I was saddened on both a personal and professional level by the news that Reeve died Sunday.
Back in May, 1995, immediately after he suffered his life-and-cervical-spine-shattering injury, he came to my hospital - the University of Virginia Medical Center, where I was on the anesthesiology faculty.
It was a media circus.
After a month at UVA, he stabilized enough to go home.
Subsequently, his unflagging focus and determination to walk again served to jump-start the field of spinal cord regeneration and take it to the next level.
My own interest in paralysis and problems associated with spinal cord damage started long before Reeve's injury.
It was during my anesthesiology residency at UCLA Medical Center when, on my first (of two) obstetric anesthesia rotations, I was assigned a pregnant quadriplegic patient.
First of all, everyone was amazed she was pregnant: apparently no one had ever encountered such a thing.
But there she was, happily married and about to give birth.
She also suffered from a potentially lethal condition known as autonomic hyperreflexia.
This is a neurological dysfunction associated with paraplegia and quadriplegia in which stimulation of the autonomic nervous system - completely unperceived by the patient - can lead to sudden lethal hypertension, stroke, and cardiac arrest.
Such things as bladder overdistention can be inciting factors.
I read everything I could on the syndrome, then proposed to provide an epidural anesthetic for her delivery.
Now, she was numb from the mid-chest down, so it wasn't a matter of controlling her pain as the baby descended.
Rather, it was to blunt the autonomic reflexes set off by cervical distention and the compression of intra-pelvic structures.
At the time I was early in the second year of my anesthesia residency.
Since after a few nights in the library, I knew far more about autonomic hyperreflexia than anyone else involved in her care, I became de facto chief of her case.
Long story short: I put in an epidural, gave her anesthesia which I controlled and regulated by monitoring her blood pressure (since the usual measuring stick - pain - was not applicable), and she delivered a healthy infant without incident.
I wrote the case up for the leading journal in the field of anesthesiology.
It was accepted for publication and appeared in December of 1979.
Here's the reference, for those of you who find bookofjoe too basic for your tastes:
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Stirt JA, Marco A, Conklin KA: Obstetric Anesthesia for a Quadriplegic Patient with Autonomic Hyperreflexia. Anesthesiology 51: 560-562, 1979
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Article comments
1 - Claire Robinson
An interesting, informative and valued account of both Christopher Reeve, his death, and his injury. I too was greatly saddened at his death. He was doing some great work in an effort to aid people with similiar and/or related conditions.
Thank you for this piece.
Claire
2 - Mac Diva
I agree that the WaPo had the best explanation of Reeve's death. I cited their package about him on my thread about his death. I also made a point of saying that pressure wounds do not normally follow the causal path Reeve's did. I think it important to emphasize that before people latch onto to something inaccurate. In an online chat at the WaPo, a physician who treated Reeve during the early years of his paralysis did what he could to dispel some of the nonsense cropping up, such as there is some kind of "winding down" process for people with SCI. But, considering how people are, no telling what claptrap they will end up believing.
Considering your interest in SCI, I think you would enjoy reading Teddy Pendergrass autobiography, Truly Blessed, which I've reviewed. He does an excellent job of describing living as a quadriplegic. BTW, he had a bout of dysreflexia at the famous Live Aid concert. It was hot and there was no air conditioning. His temperature spiraled, sparking autonomic responses. Fortunately, his aides controlled it by packing bags of ice around him.
(For people not exposed to the subject matter, quadriplegics cannot control their body temperature. They are unable to sweat below the point of injury.)
Of course, with my background, I thought about issues of negligence while reading about Reeve. But, I'm going to withhold judgment until I know more. Reeve had a very powerful personality. He made have made the decision about whether to be hospitalized to care for his pressure wound. Reminds me of Pendergrass, again. He traveled to an awards show while requiring an operation on a pressure wound. So, let's wait and see.
3 - Eric Olsen
Exceptional post Joe, perhaps your best and most important ever - I really appreciate the information beign presented in such a clear and logical manner. Now I'm sadder still about it since it never should have happened
4 - E. John Love
Thank you for writing this detailed and informative description of the medical details and issues surrounding the death of this inspirational person. I have cited your article on my own blog.
Thanks again.
John.
5 - Mac Diva
Typo in previous comment: He may have made the decision about whether to be hospitalized to care for his pressure wound.
I've seen a few other pieces online alleging negligent care, but none of them substantiate the claim, either. Such a case turns on why Reeve was being treated when and where he was. It is possible his doctors approved the home treatment and/or that Reeve refused suggestions he be hospitalized. He spoke to scientists working on SCI research within a week of the day he died. Seems that he was very determined to adhere to his work schedule. Again, I think people should wait and see before assuming Reeve's caregivers were at fault for his death.