My memory is that November 12, 1997, was a bright and sunny day. The ambulance ride from Valley Medical Center in San Jose to Palo Alto was smooth and comfortable. Building 7 of the VA hospital was a single story structure separate from the main hospital buildings. At that time the old multi-story main building, which had been damaged in the 1989 earthquake, was standing empty. Construction was almost complete on the new building which was a couple of hundred feet away.

As my gurney was moved from the ambulance into building 7 I was met by friendly staff who immediately began taking down vital information so I could be formally admitted to the hospital. Dr. Linder, who was to remain my primary doctor for the next four months, was very thorough. When he finished, I was transferred to a hospital bed in a four-bed unit immediately across from the nurses station where I could be observed very closely for the next day or two.

Ward 7F was the larger of two wards devoted to spinal cord patients. There were 28 beds in 7F and 18 beds in 7E. Building 7, and the whole VA hospital for that matter, was a relatively pleasant place as compared to other hospital facilities. The SCI wards were a mixture of one-, two- and four-bed rooms. Over the course of the next four months I would be in six different rooms.

The purpose of spinal cord rehab (rehabilitation) is to help the patient learn to live with the injury -- to learn how to make the best possible use of whatever physical abilities remain. For most (but by no means all) spinal cord injuries, there is no real recovery. This was certainly true in my case. My C6/7 injury left me completely paralyzed below the mid-chest level. This condition was considered "complete". There was little possibility of any change with time.

The situation was slightly different with my arms and hands. I had some movement in my arms but no movement, and no grip, in my fingers. There was some possibility that this injury was "incomplete", and that there could be some improvement over the next year or two.

(Note that the prognosis for SCI is changing rapidly. Current research reports

At this point I had neither strength nor stamina. My muscles had atrophied to the point that I could barely lift my arms from the bed. My arms were visibly withered. I had lost 15 or 20 pounds from my pre-accident weight of 165.

The nurses or therapists could transfer me from bed to chair or vice versa, but I could not help them. Some of the male nurses would simply lift me to make the transfer. A few of the smaller female nurses would insist on using a Hoyer lift -- a mechanical device which was cumbersome but which required little physical effort to use. Most of the staff used a technique in which they would slide me on a "transfer board". This involved putting a special "transfer belt" around my waist which enabled them to slide me without lifting me.

In retrospect I realize that I was not only very weak, but also probably very sick when I entered the VA hospital. For my first few days there I remained inert in bed. It was about day three that I met the two therapists who, along with Dr. Linder and several nurses, would be the major influences on my life in the weeks and months to come. There were many other individuals who also played major roles in my rehab program.

My care in the spinal cord injury unit was extraordinary. Even though the unit (and the entire hospital for that matter) had been hard-hit by budget cuts over the past few years, and many individuals were clearly overloaded, I never lacked for care and attention when really needed.

At least a dozen different doctors interacted with me at the VA.

Dr. Linder who had primary responsibility for my care was a dedicated specialist in spinal cord injury. He was a pulmonary specialist with a very strong interest in how dogs might be used to help SCI patients. Dr. Linder was aloof and tended to not get involved with his patients. He did, though, see that I made contact with the hospital rabbi. He was also very hard-working, putting in long hours and researching very thoroughly all of the drugs he prescribed.

There were also eight oe ten other doctors in the spinal cord unit with whom I had contact. In a remarkable example of the "small world" department, two of them were parents and one was a brother of one of Marion's former students Another friend of Marion's, from her Time and Stanford days, had just become chief of staff at the VA hospital. She visited me several times during my stay there

Among the other doctors who treated me at the VA were specialists in plastic surgery, blood pressure, hematology, gastroenterology, and radiology.

During my stay in rehab several medical problems related to my spinal cord injury were identified and treated.

