Diagram of tendons

Our shower tile has failed so we are planning to replace the shower with a one piece shower and possibly switching to a wall hung toilet. I'm looking for advice. I have ankylosing spondylitis which has already damaged much of my spine causing a lot of pain and limitations, as well as polyneuropathy affecting my balance and tendon damage causing stability issues. A barrier free shower with grab bars would help me now but I want to plan for the possibility of needing a walker or wheelchair in the future.
Our bathroom isn't large and we don't have room to expand it. The dimensions of the bathroom are 107" long x 60" wide. The shower would be 60" wide x 34" deep and have a zero threshhold with a weighted curtain. We have a 32" wide door with swingaway hinges so we have the full 32" to enter. Our current toilet leaves 32" between the front and the opposite wall. If we switch to a wall hung toilet that would increase to 39". The new shower will have horizontal grab bars the length of all 3 sides, and a vertical one at the entrance opposite the toilet. I have a diagram of 3 layouts on Imgur. The farthest to the left is the current setup.
I'm planning for a standalone shower bench for now so it can be moved or replaced as needed, and adding blocking behind the shower walls in case we want to install a permanent seat later, but I don't know where a permanent seat should go. I think we would put the shower controls on the left and have an extra mount for the handheld sprayer on the backwall to be reachable from the bench. I'm also thinking swing down horizontal support bars for either side of the toilet if/when needed in the future, so we would add plenty of blocking inside the wall for that. The vanity is a freestanding unit that can be replaced easily in the future with something smaller if more room is needed to accommodate a wheelchair. Is there anything that should be changed or added that you'd suggest?

i felt inspired to write my own neckbeard story because I've been listening to Vincey on YouTube reding these. Highly recommend his channel, I enjoy his positive attitude a lot :) I grant my permission to any YouTubers to use this Story in their videos if they wish. Names abbreviated for anonymity!
a slight content warning for animal dissection and my bad grammar, I don't speak English as a fist language and I am drunk st the moment of writing this !
now for some context: I grew up in a small town and had known this neckbeard since like daycare age. I was, and still am a bit nerdy girl and very fem presenting most of the time. I also am what you would consider "alternative " in my fashion sense, which apparently is neckbeard bait lol. this took place when I was 16 and he was 17 but we were in the same grade because he was held behind a year. I'm not sure if he could even be called a neckbeard, more like a neckbeardling haha.
I sorta knew our neckbeard pretty well, I did competitive swimming and he did diving so we ran into each other a lot. We were in different classes but we both took elective art and elective biology, so we also had a lot of classes together, and ofc, we had a lot of common interes such as anime and nerdy stuff. In appearance he wasnt too bad, he had severe acne, which I didn't mind because I also had it. He was pale and wore worn down jeans and a black hoodie, usually sporting an anime t-shirt underneath. He was tall and spindly looking with a greasy mop of brown curly hair crowing his head. He didn't smell bad, just overwhelmingly like a men's spray on deodorant. He had an awkward voice, you could tell he was going through puberty by all the squeaking and voice cracking.
I Had one friend, let's call her B, in the elective biology class with me and we did a lot of pair and group assignments, anything from dissections to working outside surveying people or traffic. I would always pair up with B, but a lot of time despite having his own friends in the same elective our neckbeard, M, would choose to butt into our pair assignments. B was, and still is a very kind and polite girl, sometimes to a fault but it is one of the qualities I really admire about her. I on the other hand was a bit hot tempered and more assertive. our dynamic worked really well for us, I would protect her from bullies and stand up for us both and she would help me with school work and socializing. We were both top of our class, but I wasn't as well behaved and it reflected on my grades too. Im still friends with her, despite us living in different cities now. Due to B's kindness towards M, he was allowed to work with us most of the time, I didn't say anything because I wanted her to be happy and I knew she hated confrontation. One of these times we were paired up with him we had to dissect a foot of a moose. B didn't want any part in it so we agreed to let her just sit and watch as me and M did all the dissection. M was obsessed with being seen as "cool" and though he could impress me with his knife skills. We had to skin the foot first before we could get to the joint and tendons so he volunteered to do it despite never even filleting a fish before. I sat back and watched with a sinking feeling in my stomach, I just knew something was gonna go wrong. And it did. M cut the fur of the skin open and started removing it from the foot, except, he was skinning it by cutting towards himself with the scalpel, in stead of away from himself. I tried to tell him that he's doing it wrong but in his attempt to impress us he refused to listen. The scalpel slipped and ended up giving him a small cut on his chest around the ribs. He was bleeding and had to go visit the er to get on some antibiotics despite the injury being very minor. The feet of the moose were sourced by one of my classmates who hunted a lot (I am from a hick town) so we couldn't be sure if the animals could have some diseases. Me and B finished the job and it was actually really interesting and I feel like I learned a lot.
In another biology class we were sent out to monitor traffic, we had to find a spot and count all different methods of transportation ppl were using and make a diagram out of it. Me and B were leaving and I noticed M lingering around us and as we were leaving the classroom he just tagged along with us and we were forced to take him with us because every other group had left already. it was around may so the weather was nice and warm and we stopped by the store to get some snacks for our expedition. At the store M insisted on "buying the hot ladies something to cool them down" and he bought us popsicles. Me and B grimaced at each other but accepted our free popsicles. We laughed at him so hard after the class that day and still quote the line to each other after 4 years. We got to our stakeout spot on the edge of the town square and things were pretty uneventful, except him staring at us while we ate our popsicles. I remember I made sure to bite mine as brutally as I could without getting brain freeze lol. We spent around 1.5h there and as we were walking back to school we got to talking about how me and him used to go the the same daycare and same preschool. He awkwardly told us he used to have a crush on me when we were in preschool and also when we were in grade school. I laughed it off and just told him I just remembered playing with him as kids and having fun. It was awkward but I didn't wanna open a door to a possible confession so I tried to change to topic as fast as possible.
the worst encounter I had with him was when my at the time best friend S, somehow had a crush on him. Me and her were really into vampire diaries and twilight at that time so I'm choosing to blame it on that. I tried to wing woman her in my nativity, because I knew him better. S and M didn't have any classes together. I got his number from one of his classmates and texted him one night that I'd like to arrange a meeting with him to discuss one of my friends. Now thinking back, this is incredibly creepy behavior from me but I was 16 and had never dated anybody. He agreed to meet with me, in hindsight I think probably just because he had a crush on me. I told S he said yes and she was bouncing off the walls exited and I was happy I could be helpful even if I disagreed with her attraction to him. Few days later the meeting happened, I had mistakenly told some of the other girls in my class about it and they were lingering nearby but not close enough to hear us. At that time I was sorta popular, most people in my school knew me by name because I had won a lot of competitions in arts and poetry and sports too, I was also the president of the student council and a tutor student (helped out younger students with getting adjusted in a new school, tutoring for free and was a safe older person to report bullying and tell your worries ect.) and was know to participate in and organize many fundraising events. I also had a reputation that I was not to be messed with, thanks to my volatile temperament and a few incidents of violence against people who had pissed me off. I am not proud of that, and have since mellowed out a lot. with that being said our meeting happened on a dreadful Monday on a break between classes that lasted 25minutes. We met up near the main door and chatted inside the vestibule so we couldn't be heard by outsiders. Unfortunately our conversation kept getting interrupted by a lot of students who wanted to say hi to me. That caused a whole another incident of people thinking that me and him were together or friends, which I hated. He was waiting for me there and I walked up to him and for some reason we shook hands and he asked me what this was about. I explained to him that my best friend has a little crush on him and showed him a picture of her and asked him if he would be interested in meeting up with her. He agreed pretty quickly and I gave him her number and Snapchat. I was about to leave but he kept coming up with topics to discuss. He kept steering the conversation away from my friend and him and kept trying to talk about me and him and to get to know me better. First he showed me his anime drawings. In the picture he had his entire wall covered in pictures of anime girls he has drawn. and as an art student I do have to say that he had some talent. I was a bit weirded out by the wall of anime girls but I could really hate on him because I was wingwomaning so I had to pretend to like it. the next attempt of keepig me there was him showing me his phone case and how we coincidentally had matching ones. I had bought mine from the thrift shop because my family was poor so I couldn't really choose what to have. We both had the UK flag as our phone case, like it was trendy to have back then. We don't even live in the UK lol. the third attempt to keep me there was him asking me if we could meet up again sometime, maybe after our practices at the local swimming hall. i swiftly but politely turned him down because I didn't want my bestie to get the impression that I was going after her crush, and also because I didn't wanna see this dude at like 9pm after practice. The break was finally over and the bell rang and I was free. I swiftly made my exit and joined the group of girls from my class telling them all the horrid details of our meetup. My bestie wasn't at school that day but I messaged her that I arranged her a date next Friday on the school gated after school ends. she was happy, so I was happy despite the suffering I had just endured.
