Injury
Andrea Scrima
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For nine months, my right arm developed normally in my mother’s womb. Think about that, my osteopath said. “Unversehrt” was the word she used; the English “unharmed” or “undamaged” doesn’t quite capture the magical effect the German term had on me. I’d never, in fact, actually thought about it much. I’ve spent most of my life pretending that my body is “normal” and have carefully avoided imagining my birth, when an intern—the doctor who was supposed to deliver me didn’t arrive in time—pulled too hard and did permanent damage to the brachial plexus, interwoven strands of delicate nerves in the neck and shoulder.
I’d never thought about those nine months of prenatal perfection; instead, I thought about how I’d always tried to hide the fact that my arm was partially paralyzed and that it hadn’t quite grown to full length; how I was unable to hold it comfortably over my heart while reciting the Pledge of Allegiance in school; how I used to catch a baseball and quickly yank off the glove to throw with the same left arm; how I pretended this was natural. I couldn’t raise my right arm beyond halfway, and often less than that; couldn’t rotate it fully, and so I couldn’t hold out my arm with an open palm facing upwards, couldn’t eat with a fork or spoon. Nine months of perfection is a long time, my osteopath said. Somewhere inside your brain, your body still recalls its initial symmetry; when it’s injured, its mission is to restore itself to an undamaged state. To its original “Unversehrtheit,” as the osteopath called it.
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The condition I have is known as “brachial plexus birth palsy,” also called Erb’s or Erb-Duchenne Palsy. I only learned this term recently—so little do I know about it. It seems probable that a memory of the injury must be lying buried somewhere in my subconscious; I once considered looking into birth trauma therapies, but decided that letting the “event” lie beneath its protective blanket of repressive coping strategies could be wiser than “going there”—my reasoning being that the human brain took millions of years to evolve into its present state and in all likelihood knows what it’s doing. I went about my life as though I hadn’t always, on some level, been struggling against my physical limitations. Last winter, when I took a trip with my son to New York to visit family there, this changed: the heavy backpack and suitcase I lugged from Long Island to Brooklyn to Manhattan to New Jersey and back again put such stress on the cervical vertebrae that my arm began to hurt in a new and alarming way. All of a sudden, I could barely raise it above the hip, and yet I did what I’ve done my entire life, and pretended it wasn’t happening.
The congenital version of Erb-Duchenne Palsy sets in when the fetus’s shoulder becomes caught on the mother’s pubic bone during birth and forceps are used to enforce the delivery, a method that violently stretches the plexus nerves in the upper arm and shoulder and leads to irreversible paralysis, which often extends beyond the arm and shoulder to include the nerves and muscles in the jaw, face, and neck. Over time, this impacts the entire body; one common result is scoliosis, as the stronger half of the body compensates and the spine curves toward the weaker side. In the sixties, treatment consisted in tying the newborn’s arm to the crib, which led, of course, to muscle atrophy. Today there are numerous support groups and physical therapy, with parents worrying—perhaps exaggeratedly, but there I am again, pretending it’s nothing—about their child’s “earning capacity” and the prejudice awaiting them out there in the cold, competitive, ableist world. I was used to my arm being the way it was; it had never prevented me from doing what I wanted to do. But was this even true?
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When I was in high school, having voiced an interest in archaeology, someone advised me to talk to the gym teacher, whose daughter, they said, had gone into the field. It took less than a minute for her to dismiss my hopes with something that felt like disdain, explaining that this was a profession that required outdoor stamina and physical fitness. And then she smiled. I had never before been told I wasn’t physically fit, and had always assumed that my disability was invisible and certainly not something with the power to diminish me in any way. I was at the top of my class and tutored schoolmates early in the morning. I was, in fact, a minor celebrity because although my test grades were perfect, I defied the math teacher’s practice of seating the students who’d scored highest in the front row—her pets—with the rest proceeding in descending order to the back of the class. To make a point, I took my seat in the last row, among the kids who’d done poorly—the very kids I was tutoring before first period, the ones she, as a teacher, had failed. I was a nerd rebel, an identity I’d forged to protect myself—and now a gym teacher I barely knew was disparaging me on the basis of a birth injury. This was the only time anyone had ever acknowledged my handicap, a word I’d never used in reference to myself. And the sad and interesting thing is that the child I was at the time felt not outrage, but shame.
