Following Julian’s visit, Ronnie Herran’s progress was phenomenal. His physical therapist Fran said that she had never seen a patient so eager to learn. And according to Fran, Ronnie was an exceedingly fast learner. In the course of a week, he was already able to write legibly.

I worked as closely with Ronnie as I could. I spent an average of greater than an hour’s time working with him each day, probing his feelings about his new disability and how it would fit into his life. Ronnie had come to accept the fact that he would need to reside in a nursing home after he finished with his rehabilitation and seemed comfortable with this situation.

Ronnie’s hope was to eventually earn his high school diploma, then a computer degree of some sort that would help him gain employment and possibly live on his own one day. While I wanted to encourage him to complete his education, I was hesitant to allow him to form unrealistic goals. Yes, it was possible for Ronnie Herran to obtain a job that might provide enough income to support him and the care that he needed, but such a situation was in the distant future. With Ronnie’s disability and with the meager resources of a nursing home, it might take him twenty years to achieve his goals.

“It doesn’t matter how long it takes,” Ronnie insisted. “Even if I don’t get out of the home till I’m fifty, I’m going to do it.”

It was difficult for me to imagine this headstrong twenty year old boy as a fifty year old man. I tried to explain to Ronnie that his motivation might change as he grew older and he might no longer wish to expend that sort of effort. “Hey, you’re a doctor already,” Ronnie pointed out. “And you’re only 29.”

“Yes, but I had a lifetime to adjust to my disability,” I told him. And even so, it was no easy task for me to earn my degree. I was the only child of two highly educated parents who encouraged me to make the most of my intelligence, in spite of my disability. I studied fervently as a child and I was still discriminated against at every step of the way. Had I been able bodied, I would have undoubtedly attended the best universities in the country, but as it was, I had to settle for what I was given.

Regardless, I was impressed by Ronnie’s determination. Even though I recognized it wasn’t what he desired, I made an effort to contact his parents to encourage them to allow him back into their home. I realized that this would be Ronnie’s best chance at achieving his goals. Unfortunately, his father was less than receptive to my proposition.

“We know everything that’s happened to Ronnie,” Mr. Herran told me over the phone. “He did this to himself. You don’t know what that kid put me and his mother through.”

“Ronnie is committed to changing,” I tried to tell him. “You have to understand, Mr. Herran, that with Ronnie’s condition, he’s going to wind up in a nursing home for the rest of his life if you don’t take him in.”

“That’s what he deserves,” Mr. Herran replied. “He made our lives hell. I told him he can’t ever come into our home ever again.”

Ronnie had confessed to me the things he had done in his parents’ home and I could sympathize with his father’s anger. But Ronnie’s offenses were simply the acts of a rebellious and sexually overactive teenager. He had dabbled in drugs, but it was only after he had been kicked out of the house at age sixteen that he became a drug addict. And now he was clean and intended to stay that way.

Ronnie was glad to be free from drugs for the first time in years, but his lack of sexual functioning was distressing to him. He confided in me that he had erections from time to time when his penis was handled by nurses, but not when he was having erotic thoughts. “It’s kind of frustrating, you know?” Ronnie said.

Many of my patients had issues with their sexuality following their injuries, but I’m not an expert in sex issues. Had I more personal experience with intercourse, I might have been able to offer some advice in this area, but I was lacking in this regard. Unlike many of my spinal cord injured patients, the innervation of my penis is completely intact, but I was yet to have intercourse, and I masturbated only on rare occasions as a matter of course. It’s especially difficult to offer advice to quadriplegic patients, because they are unable to handle their penises and often have indwelling catheters in place that inhibit sexual functioning.

“I’ve been having all sorts of crazy fantasies lately,” Ronnie told me. “But I never get hard from it anymore.”

“That’s to be expected.”

“Like that nurse Jason,” Ronnie went on, “he’s really fucking hot and I’ve been fantasizing about sucking him off, but... then I look down and... nothing.” Ronnie hesitated. “Doc, I gotta ask you something: once I’m in the nursing home, is there like... any way to get laid?”

