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Course of Recovery
One Year After a Tragic BMX Accident, Murray Is Learning to Cope With His Paralysis

By Katie Carrera
Washington Post Staff Writer
Saturday, July 12, 2008

BALTIMORE

Orange-red dirt tinged every inch of 2-year-old Mason Murray as he rocked back and forth against the sides of his father's wheelchair. Dust outlined the folds in his elastic-waist jeans, filled the crevices of his Velcro shoes and coated his corn-silk hair, but neither the clay-rich Maryland dirt nor the blur of fluorescent-colored bikes at the Camden Yards Sports Complex could steal his adoring gaze away from his dad.

He playfully tapped on his dad's unresponsive arms and giggled each time the wheelchair scooted forward unexpectedly. And when Stephen Murray began to wheeze in the heavy summer heat -- inhaling easily enough, but searching unsuccessfully to put more force behind each sputtering exhale -- Mason knew exactly what to do.

"Daddy need cough?" he asked eagerly, turning toward his father.

"Yes," Stephen Murray said.

Mason stuck out his arms, spread his fingers and placed his open palms against his dad's chest. With a furrowed brow and all the strength his toddler body could muster, he pushed on his dad's torso in rhythm with Murray's breathing. Within 30 seconds, Murray coughed and a pleased Mason began swaying in his father's shadow again.

It has been more than a year since Stephen Murray, then a top professional bicycle motocross rider, was paralyzed here in a crash during the opening event of the AST Dew Tour's 2007 season. It is considered the worst accident ever in BMX, a crash so severe that many witnesses still decline to talk about it.

He returns to Baltimore's Kennedy Krieger Institute regularly for therapy, and when his appointment last month coincided with the return of the Dew Tour, he went to the course. He wanted to see his friends ride in the first competition he's attended since the crash, and to visit the place where his life took a divergent course.

But the symbolism was lost on Mason and his older brother Seth, 5. They don't see their father as a strapping BMX rider who now is a quadriplegic, with a motorized wheelchair that he controls with his head. No. They see their dad as a human jungle gym, equipped with ears to pull on.

"It's good the accident happened at a young age for the kids," Stephen Murray said resolutely. "That way it's kind of normal for them to see me like this."

The Accident

The first run went exactly how Murray imagined it would.

Flanked by the highways that lead into the city from the south under a cloudless June sky at last year's dirt finals, he pulled a perfect series of challenging tricks that put him in first place after the opening round. The second run was a little more complicated and a little more daring, but he could afford a mistake thanks to the good first score. He nearly was flawless again, almost landing a double back flip, a trick he used to win X Games gold in 2001 and one that still is rarely attempted by most riders. But he fell off the bike after hitting the ground.

Murray stood and shook off any effects of the slip. "I didn't think anything was going to stop me from banging that out again," he said. Just do that run once more, he thought, and land the double back flip this time. He'd win this thing for sure.

The Newcastle, England, native, who had moved to California 10 years earlier, climbed the scaffolding for his third and final run, then he broke his pre-run routine. "I got into God about four months before," Murray said. "I don't know why I did it, or what made me do it, but I did the [sign of the] cross over my heart. I had never done that before."

He pressed his hands into the grips, squeezed the brake lever for a final time, took a deep breath and rolled down the ramp.

For the first jump, he threw a combination flip trick. Solid enough.

He spun 360 degrees horizontally on the next set.

At that point, he didn't need to be fancy so much as he needed to build up speed to finish with the double back flip correctly.

Up and over the final mound of dirt, Murray pulled his bike and body into the first flip. But his left foot slipped off the pedal about 30 feet in the air, causing his weight to shift violently. He separated from the bike. His limbs flapped as he fell, searching for any bearing, any direction, but finding none.

Murray landed on his head and hyperextended his neck upon impact. He was being strapped to a stretcher when he regained consciousness about 30 seconds after hitting the dirt.

"The first thing anyone did that I really remember was [rider] Luke Parslow saying: 'I love you, Murray. You're going to be all right. You've got to be all right,' " Murray said. "He was grabbing my arm, but I couldn't feel it."