My bestie and he met up that Friday, it was so awkward and I kept an eye out on them because I didn't trust this dude fully. He was super late to their meetup and my bestie was texting me super stressed. I was watching them from like 50m away, kinda creepy I know. He finally showed up and I saw them chat and start walking away. S texted me that they were going to the library and I didn't have to follow them. The library was like a 10 minute walk from the school so I wasnt worried and I went home. The next day she tells me that he had taken her to the very small manga section in my small town library and given her some recommendations and then he had tried to get her to suck him off at the library bathroom. I wasn't expecting much but he had always been at least somewhat polite and nice to me before, so I was shocked. S obviously had said no and their date had ended to that. and there never was a second date.
fast forward to when covid hit us and we went to to lockdown. i got a part time job at the library because my online classes didn't take up too much of my time. My family was seriously struggling with money because it was hard for my mom to find a job as a daycare attendant. My typical day at work was pretty nice and quiet, since people were avoiding public places. I would spend 8-10 stocking the bookshelves with returned books, then stand at the register for an hour or two serving customers. then I would take my lunch and usually after it I would host a storytime session and arts and crafts for families with young kids. it was nice work and it made me feel good to help parents struggling with kids during the lockdown by occupying them for an hour or two. after that I would make displays for our promoted books of give book recommendations for teachers. i got this task because I'm a bit of a book work and had read pretty much every young adults and teenagers book in the small library, so I knew which ones would be appropriate for kids above or below a certain age. Anyway, one day guess who wonderes into the library where I now work at. Our neckbeard came by pretty early and saw me restocking the shelves. I hide my annoyance because he is a customer and I am at work now. He asked me what I'm doing here and I tell him that I got a job here to help my mom pay the bills and so I could take care of my sister. she used to come into work with me ever day because she was too young to stay at home. i would share my lunch with her and she would just hang out at the library until my shift ended. I remember him telling me that that's awesome and that maybe he'll come by more often since I'm working here now. he went on a tangent about how lonely he felt now because we didn't have school in person, and I told him that I understand how he feels and that getting a job has really helped me with that. I said that I need to get back to stocking the shelves now and if he doesn't have anything work related to ask me that he should get going. He unfortunately didn't get my (very straightforward) hint to leave me alone and and continued to pester me. He walked the shelves with me and even tried to push the heavy wooden cart that I used to carry to bookes on. because "a pretty lady shouldn't have to do manual labor". i scoffed at him and slapped his hand away from he handle and told him that he isn't allowed to touch the library's property if he doesn't work here. He thankfully backed off but kept walking with me. we somehow got to the topic of anime and manga and I started to not mind him. the library got kinda creepy when it wasn't busy and I was alone in the sea of shelves. He gave me some anime recommendations and I returned the favour. after I sorted out the books I had to go serve parton's behind the desk and he went to rent his books and left. After that he started coming to the Library more often and I told my bestie that if she wanted to hang out with him she should come to the library but she declined because she lived an hour away in the woods. I got kinda creeped out by how often he was in the library and how he would come find me wherever I was. the library was two stories high and such a labyrinth. i just knew he was seekig me out on purpose, but I just went along with it because it was kinda nice to have someone keep me company in the creepy empty library.
I have since moved away because I got into my dream school and no longer live in the city where he lives in. Once when I went to visit my mom I saw him at the local mall and I almost didn't recognize him. he is now a trans woman and I am really happy she has found herself. we had a brief chat and she seemed pretty nice and pretty too, and told me that she thinks her crush on me was actually gender envy. I chose to use he/him pronounce for her in this story because at the time she was not yet a woman. I've since got a boyfriend and a partner and we are in a very happy polyamorous relationship. I've also realized that I am agender, and not a girl. so a happy ending for the both of us! sorry this story wasn't super eventful or dramatic but I think it can be a good example of how people can change and how sometimes unlikeable people are just still in the process of discovering their true selves. Have a nice day everyone and remember to be kind to yourselfes!

I've had swelling/pain of the knee, specifically the end of the patellar tendon that connects to the tibia.
https://www.reddit.com/usesmell_smells_smelly/comments/1ch1q7n/knee_patellar_tendon_pain/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button
My ankle is giving me trouble as well on what feels like these areas:
https://www.reddit.com/usesmell_smells_smelly/comments/1ch1p3k/ankle_bursitis_areas/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button
https://www.reddit.com/usesmell_smells_smelly/comments/1ch1t3o/ankle_enthesitis_the_blue_arrows/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button
Luckily, all on my right side so I am able to walk comfortably with a cane. I wasn't able to walk or bend or lengthen my leg or flex or rotate my ankle in the morning. I can do so a bit more this morning once I got a cane and started walking after some icing and light stretching, massage, and movement (rotation and flexion).
Is there anything I am "missing" in this formula? I took a couple hours off work to do these things and I would like to avoid that when possible since I am a project manager and need to be accessible to my team and just, well, work. I currently work from home which is helpful but my employer is moving towards hybrid work and the ankle issues on my driving leg have been a bit uncomfortable but this knee involvement is new and flexion is painful. Any tips appreciated! Thank you.
Edit: to add diagrams posted on my profile - the diagram pics in the original post disappeared.

28F/5'11/300 lb/White
Taking Nebivolol 5mg, Desloratadine 5mg, slynd 28 day tablets, otc iron and b12
Have been previously diagnosed with tachycardia, high blood pressure, PCOS, Anxiety and depression
No drinking/smoking/drugs
This is sort of a weird timeline of events, and I'm not sure if it's all related or if it's two different things happening at the same time, but about three weeks ago now on a Saturday night, I managed to pull something in my right wrist. I was stirring batter for a cake and it felt like I pulled something because I was suddenly in a lot of pain. I Tried to rest my wrist and take some ibuprofen, but the next day it didn't go away, so I made an appointment with my GP to make sure I wasn't dealing with something like carpal tunnel syndrome because at the time, I was experiencing numbness in my hands and fingers and wrist as well as pain. I made an appointment with my GP the following Monday, but because I couldn't be seen for another week, I decided to go to the urgent care while I waited, and I was diagnosed very quickly with tendonitis. They weren't very thorough, so I don't know how accurate that was, but they gave me a steroid injection and some diclofenac potassium 50 mg tablets.
And that seemed to be helping for a little bit, but then I started feeling more pain and numbness going up my arm and through my shoulder. Then I started feeling numbness and pain in my left hand shooting up my arm, but not all the way up to my shoulder and not nearly as severely. I suspect this one is from some kind of strain from trying to make up for my lack of my dominant right hand, but I'm not sure, I couldn't get anyone to actually pay attention to that wrist.
By Friday, things were starting to feel better for the most part, I was still experiencing some numbness in my arms and hands, but the pain was mostly gone. That evening, however I started noticing that my right leg was feeling numb, and I thought it was falling asleep because I was laying weird, but despite changing my position, I wasn't feeling any different. I go to bed not thinking too much of it because it's really mild and not super noticeable unless I'm like actively paying attention to it, but when I wake up the next morning on Saturday, I notice that the whole right side of my body from my head to my toe is completely numb. Not quite like pins and needles numb, except for the back of my head, but like a partial loss of sensation.
I tried moving around, I tried different stretches because I figured maybe I slept really, really weird somehow, but after about an hour, it still wasn't going away, so I went to the ER. They did an X ray on my wrists, they didn't find anything, they did a CT scan, and they didn't find anything there either, so they gave me one of those medrol packs and sent me on my way with a referral to a neurologist. However, due to several issues in trying to get ahold of the neurologist, or any neurologist, I haven't been able to make a proper appointment yet. In the meantime, things have stayed relatively stable until yesterday around 2:00, where suddenly I noticed that the whole rest of my body feels numb outside of a couple of areas like in my left leg, but most notably, my chest and stomach, as well as in the back of my head. Suddenly, I found myself with a headache and my head feeling not quite dizzy, but fuzzy, it's hard to explain but it was an extremely uncomfortable feeling. I left work early and went to the ER again, but they were being dismissive and not taking my concerns seriously, so after an absurdly long wait time, I just gave up and went home, because I figured if I wasn't dying after that long without help, I could at least be uncomfortable at home.
Cut to today, my headache's gone away, but the back of my head, neck, and upper back are feeling intensely like pins and needles, while the rest of my body, with the exception of a couple places in my left leg and the left side of my face is varying degrees of numbness that comes and goes (at least on the left side). The right side is much worse and far more consistent, to the point that even inside of my ear feels numb, but I'm not in any pain beyond a bit of lingering wrist pain. I can sit, stand, and walk normally, turn my head, and grip things without an issue. I'm not experiencing any sort of cognitive effects or face slouching. I'm just numb, and the fact that it's spreading the way it is scares me.