First there was the matter of breathing. As a result of the injury I had lost a major part of my lung capacity. While at Valley Medical I experienced a pulmonary embolism which was treated there by respiratory therapists and for which I was placed on Cumiden, a blood- thinning drug. Throughout my time at the VA and continuing for some months thereafter my blood was monitored regularly and the dosage of Cumiden adjusted as needed. Eventually a thorough evaluation showed that my coagulation rate was back to normal and Cumiden was discontinued.

After several special tests by respiratory technicians, Dr. Linder diagnosed sleep apnea, a fairly common condition in which I would stop breathing frequently during the night. (This was a condition which had existed for many years). In the hospital I was placed on a c-Pap machine, a fearsome device which pumped pressurized and moisturized air into my lungs through a mask placed over my nose. The machine was kept on a rolling stand near my bed. A respiratory technician came in every night to turn the machine on, adjust its many dials, and place the mask properly on me. With the aid of this machine and sleeping pills I was able to sleep soundly through the night. Towards the end of my hospital stay I switched to a much simpler machine called a bi-Pap which has stayed with me and which I use most nights.

"Swallowing" was a major problem for the first three months after my accident. I had lost the ability to swallow. Anything I took by mouth was as likely to end up in my lungs as in my stomach. For this reason all nourishment initially was by IV. At some later point a tube was inserted through my nose to my stomach. Finally, soon after I entered the VA, a gastrointestinal surgeon inserted a tube through my abdomen directly to my stomach. For some weeks thereafter my nourishment each day consisted of half a dozen cans of Ensure poured directly into this tube at regular intervals. Periodically during these weeks I would visit the radiology department where a speech therapist would test me to see whether my swallow mechanism was yet working. The speech therapists also tried some simple techniques to try to encourage my muscles to act properly. Finally, in mid-December one of the tests showed that I had indeed recovered the ability to swallow properly. For several weeks thereafter the speech therapists continue to work with me as I re-learned how to eat normal foods. Finally, three or four weeks later, the stomach tube was removed. This was a major milestone.

"Blood pressure" fluctuations influenced my treatment in rehab. There is a condition called "autonomic dysreflexia" that affects only spinal cord patients. It is caused by blockages in the urinary or intestinal tracts and shows up as extremely high systolic blood pressure coupled with pounding headaches. My systolic pressure would often be measured well above 160 or 170, readings that are normally associated with autonomic dysreflexia. But I would have these high readings almost every day without headaches and without the conditions that normally cause autonomic dysreflexia. Dr. Linder kept raising the point at which the nurses would give me a fast-acting drug to bring my systolic pressure down, and he finally told me to simply not take any action.

After some weeks in the hospital I began to faint (pass out) shortly after being transferred to my wheelchair or after eating a regular meal. This was caused by my systolic pressure dropping to as low as 60. So now I was in the predicament of having my systolic blood pressure varying from as low as 60 to as high as 200 or even higher, often within a span of only five or 10 minutes. I was in the awkward position of always having to have someone with me when I was in my wheelchair.

Unfortunately, while there are many specialists in hypertension (high blood pressure), there seems to be little knowledge about hypotension (low blood pressure). What this means is that the doctors, although concerned, could do little about my extreme blood pressure fluctuations. Specialists from the hypertension clinic spent many hours studying my condition and doing research to try to find some solution. They experimented with a number of mild hypertension drugs which seemed to have little effect on the hypertension but probably contributed to the hypotension.

The best they could do for me was to suggest that I eat light meals and eat more frequently to ward off the extreme hypotension. This was hard to do in the hospital but somehow I muddled through. Since leaving the hospital I have learned how to avoid the extreme hypotension and to limit the periods of extreme hypertension.

"Bodily functions", i.e., operation of the urinary and intestinal tracts, are a continuing problem for most spinal cord people. In my case nerves which would normally control muscles in the lower part of my body and in my arms and hands are damaged. This means that my brain cannot send signals to my bladder or my bowels to tell them what to do. Emptying the bladder is taken care of by an "indwelling Foley catheter" which feeds into a storage bag and which must be emptied every three or four hours. The bowels are another matter. To put it in the simplest form, an attendant must perform a "bowel program" at set times and intervals. Much time and attention were given in the rehab unit to how to handle these functions.