Murray gasped for breath.

Medical crews pushed a tube down his throat to open his airway, and then Rick Bahr, an on-site athletic trainer, turned to him.

"You must let me breathe for you," Bahr instructed. "Don't take your eyes off me. Let me breathe for you." Listening to the air enter and escape his lungs, Murray stared into Bahr's eyes.

He couldn't feel his chest expand.

The Recovery

On the way to the R Adams Cowley Shock Trauma Center, Murray's blood pressure plummeted. His heart stopped first in the ambulance, then again when he got to the hospital.

He immediately was taken into surgery. He had crushed the C3, C4 and C5 vertebrae in his neck. Doctors inserted 16 screws and three titanium plates to stabilize his spine during two seven-hour surgeries.

He awoke a week later, groggy from heavy sedation and confused by the mess of tubes that snaked down his throat, up his nose and over to the whirring life-support machines.

"I started freaking out," Murray said. "I couldn't get up. All I wanted to do was get up."

The accident had left him with only deep sensation in his nerves; his brain could tell if someone squeezed his arm tightly. There was slight movement in his legs and he showed signs of controlling his breathing independently for a few seconds, according to his doctor, John W. McDonald, director of the International Center for Spinal Cord Injury at Kennedy Krieger.

Murray had been taken to what is commonly referred to as the 15-minute ward in the shock trauma unit, so nicknamed because nurses check patients at least every quarter hour. Even with a ventilator, his lungs struggled. Dirt, from a lifetime of riding on trails, had built up and had to be suctioned out by the machine.

During the next four weeks, he developed pneumonia twice, with fevers so high he couldn't stay awake.

He suffered hallucinations, a common side effect of the combination of the physical strain he was going through and the medication he was given. He saw haunting images of family members drowning while he struggled to save them. He thought his doctors and nurses were evil, that they had been responsible for his paralysis.

He became so paranoid that for four days he refused to sleep.

"I was so scared," Murray said. "I thought if I went to sleep that I wasn't going to wake up. That I'd die right there."

A change in medication eased the psychosis, and four weeks later he was ready to move to Craig Hospital near Denver, which specializes in rehabilitation of spinal cord and traumatic brain injury. But on the trip to the airport, Murray flat-lined for the third time. He had to spend one more week in Baltimore before traveling to Craig safely in mid-July.

The next phase of his recovery involved getting off the ventilator. He could only breathe on his own for 20 seconds; he needed to reach 24 hours of independent breathing to permanently rid himself of the machine.

"I just couldn't. My diaphragm had lost the ability [to function properly] and my anxiety went through the roof," Murray said. "That's when I realized I needed to get it together. I have to give this every last thing I've got."

Doctors initially said he had a 40 percent chance of weaning himself off the ventilator. After a while, he could breathe on his own for two minutes. Then four. Then eight. After more than four months, he was up to 18 hours. But just as Murray came close to the full mark, the carbon dioxide levels in his lungs skyrocketed and knocked his ventilator-free time back to an hour a day.

With only three weeks left at Craig, the hospital staff prepared to send him home to California with the ventilator.

There was no way Murray would allow that to happen. He was sick of the machine, and tired of the one thing he could feel very well -- the stabbing pain that came each time a tracheotomy tube was removed or inserted. A week after the setback, he built up his stamina and lasted 24 hours without a ventilator. The machine to which he owed much of his life was removed from his room four days later.

"Finally! I'm off that [expletive] ventilator," Murray said. "But then I got a little scared. I was used to having something breathing for me. Now I was really on my own."

The Aftermath

It has become routine now. When friends or family gather around Murray's wheelchair, someone inevitably will grab one of his hands and begin stretching it. They pull his tangled fingers apart and push his palm backward, trying to keep the hand from locking in place.

A month ago, as the sun dipped behind the grandstands during the BMX dirt finals here, as his wife, Melissa, and a handful of friends joked about riders copying Murray's tricks, they took turns holding his wrist against the frame of the wheelchair and fully extended all three knuckles on each finger until his entire hand laid flat.