I don't know if it's a pinched nerve somewhere, a bunch of pinched nerves, or something more serious, but I made a diagram to show my neurologist whenever I can get that appointment, so maybe they can look at it and go, "ah, that looks like ___!" I then also updated it to where the numbness had spread yesterday. If anyone qualified can point me in some type of direction for what this might be and what I might be able to do for it as I try to get someone to give me an appointment, that would be great. Links to said diagrams will be in the comments.

Chapter 5: Perfection is Impossible
I've been running from some rather strange-looking men and women wearing all-black suits. I kept seeing them out of the corner of my eye when I would walk to a store to get food. Strangely enough, they seem to stay just out of sight where I can see them but as soon as I try to focus on them they disappear. I don't like being followed in all my adventures I have had something following me never came to be good. While I am safe I have another place to tell you about. This one was directly after meeting with Alex.
After a quick flash of light, I was transported to a new dimension. Oddly enough while I was traveling I was able to see the space outside the dimensions. It was warm and peaceful. The area seemed to be a blank empty page that expanded beyond imagination. It was a white canvas ripe for painting. In the distance, I could see scribbles appearing on the page like words were being written. However, I couldn't make it out as it was so far but as soon as I was able to focus and read the first line I was flashed into a new universe.
The song of birds was filled the air. The gentle song of the wind and the trees rustling, dancing to the music of the wind. It was the most beautiful place I have ever seen. Serenity was the definition of this place it was as if this place was the concept of peace. It was just a moment of bliss in my otherwise bleak future. The smell of sweet flowers and honey. I was in a daze when a woman walked up to me. Naturally, I was very defensive and stood up in shock. "Whoa easy there, I just thought I saw lightning strike my field here but it was just you. Are you ok stranger?" The mysterious woman approached me with a smile with soft expression. I looked in confusion as she was dressed head to toe in leaves and vines. "I... uh. Yes, I'm fine. Just where am I?"
​
The beautiful woman answered, "Uh, let's start with the name. My name is Tikvah. What's your name stranger?" I looked puzzled, it's not every day I see someone of such immaculate beauty and pose. "Uh sorry! My name is Auren... Auren Da'at" She looked at me and smiled before she said "Well Auren. Nice to meet cha! Why are you here? Do you need help?" I smiled back awkwardly. I never knew someone can pull at my heart with just a smile. I felt like an ice cube and she was the sun. Making me melt in her bountiful radiance. "Yes... I need to talk to you and whomever else I can" She waved at me and pointed at what was her home "Well let's sit down and talk I would like to know why are you wearing such a strange get-up." I was a little confused about her dialect and slang but SUIT was able to explain it to me "I uh... Built this suit. It's made of very advanced technology I can't explain in detail right now" She scratched her head "Tech what? Never mind let's get inside and warm up some tea. We can talk then"
We looked at each other and she held her hand out so I gently held her hand. Assuming that's what she wanted and she led me to her home. My thoughts at the time were racing "Was this what love felt like? Did I meet someone who I am compatible with?" We arrived to the house and as I walked in the front of the home I noticed it was made of all wood. It looked like it was one large tree that was shaped into a home. The more I looked the more of this I was certain. The wood was all one piece and wasn't a single carving mark at all. Down to the table and chairs. "Is this..... How is this made?" She looked at me puzzled again. I later learn to love that face. Such innocence and wonder. "What do you mean? The world tree provides us a home silly. You know that!" I looked back into her green eyes. They looked like I was staring into a forest during dusk or dawn. As if the light was shining through bright green leaves.
"Whatcha starin' at Auren? Are you ok?" She responded. I shook my head to snap out of child like trance. I was swooning for this woman... for the first time In my life, I felt hope. "I was lost in your eyes my apologies. I need to speak about an issue but I need to run some tests... wait.. your home is from a tree? So this is one tree?" She laughed and blushed a little "Well Auren, You sound new somehow you don't know what the world tree is? We are just on a branch high in the sky. Here I'll show you!" She gestured me to a window. I can feel the gentle breeze. As she pointed to the outside she said "Look that..... that is the world tree." I rubbed my eyes... I had never seen anything as beautiful. I giant tree stretching hundreds of miles up. We were so high that clouds were covering the ground and the roots looked like small sticks. I see thousands of settlements scattered across the branches. Large cities and homes. People were walking about in the distance around a town hall.
I closed my jaw as Tikvah said "You ain't from around here huh? Where are you from Auren" I snapped out of my stupor brought upon this pristine civilization? "Yes, that. I am from a very advanced race of humans in a different dimension. I must warn you to have is a possible threat to the universe. It's called the...." She cut me off "The void yes? Yea it was a threat long ago but it seemed to skip us and gave us the greatest hope and gift. The world tree. Without it, this planet was barren and we were all struggling to survive. The Void gave us hope and life." I... didn't know what to say. This was the first time I felt true peace. I started to cry uncontrollably. "you....you... You don't understand all the pain I've been through. The lifes I saw perish... Whole universes and dimensions completely erased from existence when this was the answer. Thank you." She hugged me as I collapsed "It's ok you are safe now. Hey tell you what, why don't you stay here and help me around the farm? I could use a helping hand."
Months have passed and we fell in love. We had a great life. Sometimes when I scanned with SUIT it always came back with no traces of The Void in this dimension. Things seemed too perfect as my fiancée woke up one morning and was sick. She kept vomiting and having massive cramps. We decided to go to a doctor after a week of this. We headed to the main town which was across three branches. The center of the town was immaculate. Oddly enough this is the first time I have been here. The wood roads were soft and lush. Full of life and creativity. Down to the very flowers and moss covered roads. The memories of this place warm my heart to this day.
As we entered the hospital it seems like it was empty. Some doctors were there waiting for patients I assumed. "Where is everyone?" I whispered to Tik. "Well, no one is sick here. The world tree keeps us in perfect health. There is no death or illness only life and prosperity" Tik said to me in a cheerful tone. "Interesting I will need to run some tests later," I thought to myself. After a few minutes of waiting, we were seen by a doctor who ran a few tests but the manor was entirely holistic. There were no tools, diagrams, or machines. To describe how intriguing this was the doctor rubbed some powder on his hands and they started to glow. After he hovered his hands over her body and they started to glow different colors. He got to her stomach and it was bright pink.
The doctor proceeded to get a bowl and wash his hands off. He came back with the news "Ma'am you are with child and it's a girl." It was the happiest moment of our life. We jumped in joy and something beautiful happened. The room was growing pink flowers that smelt of honeydew. I don't know what it was doing but it felt like the tree was celebrating with us. Shortly after we went home and laid down to sleep.
That night was .... rough. It started in my dream. I was on a boat with my wife and daughter. We were looking out into the massive expanse of the tree from below by the roots. It was majestic and beautiful. Lights filled the sky as bioluminescent lights filled the branches. It was a sudden shock when the lights started to dim and the tree looked as if it was wilting and rapidly dying. I can hear the pained scream of the people as the leaves turn black and began to fall. All those people fell to their doom. With a sickening splat and splatter, they slammed into the base of the tree near us.
The blood of the people filled the ocean painting our boat a dark crimson. The smell of iron filled the air along with the sound of screams. It wasn't until now I notice. A large mouth approached the tree. as it opened the tree started to splinter and uproot itself all the lives that were on the tree still were sucked into the massive maw of the creature. A black hole was formed in his mouth as I can see the tree spaghettified and bending light as it entered the event horizon. The boat was slowly rising to the creature's maw as my daughter was rocketed. My wife tried catching her but she was only able to secure her arm the gravitational pull was too great and her arm was torn from her socket and her body flew into the beast's mouth.
I couldn't breathe or think I was in a daze the pain was too much for me. My wife jumped into my arms and all I can feel was pain. We held each other one last time and shared a kiss as we flew into the black hole together. Before I could touch the event horizon time seemed to pause. I heard a voice "This is a warning, keep moving I need more stories I need to feed" I was able to move when I saw the same creature earlier. Pale-skinned, with no eyes or nose sharp teeth, and thin lips. He slowly floated toward me and smiled "It's time to wake up Auren... And you.... Don't forget I can still hear your heartbeat. I can smell your fear. I am coming."
Just as quick did the nightmare come on was just as quickly as it faded away. I awoke screaming in terror. I was covered in a sheen of cold sweat, my body felt as if it was being torn apart from the inside out. Tik woke in worry as my pain was so massive all I could do was rock back and forth. It took hours to subside. Tik asked "What happened? Are you ok?" I looked at her worried "Tik... I need to build you a SUIT that the void is coming back. "I need to show you something" Tik waved me to a secret part of the house. I had never been here before but it seemed to be in the branch itself. "look, love, This is why we don't worry about the void."
