Paul and the Just-Right Challenge

Rancho Los Amigos Hospital Ward 904

Tuesday, May 5, 1970

Paul was big for a 15-year-old and protested with loud profanity as Mrs. G. and I pushed him strapped to his wheelchair out of Ward 904, the pediatric wing for rehabilitation of children with brain injuries, to the Music Room for our first therapy session. His abusive language upset most of the nurses and doctors, but I had grown up on the streets and playgrounds of South Central Los Angeles and Mrs. G. was from another planet.

A few weeks before, Paul had been stabbed in his head during a gang fight. The knife had penetrated just above his hairline on the right side of his skull and into his brain. He had lost many of his normal inhibitions as well as the ability to use much of the left side of his body. In the general hospital he had been kept in “soft restraints” since regaining consciousness because he was combative and threatened the staff. However, in the pediatrics pavilion at Rancho Los Amigos Hospital restraints were not acceptable to Mrs. G. and Dr. Elizabeth Eberle, the head nurse and pediatrician for teenagers with brain injuries. Children, even those who were violent, were guided and encouraged, rather than controlled. Paul challenged those values.

Paul had come in by ambulance from the general hospital the day before, accompanied by his mother and grandmother who obviously loved him in spite of his unceasing verbal abuse and threatening gestures. Anticipating the fear and distaste that Paul’s behavior would create in the otherwise caring staff, they had pleaded with us to give their boy a chance, but after praying at his bedside while he fell asleep the night before, they had gone home sad and discouraged.

Fast-forward 27 years. I am testifying in the United States Congress about work rehabilitation. “Paul went on to live the American dream,” I tell the assembled Representatives. “He got a job, married and became a father, and lives with his family in his own home in Southern California.”

But that morning when I was left alone with Paul in the Music Room, I was just beginning to tap into the rehabilitative potential of Paul’s brain and, though my efforts were clumsy, start us both on journeys that continue today.

As Mrs. G. left Paul and me in the Music Room, I had only a vague idea of what to do. Basically, my goal was to get Paul to stop his cursing so that he would not disrupt the staff and the five other teenage boys with brain injuries who shared his room. We only had a few days to change his behavior because the other patients had the right to not be abused or frightened by what appeared to be a crazed and dangerous hoodlum.

The Music Room was soundproof, but I had no doubt that Paul’s abusive shouting was reverberating down Rancho’s white tile halls as I sat down and turned his wheelchair to face me. As I always do when it is possible to be struck, I took off my eyeglasses and spoke quietly to Paul, who continued his shouted curses. I tried to soothe and cajole and calm him, but my words had absolutely no effect. Fortunately, the Music Room was well-lighted and I noticed the telltale nicotine stain on the index finger of Paul’s still-useful right hand. I said quietly, “Would you like a smoke?”

Bam! Paul looked at me and stopped shouting. “Whattt?” he slurred. “Whudd you say?” I repeated myself and now I had his attention. “You can earn a smoke if you do what I say,” I said, and laid out three piles of parts on the table, picked up and put a washer on a small bolt, and threaded a nut onto the bolt. There were enough parts for 30 assemblies. “Paul, each one of these you assemble earns you a penny, and you can buy a smoke for 30 cents.”

Bam! Paul brushed his right arm across the table and scattered parts all over and started shouting again, even louder than before, now with the violent shaking of genuine anger. He reached up and yanked his helmet off his head and threw it at me.

I ducked, collected my wits, and picked Paul’s helmet up off the floor and held it in my lap as I continued to talk quietly to him. “Paul, you know cigarettes aren’t allowed in the hospital.”

More violent and belligerent cursing.

“Well, Paul, I can get a cigarette in here this evening if you want, but they cost 30 cents. You can earn 30 cents today by putting these together.”

Quiet. Wheels obviously turning. One LOUD exclamatory curse!

Quiet once again. “O-O-K-K-K,” he stuttered and settled back into his wheelchair. “Good,” I said. “Now help me pick up these parts. We only have enough for 30 and you need 30 cents to buy a cigarette.”

We spent the next three hours putting together those simple parts and counting out one penny for each one. With one tremulous hand, Paul struggled to complete the task, with help from me at first, and less as we went along. Paul was painfully clumsy and easily frustrated and stopped several times. But he always came back to the task and improved as he went along. He completed the 30 sets just before we broke for lunch.

I told Paul, “I have something that’s more difficult — it has 5 parts, but it pays three cents for each set. Would you like to try that tomorrow? If you can handle it, you might be able to buy more smokes.”

I can still remember his first smile and grunted chuckle 40 years later.