Medicine

By all odds, he’d never walk. The odds changed

MICHAEL McHUGH December 12 1977
Medicine

By all odds, he’d never walk. The odds changed

MICHAEL McHUGH December 12 1977

By all odds, he’d never walk. The odds changed

Medicine

Leaving a stuffy dinner party, he climbed out the window and up the vertical fire escape, heading for the roof five storeys up. He wanted to breathe the evening air, relax and do some karate exercises. Climbing swiftly in the dark, he didn’t notice as the ladder’s retaining bolts, reduced to hardened sand by Montreal’s freeze-thaw cycles, started to slide free from their anchor-holds. Then he felt the ladder move painfully slowly away from the building. “There was nothing below that I could fall on or jump to,” he recalls, “so I held on and wondered what would happen next.” The ladder hinged out and down. When it hit the balcony beneath him, he was catapulted toward the ground, the shock of trying to hold on breaking both wrists. He blanked out as his body landed—at a speed of more than 40 mph—on a picket fence. When he regained consciousness he felt nothing below his waist, nothing at all. He knew he was paralyzed. It was 11 p.m. on August 3, 1977.

Paul Rheault, a 24-year-old architect, was lucky to fall just two blocks from the Royal Victoria Hospital in Montreal: he received medical attention, literally, in minutes. A neurosurgeon was called from the adjoining Montreal Neurological Institute to examine his back, and again Rheault was lucky because Dr. Robert Hansebout was the specialist on call. Hansebout had been doing laboratory research with dogs for years, trying to perfect a treatment for back paralysis. It was now ready to be tested on a human.

Hansebout explained to Rheault that the procedure might not work at all and might even damage him. But the decision to operate had to be made right away, because the lengthy procedure would be of no value to any injury more than one day old. Despite these warnings Paul and his sister, Louise, who had joined him in the emergency room, agreed. Meanwhile orthopedic surgeons busied themselves repairing the badly shattered right leg. There was no need for pain-killing anaesthetic. “I realized my position was pretty serious,” recalls Rheault. “They were suggesting a positive result so why not?” The treatment, which involves cooling the spinal cord, was initiated nine years ago at Ottawa’s National Research Council by Hansebout, Dr. Cesar Romero-Sierra and Dr. Alan Tanner. Tanner was alerted and he and a technician drove in from Ottawa in the middle of the night to help with the operation. Other groups around the world had been testing similar methods, so far without success. If this worked it would be a world first.

The spinal column is like a pearl necklace. The pearls, or vertebrae, are linked by a string, the spinal cord. When a back is “broken,” that means one or more of the vertebrae are crushed or broken, which causes them to shift out of line, exposing

the spinal cord to violent stretching or compression. This blocks the electrical messages in the spinal cord so that all control of muscles below that point is lost. Of about 500 people with spinal injuries treated in Canada every year, most remain partially or completely paralyzed.

Word spread through the hospital that Hansebout and his team of neurosurgeons would be operating to try to improve that record. By 7 a.m., when the injured part of the back had been prepared for the cooling procedure, the viewing gallery was packed with doctors, nurses and technicians. They watched as Rheault’s spinal cord was cooled with a gadget that looked like a miniature saddle fitted on the cord. On the underside and sides of the saddle were whorls similar to the skin ridges on a finger tip. They functioned as a series of small interconnected channels in which cold water (six degrees Centigrade) was circulated under constant pressure for four hours. Hansebout explained that the cooling process was designed to slow down or stop a natural process discovered by other researchers but not yet fully understood: spinal cord damage starts in the centre of the cord tissue and spreads outward in a self-destructive sequence to the circumference. The sooner the spread of damage is halted, the better the chances of regain-

ing limb function. After the saddle device was removed, Dr. William Fish, an orthopedic surgeon, straightened the spine by using a pair of rods with end hooks. When affixed to the undamaged vertebrae above and below the injury, the hooks forced the vertebrae back into line. Bone chips were then filled in the space around the rods to intermesh and eventually grow together. Hence the term spinal fusion.

Rheault’s period of recuperation was like a long, slow ski tow. Nothing seemed to happen. The day after the operation he felt a slight sensation in his left foot, but it was six long weeks before he could move his leg. All along, says Rheault, he had

been fighting the horrible spiral in which his mind was spinning. “I kept going back to the same point: 1 can’t accept this, I can’t accept this.” Now all he must do is wait until his right leg, still in a full-length cast, finishes healing. Then he will learn, all over again, how to contract and release his muscles—how to walk. “1 have a very strong confidence that I will succeed,” he says. While cautioning that the treatment is still considered experimental, Hansebout says he is pleased with the results. “The chances of Paul Rheault getting to the point where he is now were less than 3% using more conventional methods. This is an exciting beginning.”

MICHAEL McHUGH