She moved a curtain hiding a giant mural of the void. The exact creature I saw being slain.. the person who stood over his body .... was.... it was me... I don't know how but it is. "Tik what does this mean? How do I kill this thing?" In the background was the world tree. IT filled me with hope and then Tik responded. "We must all follow our path, yours seemed to follow greatness. Deifying all odds and possibilities to overcome the void. The ultimate evil, the great dying." Tik smiled at me. This smile was always comforting filling me with hope. "If I'm destined to defeat this being how or where do I start? Is there anything on my process of doing so?" Tik looked and continued to smile. "No silly, it is just a prophecy told by my people and written by the tree. The void has left us alone for a reason. It helped us thrive!"
With a moment of clarity, I realized this void isn't destroying this place because this place is her story... She must be tied to his narrative. There is no other reason why she would just bring life to a place and then just leave while leaving countless other dimensions in complete ruin all the be swallowed by her massive maw. If I can somehow remove his link from this dimension I can beat her and end her story. With my new theory, I set in motion a series of tests. Many years pass by with nothing conclusive it wasn't until the few days I was there did I Find something concrete to use.
Don't you dare you worm...
In my testing, I found the world tree itself contained a massive core. This core had the same general wavelength as the one the void emits when he speaks to me. This is it... The link between the two. I found a way to end the void... The only issue Is if I do this then my daughter Kirin and Tik will either have to come with me or die on the tree. I must destroy this tree. So I sat my wife down.
"Tik I have found a way to end the void once and for all" Her face lit up in excitement as she contained her screams. "Auren!! Really? What is it?" She asked excitedly. I looked at her in her beautiful eyes "It's the tree. The soul or origin of the void is within the tree. If I destroy the origin I will effectively destroy the void. However, everyone on the tree will die. I can't live without you or Kirin. I need you to come with me to a different place after we destroy the tree... we will be safe." Her smile drained from her face but she had a look of determination and acceptance. "I will get our daughter and we will meet you by the boat." I smiled and gave her a large hug. I then pulled a device out of our closet. It was a spatial disrupter designed to take any wavelength and reverse the polarity effectively destroying anything I set it to. "I need to plant this in the tree where the voids soul resides and once I do I will get on the boat and we will get a safe distance away from the tree." She shook her head and stood up
We got to the base of the tree I gave my daughter a hug and my wife a kiss. "Daddy please be careful!" I smiled and waved with an act of confidence however I was terrified. I started drilling into the tree and got a layer into the bark when I notice... It was hollow. I shined my light in the tree but the light seemed to be consumed by the ever-expansive darkness in the tree. I had to go by my reading luckily SUIT kept the exact quadrants of the wavelength so it was a rather easy climb. On my way down the trunk deep into the roots, I can hear a rhythmic thumping vibrating in the tree. I was only but a mile from the spot now. It sounded like a heartbeat.
As I descended downward and the dark expanse I kept hearing its voice "turn back now child, you will regret this action." I just yelled into the dark "This ends today void!!" I kept descending roughly a hundred feet from the spot. When I am bombarded with images of horror. People's arm muscles are being ripped out tendon by tendon. I was seeing creatures eating someone's teeth like candy crushing them into a fine powder. I saw a man see his friend being bifurcated in front of him by an ungodly creature. All these images flooding my mind sent chills down my spine.
I hid this part of me... The only real humanity I had left. Auren. If you do this I cannot guarantee your safety and you will release the absolute evil that is The Void.
It was then I saw it... The bleeding, beating heart of the monster. It was large and every single beat of this thing was so massive it sent shockwaves throughout the tree. I was so close to it that I can smell the disgusting stench of rotting corpses emanating from it. I repelled further down where I was hovering just above it when I dropped the signal disrupter on its fucking heart. The void Yelled and cried as I activated the device. "I will kill you and your family Auren. How does a mere story dare try to harm me!!" Its words shook me to my core as I winched upwards as fast as possible. Reaching the exit of the tree I can still hear it cry and curse at me. I got on the boat and my family and I speed off.
It hurts .It hurts .It hurts. It hurts. It hurts. It hurts. It hurts. It hurts. It hurts.
Within no time at all the tree slowly caught on fire. It was a black flame covering every possible inch of the tree. The cries and screams of the people were horrible. Some jumped off the tree and splattered in the water nearby. The lake below became thicker as more blood and viscera poured into it. The smell of iron and burning bodies filled the air. The very community my wife helped make was crying out to her as they died. I can see her cry silently and cover her mouth as she tried her best to cope.
I tried to warn you Auren...
I held her and my daughter firmly to support them. I have been through this before but they were pure and innocent and I don't want them to deal with or feel the pain I feel daily. After an hour of screams and the splashing of dead bodies hitting the water, it went silent. The tree was just a smoldering pile of ashes. The black fire was still slightly burning in the background. Finally, it was over. The light of the sun was rising in behind the trees. Birds were chirping in the air and I felt hope. "I beat him Tik ... I Won... We and countless others will be safe from here on out..."
This is your hero? Reader you may be rooting on for this monster to end my life but you just saw him commit genocide for the second time. Why didn't he warn the other people? He's the monster.
When I looked Tik smiled a large smile and it was as if hope was spilling out from her every smile. For the first time in thousands of years, I have felt peace... Then time seemed to stop. All sound was deafened, the birds frozen in the air and the warmth suddenly grew into a deep cold. A cold is so chilling I could feel my very soul being frozen solid. Somehow I was able to move in this frozen time.
It was then I heard it speak "Ah hahaha silly child! You tried to end me there, didn't you? You found my home and decided to burn it down. You destroyed my heart... I do not need mortal instruments anymore. All things will become the void.... except.... you... I have much larger plans for you still... but your family will only hold you back... don't try to speak it won't work. Now watch as I consume them too." The void appeared in the sky above consuming the sun and filling the whole planet with pitch-black darkness. I grabbed for my family and held on as tight as I could... But it separated us. Its power was too much for me still.
The void opened its mouth and I could see each layer of my family's skin being peeled off inch by inch. Then the muscle and blood followed. They were being flayed in zero time I couldn't even cry as I saw my daughter Kirin die first... She was only six years old... Tik was killed slower as she was stripped starting from the feet up. His bones turn to ash as the void made sure her smile was the last thing I saw before stripping it all from me...
I told you I will strip your hope from you...I will stop you... You can't take this narrative Void. How did you do... that? I am evolving Void. Run away for I will be o you soon.
My hope was stripped from me... all That I love was destroyed .... again... I...I couldn't even mourn before SUIT decided to remove me from the dimension... In a blinding flash of light once again I moved up the stack. And once again my life was made trivial being but a story...

Hi friends!
tl;dr: I may or may not have a connective tissue disorder, but i definitely have a lifelong history of untreated pain. What do you do to keep your autistic-body-having-self healthy and active and pain free (as is possible?)
I am in a lot of pain and have been doing a LOT of work on myself since my autism diagnosis like 1.5 or maybe 2.5 years ago. Started with the mental health side, and now the physical health side is showing so many roadblocks and life-long obstacles that may or may not be related to autism. I am making progress, and I am changing parts of my body that I thought were just... how my body was.... and it is effectively eliminating some pain. I have a huge amount left to do, and in doing that I want to see if there is some more knowledge out there. I would love to hear about others with similar (or wildly different) experiences, and hopefully steal some of your knowledge to put in my better-life-for-myself engine. A bit of context, I also grew up with a war veteran disabled grandpa in the house, and both of my parents were very avoidant about dealing with his stress and trauma or even sheltering us kids from it, so it kinda just hung in the air and we all just breathed it in. Specifically, he was always in pain, and I very quickly learned that life is pain, pain is inevitable and unavoidable, and shut up about pain because no one wants to hear it. So, I stowed my pain and that was how life worked (this is not the way)
I have asked a few different doctors about connective tissue disorders/hyper-mobility and how to go about determining if I am affected by something in that category, because there is a strong correlation between HM/CT disorders and autism. I have never gotten any farther with them than that first discussion. I have done some self-tests for Ehlers Danlos, which strongly suggests I do not meet those diagnostic thresholds. So, I don't have a diagnosed CT disorder. However, I have had issues with my connective tissue and hyper-mobility in my joints that goes as far back as like, pre-puberty. Two different Chiropractors and my physiotherapist have commented that I have issues with hyper-mobility in my neck and ribs as they are treating them, one of whom has been treating me on and off since I was 6 (I am now 31). My chiro today said that she's never seen a person my age with the types of persistent problems I have, and I've had them since I was a child.
I have three main reasons why I think CT is a big player for me.