Occasionally, as a private joke, I’ve attributed my mistrust of doctors to my birth injury; it occurs to me now that I hate being rushed and will actually become slower under pressure and even balk—what comes to mind is the “turtle sign,” as it’s known in obstetrics, when the baby pulls its head back into the mother’s vagina to return to a safer position. It’s one of the many instincts of human self-preservation, and, being human, I must have pulled my own dangerously exposed head back in as well. An experienced midwife or doctor would have employed the McRoberts, Jacquemier’s, or Gaskin maneuver, named after the famous midwife Ina May Gaskin, whose choice of career was formed by her own devastating experiences with obstetrical forceps. Gaskin learned the technique during a trip to Guatemala, from indigenous midwives who promptly turned the mother over and had her continue the birthing process on her hands and knees with her back arched, a position that generally released the baby’s trapped shoulder. It sounds so simple, and yet—in a world where male-dominated medical practices have virtually eclipsed traditional knowledge, and obstetrical delivery and other gynecological procedures are rarely in women’s hands—it turns out that it’s far more political than it might seem.
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Back in Austria, I finally overcame my fear of a foreign health system and found a doctor and, after some wrangling, a physical therapist; I trudged to my early-morning appointments and, as winter gave way to spring, paid close attention to the leaves on the trees and vines lining the banks of the Mur River as they gradually unpacked their own perfect symmetries. I was proud of myself; I was taking matters into my own hands, dutifully doing my exercises, and seeing progress. By the time summer arrived, the pain was gone and my arm restored to its former limited—in other words “normal”—state. I was entering the final months of a year-long residency; I’d had a large solo show at the contemporary art museum in Graz, had published several essays, held readings, and was swimming three times a week. I was feeling pretty good about the world—until one evening, when I tripped on my way up the stairs leading to the Rose Garden atop the Schloßberg, stumbled forward, and broke my arm just above the wrist, the arm I’d been nursing back to health all winter and spring.
The pain was blinding. I maneuvered myself into a sitting position on the step I’d just fallen on, caught my breath, and waited for it to simmer down; it didn’t occur to me that I might have fractured the bone. I convinced myself it was a sprain, wrapped it in a compression bandage the next day, and set about doing a deep clean of the apartment I would soon have to leave. Over the next week and a half, I packed, moved, unpacked, and sorted things onto shelves in the new place. I even went swimming once, cautiously, and decided that I shouldn’t, perhaps, do my usual forty minutes. On the ninth evening in the new flat, at the dinner table, a metal coaster that had been stuck to the bottom of the glass I was drinking from clattered to the floor and, startled by the noise, I reacted in a sudden, jerky movement that sent a searing pain shooting through my arm. All at once I realized that something was very wrong. I’d never broken a bone before; it was as though it wasn’t in my repertoire of possible injuries, as though I’d experienced enough injury already in that particular department. I went to the hospital the next morning. Throughout those nine days, the broken bone had already begun knitting itself together on its own. I was lucky it wasn’t dislocated, lucky they didn’t have to break it a second time and reset it or operate. I waited six hours to see a doctor and learn the good news; when they eventually applied the cast, I looked on in baffled gratitude, relieved that my arm was finally safe. Five and a half weeks later, when the technician cut through the plaster, it hurt so much that I begged for a splint.
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I was worried; I could barely move my wrist. It looked deformed, felt irreparably injured, but of course everything was still very swollen. At home, I tried to interpret the X-ray and looked up the corresponding images online. Perhaps the dislocation was greater than they’d said; perhaps I’d wound up with a so-called “bayonet wrist” or “dinner fork deformity,” caused by a malunited fracture. How could I have allowed this to happen? I have ruined my arm, I thought in horror; I’ll never draw again. I should have gone to a doctor right after the fall, to a hospital, but instead I shrank into my shell like a turtle. It’s just a sprain, I’d told myself—and now I was left wondering how I could have been so careless, or so clueless, with my own body.
