Wednesday, November 27, 2002
Slowly, painfuly, Kellie pieces her life back together
By CAROL SMITH
SEATTLE POST-INTELLIGENCER
Plink.

This is the sound of progress for Kellie Cosner. Sitting in a wheelchair in a small, windowless room on the fourth floor of Harborview Medical Center, she uses damaged fingers to fish beans out of a glob of "therapy putty," a kind of Play-Doh for grownups, and drops them in a dish.
Plink. Plink.
テつ*
The story of a young woman's grueling quest to walk again -- and rebuild her shattered life.

"You're doing good." Jennifer Glover, the occupational therapist, is cajoling, encouraging, patient. There's a fine sweat on Kellie's face, still swollen from medications and her body's own stress hormones five months after a devastating accident put her in this room, fighting to regain her independence.
Plink. Plink. Plink.

Kellie beams in triumph. All of the beans are nestled in the dish. A red welt of a scar wraps around her forearm where surgeons repaired the bone. Her left hand trembles from exertion.

This, too, is progress. Two months ago, the 26-year-old Bellevue woman couldn't hold a telephone to her ear. She couldn't push a call button to summon a nurse.
She was, in essence, paraplegic.

On Thanksgiving weekend a year ago, Kellie and her husband, Jason, were on their way to Paradise Lodge on Mount Rainier when a freak gust of wind slammed into a towering hemlock, shearing the trunk 70 feet up. The tree's top 35 feet plunged onto the couple's Ford Explorer, killing Jason and nearly crushing Kellie to death.

She wasn't expected to live, but surgeons pinned her body back together with 24 metal rods, plates and screws.

Kellie Cosner's first time in the pool with recreational therapist Jodi McKenzie is a welcome break. "It was a taste of normality," Kellie said.

Now comes the hard part: piecing her life back together.

Nearly two months after the accident, including 37 days in the trauma ICU, the hospital deemed her ready for discharge.

But ready for what? She couldn't sit. She couldn't raise her arms to hold a cup to her lips.

And she barely had the will to try.

On Jan. 16, the hospital sent her to Providence Marionwood in Issaquah, a 24-hour nursing home, as a "total assist" patient. It took four people with a mechanical lift to hoist her into the bed in a private room behind the nursing station.

Set on parklike grounds, Marionwood looks more like an apartment complex than a clinical facility. Most of its patients are older, recuperating from strokes, or easing through their final days. Kellie was the youngest patient there.

It was winter. A dark time.

Although her room looked out on a pleasant, tree-shaded courtyard, she would lie in bed with the blinds drawn and the door closed.

The boy she'd grown up with, the man she married, was gone. Her best friend and movie buddy, the kitchen-gadget freak who cooked for her, the hoped-for father of her children someday. Dead.

The enormity of it worked into her gut.

She couldn't eat. She told her mother she didn't think she'd make it through another night.

Too weak to lift a remote, she couldn't even channel-surf into oblivion.
The staff tried to coax her to work on her strength. They put a chart on the wall with a list of tasks and goals. At the top were two words: "Baby steps."
One time she asked her mother for a tissue, and the nurse wouldn't allow it.
"Do it yourself," the nurse said.

Try.

"At first she would say, 'I can't, I can't,' " said Nancy Dunn, a physical therapist who worked with Kellie at Marionwood. Stern and steady, she challenged Kellie even as she wondered whether the patient had the emotional stamina to pull through.

Just trying to help the staff pull on her pants in the morning would frustrate Kellie to tears.

"Baby steps," the therapist ordered.

"Firm kindness," Dunn called it months later. "Sometimes it takes that."

Agonizingly slow pace

But winter is a fallow time for a reason. Over the months, Kellie had taken to sitting in a long hallway, away from other residents, where she could cry as she watched the snow come down.

Gradually, the snow melted, and a new desire stirred insider her. After two months Kellie found her own goal. By mid-March, she wanted to leave Marionwood.
And she wanted to get better.

"I want to be able to use chopsticks again," Kellie is saying as she tries squeezing a handgrip at the end of a therapy session. Her fingers won't pinch together, and she misses going to her favorite Thai restaurant.

That gets her thinking about the little things she misses about life before the accident.

"I want to get massages and I could really use a facial," she says with a laugh.
The aftermath of trauma wreaks havoc on the body's systems. Hormones are topsy-turvy, the way they are in adolescence. The body sheds its skin entirely, in large, constant flakes.

Kellie shifts slightly in her wheelchair, an effort that makes her wince.
Then she almost whispers, "But what I really want to do is walk."

Rehab is a game of incremental gains, measured in millimeters of range, ounces of strength, micrometers of nerve growth. The pace can be agonizing and uncertain. There are no guarantees.

Kellie's doctors can't tell her when she will walk again.

Or if she will.