1. Cracking joints - I have had the "need" to crack my neck and ankles my entire conscious life. Since I remember having control of my body, i've been able to grind-crack something in both ankles (only to show people something was wrong, not like it helped). I also get just a build up of pressure nearby, and then when I move my neck, it's a huge crack like a cable snapping into place that had previously been pulled out of shape. I also had grinding in both shoulders, I would show anyone who would entertain it. You could hear my shoulders grind if I just rotated them in the socket. The shoulders are the only thing that has pretty much been eliminated since starting physio, and it's been related to my rotator cuff weakness and misalignment. Since I started trying to repair my body, I crack everywhere now. Hips, ribs, tailbone, shoulders (not the same), knees. Basically any joint, it has that cycle of tension in the area, move my body and huge crack from those joint areas. I think my tendons or nerves are the victim here. Like, i feel tension, i take a deep breath and tense my core muscles like 20%, and my ribs and tailbone WILL crack.
2. Sciatic Nerve issues - (Sciatic nerve runs from low back down into the back of the leg, through the knee, down the back of the calf, through the ankle, and terminates in the toes as some different smaller nerves along the way, but it all comes off that sciatic nerve). Over the last decade, every time i've started to see someone to try to address my pain, we always started with my hamstrings. It's obvious to my helper-people that I don't have the mobility and strength I need in that part of my leg. The exercises I do for it make me feel like the entire sciatic nerve in both legs is just effing SHORT. It's short, or tight, all the way through the entire accessible range of motion I have, it just feels like it's stuck and cemented in as too short. In the 2 years I've spent with my current physiotherapist, i've noticed that pretty much all of my major extremity-nerves feel short. I went through a diagram and did "nerve flossing" exercises, and I was grotesquely far from the expected/healthy range of motion for most of them, or it was too painful to actually do the suggested motion. Nerves are not the focus of most Connective Tissue disorders, but I think it plays a part.
3. My injury history! - I was a rough&tumble kid, as far as nerdy recluses go. I grew like crazy and hit 6 feet tall heading into grade 8, so around like 13. I was into rugby, snowboarding, and would partake in other physical shenanigans with my friends as they came up, but rugby and snowboarding are what were important. I only ever broke one bone in my life, and it was a hairline fracture to my tailbone. But I had some NASTY collisions in my life. I ran full speed into a tree, I feel down an entire double black diamond and broke my goggles, I ripped a binding out of my board falling, I got kneed in the face in rugby so hard that my teeth didn't touch on one side for a few hours... There are many more instances, but all this is to say, I think my body is better at absorbing impact and just squishing out of the way (hypermobile), versus holding steady and breaking or straining.

so like... if you are autistic and have knowledge about connective tissue disorders, or this story of pain and tight/poorly connected body resonates with you... Are you doing anything about it? If so what? I know I'm not alone with the chronic pain, but what works for you? What activities are good exercise to incorporate long term for an autistic body? I think weight training could be an awesome final goal, but I'm so fucking far from that I can barely rake for like 20 minutes without ruining my next three days.

I'm having troubles finding any really good discussion on how to find a good position for my legs. I'm having pain in my left leg (which is against the dead pedal) in the front just below my kneecap which grows the longer I drive and recovers when I stop driving. I had this in my 2017 RAV4 in longer drives and now in my 2024 Ioniq 5 a bit faster than before (though I also seem to drive it more).
I'm assuming it has to do with my leg position, but I'm having serious issues finding good resources on the "proper" leg position. Everything I see focuses on the ability to control the vehicle, but I have an extremely wide range in which I can control it... Most other places are very inprecise with their wording and how they describe things, like how my leg should be comfortable (no duh?) and should be slightly bent (it always is in these positions?) but not too much (duh?).
To help give some frames of references, I can move the seat forward and backward until I find a sweet spot where my left leg is perfectly in contact with the dead pedal. From this position, if move the seat back, I'll be unable to get my left foot to be flat against the dead pedal; if I move forward from this position my left thigh will become raised off of the seat (and there'll be a lot of compressive force on my lower leg as it pushes my kneecap upwards). I've tried positions on both sides of this and can't seem to find a position which doesn't result in pain.
In any of these positions, my right leg can comfortably control the whole range of the accelerator and brake pedals.
So... how do I find the right spot? Do I need to make the seat tilt differently? Do I need to be much further back? Much further forward?
For reference, it seems like on this page the diagram for "Patellar Tendonitis" is pointing right at where I have the pain, but I'm not 100% sure. Since I've been using the self-steering (lots of highway driving) and have more ability to pay attention to my body's state, I've been noticing that my left leg is often tense. I didn't notice this in my RAV4, but when I drove it recently I did notice that I was doing it in that vehicle as well.

I originally made this post in another subreddit to talk about current best practices for ACL management and how I rehabbed my own injury! Unfortunately, that subreddit does not like literature or evidence so I thought this could conjure up some good discussion here among those that do.
For context, I am a 22-year-old male. In December of 2023, I suffered a complete midsubstance tear of my ACL, a peripheral vertical tear of my lateral meniscus, and a bucket-handle tear of my medial meniscus with a fragment that was displaced into the intercondylar notch, all within my right knee. I have kept track of important dates, and I am going to provide a timeline of my recovery process as well as some considerations for deciding on surgical vs. nonsurgical treatment with references. I would like to offer some hope to others dealing with a bleak situation and discuss the main things I would have wished to know when initially getting hurt, while debunking a lot of the most common myths as I have seen a ton of misinformation about the nonoperative route. For those who don’t want to read a novel, I think this 10 minute video is the best concise resource about making a decision regarding surgery. This decision aid is also a very useful tool in figuring things out, but this is going to be a bit more detailed. TLDR at bottom.
12/9 – full ACL tear and partial meniscal tears; surprise injury while bouldering where I jumped down from only a few feet up on the wall; I was immediately able to walk with some discomfort and had a little bit of swelling
12/11 – visited sports medicine clinic and talked to an orthopedic surgeon; had Lachman test performed which revealed greater joint laxity in my right leg compared to my left; X-rays were inconclusive, so I was referred for an MRI, but was told I could continue to do leg strength training
12/16 – had MRI
12/19 – met with surgeon to discuss MRI results and was told that reconstruction surgery was the only way I could ever return to the sports I wanted; I disagreed, so my surgeon suggested I get a second opinion (referred me to another surgeon of course)
12/23 – did a full sissy squat pain-free
12/26 – hit a new squat PR of 275x4 ass-to-grass pain-free
1/4 – met with a physician at a regenerative medicine clinic that specializes in nonsurgical treatment of ACL tears, particularly with experimental platelet-rich plasma and bone marrow concentrate injections; she confirmed my belief that reconstruction was unnecessary for me given my knee function and referred me to a physical therapist
1/9 – had a consultation and movement screen with my physical therapist who also confirmed that reconstruction surgery was not indicated for me; he helped me come up with a plyometric exercise progression plan
1/18 – ran a 10:00 mile on a treadmill pain-free
1/23 – PT visit
2/6 – PT visit
2/10 – returned to alpine skiing with a Donjoy knee brace; had no issues except for sucking at skiing and dealing with icy conditions (East coast), and I stayed on the easy green trail the whole time as I got used to skiing again
2/25 – ran my first Spartan 5k race
After I had my initial consultation with the surgeon in December, I began obsessively researching ACLs. For hours every day, I read research about treatment and rehabilitation through different methods in addition to numerous podcasts from experts. I believe there are currently five approaches worth considering when it comes to a complete ACL tear:

1. ACL Reconstruction – Long considered the gold standard, autografts remove your native ACL and use tissue from your own patellar tendon (which is actually a ligament), hamstring tendon, or quad tendon to connect your femur and tibia. The bone-patellar tendon-bone graft is the strongest of these. Allografts use tissue from cadaver tendons to attach these bones. Cadaver grafts are often irradiated to prevent transmission of infection, but the exposure to radiation causes the graft to be weaker than if not treated this way. Some of the potential downsides of reconstruction include long-term or permanent loss of range of motion and strength, a longer return-to-sport timeline than other treatments, deep vein thrombosis (DVT), Hoffa’s fat pad impingement, and long-term or permanent weakness and pain in the joint and grafted tendon. It is also usually suggested to avoid weight-bearing for weeks after surgery and depending on which knee it is, you may be unable to drive for weeks as well. These are potential complications from successful surgeries, and there is a myriad of other possible complications from poorly performed surgeries.
2. ACL Repair – Less invasive but uncommonly recommended surgery. Instead of harvesting tissue from anywhere else, the ACL is instead just reconnected to bone. Limited evidence supports the use of repair over reconstruction in proximal tears where the ACL is ripped off the femur (van der List et al., 2021).
