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A Day in the Life

This feature is a sometimes humorous, sometimes offbeat, and sometimes irreverent look at life as seen through the eyes of a severely disabled person. Management takes no responsibility for these ramblings.

What Is She Doing to That Guy?

Dictionary.com defines a cough as "to expel air from the lungs suddenly with a harsh noise, often involuntarily." We all do it, often without even thinking about it. Quadriplegics however do it with a style that perplexes some, concerns others and even scares a few.

One of the byproducts of a high-level quadriplegic is that their lung capacity is diminished to about one third of its former capability. Where that is sometimes noticed is when trying to sing, although I have yet to have someone tell me they miss my golden pipes. Where it is most often noticed is when I have a need to cough. In those situations we employ a technique known as a Quad cough. The free medical dictionary defines this technique as " a form of assisted coughing for patients with central nervous system disorders such as spinal cord injury who are unable to generate sufficient force to clear respiratory secretions. After a maximal inspiration, the patient coughs while an assistant exerts gentle upward and inward pressure with both hands on the abdomen. The increased intraabdominal pressure produces a more forceful cough." I think the term maximal inspiration refers to the patient's pending expiration if they don't get help coughing soon. In real life, a Quad cough more resembles something between defibrillation and abuse.

I have found that the techniques utilized by the assistant vary dramatically. When I was in the hospital, I was given a breathing treatment 3-4 times a day by a physical therapist who then followed up with a Quad coughing exercise. Since this went on 24 hours a day I would see different therapists through their shifts. There was one guy that concerned me. He would climb into bed and kneel over me, get this wild look in his eye and push with a force that would not be defined as "gentle upward and inward pressure." By the time he finished I was always glad for the structural integrity of those hospital beds. The tendency of most assistants however is the exact opposite. Their first concern is that they don't want to break your ribs. You want to encourage them in this regard. Beyond that, every assistant is different. I have one relative who after carefully placing their hands in position, lurches violently forward to deliver something slightly less than a gentle upward and inward pressure. I am always afraid they are going to incur whiplash. On the other hand, my son reminds me of the physical therapist in the hospital with a couple of exceptions. His approach is calm and unassuming. Don't let that fool you. He can deliver a blow worthy of the best of Joe Frazier. I also don't see a wild look in his eye, it's more one of payback for various aspects of his raising. My wife on the other hand has become very nuanced in her approach. Before giving me a push, she will ask "small, medium, or large?"

The most interesting situations involving Quad coughs involve those administered while we are in public. Many people pretend not to notice, but they are betrayed by the panicked look on their face when their eye inadvertently catches mine. Others suspect they are watching bad behavior, such as when a parent starts swatting their child in public. Once while in a restaurant, a nearby patron came over to see if everything was all right, giving me all the nonverbal signals that it was okay to expose my tormentor. Still others glance at us with a look of fateful resignation. If you were a mind reader, you would hear them say "Damn, I knew it was a problem when they put that wheelchair at the table next to ours, and now this guy is going to die right in front of me."

I've often thought these forced coughs set a perfect stage for a Candid Camera moment. I wonder how people would react if, when we are out at a restaurant and I need a pressure cough, my wife were to stand, look around in a 360 arc and say very loudly before giving me the assistance, "Clear"? While it would be fun to catch people's reaction, I just don't think I have the heart for it.



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