Sunday, May 24, 2015

Not Zen 162: Crutches

c. Jessica Fisher via Wikimedia Commons


"You let him stay in a cast for how long?" The doctor ran a hand through her hair. At the beginning of the day, she had tied it back. Now strands had come loose from the braid. She pulled them behind her ear.

"Nine months." The boy's mother folded her arms.

"No wonder he's complaining." The doctor nodded. "He must feel crippled. Why didn't you bring him to me earlier?"

"He said his other doctor was doing it."

"What other doctor?" She spread her arms wide, hands up.

"The one near his father's house." The woman shifted. She glanced at her son on the examining table. The young fellow remained where he was, lying down in shorts and a shirt, but he openly listened to every word. "It turns out he did it himself, though. He admitted it. His father and I are separated. I moved out a couple of years ago and I took him with me. But he wasn't getting enough sympathy for his situation at school, I guess."

The boy sat up. He put his hands on either side of his hips as if he were about to hop down to the floor.

"That's not it!" he protested.

"Well, then," said his mother. "You tell the doctor, honey."

"I thought it was neat." He leaned forward. As he eyed the floor, though, he seemed to decide against getting down from the table.

"Having a broken leg? Neat?"

"Having a cast on." He gestured to the blue, plaster cast that anchored his left leg. "Getting the stuff, the plaster, that was kind of hard. But when I got it, I found out it was easy to get colored tape. That made it look real. I knew it would."

"You can't just give yourself a cast and have no one notice." She pointed at the boy, at first, but switched the gesture to indicate his parent.

"Sure you can." His gaze darted between his mother and the doctor. "I folded up the crutches and hid the stuff in my duffel before mom dropped me off at my dad's. She never stays to see him. So when she drove off, I pulled out the crutches. I cut my pants up the seam, then I crutched to the door and said that I'd broken my leg so can I go to bed early? My dad was pissed off about it. But he let me go to bed. And I made the cast in the bathroom."

That might work, she thought. She rubbed her forehead. She didn't trust himself to say what she was thinking yet or it might sound unprofessional.

"I crutched around for a couple of days and had dad drive me back." The boy shrugged as if it had been nothing. Maybe it hadn't been too hard.

"When my son got home, he told me he'd broken his leg," his mother said. "The doctor over there, someone his dad drove him to, put a cast on it."

"And you bought that."

"Well, he had crutches! And a cast!" This time, it was the mother throwing up her arms in exasperation. The doctor turned to her young client.

"You told each parent that the other was taking care of your leg," she summarized. She hoped the boy would tell her more about the situation. He seemed to speak easily enough about it.

"My dad just sort of assumed it, but yeah."

"For nine months? Really?" No one kept on a cast that long for practically anything. She thought of all the things that could have gone wrong. For one thing, the kid smelled like he had a skin infection under there. Even if he'd made the cast right, the padding materials weren't meant to last. The plaster and tape had probably gotten exposed and rubbed him raw.

She stuck her head out of the office door and called for a nurse to bring the oscillating saw. This much, she knew from her routine. She gave her standard speech about what would happen and how the saw would feel as it cut the cast. The blade was dull. It wouldn't cut his skin. The buzzing sound might hurt his ears. 

The boy's eyes glinted. It became clear that he had already researched the procedure. The doctor ended up addressing the mother more directly. The poor woman had never dealt with anything like this before with an imagined injury or a real one.

"Oh my god," she hissed as the saw roared to a start. She put a hand over her heart.

The nurse held the boy steady, not that he seemed to need it. He gaped at the saw in fascination. His torso shivered, apparently involuntarily. He squirmed a few times as the vibrations from the circular steel machine arm tickled him. Pieces of the cast began to crumble away. Unlike a professional job, this one had apparently cracked several times and undergone repairs. The child had used layers of plaster and tape.

When the cast fell off, it unleashed a stench. It wasn't as bad as the doctor had feared. She ran her hands over the bruises and cuts. The skin had broken in places. In others, the inexpert cast joints had abraided and callused it. She noted a few scabs, some of them full of white pus. 

She ran her hand over a shin bruise. 

"No gangrene," she sighed.

The boy's eyebrows shot up. He knew what gangrene was, all right.

"I was fine the whole time," he insisted.

She nodded.

As she turned to hand the pieces of the cast to her nurse, the boy surprised her by hopping off of the examination table. His left leg crumpled. He toppled toward the nurse. Everyone reached out to catch him, to protect his head before it hit the floor, but he was quicker than them. He helped himself by grabbing the table.

"What's wrong?" he yelped. He scrambled to upright himself.

"Why on earth are you trying to stand?" The doctor pushed he chunks of plaster into her nurse's hands. "You can't do that."

"Yes I can. I never had a broken leg!" From his voice, the boy was starting to panic. He kept trying to stand up with one side braced against the examination table. "I didn't. Really."

She waited. He noticed her expression, her silence, and he started to calm himself. His mother couldn't stop touching him, though, and after a minute he pushed her away.

"Well?" he asked the doctor.

"Look at how small your left leg muscles are now," she replied. "Hold your legs straight, side by side."