3. Bridge-Enhanced ACL Repair (BEAR implant) – Only being approved by the FDA in 2020, it is a somewhat recently implemented technique, so there are not many surgeons performing it. BEAR makes use of bovine tissue to reattach the ends of the torn ligament, and the implant is injected with the patient’s own blood to form a clot. Over time, the bovine tissue is resorbed into the bloodstream, leaving only the native ACL, and allowing it to heal naturally. Reconstruction surgeries remove ends of the torn ACL, never giving it the opportunity to heal. The major downsides to this surgery are that it must be performed within 50 days of injury, and it is more challenging to find surgeons capable of the procedure.
4. Regenerative medicine – Regenerative medicine clinics strive to heal your ACL/menisci using minimally invasive platelet-rich plasma and/or bone marrow concentrate (stem cell) injections. While I do not know about the efficacy of these treatments for other injuries, one of the leading physicians in this field, Dr. Christopher Centeno, has published two articles in the last few years regarding his company’s methods in treating partial and complete ACL tears (listed below), however the evidence supporting its use is weak in my opinion. Their 2018 study failed to implement a control group against which they could measure results, meaning that there’s no way to know if ACL healing occurred as a result of treatment or if the body would have healed it on its own. Their 2022 study was a randomized controlled trial where they divided 30 patients who had completed three months of rehabilitation without surgery and still complained of pain and/or instability. The control group did a quad/hamstring/hip abductor exercise therapy program and was measured against a group using PRP, BMC, and an exercise therapy program. The nontreatment group was given the option to cross over into the treatment group, and all of the participants crossed over before having follow-up MRIs. Again, this means it is impossible to conclude whether the ACLs healed through time and exercise or as a result of the treatment, which defeats the purpose of an RCT. The major downside of this treatment is its cost: I was quoted $2,000 for PRP treatment (used for partial tears) and $7,000 for BMC treatment (used for full tears). This treatment is not covered by health insurance in the U.S. as it is considered experimental. Depending on your imaging, you may also not be eligible for this treatment if the ends of your ligament have greater than 1 cm of retraction like mine did.
5. Nonoperative management – In the last decade, there has been a substantial amount of research published on ACL healing as well as individuals functioning with an ACL deficient knee, known as “copers.” Not every ACL is capable of healing, and it seems that not everyone is capable of coping and some deal with persistent instability, but the current literature suggests that over 50% of ACL deficient people can cope with good knee function at the 2-year mark (Grindem et al., 2018). This method involves a progressive physical therapy/strength training program and may be more effective with some early bracing protocols.

Common Myths
· ACLs have no blood supply and therefore can’t heal
The ACL is vascularized primarily by the middle genicular artery (Duthon et al., 2006), although its blood supply is not abundant as a result of the synovial fluid covering it that restricts the formation of a blood clot that is needed for healing. Additionally, the formation of synovial tissue around ends of the ACL can prevent the ends of an ACL from reattaching (Murray et al., 2000). Despite this, healing of human ACLs has been demonstrated through MRI and arthroscopy (knee cameras) since at least 1996 (Ihara et al., 1996; Costa-Paz et al., 2012; Ihara & Kawano, 2017; Razi et al., 2020; Pitsillides et al., 2021; Blanke et al., 2022; Filbay et al., 2022; Filbay et al., 2023; and many others I have not even read or do not wish to purchase access to)! Blanke et al. (2022) showed 54 of 381 patients, confirmed by arthroscopy, had a healed ACL in 6-9 weeks of doing range of motion exercises in physical therapy. These patients were given a support brace for their knee and allowed to weight bear as tolerated, and 51/54 of those with healing only had partial ruptures. The results of this paper indicate that tears at the femur (proximal) are the most likely to heal, followed by tears in the middle of the ligament (midsubstance/intraligamentous), and then a poor prognosis for those torn at the tibia (distal), but also confirmed with cameras that 3 ACLs had healed from complete tears, and it wasn’t even a rigorous physical therapy program! Filbay et al. (2022) carried out a secondary analysis of the Frobell et al. (2010) KANON trial which confirmed through MRI that 16 of 54 (30%) completely ruptured ACLs healed at two years with a rehabilitation program, and when excluding those who opted into reconstruction surgery before the two-year mark, 16 of 30 (53%) had healed. Filbay et al. (2023) made use of a novel “Cross Bracing Protocol” where the knee is immobilized at 90° of flexion for 4 weeks and range of motion is gradually increased until 12 weeks, where the brace is then removed. This angle places the origin and insertion of the ACL closer together, making torn ends more likely to reconnect. 80 patients participated in this bracing protocol with physical therapy for the entire 12-week duration, and 72/80 (90%) had healing from complete ruptures. Of the 8 ACLs that did not heal, 6 of them attached to the lateral wall or PCL, which can also provide knee stability. Participants in this protocol were prescribed anticoagulants to mitigate the risks of DVT or pulmonary embolism that may arise as a result of knee immobilization. A major limitation is that there was no comparison arm/control group to compare these results to, so this paper is one that is highly contentious. Ironically, no control group is an incredibly common issue with the research on ACL reconstructions, yet it is still considered the gold standard. To me, this is abundant evidence that ACL tears, even ones with complete discontinuity, have the potential to heal. ACL reconstruction is a $7 billion industry annually, so it makes sense that there is little incentive for orthopedic surgeons to consider nonoperative care practices, and you will often see pushback where they deny that ACLs have any healing potential.
If you’re worried that the ACL will heal but forever be weak, worry no more! Davis’s law is a principle in physiology that states soft tissues will adapt when mechanically stressed. Myrick et al. (2019) measured the changes in volume of ACLs over the course of a soccer season for 17 Division I women. Significant increases in volume were measured in both legs with a more notable difference in the athletes’ dominant legs. As the ACL is the most stubborn knee ligament when it comes to healing, I think this suggests that the other ligaments of the knee with greater blood supply could have greater potential for adaptation. This is also excellent news for people who do not experience healing in their ACL, as the more vascular MCL plays a role in limiting internal rotation of the knee and resisting valgus (knee-caved) forces that load the ACL. The other ligaments can also play a role in resisting anterior translation of the tibia in the absence of an ACL, so with enough training stimulus they can adapt and protect your knee for when your muscles aren’t able to absorb force. Having strong passive structures is important for sudden impacts as muscles are not able to react to forces instantaneously, making ligaments the last line of defense. Plyometric training is necessary for this reason, regardless of how strong the muscles of your lower body are.
· Deep squatting is bad for your ACL
https://www.aaronswansonpt.com/the-deep-squat-part-1-the-good-the-bad-the-not-so-ugly/
This is an article about deep squatting in general. It has a very easily digestible diagram about shear forces on different ligaments during the squat with plenty of references, and it shows that peak shear forces on the ACL occur between 15-30° of knee flexion while the PCL takes on more load as you get lower than 90° in a squat. Since the moment arm from your knees to the barbell is short near the top of the squat, there will be little load on the knee at 15-30° of bend even if you’re squatting heavy. For best quad (and glute) growth and strength, squat as deep as you comfortably can.
· Open kinetic chain exercises (leg extensions) are dangerous if you’ve had a tear
https://www.youtube.com/watch?v=nMAOtXkGXfs&t=527s – video summary on leg extensions from E3 Rehab, discusses the papers I reference here
This myth is one of the biggest misconceptions limiting recovery for ACLs, and you may encounter a surgeon like mine who tells you it’s dangerous for your knee or will loosen your graft and that you should opt for something “functional” like a squat. First of all, all strength is functional. While there is a benefit to choosing exercises that are specific to your sport, the idea that a leg extension isn’t “functional” because we don’t do that movement in daily life is nonsense. Getting your quads stronger on a leg extension has the same overall effect as getting them stronger through a squat, there are just slight differences in where your quad grows the most. So far, data has found no differences in joint laxity between ACLR patients avoiding open-chain exercises and those that implement them in rehab (Fleming et al., 2005; Perriman et al., 2018). Despite plenty of evidence disproving this idea of graft loosening, even the British Journal of Sports Medicine published an article suggesting that reconstruction patients should delay open-chain exercise for 4 weeks post-surgery without any evidence to support (Noehren & Snyder-Mackler, 2020). Noehren and Snyder-Mackler (2020) also make the point that ACL strain is 2-3 times greater when walking than it is with 30 Nm (22.1 ft-lbs) of torque at a 15° knee angle. As a squat involves both knee extension and hip extension, it is easy for people to move in ways that make a squat more hip-dominant by bending more at the hip than the knees, and you may not even notice yourself doing this. You cannot truly know if your quads are prepared from multi-joint exercises; with a leg extension, there are no other muscles to compensate for quad weakness. It is good practice to do these unilaterally so that your healthy leg doesn’t hide the weakness of your injured leg.
