A while ago, I wrote a diary about what my wife went through when I was in the hospital during February and March.
Yesterday was my last day of physical therapy on my right shoulder, which had atrophied greatly while immobile in bed for 42 days.
I distinctly remember that moment in March when I realized I was too weak to raise my right arm without grabbing my wrist with my left hand and moving it. When I realized that my arm was the same thickness from wrist to shoulder. That my wife, who is all of 140 pounds, perhaps 145 if it's pizza night, was at that time ten times stronger.
On top of it all, I could not walk, even sit up without help, and worried greatly that I would be maimed in one or more fashions for the rest of my life.
(More below the break)
Range of Motion
I've titled this diary "Range of Motion" because it captures a lot of what I went through, from the constraints I described above, to where I am now, to where I am likely to be in another four months.
I can't believe it's only been four months since I was discharged from the hospital - and could stand and walk and go up stairs, barely. That it's been only three since I went back to work and could start to run - barely. That it's been only two months since I could walk long distances and dare to start serious training again...barely, a third time. That not two weeks ago, I swam - barely yet again - for the first time.
These are just benchmarks and touchstones, dotted lines that do not convey all of the steps required.
For let me assure you, physical reconditioning is hard, hard work.
I had it easy. Aside from some scarring around the shoulder and between my ribs, I was profoundly out of shape (thanks to de facto zero gee in a hospital bed) but I still had all my basic muscular-skeletal strcture intact. All internal organs - even the heart and lungs - were officially okay, though as I quickly learned I had severe tightness and pain from breathing hard, a condition that made running, even walking, even sitting for long stretches a challenge at first.
I was terrifed I would never breathe easily ever again. I was used to being able to run like the wind - or credibly imagine I could, given time and training.
I had to face the prospect of never running again, by any understanding I had of the term.
And yet I could walk, I could gradually sit up for long periods, then walk more, and test out shuffling for short distances - like, jogging slowly for 20-30 seconds at a time.
My first running workout was a combined two minutes of shuffling in the midst of roughly half an hour of walking. My wife said it looked like I was just out of the hospital. That it looked nothing like she was accustomed to seeing when I run. Yup. That's a natchul fack, Jack.
It became my life, from the start of May on, to patiently wade into working out. One of the doctors told me it would take five days for each day on my back in the hospital to get back in form. I estimated that to be 215 days. Roughly until Halloween. August. September. October. Three more months to go.
Since I could not run easily, I took up walking. A lot. I would routinely walk an hour to ninety minutes during the work week. Gradually, I added evening...grimace...running workouts to the mix. Since I could not handle running more than short distances at a time, I developed interval workouts. I would budget out a number of seconds to run every five minutes. I started with 90 seconds, then two minutes, and plateaued for a while at 210 seconds - 3 1/2 minutes.
Two days a week I would be at the mercy of Lashonda, John or Tara at physical therapy. Lashonda's initial assessment of me was that I was generally tight in the shoulders, especially so in the right side and definitely weak as all get-out in the right arm and shoulder.
Their clinical interest in my case was that I was a straight reconditioning case - save for the surgical scarring adjacent to the shoulder, the joint itself was fine. However, as I learned, the shoulder joint of the human body is one of the most complex biological instruments ever put together. The arm proper is not firmly fixed to the rest of the body. Far more than I realized, its functionality depends on a complex array of muscles extending like a fan across the back and levering off the spine. There are neck muscles that can come into play as well - but the therapists frowned upon overcompensating with the upper trapezoid. I heard "Don't do that!" a lot. :)
Another thing I learned was that there are a lot of little bitty muscles and movements of same that I had no conscious idea were even possible. I remember the first time feeling some pair of little muscles between my shoulder blades move as the therapist (Lashonda for sure) indicated and my going - "OMG I had no idea that even moved!" Yet it was of a piece with the rehabilitation of my shoulder. We had to activate (or "recruit") muscle movements I never knew where possible - because the little bitty ones connected the spine to the foundation muscles in the lats and traps, which in turn connected to the deltoid and triceps and all the loom-like weaving of tendons and ligaments around the shoulder proper and - off we went.
I have lifted dumbbells into the thousands of repetitions. Stretched big rubber bands. Done every incrementally harder variation of pushup you can think of. Discovered belatedly in life that doing lat pulls on a machine behind your neck is a no-no. Learned that, wow, despite being left handed I can actually through a heavy rubber ball with my right gainst a trampoline and catch it straight-handed consistently. Woot.