The shame of a handicap is something that haunts the mind, that returns again and again, like a stain. I could have grown angry at a health care system already pared down to such a minimum that doctors can’t or won’t take the time to explain to patients who are frightened and in pain what, exactly, has happened to them. I barely knew what to ask when I was sent on my way with an appointment in two months’ time, but instead of growing angry, I sought the fault within. Why had this happened? I’d broken my arm just as I was moving, just as a year-long fellowship was coming to a close. Suddenly, it seemed symbolic: I was losing my special status, trying to hold on, and had taken the inevitable fall. Yet if you look at it statistically, a distal radius fracture is the most common bone break there is. It happens every day: people trip and fall with their full weight on the arm they’ve used to brace themselves, and sometimes they fracture it. No biggie—yet it felt like a portent of some kind. I held my final reading as the city’s writer-in-residence and hid the cast beneath a wide-sleeved shirt, but in the tram I discreetly displayed it, hoping people would stop jostling or shoving past me because I was afraid of losing my balance, instinctively reaching for the pole, and encountering that searing pain again.
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As a child and adolescent, my family ignored my disability, which came with advantages and disadvantages. It was, in any case, virtually non-existent. It wasn’t until I moved to Berlin at the age of twenty-three and taught myself to swim that I began any form of physical therapy; although I can’t raise the arm very high, in the water I can extend it well enough to do a decent backstroke, and I was soon swimming laps. I knew, as a child, that I was different from other kids; I have a distant memory of freakishness, actually more like a memory of a memory: I recall that I was once still able to recall it. Not long ago, as one of my first hesitant steps toward what felt like coming out of the closet with my handicap, I mentioned my impaired arm to my sister for the first time. I told her that growing older and losing muscle strength made me increasingly aware of how much the left half of my body had been doing the work for both sides, and how I was growing worried about aging. She stared back at me with a blank look, as though she didn’t know what I was talking about—or perhaps it was a vestige of sibling rivalry, an alertness to any new claim to attention. Many years later, I noticed a little bulge forming along the underside of my upper arm; it gradually dawned on me that my brain, operating from a fetal state of “Unversehrtheit,” had allotted the same amount of fat cells to both arms, although one of them is measurably shorter. This past year, I’ve noticed the bulge drooping and the skin crinkling, the very “underarm dingle-dangle” we detected in our grandmother, although in my case, it’s one-sided, and—ironically—proof of that long-ago prenatal perfection.
There are several athletes with Erb’s Palsy who compete in the Paralympics, among them the American Brittni Mason, a track medalist. In other words, Erb’s Palsy really is a bona-fide handicap—although, as I inspect an online video of Brittni, both of her arms appear to be the same length, and she can evidently rotate the afflicted arm normally and raise it fairly high. She calls attention to her arm by wearing a colorful compression bandage. She’s cheating, was my first thought—how does a little diminished movement in one arm impair her running?—which just goes to show how much ableist self-disdain people with unacknowledged disabilities internalize. And how even the official validation of a disability is still, somehow, not enough to convince some handicapped people that they are, in fact, different and maybe, just maybe deserve special consideration.
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The cast has been off for more than a month now, the swelling has gone down, but the wrist continues to hurt and I find myself growing worried about my “earning capacity.” I look up physical therapy exercises online; I use a rubber ball to improve my grip. After a month-long wait, I finally had an appointment with an orthopedic doctor. The fracture has healed well, and the altered shape of the wrist is a sign of a process still underway. I am not deformed; it turns out that I did, in fact, take good care of myself, because despite nine days of walking around with a broken arm, the displacement of the bone was negligible. The pain I still feel is likely due to a tear in the triangular fibrocartilage complex, a buffer of tendons and cartilage in the wrist. I’ve made an appointment for an MRI; I’ve managed to make two drawings, although my hand is still very stiff. I soldier on, stroke my arm with the extra bulge and drooping skin, and tell it to get better, to heal, to know that I love and need it—but an uneasy sense of shame lingers, as though my disability were my own fault, or a figment of my imagination.
November 2024