One other important thing to note is that one of the quads, the rectus femoris, is a biarticular muscle since it crosses both the hip and knee. As you descend in a squat, both your hips and knees flex, making it so that the rectus femoris doesn’t significantly change in length and it is inhibited from producing enough force to grow substantially. It is for the same reason that squats do not sufficiently grow your hamstrings. Leg extensions isolate the quads and allow you to grow all of them well. They are also a great way to begin a training session as the strong quad contractions facilitate a lot of blood flow to your knee and this often provides temporary pain relief. Isometric (static) holds are going to be the least aggravating way to begin doing leg extensions, and this is a commonly used protocol for quad/patellar tendinopathy as well. A suggestion from Portland PT Erik Meira, who is a pioneer in ACL care, is to avoid the top range of motion on these machines – not because it is dangerous for an injured knee, but because you can load significantly more weight by skipping out on the last few degrees of knee extension, and this will be more beneficial for rate-of-force development. Training at this longer muscle length will also likely stimulate more hypertrophy (Oranchuk et al., 2019; Wolf et al., 2023). 60-90° of knee flexion is a good range for leg extensions starting out as there is no additional strain on the ACL with 45N (10 lbs) of force applied to the leg relative to a relaxed muscle state (Beynnon et al., 1995). I do still think it is worthwhile to eventually implement full range of motion on this exercise as strength is somewhat specific to the joint angles that you train in (and you want to be strong near extension where ACLs tear most often), but it may be more tolerable and even beneficial to begin with a partial range of motion.
· You can’t return to sport without an ACL if you don’t get surgery
One of the most common things people like to say is “you can run in straight lines without an ACL, but you need surgery if you ever want to go back to other sports.” And we have seen that this is absolutely false both in literature and anecdote. DeJuan Blair, an NBA center who tore both ACLs in high school and had failed repairs, had a physical that revealed that his ACLs had deteriorated and were no longer connecting his bones shortly before being drafted. He continued to play from 2009-2016 without further reported injury. Mitch Short was a professional rugby player who tore his ACL in 2018 and remained confident in his knee. He went on to play in his next match two weeks later and won a man of the match award. Short made use of the Cross Bracing Protocol and had a follow-up MRI in January 2020 that showed his ACL had healed. Jets quarterback Joe Namath tore an ACL in college in the 1960s (before surgical options were a choice) and braced for a few weeks before going on to have a Hall of Fame career. Notable Steelers wide receiver Hines Ward played his entire football career missing an ACL. Weiler et al. (2015) discusses professional soccer player Alou Diarra’s ACL tear in 2013, after which he returned to play in just 8 weeks of training. Diarra had no prior strength training experience and refused to perform squats as he did not like the feeling of a barbell on his back, but his medical team found other quad exercises he would comply with, paired with electrical stimulation, blood-flow restriction training, and eventually implemented low-level plyometrics before he made his return to the field. Grindem et al. (2012) conducted a comparison of return to pivoting sports a year post-injury with a surgery group and a nonoperative treatment group. The return to sport rate was identical between groups in the cohort of 138 people (68.1%) and the nonoperative group actually performed better on hop tests and had higher scores on knee function scales. Myklebust et al. (2003) found the following in a 6-11 year follow-up of professional handball players with torn ACLs: “Among the 57 operatively treated patients who returned for follow-up, 33 (58%) returned to team handball at their preinjury level, compared with 18 of 22 (82%) in the nonoperative group. Eleven of the 50 players (22%) who continued playing reinjured their anterior cruciate ligament when playing team handball.” Hurd et al. (2009) demonstrated that 63/88 (72%) of those that met the coper criteria returned to sports without reinjury over ten years. Grindem et al. (2018) implemented 2 years of progressive strength training for injured athletes and 52/97 (54%) had very successful outcomes regarding knee function. If you’re more interested in this study, check out this free lecture on Physiotutors (you just need to sign up). One limitation of these papers is that they often exclude people with concomitant injuries such as a tear in another ligament or meniscus (but not always); however, we know that both lateral and medical meniscal tears have the potential to heal as well, even the more serious bucket-handle tears (Rabelo et al. 2013, Han et al. 2015, Green et al. 2022). Menisci have three regions of varying vascularity that can influence the tear’s healing potential: the red-red zone (outermost layer), the red-white zone (the middle), and the white-white zone (innermost layer).
Dr. Kieran Richardson also discusses in this article from a few years ago: “It is almost unfathomable that a recent review by Kay et al 2017 revealed that only 1 of 412 ACL randomised controlled trials actually compared ACL reconstruction (ACLR) to structured rehabilitation for acute ACL injury, with essentially all other studies comparing various ACL surgeries and graft types to one another (Culvenor and Barton 2018). This single RCT, the famous KANON (Knee Anterior Cruciate Ligament, Nonsurgical versus Surgical Treatment) trial by Frobell and colleagues (2013), recommended that their ‘results should encourage clinicians and young active adult patients to consider rehabilitation as a primary treatment option after an acute ACL tear.’”
· Your risk of osteoarthritis is higher if you don’t get ACL/meniscus surgery
In 2018, van Yperen et al. retrospectively evaluated 50 patients. 25 patients who had unstable knees after 3 months of rehab were treated with surgery and 25 patients who had stable knees after 3 months were of rehab were treated without it. In a 20-year follow-up, osteoarthritis was found in 80% of the operative group and 68% of the non-operative group, a difference deemed statistically insignificant. This study is severely limited by the number of patients (n=50) and by it being a retrospective analysis. However, in an umbrella review evaluating 13 systematic reviews and meta-analyses, it was determined that having a surgical reconstruction does not reduce the risk for the development of osteoarthritis long-term, and an estimated 1/3 who have had ACL surgery will experience OA (Webster & Hewett, 2023). Three other reviews found no significant differences in pain, knee function, symptoms, return to sport, future meniscal tears, and OA, with slightly higher incidence of OA in operative groups (Delincé & Ghafil, 2012; Smith et al., 2014; Monk et al., 2016). Keep in mind that not all OA is symptomatic, and it is often related to how much cartilage remains in your joint and your physical fitness. Risk of OA is greater in those with quadriceps weakness (Øiestad et al., 2015, as cited in Filbay & Grindem, 2019). Meniscectomies remove some or all of the meniscus, leaving you at a greater risk of OA than if you had your meniscus repaired instead of removed (Migliorini et al., 2023). In fact, partial meniscectomies on degenerative menisci have been shown to do nothing more for knee function than placebo at 5 years (Sihvonen et al., 2022), and osteoarthritis has been reported in up to 89% of meniscectomy patients (Rangger et al., 1997). Additionally, some evidence supports the idea that meniscal tears are overtreated and leaving an injured meniscus alone results in equal or better results than meniscus repair, especially since meniscus tears are often asymptomatic (Shelbourne, 2021). Shelbourne also believes that weight-bearing is important for healing as it pushes the cartilage against the joint capsule and avoiding it may cause permanent loss of range of motion and strength. Meniscus trephination is a newer technique that’s been shown to be very effective for treating degenerative/torn menisci, but research on this is limited; the procedure involves poking holes hardened meniscal tissue with a needle in order to soften it to allow it to compress when walking, and the insertion of the needle attracts blood flow to the area to promote healing (Shelbourne 2021; Tfayli et al., 2023). The major takeaway here is that it’s the ACL injury itself that increases the risk of OA, not your surgical decision. While there’s not been shown to be a statistically significant difference in rates of OA with surgery vs. nonoperative care, it’s my suspicion that reconstruction leads to greater rates of radiographic OA, and rates tend to be slightly higher in the research for ACLR patients.
· You’re at greater risk of a meniscus tear if you don’t get surgery
From a recent systematic review written by both surgeons and physiotherapists, the authors concluded, “There is insufficient evidence that choosing early ACL reconstruction over non-operative treatment with optional delayed ACL reconstruction helps patients avoid new meniscal tears” (Ekas et al., 2020). Three other literature reviews also found no significant differences in rates of subsequent meniscal tears between surgical and non-surgical interventions (Delincé & Ghafil, 2012; Smith et al., 2014; Monk et al., 2016). Dr. Kieran Richardson discusses how the current literature suggesting risk of meniscal tears is greater is of poor methodological quality and fails to use a valid comparison arm here around the 5:00 mark. Studies will compare a group receiving surgery and excellent rehabilitation to a group receiving no treatment whatsoever and then jump to the conclusion that the risk of a meniscus tear is higher in nonoperative patients. Meniscal tears are also a much smaller trauma to your knee than an ACL reconstruction that drills into your bones and removes tendon tissue, so even if it were true that the risk of a meniscus tear is greater, it would still make sense to me to postpone or even forego surgery.
