Joshua Basile waits backstage at the Potomac school where he graduated two Junes ago, listening for the cue that will launch him as a young man with a cause.
If he's remembering how different things once were, before the accident forced so much in his life into past tense, he doesn't say.
If he's wondering how his debut audience will react, well, Josh already knows what 700 students will focus on first.
Not shiny, sexy chrome. They're the thick, heavy tread of an all-terrain wheelchair.
The old Josh was a hot-shot tennis player and a good-times party guy. "He played with big, broad strokes," a school official says as introduction. Yet last summer, Josh was doing little more than standing, watching in waist-high water for the next big wave at Bethany Beach. An instant later, he was floating helplessly in the ocean. Paralyzed almost completely and certain he would die.
The new Josh gingerly maneuvers his right hand onto his drive control, shifts his chair into gear and crosses the 25 feet to stage center. The school assembly is pin-drop quiet as he starts to talk. He recounts the journey that has gotten him to this point, glosses over the distance he still hopes to cover. He shares a memory:
My eyes looking at the beach
Like any other day
Unbreakable, I think
Until that single wave
Temporarily imprisoned me.
It took me
Too powerful to let go
He is a 19-year-old, moon-faced quadriplegic with a completely upended future and no notion of how he will matter now in life.
The first of August was the first full day of a weeklong getaway. For Josh, it capped a summer spent living large -- an internship at Smith Barney on K Street NW, golf at Avenel with his boss. In a month, he would enter his sophomore year at Skidmore College, where the tennis coach had him pegged as a future team captain.
"I love my life," he told his father.
The family's house was on the north side of town, across the street from the beach. What everyone remembers is that the first morning was wet and gray, which was okay because stormy weather churns up surf. That Josh and his friends stopped by a grocery mart, where he bought a cheap plastic boogie board. That the rain cleared in the waning afternoon, and they wanted to try out his purchase.
What John Basile remembers next is the pounding, not of the ocean but of someone rushing toward the house, too fast, taking 10 steps in two. A panicked shout from Josh's friend Paddy: "Dr. Basile, Dr. Basile, Josh is hurt really bad!"
People were standing in a stunned semicircle. Josh lay on his back where several of them had dragged him onto the sand after the wave had come crashing in and the boogie board had shot off into the foam, and they had looked around for Josh and found him facedown in the Atlantic -- kidding, they thought, until they realized how utterly motionless he was.
The wave's violence had ripped off his swim trunks. Someone covered him with a towel. "I can't feel my arms and legs," Josh cried. "I can't move." It was his father, a physician, who saw the crook in his neck, bone jutting obliquely under the skin.
A state police medical helicopter set down along the highway in Bethany Beach. Choppers land with chilling predictability on the summertime strip of fun from Cape Henlopen to Ocean City. There is no Hollywood "Jaws" drama, only the devastation of spinal injury. The luckier cases leave by ambulance rather than by air. Josh was among the unluckiest.
Rescuers such as Mike Jandzen, director of lifeguard service at the Sea Colony resort, call the Delaware and Maryland beaches some of the most dangerous in the country. Scientists such as Stephen Leatherman, director of the Laboratory for Coastal Research at Florida International University, fault government projects to replenish the shoreline for making the beaches' naturally steep slopes far steeper. At the point where deep water suddenly becomes shallow, waves build in height fast, then break hard.
The experts use vivid vocabulary to describe the action and peril involved. The waves don't spill; they "plunge." Bodysurfers and boogie-boarders such as Josh "go over the falls." Even unsuspecting swimmers risk "getting slammed" -- pile-driven headfirst into sand as hard as concrete. The spine suffers the worst of the trauma.
Outside her son's hospital room, Nedra Basile alternately despaired and raged. Maybe the locals understood the dangers, she said, but where were tourists' warnings? Not upside-down stick figures on beach patrols' marker boards, but permanent signs like those along the Potomac River near her home. Signs that would graphically detail the risks of playing in these waves or diving into shallow water.