"Spasms" are another continuing problem for many spinal cord patients. I began having very mild spasms even before reaching the VA. The frequency and intensity increased during my four months there but nothing much was done about them.

"Blood chemistry" was a major preoccupation of the doctors in the rehab unit. On many mornings a "blood drawer" would wake me up about 6 a.m. to draw blood for a coagulation test, the results of which would determine my Cumiden level for the next few days. Every week or so more blood was taken for a more complete blood analysis. On the good side I learned that my cholesterol level had dropped from the pre-accident 200 plus to the vicinity of 150. On the negative side I learned late in February, just before I was scheduled to be discharged, that my blood chemistry had gone askew. There were two problems. My sodium level had dropped to a dangerously low level. The symptoms of this, mainly loss of sense of humor, went unnoticed until too late. I was quickly placed on an IV to get a saline solution into my blood. I was also transferred, fortunately for only one night, into one of the medical wards in the main hospital where I could supposedly be monitored more closely. The condition was quickly corrected and I was told to increase my salt intake. (This was one of the many contradictory aspects of my treatment; too much salt could aggravate my hypertension, but too little salt could kill me).

The second blood chemistry problem was more serious. The measures of iron in my blood showed that I was severely anemic, a condition that could be caused by internal bleeding or by a failure of my bone marrow to generate the necessary red blood cells. I was given an emergency blood transfusion, and the hematology department was called in for consultation. The head of the department was one of our neighbors on Ramona Street.. He ordered a bone marrow test (here I learned there is at least one good thing about spinal cord injury -- I felt nothing during this normally excruciatingly painful test). The test disclosed that my bone marrow was producing red blood cells, and the doctor ordered a series of special shots which quickly cleared the problem. There was no evidence of internal bleeding.

The nursing staff of Ward 7F took good care of me. There were well over a dozen who rotated their schedules in the ward. Grossly overworked because of budget cuts, the individual nurses often went an extra mile or two to give me extraordinary help when I needed it. They also gave enormous support and help to Marion.

"Occupational and Physical Therapy" occupied much of my time each day. My physical therapist (PT), and my occupational therapist (OT), worked with me almost every day while I was in the hospital, and they remained available and helpful after I left. Several times they gave up personal time and rearranged their schedules to help me. The PT was a gruff, no-nonsense task master with a heart of gold. Her profession/job was her life and she expected her patients to be as serious about it as she was. The OT had a more relaxed attitude but was just as serious and dedicated.

One example of their dedication was when they gave up part of their Christmas Eve so they could have me ready for my first "pass" from the hospital to the outside world. They stayed several hours beyond the end of the normal working day to be sure my wheelchair was ready and to train Marion on how to get the chair up and down stairs and over curbs. The OT rearranged her entire working schedule so we could leave the hospital on New Year's Day (1998) and use the public transportation system to visit the apartment which Marion had rented just a few weeks earlier.

The first outing was on Christmas morning to have brunch with a group of friends with whom we have shared many meals and adventures over the past 25 years. We hired a special elevator-equipped van from the Yellow cab company to pick me up at the hospital and take me the three or four miles to the home where we would meet. Leaving the hospital and riding upright through the streets of Palo Alto brought out many emotions which reached a peak when we stopped, lowered me from the van and I was greeted by eight very good friends. I doubt that any of us had expected two months earlier that we would ever see this day.

Two interns were also involved in my therapy. The OT intern was particularly memorable because she was learning just as much as she was teaching me. She was very small, probably about five feet tall and perhaps 100 pounds. I will admit to being concerned the first time she transferred me from chair to bed. Not only was it her first transfer, but it was my first experience at being transferred by somebody without lots of prior practice.

Physical therapy concentrated on building up my muscular strength and in teaching me techniques for transferring and doing regular exercises. I don't think I did very well in physical therapy. I never did get enough strength to do a complete transfer from bed to chair, although I was able to slide by the time I left the hospital. Also, because of my blood pressure complications, I could not do exercises that called for me to lie flat on a mat, nor could I use a standing machine to help maintain muscle tone in my legs.

