Shattered Nerves: How Science Is Solving Modern Medicine's Most Perplexing Problem

8 The Dirty Little Secret

∑ 8 The Dirty Little Secret ‘‘One of the things about spinal cord injury is that everybody sees the outside, as far as you’ve lost the ability to use your legs, but they don’t realize—and it’s really demoralizing—that you’ve lost the ability to go to the bathroom like a normal person, or to even have any feeling to know that you have to go to the bathroom, and having accidents in your pants all the time. It’s something you don’t talk about except with other people who are in similar situations.’’ Speaking the unspoken was Holly S. Koester, of Walton Mills, Ohio, near Cleveland, who was a 29-year-old captain in the U.S. Army when in 1990 an SUV she was driving at Redstone Arsenal in Alabama, flipped over and broke her back. Her T7 (thoracic) vertebra was crushed, leaving her without feeling or function ‘‘from about the bra line down,’’ as she put it. Since then, Koester has been implanted with a Vocare bowel and bladder neural prosthetic system that has helped prevent the kinds of embarrassing and unhealthy circumstances she described. Prior to her accident, Koester had been a paratrooper and company commander with the 101st Airborne Division at Fort Campbell, Kentucky. She had been transferred to Redstone but was about to return to Fort Campbell as preparations were underway for Desert Storm in Iraq when tragedy struck. 118 Shattered Nerves Always an active person, Koester had run in several 10-kilometer races as well as a half marathon while in the Army. She also played softball and was on the All Army volleyball team. While a student at Fredonia College in New York, she played intramural basketball and soccer. She had a Reserve Officers ’ Training Corps scholarship to help her through college, and immediately following her 1981 graduation, with a degree in political science, was commissioned in the Army. She was well on the way to making the Army her career when her back was broken. Though she was rendered a paraplegic, Holly Koester did not take her fate sitting down. Shortly after her accident, she was transferred to the Cleveland Veterans Administration Hospital—the closest veterans’ facility to her hometown of Bu√alo, New York, with a spinal cord injury unit. Shortly thereafter, Koester volunteered to be a test subject for an experimental standing and stepping system being developed by the Cleveland FES Center, a consortium that includes the VA hospital. But the experience did not work out well. Koester was implanted with electrodes that protruded through her skin, which caused frequent infections. The coup de grace came when it was discovered that she had sustained a broken hip, apparently in the accident that paralyzed her, which threw o√ her gait when she tried to walk with the implanted system. As a result, her ligaments became stretched, causing her hip to pop out of its socket. An attempt at corrective surgery failed. The result, according to Koester, was that, ‘‘I wasn’t any use in the walking FES program.’’ But her enthusiasm for the potential benefits of neural prostheses was undiminished . And then she met Graham Creasey, an English physician specializing in spinal cord injuries. Creasey had recently moved to the United States and was working to have an implantable bladder and bowel device approved by the FDA. The system had been available in Europe for several years, where it was known as the FineTech Brindley Bladder Control System. Creasey had grown up in Northern Rhodesia, now Zambia. His parents were from London but had moved to Africa, where his father, an engineer, served as a missionary. When Graham was 18 years old, he reversed his parents’ footsteps and returned to Britain, where he attended college and then medical school in Edinburgh. During his studies, Creasey found that in The Dirty Little Secret 119 addition to medicine, he was fascinated by things technical, which he traces to his father’s profession. ‘‘My father was an engineer who would like to have been a doctor, and I’m a doctor who rather likes engineering,’’ he said. As a result, he gravitated toward the hands-on field of general surgery. He began to focus on spinal cord injuries when in 1978 he returned to live with his family, who had moved to Zimbabwe, then in the middle of a guerrilla war. He joined the sta√ of a...