Signs that would say: This many people have broken their necks here.
"If three people in a two-week period had been eaten by sharks, it would be all over the world," she said.
Actually, those numbers were low. Counting Josh, Maryland Shock Trauma Center in Baltimore admitted four severe spinal cord injuries during the first two weeks of August. The following week, a fifth. On Sept. 1, a sixth. The following, a seventh.
All were from Delaware and Maryland beaches.
Medically, there was nothing surprising about the diagnosis -- fractured cervical vertebra, fifth from the top. Hours after Josh arrived, surgeons at Shock Trauma stabilized the bone by fusing the C5 to its neighbors.
In his CAT scan, the scaffolding of internal hardware came into glaring, startling view as the machine traversed tissue. John Basile loaded the images onto his laptop and nightly searched the Internet for the top treatment options, the most promising clinical trials. A urologist, he knew enough neurology to realize what little hope there was. The way the doctors talked discouraged even that.
"Your son has a 2 to 15 percent chance of recovery," one informed Josh's parents, without specifying what recovery he meant.
"Your son will never get off the ventilator," another said.
The spinal cord often is likened to a highway of nerves traveling south from the brain. Protecting it, like a segmented tunnel, are 33 vertebrae. From each hard ring extend lesser roadways, which carry nerve signals to the farthest extremities of the body. A catastrophic accident on the main thoroughfare wreaks the same havoc as a catastrophic accident on the Woodrow Wilson Bridge. It stops virtually everything.
Yet the central nervous system's ability to respond is tragically limited, with no emergency crews that can repair damaged cells or reopen, much less rebuild, connections. With neural traffic blocked at C5, the most mundane motions and sensations of living would be beyond Josh's reach. Walking, rolling over in bed, brushing his own hair, brushing his own teeth. He would lose control of his bowels and bladder. He would need to be belted into a chair to not fall.
He was grossly swollen and medicated. He couldn't move and, hooked to a ventilator, he couldn't speak. His parents and older sister, Katherine, held up homemade signs in his hospital room. Do you want ice? Do you want your pillow turned? Blink once for no, twice for yes. His eyes signaled pain, exhaustion, fear.
Friends from school and the neighborhood headed up Interstate 95 and signed the blue spiral notebook labeled, "Josh's Log of Visitors and Well Wishers."
The girls pretended to be bubbly, and the guys urged him to stay strong. They managed brave faces, until they left the room.
Everyone was long back at college, and the trick-or-treaters had collected their candy. And still Josh, on Day 93, was not home. On Day 34, he had his 19th birthday. On Day 38, he was transferred from Shock Trauma to the National Rehabilitation Hospital in Washington. On Day 71, the morning news announced the death of an actor who had inspired millions after his own spinal cord injury.
"Chris Reeve died," Josh's mother wrote on his calendar.
The calendar lay half-hidden by a pile of papers and magazines cluttering the small extra bed that paralleled Josh's, where Nedra Basile had slept nearly every night for eight weeks. If in the predawn dark he called out, his voice a faint, shallow rasp, she was close by. She grew adept at suctioning the phlegm that his compromised lungs struggled to clear.
An entire season of medical crisis and immobility can waste the brawniest athlete. Josh was 55 pounds weaker, as limp and pallid as his thigh-high support tights. Anxious and fearful, he seemed to have lost his edge in other ways, too, and the spinal cord injury team was concerned. What was he willing to see when he looked in the mirror?
"A lot has to do with Josh himself," Pamela Ballard, program director, said. "His fortitude, his attitude, his adjustment to where he is in life."
The accident spared him a shoulder shrug, a modest movement that physical therapy sought to use to advantage. "Pick it up, pick it up, pick it up," assistant Bruce Varnes pushed, much the way Josh's tennis coaches once did. Except that Josh was not racing to save a drop shot at the net but straining to convert his shrug into something that could help position his right arm within range of a wheelchair joystick.