Occupational therapy was devoted to teaching me how to use what I had in the best manner. I learned, for example, how to pick things up, how to do rudimentary writing, how to operate a computer with special hand attachments, how to eat, again with special hand attachments, and how to use my wheelchairs. I even learned how to prepare food and cook. A great deal of effort was devoted to teaching me how to dress myself. Unsuccessfully.

Initially I resisted doing things for myself and would ask nurses or therapists or visitors to do things for me. At some point during the rehab process all the people involved with me decided that the time had come to force me to be more self-reliant. From that point on, whenever I asked for help, I was told "do it yourself, Harry". At first I was annoyed, but later came to see the wisdom of this action. I was amazed to find that I could do far more with my hands that I had thought possible. The results have made my life far more pleasant than it might otherwise have been.

Several pulmonary technicians and a number of respiratory therapists helped me during my stay in rehab. For the first couple of months a respiratory therapist would come in twice a day and run me through a series of breathing exercises with a large and complex machine which forced medicated air into my lungs through my mouth. Then, after I was diagnosed with sleep apnea, an RT would come around at 10 every night to place a breathing mask over my nose. Two pulmonary technicians became involved with finding and fitting a suitable mask.

The SCI unit had a resident psychologist, Dr. Mike Dunn. Marion and I had regular contact with him for a couple of months after which he proclaimed that we were reasonably well adjusted to our situation. I enjoyed our sessions with him.

A nutritionist spent part of her time in the SCI Ward. She worked with me to design a suitably bland diet when I first began eating, with a gradual progression to the point where I ate normal meal selections. The kitchen staff often did not always follow the nutritionist's instructions, but I was told not to complain too loudly. Food at the VA was probably adequate, but certainly not gourmet. Soggy vegetables, tough and stringy chicken, melted ice cream were standard components of many meals. I became reacquainted with such things as grilled cheese sandwiches and macaroni and cheese. Breakfasts were consistently good -- cereal, eggs or pancakes with bacon or ham, a banana every Wednesday morning, juice.

The day actually began at 5 a.m. when the two people on night duty made their final "turning" rounds. They visited each SCI room at roughly 1 a.m. and 5 a.m. to drain urine bags and to turn each patient so none of us would remain on either side for longer than four hours. I usually went onto my back when I got into bed, over on my right side at 10 p.m., turned to my left side at one and then onto my back again at 5 a.m.

Breakfast trays arrived about 7. I needed help to get started and had to wait for another half-hour or so for someone to come and cut my food, remove the top cover from my coffee cup, put the tray into a position where I could eat from it and put my fork into its holder.

The nurses began working with patients at about 8:30 a.m. I was usually out of bed by 9:30 or 10 and would spend the next hour or two in the therapy room. Lunch, mainly in the dining room after I recovered swallow and could stay up all day in my chair, began between 12 and 12:30. My afternoon therapy sessions went from 2 p.m. to 4. Dinner began between 5 and 5:30. I would read or listen to tapes in my free time. I also became addicted to what I called "mindless comedies" on television. The hospital cable system had only the networks and one or two other channels. The comedy programs were an excellent diversion for me -- the only problem was that I could not tell one sitcom from another. They all seemed to have the same actors saying the same lines with the primary purpose of teaching their teenage audiences the virtues of sexual promiscuity. I was grateful for the entertainment they provided; the bedside TV helped me through the early morning hours when I would watch news programs, and the hours in the evening from the time I got into bed, usually about eight, until lights out at 10.

Each day was a little different. Perhaps once a week therapy made way for medical appointments in the main hospital building where I would go for x-rays, and for various ultrasound or nuclear medicine tests. Occasionally Marion and I would go over to the canteen in the main building for lunch as a break from the dining room fare. Some mornings I would have to stay longer in bed while the doctors made their "grand rounds". The routine was varied enough that I did not really get impatient to get out of the hospital until just two or three weeks before I was discharged.