"I'm trying. I"m trying to be straight."

"So you can't even do that." She held her fingers across the boy's right leg, then his left, to make her point. They all looked at the difference in the sizes of the thighs and calves. "Your left leg is almost thirty percent smaller. You've made yourself actually ill. Were you this hunched over before?"

"He's never been hunched."

"He is now. I want you to try something." She turned to her patient. His leg that had been in the cast had atrophied so much that she felt a little fascination for it. It was hard to believe that the limb had been perfectly healthy. "Put one hand on my shoulder and one on your mother. Then, without turning your hips, I want you to rotate your leg in and out. Like this." 

The doctor demonstrated the torsion with her own left leg.

"I'm trying." The boy grunted. His left foot moved about forty degrees clockwise. Counter-clockwise, he could hardly get any twist at all.

"I thought so." She tapped the top of his femur, right at the joint. "You don't have full range of motion in your hip any more."

"What am I supposed to do?"

"I'll send you to a physical therapist." She turned to pick up her prescription pad. "There's a good practice only a block away from here. They'll help you work your leg back into shape. It'll probably take all summer. Keep in mind, you'll only make progress if you work hard."

"Will I be normal by school?" He threw himself onto the exam table. When he turned to sit, he stared at his normal foot, not the one he'd bandaged, as if he were envisioning the looks he might get from other teens for being so asymmetrical.

"Could be." 

The boy's mother stood in silence for a while. She watched the doctor writing on the pad. When her son picked up a magazine, content to ignore the adults in the room, she leaned over.

"Can't you give him something?" she whispered.

"I am." In deference to the mother's privacy, the doctor kept her voice soft too. "I'm giving him a prescription for physical therapy."

"I mean something for his school anxiety. A pill or something."

"Ma'am, his leg wasn't broken." She put down the pad. "You saw what using the crutch did to him. His mind isn't broken either. He doesn't need a crutch for it. Yes, he's anxious about his peers. He's worried that everyone will find out what he did. What teenager doesn't get frantic about things like that? It's normal."

"Other kids take these things, these drugs. He's got friends on them."

"Maybe those kids should have prescriptions. Maybe they shouldn't. I don't know them." She put her hands on her hips. She started to feel irritation with the doctors who over-prescribed drugs or maybe it was just aggravation with her patient's mother. "It depends on their medical situations. If you've got a serious chemical deficiency, you need to treat it like any other physical issue. But that's not your son. Besides, for most drugs, no one should be on them for long. They haven't been tested for durations of more than a few weeks. That's how they're meant to be used."

"That's not how they work."

"Actually, it is exactly how they work. Most of the drugs given for anxiety or depression are meant to be used in therapy treatments. They're like crutches. They give you a way to function until the therapy gets you back on your feet. They're not meant to be used by themselves. They're certainly not meant to be forever."

"Couldn't he use them for a while?"

"He's normal." Her volume had gone up as she'd explained. She listened to herself and lowered her tone. "Feeling depressed may be appropriate for him. Feeling worried may be good. Giving him a drug for anxiety wouldn't do him any favors. His body will adjust. If he takes an anti-anxiety drug, he'll grow dependent on it. He'll find it hard to stop."

"He can keep taking the same thing while his friends do."

"That's what some people might decide, yes. Because the real therapy is hard, whether it's physical or it's mental. Most of it is up to us."

That was the problem with all therapies, really. They took work.

"Doctor, I'm at my limits." The mother covered her face at the sides like a horse with blinders. She apparently didn't want her son to see her words. "I don't think I can handle him on my own. You can see how he's been gaming me and his dad."

"That's an admission that drugging him is for you, not him. Again, no." She turned to finish the prescription.

"I don't believe it would be a problem." The mother reached out and pulled on the doctor's wrist. "It's better to have medicine than marijuana or alcohol or whatever he's going to try next. I know I did things like that." 

The doctor disengaged herself. She caught the nurse's eye and the nurse stepped a little closer.

"Yes, when I was young, I tried some recreational drugs myself," she said. "Lots of folks try that. It seems like an easy answer to hardships. Just take a pill. But it turns out that the easy answer isn't the best one. A medicated feeling is not a substitute for friendship. A chemically-induced calmness is not wisdom."

"I don't think you're an expert in this." The woman took the hint. She saw the nurse leaning close and stepped back.

"At some point in a therapy, everyone needs to throw off the crutch," the doctor continued. "We have to go on without it. It's not easy to do but there's no escape from it."


  1. Wow...just wow. There are such metaphors and lessons in one point or other we all use crutches or modes of desperation to conquer our mental terrors...those things that eat at us until they become in the forefront of our minds. Hopefully we all have someone who can help us see our crutches for the illusions that they are...and they can aid us in learning to walk on our own again.

  2. In my life, the metaphor is a serious one. My use of crutches of any sort has been an exercise in discipline. They're good in the short term. In the long term, they have unintended consequences. Dependence on aids creeps up on all of us. We're more healthful if we maintain mindfulness about the dependence, at least.

  3. Your point about listening to the people around us is a great one.