"Big lift, big lift."
"C'mon, up, up."
Rehabilitation provided meager progress but progress nonetheless. On a crisp November morning, his mother packed up the calendar and several plastic bags of belongings. A parade of staff members stopped by Room 224 with hugs and farewells and, "Are you happy you're leaving us?" Josh's favorite aide was off, but she called at the last minute, and the phone was held to his ear so he could hear Sharon's pep talk. The rest of his life would commence when he exited the hospital's front door -- a threshold he was terrified to cross.
He was, in ways he wouldn't fathom for months, exceptionally lucky. His family had the financial and intellectual means to provide. A specially outfitted $60,000 minivan was parked at the curb. A $35,000 wheelchair (capable of 8.5-minute miles) was on order. And waiting in Potomac: A custom-built ramp for circumventing the Basiles' front-porch steps; a living room-turned-bedroom and doorways widened to give Josh the breadth of that first floor; plans for an elevator so he could extend his range upstairs and into a redesigned basement; a hired caregiver.
Still, he was a quad.
"Fix my shoulders." He was listing, despite double pillows under his elbows.
"I'm having trouble breathing." Worry clouded his face.
Josh finally came home on Day 101. In the garage, soccer balls, lacrosse sticks and other artifacts of his past remained where he had tossed them more than three months earlier. He was pushed up the ramp and into the kitchen. Within seconds, a sleek feline named Isabel, his favorite, jumped into his lap. She settled contentedly on one of his pillows, in the crook of his right arm. He could not feel her purring.
Primum non nocere. A bedrock medical dictum: First, do no harm. In the desperate aftermath of Josh's accident, this was the only constraint in John Basile's mind. Advances with stem or immune cells might never come in time. Josh needed a breakthrough now.
His father found the rat-and-laser study on the Internet through a chance combination of search words. Just 12 miles away, researchers at the military's medical school in Bethesda had partially severed the spinal cords of 85 female rats and then treated half of them with 810 nanometers of near-infrared light. Basile read on. The results showed that the dosage had penetrated to the spinal lesion. And that the nerves there had regenerated in greater numbers and to greater degree than in the control rodents.
Nine weeks after the knife, the lasered rats walked almost normally. The results, the researchers said, suggested light as a useful therapy for people with spinal cord injury. Basile picked up the phone. He ordered two of the same lasers used on the rats.
So, late at night as Josh slept, the physician began irradiating his son, placing twin circular diodes on the back of the neck, top and bottom of a five-inch zipper of a scar. He tracked the study as best he could. As long as he did no harm, he reasoned.
Against skin, the laser created a luminous red sun. Energy, Josh's father hoped, for healing.
Something was happening.
"Mom, scratch my head," Josh said.
"Scratch it yourself," she retorted, smiling.
Because suddenly, Josh could.
In the early hours of a winter evening, his right hand reached up awkwardly as he lay in bed, past his shoulder, past his ear, above his forehead. It dangled for an instant like a precarious crane boom, swung over and lowered inert fingers toward his scalp -- a performance he gleefully repeated.
He started trying to feed himself, a special wrist splint holding a curved fork worthy of Salvador Dali. He speared the target in front of him, then aimed with slow, obvious effort for his mouth. When the segment of clementine at last hit its mark, Josh stuck it in whole. "Tasty," he declared.
Something was surely happening, accelerated by the daily exercise of Josh's limbs -- the repeated extension and rotation of muscles and joints, the gentle stretching, finger by finger, of his hands. The rehab doctors always expected some improvement; how much, they could not predict.
But something else also was occurring, equally unpredictable and arguably more momentous: Josh was reconnecting with life.