The hospital had a very active chaplain service. The principal chaplain breezed into my room about once a week, said hello and breezed right back out. I never did find out what his denomination was, but he wore a black suit and a clerical collar.

I suppose that my admission records showed that I was Jewish. Soon after being admitted I was visited by a very friendly white-haired man who introduced himself as Norman Auerbach, the hospital rabbi. A retired veteran himself (navy chaplain), rabbi Auerbach was employed by the VA to service Jewish veterans at all of the Bay Area VA facilities. We visited a number of times and, once I convinced him that I did not need or want spiritual solace, we got onto a first name basis and had some stimulating conversations. Norman was a very sick man himself and he died shortly after I left the hospital. He organized a very elaborate Hanukkah party which Marion and I attended. There was lots of food which I could not eat because I had just recently recovered swallow function. There may have been one other Jewish person there but it was really a very sad affair. Perhaps a dozen other hospital patients showed up to get the free food. A recent Russian immigrant came and played some very good classical accordion pieces. He was quite surprised when I asked him to play "Stenka Razin", a Russian folk song which I happen to like so much that I have two different CDs on which it appears.

One of the most valuable bits of advice I received came in a casual conversation one day with Mike Dunn, the psychologist. Mike was an SCI survivor himself. Because I could not grasp small items easily I did not know how I could handle money. I asked Mike how quads handled this very basic part of daily living. He told me that you had to learn to trust people. He told me that I could use credit cards to avoid carrying any large sums of money. For small purchases he suggested I just hand my wallet to the cashier and tell them to take out what was needed and put the change back in the wallet.

For the first couple of months the furthest I went from my room by myself would be the couple of hundred feet to the therapy room or the dining room. I did not have the strength to wheel my manual chair to the main hospital building and, to be perfectly honest, I was afraid to go that far by myself in my power chair. I would venture out to the store (a miniature PX) with Marion or a visitor. After I got my power chair Marion convinced me that I could go on the one-mile hike around the perimeter of the hospital grounds. We did this a number of times, and I would sometimes do it with other visitors.

Gradually, as I became used to the chair, I became more daring. It was a great day when I went by myself to the store, picked a box of Kleenex from the shelf, wheeled to the cashier, handed her my wallet and completed the purchase. Once again I learned that I could do something by myself if I really wanted to.

We knew that we would not be able to return to our house when I left the hospital. We loved the house which we had lived in for 22 years. However, there was neither bedroom nor bathroom on the first floor, and we were not sure that the city would allow us to add these necessary rooms. By the end of November Marion had hired an architect to develop plans and to sound out city planning staff about the possibility of making the necessary changes. At the same time, Marion began looking for an apartment that would have both the space we needed and the wheelchair accessibility.

Early in December she found a two-bedroom apartment on the second floor of a new building just south of California Avenue. Pricey, but apartments were very scarce in Palo Alto. She signed a lease right away so we at least knew we would have a place to go. Marion moved into the apartment in January and began the task of arranging it for our needs.

I first visited the apartment on New Year's Day, 1998. This was my second trip away from the hospital. The apartment was spacious and cheerful. It overlooked a public patio decorated by a truly original sculpture of a nude woman holding a washing machine over her head. There were also two large ancient Greek warriors modeled after the Riace bronzes (i bronzi di Riace) which we had seen in Italy 16 years earlier. Another very worthwhile feature was an excellent Italian restaurant on the ground floor.

My next visit to the apartment was on my 71st birthday, Jan. 30, when we joined two other couples for a joint birthday celebration. Bailey was visiting that weekend and we enjoyed our time together in the now partially furnished temporary home.

There were two more visits to the apartment, both for overnight stays. These helped prepare us for the eventual departure from the hospital.

My hospital stay was made much more pleasant by the incredible support I received from Marion and from our children and other family members as well as the support that all of us had from friends.