I had been concerned that he might ask me this question. “If you had a significant other who came to visit you, I’m certain you could have some privacy.”

“I don’t have a significant other though,” Ronnie said. “I mean, isn’t there some... I don’t know, service for quads who just need to get off every once in a while?”

“I don’t think so, Ronnie,” I told him.

“Can’t they at least hire someone to jack me off? I can’t do it myself anymore. What do guys do?”

Ronnie was very earnest in his question. His blue eyes were wide and full of anxiety. “I honestly don’t know, Ronnie,” I confessed. “But I know people who do.” This is when I made my decision to introduce Ronnie to my quad circle.

Quad circle is a group that I started myself two years ago and it has grown to include over thirty members. Of course, since all of the members are quads, attendance is spotty and I’m pleased when over half of the men make an appearance at the weekly meeting. Some of the quads are patients that I treated myself, but many of them are former patients who I contacted via telephone when I began the group.

During quad circle, the members socialize with each other, discuss their problems and frustrations, and share inspiring news. Almost all of the members have told me that the group has been extremely therapeutic and I feel that each and every one of these men are my friends. I’m proud of quad circle and I hope it will be maintained even if I ever leave the rehab facility.

This week the quad circle attendance reached fourteen members plus Ronnie and I was glad to see that there was a wide variety. There were quads who were married and lived with their wives, quad who lived with their parents or other family, and several who had been brought in by nursing homes. I was particularly interested in Ronnie speaking with the quads from nursing homes.

“I have an announcement to make,” I addressed the group. “Or rather, Charlie has an announcement to make.”

Charlie Simms, a C6 quad, beamed at the group. “I just wanted everyone to know that two days ago I finally popped the question to my wonderful girlfriend Jessica... and she said yes! We’re getting hitched in June.”

I couldn’t have been happier for Charlie. He had progressed through his insecurities about dating and sexuality, and now he had finally found happiness with another person. Everyone offered Charlie their congratulations, but I could see a few sour faces. There were many men in the circle who still believed that love was out of their reach.

“One more announcement,” I added. “I’d like everyone to meet Ronnie Herran. He received a C5 injury a few months ago and he’s been making fantastic progress.”

Everyone greeted Ronnie enthusiastically and I could tell Ronnie was enjoying himself. I pointed him in the direction of Shane Hannigan, a relatively young C3 quad who was now living in a nursing home. I watched the two men talking as I sipped lemonade in a corner of the room.

“Seems like a nice kid,” a voice from behind me spoke up.

I turned my wheelchair to see the face of Lewis Patterson. Of all the gentlemen in quad circle, I must confess that Lewis is my least favorite. I don’t know the exact extent of Lewis’s injury because I never treated him and he refuses to discuss it with me, but I can observe that he has no movement at all in his arms and controls his wheelchair with his chin. He’s in his mid-fifties, balding, but otherwise in good shape. What bothers me about Lewis, however, is the way that he looks at me.

“He is a nice kid,” I confirmed.

“Quite... attractive,” Lewis added.

I am never certain if Lewis makes these provocative statements for the sole purpose of making me uncomfortable. I suspect he thinks that because I’m young, I am unable deal with people like him. I know that Lewis is a homosexual, but I highly doubt that he has much opportunity to enjoy any sort of sexual practices lately, considering he has been cared for by his elderly aunt for the past ten years.

“Not as attractive as you though, Ned,” Lewis said, smiling at me. “I wouldn’t want you to think I didn’t like you anymore.”

“It’s all right,” I said vaguely.

“Have you given any thought to my offer?” Lewis asked me, raising his eyebrows suggestively.

“I think your offer is highly inappropriate.”

“Come on, Neddie,” Lewis said. “You know you’re just as horny as I am. All you gotta do is show up at my house, tell my aunt you’re a friend, and we can go to my room and I’ll give you a mouthful of dick.”

I came dangerously close to choking on my lemonade. “I’m not going to have this conversation with you again, Mr. Patterson. If you’ll excuse me, I’m going to congratulate Charlie.”

I directed my wheelchair toward Charlie Simms, hoping that Lewis Patterson wasn’t staring after me.

To be continued...