sorry that took so long. Almost two hours.”
“Don’t apologize. I got three chapters read.” Bert held the door open for her, then walked beside her toward the SUV. “Can I ask questions, or would you rather not talk about it?”
Mary considered as they reached his vehicle. Bert had already moved to open the passenger door and then lifted her into the seat. “You can ask anything you want.”
Bert folded her wheelchair and loaded it in the back with the kind of careful attention that he always showed. Then he climbed into the driver’s seat and turned to face her, his expression open and genuinely curious.
“Is it always the same routine? Doctor examination and PT?” he asked.
“Every three months,” Mary confirmed. “Dr. Casteel monitors my overall health and any changes in the injury. Marcus keeps my upper body strong and ensures I don’t develop any secondary complications, such as contractures or muscle imbalances.
It’s maintenance, basically. Making sure things don’t get worse. ”
“And the incomplete injury thing the doctor mentioned—that means there’s still some nerve function?”
“Some,” Mary said. “I have sensation in my upper thighs, and I can feel pressure and temperature. But from mid-thigh down, there’s no sensation and no voluntary movement.
An incomplete injury means the spinal cord wasn’t completely severed, so there’s some communication between my brain and the lower part of my body. It’s just very limited.”
Bert nodded, processing. “And the spasticity—is that painful?”
“Not painful exactly, but uncomfortable. My legs will suddenly contract or jerk without my control, usually when I’m tired or stressed. It can be annoying, especially at night when I’m trying to sleep, but it’s manageable with medication.”
“Is there anything I should know? In case… I don’t know… in case something happens and you need help?”
Mary felt something warm move through her chest. He wasn’t asking out of morbid curiosity or pity. He was asking because he cared, because he wanted to be prepared to help if she ever needed it.
“The main thing is pressure sores,” she explained.
“They’re one of the biggest complications for people with spinal cord injuries.
Because I can’t feel pressure or pain in my legs, I could develop a sore without realizing it.
That’s why I do pressure reliefs throughout the day and check my skin every night.
If I ever mention redness that won’t fade or any skin breakdown, take it seriously.
Pressure sores can become life-threatening if they get infected. ”
“Noted,” Bert said seriously.
“And if you ever see my legs spasming and I seem unconcerned, don’t panic. It’s just the spasticity. It looks dramatic, but it’s not dangerous.” Mary smiled slightly. “Though if my legs are spasming and I am concerned, then yeah, something’s wrong, and I probably need help.”
“Got it. Trust your assessment of the situation.”
“Exactly.” She looked at him, this man who’d voluntarily spent two hours in a waiting room just to be there for her, who asked thoughtful questions without making her feel like a medical curiosity and seemed genuinely interested in understanding her reality.
“Thank you for coming today. I know it probably seemed boring—”
“It wasn’t boring,” he assured. “And even if it had been, I wanted to be here. This is part of your life, part of what you manage every day. I want to understand that.”
“Well, friend,” Mary said, laughing, “I’m starving. Want to grab dinner? My treat.”
“Absolutely.” Bert started the truck. “Your choice of restaurant, but I pay.”
As they drove toward town, talking about nothing and everything, she relaxed, realizing that for the first time after leaving one of her medical appointments, she was smiling.