One Step at a Time by Alan Dwight

[Rutabaga]

http://www.awesomedude.com/alan_dwight/one-step-at-a-time/one-step-at-a-time.htm

An uplifting story that will have you cheering.

R

[Altimexis]

Not to denigrate Alan's wonderful writing, but this is the kind of story that got me into writing gay-themed fiction in the first place. It was after perhaps reading the fifth story in which a paraplegic young man was portrayed as a helpless invalid that I wrote my first story, Love in a Chair. Now, I find that first effort so over-the-top and one-dimensional that it's embarrassing to even mention it, but at least it portrayed a paraplegic character accurately. At one time I was the medical director of a model system spinal cord rehab center, so I know something about what paraplegics and tetraplegics (the preferred term for quadriplegics) can and cannot do. Please feel free to contact me for advice if you ever write a story involving a character with a disability.

Here are some common myths about spinal cord injury that I'd like to dispel right now:

1. People with spinal cord injury need help - God No! Nearly all paraplegics and even tetraplegics with intact function in their elbow extensors (triceps) are capable of living independently. A person with full use of their upper limbs, as was the case with the main character in Alan's story, can bathe themselves, dress themselves, transfer in and out of a wheelchair without assistance and use an accessible toilet without any assistance whatsoever.
2. Paraplegic children must be confined to a wheelchair - True only with what are referred to as lower motor neuron disorders such as spina bifida. Even then, many learn to stand and walk with braces. Children injured in early childhood and some injured in middle childhood commonly develop the strength and balance to stand unaided and some even are able to walk short distances with crutches.
3. A person paralyzed as a result of a spinal cord injury will never walk again - Occasionally true, but often false. Although there are injuries so severe that there appears to be little hope of any recovery, I've seen even the hopeless walk out of rehab after a few months, and I've seen people regain function even more than a year after injury. I never would tell a patient they would never walk again, partly because it's demoralizing to someone who needs to put everything they have into their rehabilitation, but also because I've often been proven wrong. The only way to 'sever' the spinal cord is with a knife. Usually it's stretched, mashed or otherwise mutilated, and function often returns, at least in part, once the swelling has subsided.
4. It is possible for one to retain bowel, bladder and sexual function, even though they have lost the use of their legs - Generally false. Yes, it's possible, but we're talking about a fraction of a percent in paraplegia. Bowel, bladder and sexual function is controlled in the very lowest portion of the spinal cord, a part called the conus medullaris, in the sacral section of the cord. The segments that control function in the legs occur above this, in the lumbar region. Think of a lizard, with a tail and the legs off to the side. That's the model from which we evolved. Embryonic legs begin as buds that grow out of the lower portion of the body at a time when there is still a tail, and the anus, the bladder and the penis all originate from the very lowest segments of the tail. Anything that disrupts control of the legs usually affects bowel, bladder and sexual function. The one exception is something called cauda equina syndrome, which is an injury of the 'horses tail' - the bundle of nerves emerging from the spinal cord. However, cauda equina syndrome has a good prognosis, because it's a peripheral nerve injury and peripheral nerve fibers can regenerate, so people can often walk within about a year after injury. I've never seen a pure cauda equina syndrome from a tumor, however.
5. Sexual satisfaction requires a functioning penis - Are you serious? If that were the case, why look at porn? People with spinal cord injuries can and do find ways of achieving sexual satisfaction and for satisfying their partner. It's said that the primary sexual organ is the brain.
6. The majority of partnered men who sustain a spinal cord injury lose their partners within the first year after injury - Sadly true. Divorce after SCI is usual, even though most paraplegics and a large number of tetraplegics are fully capable of independence. Ironically, partners of people sustaining severe traumatic brain injuries tend to stick it out, at least for the first year, in the hope there will be a meaningful recovery.
7. Workplace discrimination is common and many employers will not hire someone with a spinal cord injury, even when minimal or no accommodation is required for a given job - Unfortunately true. The majority of paraplegics and the vast majority of tetraplegics are unemployed, even though they're perfectly capable of gainful employment and no less capable than their able-bodied colleagues.

I loved Alan's story, but the reality is that his character would have had a much rougher time of it due to the lack of proper bowel and bladder management the late 1960s and early 1970s. However, if he'd been directed to one of the newer model systems spinal cord injury rehab centers that were just coming into existence then, he should have done well. By using intermittent catheterization, and a timed bowel program, he would have avoided urinary and fecal incontinence and these are things he would have been able to do on his own after training. He probably wouldn't have derived pleasure from masturbation but, having never been sexually active, he wouldn't have missed it either, and likely would have found sexual pleasure in other activities. He would have been able to stand unaided and to walk short distances with crutches, and he would have been fully independent in dressing, bathing, personal hygiene and wheelchair use, and in driving with hand controls. He might well have been demoralized regarding getting a college education, not because of concerns about personal hygiene but because of the limited job prospects after college.

Again, please feel free to contact me if any of you decide to write a story with a disabled character.