She never told him.
Paula (identities protected) said, “Does he even need to know?”
“It would be cruel to tell him. I just don’t think Steve could handle it now.”
We stood alone outside the door to exam room 2. She asked to speak to me before going in. Her fingers pinched at the edge of her jeans. She avoided eye contact until she stopped talking then her eyes opened wide and pleading.
We already answered this question, “No.” Steve doesn’t need to know that his parachuting accident was probably a suicide attempt.
Why would Paula bring it up again?
Inside, Steve answered the routine questions from my assistant. “Any new medical issues? How’s it going with therapy? How’s it going at home?…”
“What’s up, Paula?” I asked.
“Steve can’t do it. You know. Get it up.” Her eyes went down and her hands twisted the belt loops of her jeans into little screws.
“He did before. He’s mad about it. I know that means he’s sad but is there anything to help? I mean, I love him so much just like he is and I don’t mind but …” she trailed off.
I knew that in the case of incomplete spinal cord injury, such as Steve’s, it was possible to have psychogenic erections and that he had reported success before. Why the problem now? Something like 18 million men in the USA have difficulty with it and it’s not usually due to being in a wheelchair.
“Yes,” I answered. “Let’s talk and make a plan.” We walked in just as the blood pressure cuff deflated on Steve’s arm.
Steve’s arms were the size of my legs. Muscle rippled as he lifted himself to reposition his paralyzed lower body on the specialized seat cushion. He leaned so far forward his barrel chest pressed against his boney thighs and his seatbelt strained as he grabbed his ankles and roughly pushed his feet back against the heel plate. He re-strapped the velcro tightly like he was punishing his feet for their uselessness.
As we talked about life I noticed Steve repeatedly shrugging and shifting in his seat. It was almost like writhing but slower. He grimaced and shifted impatiently.
“What is sex anyway?!” Paula said as she raised her hands palms up. The gesture raised her tight gray T-shirt showing her hard midriff.
“It’s something other guys get to do,” was Steve’s mumbled response from his black powered wheelchair. “Something you should do with some other guy.”
“I don’t want some other guy.” Teeth clenching now Paula shook her fists.
Steve pushed to sitting upright and ran his calloused hand through the wavy shock of dark hair falling to the side of his forehead as water pooled in his eyes. “I came out of the mud. It’s like I’m Adam but didn’t get enough of that breath of life.”
The mud was at the bottom of a wet hillside where Steve crumpled after his parachute did not open almost two years earlier. At first, his amazing survival was matched by his ridiculously positive view that he would “get it all back.” As the months past and he stayed paralyzed his reality melted into dark catastrophising about his future. With team support he adapted and became independent in bathing and driving and many daily activities. His upbeat mood returned often, but sometimes it was, “Doctor Johnson, I can’t take care of Paula, or anybody. I don’t know why she bothers. I’m sick of the pity. I’m tired of the looks.”
Then there was Friday night at the club. “Steve, you're back! You look great, man” and “Wow, you’re an inspiration!” and “Steve, honey, take me for a spin on that sweet ride!”
Paula had finally convinced Steve to go out with her to one of the clubs they used to enjoy, “just to get out and see everyone again.” Overwhelmed by the memories, perfumes, sweat, staccato lights in his eyes, and confusion about his role there, Steve retreated to a dark corner. Like a paddle ball on a rubber string, Paula ran back and forth from his table to say “Hi” to friends, bring them over, get drinks. Awkward.
A fight started, glass broke, gunshot, stampede for the exit. Nobody thought of the guy in the wheelchair, except Paula.
“I was like, I’m so not afraid,” said Steve. “It was awesome. It wasn’t that I was brave. I just wasn’t scared. The whole thing just seemed silly to me.” His body relaxed for the moment as he remembered then went back to twisting.
“Whoa. He’s really hurting.” I thought. “His blood pressure is up.”
In a brief discussion, Steve made me understand he ached all over and his back pain was building up again. He noted that he stopped his daily antibiotic over a month before. He wanted to be done with them. Lab results showed a bladder infection. He couldn’t feel it and didn’t want to look for the other signs. It cleared with medication but his back pain got worse. He didn’t want to accept it. The fluoroscopic spine injections helped again. His marginal erectile function returned with the need for additional medical assistance.
Steve’s denial cost him pain, a bladder infection, and the loss of his tenuous sex life. Left unchecked, it could have cost him his life. Why doesn’t he just accept his situation and take care?!
It the face of overwhelming catastrophe, denial can keep us alive. It allows us to carry on under unacceptable stressors. Being in denial can allow the mind to unconsciously absorb a shock at a pace that won't cause immediate psychological collapse.
How much is too much?
It’s easy to point out the smoker or drinker or angry person who denies the health cost but more subtle forms are everywhere. The job that drains you. The years of prolonged conflict with a parent or spouse. The buried memories of rejection.
Denial, like other powers, works best when checked. Paula and the team at the Spine Institute were Steve’s checks so he didn’t die from that infection. It’s obvious in Steve’s case that he should have a trusted team to help him. The truth is, we all need trusted friends to check our thoughts and feelings. Sometimes our denial should be supported and sometimes not.
We all need faithful friends to check our extreme feelings and thoughts. The people with the most smiles, energy, and stability are the ones with the best check system. We want friends to be accepting and forgiving but also insightful and able to save us from ourselves. Sometimes that’s too much to ask of any one person, especially ourselves in denial. You can use denial to survive and thrive when it’s checked by good friends; people, books, art, nature, ideas.
I wonder what I’m in denial about right now. Oh, my friends are rolling their eyes.