The tree lady stands

It's early April, and Kellie has been back at Harborview as an inpatient doing intensive rehab since mid-March, when she was strong enough to leave Marionwood.
テつ*
テつ* Paul Kitagaki Jr. / P-I

テつ* Anna McMakin, physical therapist intern, helps Kellie stand up in the parallel bars as Amy Icarangal locks her knee brace. Kellie's left leg sustained the most nerve damage in the accident. Kellie loved dancing, and walking the shell beaches near her home.

The fourth-floor rehab gym is now the fulcrum of her days. Twice a day, two hours at a time, she comes here to work and stretch her damaged body muscle by muscle, a tiny bit at a time. She does her occupational therapy here as well.
Beyond the wide banks of windows that line the walls, ferries slip back and forth across Elliott Bay. Just below sit Seattle's two new stadiums.

The game here is different from those played down below. The players are broken -- some in their bones. Some, their brains. Some smile and chat while they work. Some stare vacantly, as though they are elsewhere. Or wish they were.

In the shorthand of a trauma center, you're known by the agent of your catastrophe. At Harborview, there's the skateboard guy, the hammer man. Kellie is the tree lady.

The clink of weights and the clack-clack of walkers mixes with the voices of patients and therapists, creating a backbeat to the pop music that blares from a window-ledge boom box.

In the heart of the gym is a set of parallel bars. A model skeleton dangles nearby for illustrating the way the body works, or should.

Kellie wheels her chair between the bars. Today, she'll try to stand with braces on both legs for the first time.

She closes her eyes, inhales, then squints at Anna McMakin, the physical therapy intern who will guide her through the exercise.

"I warn you, I lean a lot," Kellie says.

Anna has wrapped a gait belt -- a heavy canvas strap -- around Kellie's waist for support.

Kellie grits her teeth. Her face reddens. Her jaw clenches as pain shoots through her legs. She hauls herself up, leaning hard on the bars, her weight largely supported by Anna.

She exhales.

"How are you doing?" Anna's tiny frame belies her strength. With cool, dark-rimmed glasses, zip-top Nikes and a ponytail, she looks no older than Kellie.

"I'm doing OK . . . Oh, oh . . .," Kellie's left leg slips sideways and her right knee buckles. Anna braces to take her weight.

"It's not working," Kellie says.

"It is working," Anna counters.

Gingerly, awkwardly, Kellie tries to swing her legs forward from her hips, maneuvering one foot in front of the other. Her legs are encased in metal-and-plastic braces. On the left, the brace goes half-way up her thigh.

"This makes up for the muscle at the front of the top of the leg," Anna says.

"So this means it won't come back?" Kellie asks.
Anna pauses, choosing her words.

"Braces won't stop you from getting better," she says. "Nothing is written in stone."

Rehab team gathers

Peter Esselman runs the rehab team at Harborview. A former physical therapist, he knows how excruciating both the work and the wait can be.

That gives him a special credibility with patients. Earnest and silver-haired, "he has the kindest touch," Kellie said.

He knows, too, that his role as a doctor is to balance honesty and hope.
テつ*
テつ* Paul Kitagaki Jr. / P-I

テつ* Kellie and her mom meet with the rehab team once a week to talk about progress and set goals. Her father listens on the speaker phone from Florida.

It's a few days after Kellie's first efforts at the parallel bars and Esselman has gathered the rehab team for its weekly meeting.

It takes multiple specialists to accomplish a rehab as complicated as Kellie's. There are people to help her with the mechanics of getting her body working again, people to help her accommodate to the pieces of it that won't, people to help her with the psychological trauma of losing her husband, people to help her venture back to an outside world that no longer seems safe or predictable.

And then there's Rainier, the unofficial mascot of the fourth floor. A golden retriever who flunked therapy dog school, he has a bed in his own corner of the gym.

At today's meeting, 11 people plus the dog surround a conference table. The voice of Kellie's father filters through a speaker phone. A relentless optimist, Ed Hobin had to return to his job in Florida after seeing Kellie through the first six weeks of her hospital stay, but now talks to his daughter and his wife several times a day.

Kellie and her mother sit at the head of the table. Although they've been to several of these meetings in the month since beginning rehab, they're anxious about this one.

When the tree crushed her pelvis, it smashed and tore the major nerves that run through the bones of the pelvis. You need nerves to work muscles.

About a week earlier, Kellie had her first test to tell whether the nerves that powered the large muscles in her legs could still carry electrical signals from her brain.

A technician hooked sensors to her muscles, then passed a small current through the nerves, as though testing the conductivity of a wire.

After months of having no sensation in her legs, the pins used to test the mild electrical impulses registered as pain. Kellie, already on edge about the procedure, started sobbing. "I just freaked myself out," she said later. "It was so overwhelming."

But that wasn't the hardest part.