This was an hour of work on two days a week. For fifteen weeks. So long as I kept improving, they kept me coming back for more.
Some days, between therapy in the morning, walking during my lunch hour and a combo of walking and running at night, I would put in north of 3 hours of exercise. Sometimes north of 3.5 hours. 2-3.5 hours, five days a week. I have not put in that kind of routine exercise, ever.
I remained discouraged about how hard it was to breathe. This was driven home by my friend Dawn's drafting me to start running 5K road races in July.
The first race was a mighty 32:34. I have never, ever, not once, not at any weight, run slower than 25 minutes in a 5K. To say my breathing was restricted is an understatement. It was agonizing. I walked for much of the final mile but at least kept it together for the finish.
The next week I ran a 28:59. The breathing was basically the same level of restricted but I focused on relaxing. However, it was very unsettling - this idea that I would not be running more than a slow, painful shuffle ever again.
In the middle of the following week I did a time trial on an indoor track. 50 laps on a 100-meter track. It was flat, consistent cool climate - I ran a 27:43.. I think. Also, I had started to realize WHY I was having such trouble breathing.
In hindsight it was a real "D'oh!" of a moment. Consider what part of your body is most relaxed when lying on your back.
Your stomach.
I tested this notion the hard way - I attempted a sit up. I, who used to be able to do these at will - the one exercise it never occurred to me that I would need.
I could not do a single fracking situp.
However, I could do crunches. I could raise myself up, then fall back, then rise back up to my knees within a limited range.
Then I told the PT peeps about this. They adjusted the training. Since we were working on the shoulder, naturally we had to do shoulder exercises -but we could do them while laying across a big rubber ball to "recruit" the core muscles of the abdomen and back.
A little more than a week later, I took my training to a treadmill. In my experience, treadmill running is not particularly easy as you have to do pretty much the same monotonous motion. On the other hand it was cool indoors.
I ran a 25:04 5K. I won't say the breathing was grand but it was much easier.
That was the point I said - ok. I can do this.
From that point on I realized how silly it had been to expect instant return to running form. Running is seemingly simple yet it requires not just many physical systems working at strength but working in sync. You have to have strength, flexibility, coordination, cardiovascular fitness, posture and your guts have to be accustomed to jostling about inside of you. None of these systems snap back to full form. All of them take time to get reacquainted with one another after, borrowing from the movie Four Weddings and a Funeral, an awkward pause in physiological conversation.
Yet even then it felt like jogging.
I've mentioned this elsewhere, but when I went to NN in Vegas, one of the first things I did was go running but a sprint workout. Forty seconds fast. Eighty seconds walking. Over and over again. And I did this for three miles. For me it was a fine memory because I ran like the wind and breathed just fine.
Range of motion, indeed. Afterward I felt, aside from very hot and parched and cognizant that I was really, really out of shape even still, like I had my wings back. Those little invisble Mercurian ankle-wings that had always been there for me. For those short moments in the Las Vegas night, I was at full strength again.
Now, back to the shoulder.
So...yesterday, I had my final assessment and discharge from physical therapy. Tara got to do the honors, which mostly included various attempts to force my arm to move (I did well in all save one pose, which was recognized as okay because it's hard to hold your arm at a 45 degree angle forward while lying down on your stomach and keep it from going anywhere). My active range of motion had basically doubled in every direction and in essence my right shoulder was as functional as the left -though both need more work as both arms were weakened during my hospital stay.
And with that a farewell, a handshake, and off I went to get ready for work. No more morning sessions lifting weights and stretching big rubber bands.
I stood outside in front of the therapy wing of the hospital for a moment, thinking - well, that's done. Graduation. And I smiled...then noticed the little boy using a hand-pedal to move a large tricycle down the parking lot drive. He was dark-haired, very pale, surrounded by three nurses/therapists and a bearded man who was clearly his father. The boy never made a sound, never stopped smiling as he pedaled from his upright seated position on the trike.
I don't know a thing about the child's condition. I did not feel it proper to go ask. It was clear to my now-experienced eye that this might well be his first day out in the sun in a long time.
My journey in therapy was over. This young boy was just starting his road to therapy. I had no idea where he was coming from, or how far the Fates had in mind for him to go, or where that big hand-powered tricycle was going to take him.
But he was smiling nonstop, the nurses were cheering him on and the weather that North Carolina morning was splendid.
It was a good day to start a road trip. I had to fight back tears as I said quietly "You'll get there, kid. We all do in our own way."
Then I looked down, smiled again, and headed off to the rest of my own life.