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Later in the day a respiratory therapist comes, and Reeve goes through his nif training. He exhales off the vent. Then the therapist tests his vital capacity. "You let out all the air, and this time the trach is open and you breathe in. And you breathe and breathe and breathe and take in as much as you can and then let it out. Some people blow it out forcefully and get good numbers that way. I just relax everything, and the air comes out 'cause obviously whatever came in has to come out. When I left Kessler in December, my vital capacity was about 75. Meaning I could take in 75 cc of air, which is about what a canary breathes in. The last measurement was 860 cc. A condor. Now, an animal my size requires 1,200 cc of air to wean, to get off the vent and really breathe independently. So I go off for periods of time building up to that. I'm hoping to get to that number. For your grandmother, 750 cc would be plenty; she'd be very happy with that. But I'm huge, and I need all that air.
"One of the things I like to do is to breathe for 30 minutes with the resister set on level 3. So imagine you're breathing through a straw, but somebody basically has their finger on the other end and just takes it off a little bit to let some air in. And this works the chest and the diaphragm. So I do it a minute on, a minute off, a minute on, a minute off, for 30 minutes.
"But then, for an experiment, I recently said to the nurse, 'This thing goes up to level 5. So I cranked it up to 5, started sucking on this thing, and it was like I thought I was going to implode from the effort. But I was having a really strong day, and a minute went by, and my sats [oxygen saturation levels], which should not go below 88, were still 95. Then two minutes, 95. Three minutes, went up to 96. Four minutes, still 96. Anyway, I kept going for 10 minutes on my first try with this thing at 5. Definite proof that I'm getting stronger. Something like that can make my whole day."
Added to his daily therapy routine are visits from specialists. A urologist comes every three weeks to change his catheter. Another doctor comes to change his trach. A podiatrist comes every three weeks to cut his toenails. This must be done by a specialist because an ingrown nail can cause an infection. While he undergoes his therapies, in fact, Reeve is in a state of constant danger. It is generally assumed that because paralyzed patients are immobilized and without feeling in areas of the body, they are also locked in secure positions, safe from diseases and other menaces. But several swords of Damocles hang over people like Reeve that threaten respiratory function, bowels, bladder, urinary tract, skin and emotional well-being.
Last January, shortly after he returned home for good after the stay at Kessler, Reeve suffered so serious a bout of dysreflexia that he had to be hospitalized at Westchester Medical Center. A urinary infection caused a bowel blockage, and his blood pressure soared. The only symptom he could feel--the single sign that something was going wrong--was an excruciating headache. "You know what an ice-cream headache feels like?" he asks. "Take that and multiply it 20 or 30 times. You just want to jump off a cliff." The worst of it was psychological: "You work to escape that sense of helplessness, and it throws you back."