Each time the pulse went all the way through the nerve to hit a muscle, the machine would crackle and screech, a sign the nerves were working. When the signal failed to reach a muscle, the noise level fell. For key parts of the test, the machine lay quiet.

For days afterward, Kellie retreated into herself, consumed with doubts. Up to this point, nearly six months since the accident, no one had told her she wouldn't walk again. Now for the first time, the possibility of never stepping forward on her own was shockingly real.

"Some of the nerves look like they're not reaching the muscle," Esselman confirms later in the team meeting. "That's bad news."

Regeneration of nerve tissue can take months to a year or more. If the nerves are severed, and the ends aren't aligned, or too much scar tissue blocks their path, they may never reconnect.

"We're really in a waiting situation," he says.

Fate and consequences

Consequences have become the hard truth of Kellie's life, something she had little experience with prior to the accident.

Bright and sociable, she grew up in a close, middle-class family in Brooksville, a West Coast Florida community so small the high school kids would party in the principal's cow pasture.

Her mother was a teacher; her father works in a public agency's communications office. Her younger brother, Tommy, was one of Jason's best friends.

A natural student with a flair for the dramatic, Kellie loved dancing, and walking the shell beaches near her home. People gravitated to the outgoing young woman with the husky laugh who loved a good story.

A planner by nature, she had expected to get married right after college, travel the United States, then have kids shortly after that. She planned to be an empty-nester when she was still young enough to enjoy herself.

"That's the way my mom did it," she said.

By her own admission, she didn't push herself much.

"Except maybe once," she said, "when I was taking lifesaving."

Tearful journey home

Now every day is about lifesaving.

Kellie's hours are consumed with the tedious physical details of learning how to function again. Getting out of bed and dressed takes half the morning. Her work in the gym is followed by "recreational therapy," outings designed to practice getting around in a wheelchair. She's forcing herself to keep pace, even when she's exhausted.

One of the philosophies of rehab is to let physical and emotional recovery happen together, providing parallel bars of support for a new life. And emotional recovery is much harder to predict, or control.

By mid-April, Kellie is expecting a visit from Pam Cosner, Jason's mother, who is flying out to see her.

But before Kellie can face her, she must face something else: going back to the Bellevue home she shared with Jason.

She wants to pet their cat, sit on the couch where they would spend afternoons watching Florida State football. She wants to watch the video of her wedding, which she has never seen, to hold that piece of their life one more time, before she sees his mother.

Even now, months later, Jason's death still seems like a kind of illusion, a reality that fades in and out like the M.C. Escher prints that Jason insisted they hang on their walls.

She's afraid the sheer force of Pam's grief will force the reality of his death to the foreground. She and Pam, as well as their families, had been close before the accident, but now they are grieving in different ways, locked in different places.

For weeks now, she and the recreational therapist have been practicing transfers in and out of cars, and up and down wheelchair ramps to prepare her for the trip home.

The night before brings high winds and a hard rain. Kellie doesn't sleep well. Her stomach is queasy.

"The last time I was there, I was with him," she says. She starts to cry.
But by Sunday, April 14, she's ready.

It's been 5 1/2 months since she last saw the neighborhood of wide streets and low-slung ramblers in Bellevue where they had lived.

Though her mother has been camped out here since the accident, the small house looks unlived in from the outside. A tattered basketball hoop hangs over the driveway. The weeping cherry in front is just starting to bloom, its smudge of pink the only color in the yard.

"Kitty, kitty," Kellie calls as she painstakingly shifts from the car to her wheelchair. Their cat, Tiger, meows and dances anxiously on the sidewalk.
Kellie rolls through the living room, furnished with the Ikea chic of newlyweds. A guidebook to Italy, where they spent their honeymoon, still lies on the floor. Jason's dark eyes peer out of the photographs that line the mantel and bookshelves.

"He was a sweet boy," she says softly.
テつ*
テつ* Paul Kitagaki Jr. / P-I

テつ* Kellie goes home on a day pass to the house she shared with her husband, Jason, for the first time since the accident. She watches her wedding video from the year before for the first time. Even now, months later, Jason's death still seems like a kind of illusion.

Kellie asks for her wedding rings.

Her mother disappears in the bedroom. "I had them cleaned," Debbie says. They are still slightly crushed. Searchers never did find Jason's ring, although they twice went back to the wrecking yard to comb through the Explorer's remains.
Kellie slips them on and rolls through the kitchen toward a work room in the back of the house.

Jason's territory. She pauses in the doorway. The chair won't fit through. Beyond her, there are bikes everywhere, stacked against the wall, hanging from the ceiling. Jason, whose passion in life was cycling, had come to the Northwest to work for Raleigh America, vowing to take any position, even if it meant starting at the bottom. She had followed him across the country and taken a job in communications for Sierra Entertainment, a computer games company in Bellevue.

