THE PASSIVE VOICE

Barrett L. Dorko, P.T.


          His name was Richard Maxwell. "Dick" was the patient service coordinator at a rehab center in Columbus, shuffling papers, writing memos, and dealing with the personalities of the patients, families, and staff each day. In 1970 he was a very conservative ex-Marine who actually had an autographed picture taken with Spiro Agnew and Bob Hope on his desk.

          I was struggling academically and financially, and needed a way of impressing those selecting students for the physical therapy program with a quasi-medical job while paying my rent at the same time.

          Dick needed somebody to help him each morning, and we seemed a good match.

          I hadn't the slightest idea what it meant to be a quadriplegic, but Dick would teach me. Each morning I would drag myself out of bed at 5:30 a.m., and walk several blocks to the building where Dick both lived and worked. Walking through the darkened hallways, I would occasionally glimpse patients half awake and shuddering with the muscular spasms that greeted them each morning. Moonlight still reminds me of this sight.

          I learned from Dick's mother and some of the nurses the rudiments of a bed bath, how to shave someone else's face, how to dress another who had no hand function. From Dick, I learned how to do all he needed without aggravating a sleepy man with a quick temper. He was not my patient; he was my boss. There was nothing I could suggest to alter his routine that he had not been through before in the 7 years since his injury. I had to merge with the small motions of his head, and understand the meaning in his face. Dick actually taught me how to perfectly knot his tie in a windsor. Nothing but perfection was accepted and whatever else might be wrong with my dress these days, no one can find fault with my knot.

          During my first few months, I would nap in the afternoons and suddenly waken convinced that I had overslept and left Dick waiting. My roommate would watch me race frantically around the apartment, hyperventilating, and moving like early Jerry Lewis until I realized that this was just another manifestation of the job I had accepted. I never mentioned my fear of failure to Dick. I just managed to show up 7 days a week and apply myself to this task over and over again.

          All of the manual care I provided for 3 years was passive range. I was not moving joints their full available range, just far enough to accommodate care. Each day I handled limbs that could not be consciously moved or normally sense their being moved. Still, this part of Dick had a way of being alive that was simply more subtle than my own. Unless moved with a certain care and respect, they would object violently with spasm that would preclude further movement until their voice was heeded.

          The skills we acquire in life are not always chosen. They are often the end result of what we had to do in order to get by. If we are lucky, the very skill we inadvertently acquire may help us later on, perhaps even shape a significant portion of our chosen work.

          Today, I handle patients in a fashion that reminds me of those mornings with Dick. I understand that the body that is not consciously moved is also not perfectly still. In a way, unique to itself, it always remains reactive to the intent of our touch. Dick's seemingly passive limbs were always wary of my agenda, and I learned to move him with respect for their unconsciously controlled ability to object. This voice wanted to be asked permission to move, and it safeguarded the dignity of every part, paralyzed or not. I have come to hear this voice in all my patients.

          I spoke to Dick recently for the first time in 17 years. He is working, he is married, he coaches a young girls' softball team. We are not very different, really. Among other things, he taught me that my disabilities were just harder to see.

          I think of that when I waken and see the moonlight.