Murray said he can feel the hand being stretched, comparing the sensation to a healthy person moving a frozen limb. But it doesn't stay stretched for more than a few minutes.

"There they freaking go again," Murray muttered as his fingers started to creep inward. "It never matters how many times they stretch me out."

"Stephen now has sensation through most of his body to the tip of his toes," said McDonald, who also worked with the late actor Christopher Reeve. "He can move muscles in his arms and his legs and he will see usable improvement in muscle function that will change his quality of life. But improving neurological function is something that takes years, not months."

The stretching is one item on a seemingly endless checklist of new activities that has become rote. His weight must be shifted every 20 minutes to prevent pressure sores. The towel wedged between his left arm and side that compensates for the scoliosis, or curvature of the spine, has to be regularly refolded or replaced. And an endless supply of straws must be at the ready for when Murray needs a drink.

Murray's parents, Jeffrey Murray and Cynthia Edgworth, travel from Newcastle to the United States regularly to help Melissa care for her husband.

And then there are the transportation logistics.

Stephen Murray visits Kennedy Krieger every three months for six-week therapy sessions, but there are only four wheelchair-accommodating vans for hire in the city. His family has the cellphone number of every

driver and company to carefully coordinate the arrangements, but sometimes even the most thorough plans go awry. One day, a driver forgot to pick up Murray after his morning rehab. He had to wait more than five hours to reach his apartment, less than two miles away.

"I called the driver over a dozen times, never heard back," said Jeffrey Murray, who has made 11 trips to the United States since the accident. "I asked myself, 'Why did I let that happen?' It shouldn't have happened. I'm always looking to make sure there are no problems, and it really got to me that I'm in charge of him and I shouldn't have let it happen. I shouldn't have trusted somebody else to come and pick him up."

After the mishap, Jeffrey began booking a single van for multiple days as much as possible, especially during the tour when Murray would want to go back and forth. It costs about $150 a day to rent the van and pay insurance on it, which after six weeks adds up to $6,300.

Murray's health insurance covers some costs -- 90 days of two-hour nursing visits a year and $2,000 for medical equipment -- but most of his medical expenses are covered by donations from fellow BMX riders or auctions and fundraisers to benefit the Stephen Murray Family Fund.

"It gives us as a family a lot of peace of mind knowing how willing people have been to help," Jeffrey Murray said. "I didn't even know if I could stand being at the tour, but one of the reasons I wanted to be there was to say thank you to everyone who made this easier. Easier for Stephen to focus on getting better."

Murray obtained a DVD of the crash, which was broadcast by NBC. He said he repeatedly watched it to learn what went wrong, concluding that the foot leaving the pedal caused the problem. But he does not dwell on what happened or express any bitterness. The accident, he says, is his reality. No use in trying to escape it.

In therapy, Murray learns how to reeducate his nerves, a process that focuses on the mental connection just as much as the physical one. Before trying to move anything, he thinks for three seconds about what specific muscles it takes to complete a task, like wiggling his big toe. Over and over, nothing but "wiggle that toe" echoes in his brain, until one day in December his big toe wiggled.

Functional electrical stimulation (FES) also is a regular part of his therapy. Equipment such as an FES bike -- a recumbent-style bicycle that paralyzed people can be strapped into -- sends electrical currents across Murray's skin telling the different muscles what it takes to pedal the bike. With the support of the machine, or in some cases a therapist, he can move his legs in a regular pedaling pattern. The current serves as a substitute for the normal neurological signals that don't reach their destination because of the injury.

Murray's main concern after strengthening his core so he can breathe deeply and cough on his own is to develop his arm strength in hopes of switching to a hand-controlled wheelchair.

"Bare minimum is that I want to be able to use my arms again," Murray said. "I want to hold my wife, give her a cuddle, hold my kids. I miss it, you know? . . . But I hope that I'll eventually be able to ride my damn bike again."

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