Boxes of parts, enough to build several more bikes, jumble together on the floor, sharing space with the laundry center. A guy's clothes, T-shirts, a fleece vest, hang neatly by the washer-dryer. Kellie asks for the fleece and puts it on like an embrace.

"I'm cold," she says.

She wheels back to the living room, transfers awkwardly to the couch. She begins flipping through scrapbooks, cards, photographs. She bites her lip. Tears well.
"I'm only 26 years old; my life's gonna go on," she says. "I'm just not ready for it yet."

The advice of a stranger

It was a relief to get back to the hospital.

"The hospital right now is a real safe place for me," she says. "It's like being in a womb. A lot of people can't wait to go home. I don't have any illusions. I think when people in the hospital want to go home, what they really want is to go back to the way things were before."

It's odd how quickly the foreign becomes familiar.

Kellie is easily maneuvering her wheelchair around her room. Except for the adjustable hospital bed and equipment bolted to the walls, it could be a college dorm. The walls are plastered with cards and posters from the friends who drop by on a regular basis, sometimes spending whole evenings splayed out watching TV with Kellie. Stuffed animals perch on high shelves. A Chi Omega sorority banner from her alma mater, Florida State, dangles above the bed.

Kellie tidies slightly in anticipation of a visitor, a stranger, but one with whom she shares a strange, unwelcome bond.

Lesley Watson, elegant in a white wool coat, enters the room -- four-prong cane in one hand, box of chocolates in the other. At 76, her face is still beautiful, although, as she is quick to point out, it's mostly metal.

"My eyes, nose, and jaw -- they're all titanium," she says.

Watson was driving with her husband of 48 years over the North Cascades Highway in 1995 when a tree fell on their car, killing him and crushing her.

She went through 22 hours of surgery to reconstruct her face and arm. She
doesn't dwell on it much, but she wanted to meet Kellie.

"Oh, I have lots of metal, too," Kellie says with a laugh. "I am the bionic woman." She rattles off her equipment. "I have a pin through the right leg, two screws at the top, three screws in my knee. Two plates and 10 screws in the left side of my pelvis and one screw on the right side of my pelvis. And a plate and four screws in my arm."

"So tell me, what are your plans for the future?" Watson, who now lives nearby, has settled gracefully on the vinyl sofa. Seven years ago, she spent a month in the room next door.

"I need to go through all of his stuff," Kellie says. "Then maybe I'll get my own apartment and start living on my own, maybe be back working part time in three to four months."

"Yes, getting a normal life back is such a joy," Watson says. "People stop feeling sorry for you and you forge ahead.

"But is there a hurry?" She knows you can't rush recovery -- or grief.

"If you don't feel like doing it, dealing with his things, just close the door. For a while."

They speak of other things, comparing notes about the hospital room, the tiny acts of life taken for granted.

"I was thrilled over an infinitesimal thing," Watson says.

"After four years, I could brush my teeth. That was big."

Kellie says she still can't raise her right arm above the shoulder. "Doing my own hair -- that would just be a thrill."

They speak delicately of the accidents.

"The tree fell and his heart and lungs just stopped immediately," Kellie says. "It's very peaceful for me to think of it that way."

"That matters," the visitor says.

Watson rises to leave.

"You've done an awful lot in a short period of time," she says.
"I've been pushing myself real hard," Kellie says. "I've been real lucky."

Fears of falling

But gratitude soon yields to fear.

In a few weeks, Kellie is scheduled to leave her 24-hour nursing care behind. As her discharge date looms, even simple tasks such as showering without assistance seem overwhelming; her goals of going home and living independently,
unattainable.

She and her mother have been combing the classifieds for a wheelchair-accessible apartment. She isn't sure she can continue living in the house she shared with Jason. The rent there is more than she can afford on her disability income, but it's more than that. The emotional price is too high.

The search isn't going well.

"The first place I went to said it was wheelchair-accessible, but I couldn't even reach the faucets," she said. "It's hard. The world is not made for you."
The anxieties that consume her days have now invaded the solace of her sleep.
She used to dream of walking.

Now she dreams her wheelchair is missing. She's frantic.

And in her dreams, she's afraid of falling.

Continued ...

This is the second of three parts. Read Part 1.
Part 3: A Thanksgiving story. Hopeful about the future, Kellie tries to pick up the pieces of her life.

HARBORVIEW REHAB

Harborview Medical Center has the biggest rehabilitation unit in Washington, treating 350 patients a year.

Why patients are admitted:
* Brain injury -- 31 percent

* Stroke -- 28 percent

* Spinal cord injury -- 20 percent

* Multiple trauma -- 10 percent

* Burns -- 4 percent

* Neurological injury -- 3 percent.

* Other -- 4 percent

Other facts:
* Average age of patients -- 47

* Average stay -- 20 to 25 days

* Male patients -- 68 percent

* Female patients -- 32 percent

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