At first, it was mainly in his converted bedroom, where a buck's head ruled over the fireplace. On weekends, friends home from college would hang out, talk sports, play games, watch movies. They overlooked the urine bag hanging beside Josh's leg. He showed off his clementine trick -- "the coolest thing ever," decided E.J. Watkins, a daily visitor -- and after delivery of his Storm TDX5 power chair, Josh demonstrated how its hydraulics could raise the seat 10 inches or more.
A handy feature, he bet, for sidling up to a bar. After all, who would card a guy in a wheelchair?
Those new wheels gave Josh his first measure of independence, though that entailed risk. He worried about the stares he would get or, worse, the pity. Jane Altshuler set him straight. His former Advanced Placement art teacher remembered others' reactions when breast-cancer chemo left her bald.
This is what a spinal cord injury looks like, she told Josh. Deal with it.
He dealt in part by composing poetry. "I've got a lot on my mind," he said. One piece rewound to the accident. Other musings contemplated the present:
My ascent began three months ago
Every day I progress two feet forward
Yet fall back a foot
Because of the boulder attached to my neck.
With Altshuler's encouragement, he enrolled for the spring semester in a weekly poetry course at Montgomery College. She offered to go with him, and Watkins signed up for the same three credits, and there they were, Team Josh.
They arrived a half-hour early that first Wednesday. Josh was more excited than nervous; now he could tell people, I'm back in school. In the classroom, he parked where he could face the other students. He and Watkins traded knowing glances when one particularly attractive woman walked in.
The teacher passed out a short biographical questionnaire. Altshuler filled in Josh's answers.
What do you like to do in your free time? Physical therapy.
What is your major? A question mark.
Any athletics/extracurricular activities? Left blank.
"I loved it," Josh gushed that night, already impatient for the second class. "I felt normal again."
By early April, Josh was thinking more expansively. He had things to say that went beyond poetry.
His alma mater, the private Bullis School, seemed a fitting backdrop for a first speech. He prepped with Altshuler as if he were holding a Capitol Hill news conference, and by the time his small entourage drove onto campus, he had a PowerPoint presentation packed with facts, stats and photos -- an intensely personal public service announcement. "The video's going to make the kids cringe," he predicted.
The presentation flashed on the huge screen behind him in the Bullis theater, with a collective gasp every time the video demonstrated the mechanics of a spinal cord breaking on the ocean floor. Each of its four scenarios, borrowed from a California program called Project Wipeout, was accompanied by an awful cracking sound.
"This is the injury I had," Josh said as compression, scenario No. 3, showed vertebrae piling up on one another like a chain collision on a highway.
Except for Altshuler's younger daughter, beside him to turn the pages of his speech, Josh was alone at stage center. He narrated his story without any hint of bitterness. "I'm fully dependent on others for the most basic things," he said matter of factly.
But he did not elaborate. He did not go step by step through his mother's tedious attending to his bodily functions every morning, or the lesser routine every night, when his aide assembles three buckets of water and drapes him with towels to clean face and teeth.
He didn't mention how often the most ordinary outing must be aborted if a kink in his catheter or a shoe tied too tightly triggers signals his brain can't receive, and his autonomic nervous system sends blood pressure soaring.
He didn't explain how a half-flight of stairs can be as insurmountable as Everest, how quickly in most friends' houses he is blocked, stopped, defeated.
He closed with a dozen beach safety tips and a composition titled "Different But Not Ruined." At which point 700 students spontaneously stood and applauded. For a long time after, he was the center of congratulations.
A week passed, and Josh received an envelope of thank-yous from the third and fifth grades. "Many people would say that Derek Jeter is their idol," a boy named Chris wrote. "But not me, if anyone asked me who my idol is, the answer would always be the same. Josh Basile, my superman!"
No, not ruined at all.
His future is all about connections.
The personal ones Josh makes easily, thanks to his natural gregariousness. At Tysons Corner Center, Josh spotted the Washington Wizards' minority owner in the Nordstrom shoe department and rolled over to introduce himself -- and complain. Getting good seats at MCI Center was tough with a wheelchair, he said. Ted Leonsis listened, asked about the accident. Call me tomorrow, he said, and handed Josh a phone number.
