Neuro Note 1: Spinal Cord Injury

Me Before You is about a man, Will Traynor, in his thirties who was struck by a motorcycle as he was crossing the street and sustained a spinal cord injury which left him quadriplegic, paralyzed from the chest down.  The accident resulted in Will losing his physical abilities, girlfriend, vibrant, intense life and residing in a castle with his mother and father where he has his own annex and staff to care for him.  The Traynor family was in search of a new caregiver for Will which is how they meet Louisa Clark who goes to the castle to interview for the job to help support her parents who are struggling because her father was unemployed.  Lou, for short, get's the job and meets Nathan who is the primary caretaker of Will who performs his activities of daily living each day as well as takes him places and helps lift him to and from.  Nathan explains to Lou, who is feeling discouraged about her rigid and cold encounters with Will, how to just give him time and patience and that some days are better than others.  With time and persistence, Lou begins to form a bond with Will and they begin enjoying each other's company.  Lou overhears a conversation between Will's parents about some sort of dignified death Will wants and how Will promised them 6 more months with them before he does so.  She comes up with the idea of showing him what a great life he can lead through adventures with her and Nathan.  The adventures weren't enough so she approaches the Traynor's about taking him on a destination vacation with just Will, Nathan, and her.  As a friendship grows into love, Will decides he needs to tell Lou of the dignified death and assures her he is still going through with it because he cannot live a life where he can't give her all she deserves with touch, adventure, a family, and so forth.  Lou is distraught and explains to Mrs. Traynor that she couldn't change his mind so she left and didn't want to be a part of such a cruel act such as a "dignity death."  As the day comes when Lou knows the Traynor family is in Switzerland for Will to put his plan into act, she travels there and gets to spend the last moments of his life with him.  Will leaves Lou letters encouraging her to go see the world and funds so she could do it as he would've done for her meanwhile not burdening her family's finances.

The story gives a great depiction of how living with a spinal cord injury isn't just a physical ailment but also a huge mental and emotional journey as well. There is one scene in particular where Louisa and Nathan are outside of Will's hospital room where he is receiving therapy and Louisa asks if he's there to improve his circumstances.  Nathan then explains Will's journey about how was initially motivated and tried so hard in physiotherapy for a year with the only result being minimal movement in his first and second digits, which is how he can control his motorized wheelchair.  He tells her how Will got pneumonia early on and acquired autonomic dysreflexia which is where his blood pressure is always fluctuating and he's at high risk for constant infection.  Lou interrupts him and asks why he performs daily exercises with Will then with Nathan's response being that they do it to prevent muscle atrophy.  The conversation concludes with Nathan saying this is Will's life because no one has figured out how to fix a spinal cord injury yet.  I strongly encourage everyone to read this book or watch the movie because it is informative about SCI as well as gives the emotional experience.  I did some research to learn more about autonomic dysreflexia and I was shocked to see how common it is among people with SCI and the major risk factors that come with it if left untreated, including death.  I even found a tab on the website that explained how OTs can play a role in SCI but also autonomic dysreflexia, "Occupational therapists perform extensive training in the performance of activities of daily living with patients who have sustained SCI. Such activities include proper bowel and bladder management, which can help to prevent to the occurrence of autonomic dysreflexia."  

Autonomic Dysreflexia in Spinal Cord Injury. (2018, March 09). Retrieved April 02, 2018, from https://emedicine.medscape.com/article/322809-overview#a11

Moyes, J. (2012). Me before you. Camberwell, Vic.: Penguin.