Neuro Note #2

For my second neuro note, I chose to watch the popular movie Me Before You written by Jojo Moyes.  I had previously read the book and seen the movie, but rewatching it now after we have learned so much information about spinal cord injuries (SCIs) in neurological aspects, neurobiology, and pathology, I was able to understand and see the many things associated with SCIs.  

The movie begins by showing a young couple beginning their morning together as normally as one would expect.  Within minutes the young man, who we come to know as Will Traynor, is struck by a motorcycle when walking to work.  The film then skips ahead a couple years and shows the life of Louisa Clark, who becomes one of Will's caregivers.  She has not held any previous caregiving jobs, but she quickly learns what caring for an individual with an SCI entails.  As the movie continues, we learn much more about Will Traynor and the ways he has tried to adapt to a life without his independence and the use of his 4 limbs.  The book and movie never stated what level Will's SCI was, but based on his paralysis of his legs and most of his arms, I believe it was around C7-T2.  His nurse stated that he had slight finger movements at times, which was enough to allow him to control his power wheelchair using his hands.  He also was able to maintain most of his trunk in a nearly upright position when outside of his power wheelchair.  

If you have been trying to find the time to read this book or watch the movie, I am warning you now that there will be a few spoilers as you continue reading.  So if there was ever a time to pick the book up or turn the movie on, STOP NOW AND DO SO.  

Will Traynor lived a spontaneous and carefree life before the accident causing his spinal cord injury.  He was a successful banker, dated a beautiful girl, traveled to numerous countries, and aspired to never live a simple and predictable life.  Just with these few details about his life, you can imagine how hard of a transition he had from being able to do all of those things to not being able to even get dressed on his own.  This is a very tough transition that all people with SCIs undergo.  No one ever expects to wake up normally one morning and then not be able to use your arms or legs later that night.  At one point in the film he stated, "I just about exist," which let the audience know that he very seriously struggled to find a purpose within his struggles.  

Will had his good and bad days, but it was apparent that he was depressed and consistently unsatisfied with the way things were.  He experienced four cases of pneumonia within a 2 year time period, each case taking more and more of a toll on his body.  During the movie, he also showed the signs associated with autonomic dysreflexia.  His body struggled to maintain a balanced temperature, so when he began profusely sweating in one scene we got to see his nurse and Louisa take immediate actions to bring his body temperature back down to a normal level.  Will seemed to be in pain on many occasions.  This pain was not just physical but also mental and emotional.  

[SPOILERS-->]  We learn that Will had tried to take his own life at some point in the last couple of years when the movie shows scars on his forearms.  Louisa also overhears a discussion between Will's parents discussing the fact that Will planned to undergo a medically-assisted suicide in a few months.  Will undoubtedly had a very had time trying to adjust.  His decision to carry out the medically-assisted suicide shows that he never truly did find a way to cope.  

Will's parents ultimately brought Louisa in to try and persuade him to continue living and trying to adjust to his new circumstances.  She did the most she could with the 6 months she had with him.  The film shows her researching adaptive sports, adaptive equipment, wheelchair friendly locations, and many more activities that could help him find more meaning in his life.  In the beginning, Will was very opposed to her ideas to get him out of the house.  Once an avid traveler, he now doesn't find much interest in it because he knows all of the challenges that will come with his lack of mobility and the location's lack of accessibility.  He knows people will look at him differently, and he can't help but reminisce on the times when he could do all of these things as the "real" him.  

This movie portrayed what I think is a very true view of the challenges those with spinal cord injuries face on a daily basis.  From the frustration of having to rely on others for everything to the extra considerations that have to be incorporated into every plan to the emotional, physical, and mental hardships, living with a spinal cord injury requires much adjusting and coping.  As a future occupational therapist, these are all very important aspects we have to consider when treating clients.  We have to remember that they are still a very functional human being that desires to carry out activities just as they used to before the injury.  

In one scene, Will says to his mother, "Don't talk across me, mom; my brain isn't paralyzed."  I found this statement to be extremely significant.  Many times people in wheelchairs can be seen as incapable of things or lacking intelligence, which is completely incorrect.  Will's ability to think and reason was not affected by his spinal cord injury.  He was still a highly intelligent individual, but due to his lack of physical independence it was easy for others to assume he needed help with thinking, as well.  As occupational therapists, we have to ensure that our clients still understand that they are capable of being independent in many different ways.  Finding the ways for them to do so and feel as if they are still themselves in the midst of so many big life changes is what we have to strive to do on a daily basis.