The next day, four special playoff tickets were waiting.
The other connections, the nerve couplings crucial to Josh's future, are being made, too. All spring, he reported tiny, invisible changes in sensation deep in his abs. He gained strength through his torso and by late April, capitalizing on his right arm's greater control, he could sit on a matted bench and hold himself upright. "I discourage him from pursuing a miracle cure," said Trish Esposito, a physical therapist at the rehabilitation hospital. "I don't discourage him from dreaming."
In late May, he suddenly could move his left arm, curling it through the bicep. He hid it from his mother for 12 hours -- to show her as a present on her birthday.
Watkins sees his friend as constantly inspiring. Every so often, though, he hears Josh lash out in frustration: "God, I wish I could do that." Or confess: "I feel like such a nuisance." Altshuler, whose counsel and commitment have become indispensable in his life, comforts Josh in the rare moments of tears.
Josh insists that he doesn't dwell on the what-ifs. The biggest one: What if he never walks again? "You push it away. It's in my closet, my attic, way above." He has concluded that he simply was unlucky that summer afternoon last year. "Wrong place, wrong time, wrong beach, wrong piece of sand."
Last month, he became one of the Kennedy Krieger Institute's first patients at its new International Center for Spinal Cord Injury. The director is neurologist John McDonald, whose research helped Christopher Reeve regain sensation and movement. Even after major damage, McDonald said, more neural circuits remain than doctors had presumed. And even long after injury, he believes, their function can be restored through exercise and patterned, repetitive activity.
During a head-to-toe assessment, Josh went over everything he had done since Aug. 1. He listed the vitamins and supplements his father had prescribed to nourish nerves and tissue -- 22 at last count. He ticked off how many hours a day he wore the EMS units that electrically stimulate dormant muscles. He talked about his acupuncture treatments. He recapped a trip to Shriners Hospital in Philadelphia for evaluation for tendon-transfer surgery on his arms.
"It's really critical that you dedicate the next two years to this," McDonald told him. Initially, four hours a day, five days a week at the center in Baltimore. Plus more time at home. A level of training that a former tennis jock had not achieved.
"I'm with you," Josh said.
By week two at Kennedy Krieger, he is going strong.
"Oh, God, I love this machine," he says. He is sitting in his wheelchair with his hands Velcroed onto a set of miniature bicycle pedals mounted on a table top. His arms are pumping, pushing, pulling the pedals -- absolutely on their own.
"I'm feeling a lot of delts," Josh tells a therapist.
"A lot of traps." She nods.
"I'm feeling, I think, a little triceps." That's C6 to C7, just maybe the edge of real recovery.
"And there are pecs, definitely a little pecs."
Josh breathes heavily, happily, remembering what a sweat-producing workout can be. It gives him hope that soon he'll feel a familiar twinge, a tiny jerk of a finger or toe, that will mean a signal has made it. Beyond the C7 level, beyond C8, even lower. Down, and all the way back.
He's closer to figuring how a future as a quadriplegic can matter. But his new schedule complicates his planning. He has too little time for other projects. He wants to give free chess lessons in his neighborhood because that is something he can do for others instead of others doing for him. He's launching a foundation to benefit new spinal injury patients and their families, which will be named Determined2Heal because, "That's what I am."
People see his mother in the grocery store in the neighborhood and ask, "How's Josh?"
"How do you answer that in one sentence?" she wonders. How does she say, "My son is a better person than he was a year ago"?
He has given speeches since Bullis, the points about beach safety increasingly honed. This fall, Josh intends to take a public speaking class. "We have such a powerful message to get out," he urged the other quads he met during his visit to Shriners. Few of them had ever thought of their paralysis that way. "They never thought they could make a difference."
He is a long way from Bethany Beach. A long way toward appreciating that his life can be -- he searches for the right words -- "a fully contributing life."