I became very self-centered and selfish. This was particularly hard on Marion because I wanted her to be with me in the hospital all the time. Meanwhile she had to take care of all the details of the house, the apartment, and the minutiae of daily living. We finally worked out a. routine in which she would come to the hospital to help me eat lunch, leave for several hours and return for dinner. As I regained strength and began to stay up in my chair for most of the day, and to trust others to help me, my demands decreased a little bit. Marion would recruit my brother and a variety of other friends to spend meal times with me as I gradually adapted to being alone for longer periods.

Although I discouraged visitors during the week because there were so many demands on my time for therapy and medical appointments, the weekends were crowded with visits from our many friends in the area. The hospital staff seemed truly impressed with the number of visitors; several remarked that they had never had a patient in the ward with so many.

As mentioned earlier we used a lift-equipped Yellow Cab van for our first outing and a local bus for our second. After that we made use of a para-transit service available for handicapped people. For a very modest fee a ramp-equipped minivan would pick us up and take us to our destination. This required advance planning and reservations, with the pickup promised only within a half-hour time span.

Among the services offered at the VA hospital was help in selecting and purchasing suitable private transportation. We had a couple of sessions with the transportation expert and finally decided to buy our own van. We placed our order in mid-March and received the van shortly after moving into the apartment.

A lot of time and energy went into finding individuals who could be my medical attendants after leaving the hospital. Someone would have to spend several hours with me every morning for my bowel program, to wash me, get me dressed, and then transfer me to my wheelchair. Similarly an hour every night would be needed to get me into bed, get my clothes off and prepare me for the night.

We were basically on our own (or, to be completely truthful, Marion was on her own) to find attendants. Few if any of the people available through home care agencies were either qualified or willing to take care of spinal cord patients. Nurses from agencies would be exorbitantly expensive. Hospital staff helped us contact other spinal cord patients in the area so we could learn how they found their attendants. The answer generally was "it is not easy". We learned that the most likely sources of help would be in local minority communities, most likely the South Pacific Islanders or the Filipino groups. After many calls Marion began to zero in on several local churches as potential reference points. During this period a friend, while walking down Hamilton Avenue, saw a South Pacific Islander pushing a wheelchair. The friend asked that attendant if she knew anyone looking for a similar job. This led through two or three phone calls to a young man living in East Palo Alto who, when interviewed, said he would be interested in the job, would be willing to be trained, and willing to wait for me to be discharged from the hospital. Over the next several weeks Paul went through several training sessions with hospital staff to learn how to do the basic functions. He slept over in my room one night so he could learn the complete morning routine. Paul brought in a distant relative who could serve as an alternate attendant. Paul and Finau became our major support from the time we left the hospital until early October.

By mid-February, after three months at the VA, I was beginning to feel that it was time to leave. I had progressed from a helpless blob lying in bed with nourishment and medicine supplied by tubes to a reasonable facsimile of a normal human being. I had regained some strength, I could be up in my wheelchair for up to eight or 10 hours each day, I had learned how to use my limited arm and hand movement to eat, drink, operate a computer and perform such basic and necessary functions as brushing my teeth.

By this time it was clear that further progress would be slow, if at all, and that there was little reason to be in the hospital rather then home (the apartment). Our attendants were lined up, we had made a couple of trial runs at staying in the apartment overnight, and I had grown tired of the hospital food. A meeting of all of the key staff members who dealt with me was held and we decided that I could probably leave the last week of February.

Then complications developed. My blood chemistry went awry and the doctor decided I could not be discharged quite yet. Even after the blood chemistry problems were straightened out, the key doctor decided I had to remain. Another two weeks would pass before I was finally discharged on March 12, 1998.

With the help of a friend, Marion transported all of the gear I had accumulated from the hospital to the apartment. At the nurses station we were given several large bags full of medications and supplies. Finally the para-transit van arrived, and we were on our way.

My rehab program lasted exactly four months. .

This ends chapter 2 of my saga about how I became a Quadriplegic and learned