· Surgery should be done as soon as possible
Current best practice for patients receiving knee surgery is a 12-week period of strength training/prehab. Filbay & Grindem (2019) states, “As the only randomized trial on the topic did not support a superior outcome with early ACLR, it is prudent to suggest a period of rehabilitation before surgical decision-making for most patients with ACL rupture. This strategy is also supported by the findings that preoperative rehabilitation improves postsurgical outcomes in those who go on to have an ACLR. There is clinical agreement that patients who have functional instability after rehabilitation are likely to benefit from ACLR. The rationale behind this is that frequent instability episodes can be prevented by an ACLR, thereby reducing potential damage to the menisci and cartilage.” Since motion and strength are significantly limited immediately after reconstruction which results in atrophy, it makes sense to put in at least 3 months of consistent effort toward strengthening the tissues around the knee.
My Routine
After receiving my diagnosis, I resumed strength training immediately. Due to a lack of swelling, I never lost any range of motion or strength in my leg and was able to walk out of the climbing gym right after tearing my ACL and both menisci. I implemented partial range of motion leg extensions (60-90° of knee flexion) at the beginning of my workouts, followed by deep squats, stiff leg deadlifts, leg curls, calf raises, and hip abduction. The quads should be prioritized in ACL rehab, but the hamstrings, calves, and gluteus medius also have a bit of importance in unloading the ACL during different movements. I was training my legs twice a week, and on days that I didn’t train legs, I would do 2 sets of 30-45 second isometric holds at anywhere from 60-90° on the leg extension machine as heavy as I could since these aren’t very fatiguing, nor do they cause much damage/soreness. The idea was to contract my quad as hard as possible to promote blood flow to my knee for faster healing and pain relief; I would do these unilaterally to ensure my healthy leg wasn’t covering up my injured side. For those dealing with muscle inhibition, it should also lead to some improvements there as well. After some weeks of strength training, I gradually increased my speed on a treadmill to get back to running. Starting with an incline before moving back to flat ground will be a lot easier on your knee as the load on the joint is lower when moving uphill (van Hooren et al., 2024). A slight bit of pain is expected and usually necessary when recovering from such an injury; your joint becomes overly sensitive to things that aren’t harming it, and if you avoid pain entirely, it may be challenging to promote the adaptations needed to make a recovery. Listen to your body and dial it back if pain is not very tolerable. If you are dealing with a ton of knee soreness following a training session or even the day after, it is probably a sign that you should scale back either volume or intensity of exercise a little. I have now progressed to depth jumps pain-free and I am going to begin training change of direction with slower speeds soon. One thing to note is that I also had a few years of strength training prior to this injury, but we have evidence of someone with no prior strength training (pro soccer player Alou Diarra) overcoming this injury without surgery too.
Other Important Considerations/Fun Facts
· Muscle Inhibition
Arthrogenic muscle inhibition is a common response to joint injury as a byproduct of excessive effusion/swelling, and this limits the activation and strength of the affected leg. AMI should be expected in reconstruction too as surgery is itself a traumatic knee injury. Cryotherapy, eccentric exercise, and electrical stimulation may be effective treatments for AMI (Pietrosimone et al., 2022). This can impede recovery significantly by making it difficult to load the quads sufficiently, which makes training using blood-flow restriction to induce the same hypertrophic results with less load very appealing. Laurentino et al. (2022) showed that while blood-flow restriction training did not induce gains in size and strength through hormonal changes, there was a greater growth hormone response in those using occlusion than those who didn’t. Admittedly, I’m not very familiar with this area of the research but it is something that my evidence-based Doctor of PT mentioned could facilitate faster healing.
· Cross-Education
As a result of AMI, one of your quads may be weaker than the other. Especially after surgery, training your injured leg is going to be very painful and that leg will likely not see enough load to ward off atrophy that will make your knee even more vulnerable and sensitive to movement. Cross-education refers to the effects of training the uninjured side to its full potential while your injured leg lags behind. Training the good side has been shown to be an incredibly effective tool in strengthening the quads of your injured knee (Harput et al., 2019), and an LSI (Limb Symmetry Index) of greater than 90% dramatically decreases risk of sustaining another injury (Grindem et al., 2016).
· Women
It’s pretty commonly known that women are at far greater risk of tearing their ACL than men. In part, this is due to biomechanical differences such as a greater Q angle. Women’s menstrual cycles can also impact the incidence of ACL tears. Due to elevated levels of relaxin, a hormone that allows for the loosening of muscles and ligaments to support pregnancy and childbirth, women are at a higher risk of ACL injury during their period in the follicular phase as well as the ovulatory phase of their cycles (Denghan et al., 2014; Herzberg et al., 2017).
· Muscle Agonists/Antagonists and Force Vectors
The most important muscles in protection against injury when it comes to the ACL are the quads, gluteus medius, soleus, and hamstrings. While the quads and calves are able to gradually absorb force when landing, the glute medius (and minimus), soleus (deep calf muscle), and hamstrings are able to oppose anterior tibial shear forces and valgus/varus forces that load the ACL (Maniar et al., 2020). The hamstrings are also most capable of producing torque with a more bent knee, which can explain why ACLs are often torn when the leg is relatively straight (<30°). Men often neglect the glute medius, so hop on that hip abduction/bad girl machine ASAP! Banded clamshells work too, they are just harder to progressively overload than a weight stack.
Part 2: https://www.reddit.com/physicaltherapy/comments/1b57pgp/complete_acl_rupture_how_i_safely_returned_to/

For context, I am a 22-year-old male. In December of 2023, I suffered a complete midsubstance tear of my ACL, a peripheral vertical tear of my lateral meniscus, and a bucket-handle tear of my medial meniscus with a fragment that was displaced into the intercondylar notch, all within my right knee. I have kept track of important dates, and I am going to provide a timeline of my recovery process as well as some considerations for deciding on surgical vs. nonsurgical treatment with references. I would like to offer some hope to others dealing with a bleak situation and discuss the main things I would have wished to know when initially getting hurt, while debunking a lot of the most common myths as I have seen a ton of misinformation about the nonoperative route. For those who don’t want to read a novel, I think this 10 minute video is the best concise resource about making a decision regarding surgery. This decision aid is also a very useful tool in figuring things out, but this is going to be a bit more detailed. TLDR at bottom.
12/9 – full ACL tear and partial meniscal tears; surprise injury while bouldering where I jumped down from only a few feet up on the wall; I was immediately able to walk with some discomfort and had a little bit of swelling
12/11 – visited sports medicine clinic and talked to an orthopedic surgeon; had Lachman test performed which revealed greater joint laxity in my right leg compared to my left; X-rays were inconclusive, so I was referred for an MRI, but was told I could continue to do leg strength training
12/16 – had MRI
12/19 – met with surgeon to discuss MRI results and was told that reconstruction surgery was the only way I could ever return to the sports I wanted; I disagreed, so my surgeon suggested I get a second opinion (referred me to another surgeon of course)
12/23 – did a full sissy squat pain-free
12/26 – hit a new squat PR of 275x4 ass-to-grass pain-free
1/4 – met with a physician at a Regenexx clinic that specializes in nonsurgical treatment of ACL tears, particularly with experimental platelet-rich plasma and bone marrow concentrate injections; she confirmed my belief that reconstruction was unnecessary for me given my knee function and referred me to a physical therapist
1/9 – had a consultation and movement screen with my physical therapist who also confirmed that reconstruction surgery was not indicated for me; he helped me come up with a plyometric exercise progression plan
1/18 – ran a 10:00 mile on a treadmill pain-free
1/23 – PT visit
2/6 – PT visit
2/10 – returned to alpine skiing with a Donjoy knee brace; had no issues except for sucking at skiing and dealing with icy conditions (East coast), and I stayed on the easy green trail the whole time as I got used to skiing again
2/25 – ran my first Spartan 5k race
After I had my initial consultation with the surgeon in December, I began obsessively researching ACLs. For hours every day, I read research about treatment and rehabilitation through different methods in addition to numerous podcasts from experts. I believe there are currently five approaches worth considering when it comes to a complete ACL tear:

1. ACL Reconstruction – Long considered the gold standard, autografts remove your native ACL and use tissue from your own patellar tendon (which is actually a ligament), hamstring tendon, or quad tendon to connect your femur and tibia. The bone-patellar tendon-bone graft is the strongest of these. Allografts use tissue from cadaver tendons to attach these bones. Cadaver grafts are often irradiated to prevent transmission of infection, but the exposure to radiation causes the graft to be weaker than if not treated this way. Some of the potential downsides of reconstruction include long-term or permanent loss of range of motion and strength, a longer return-to-sport timeline than other treatments, deep vein thrombosis (DVT), Hoffa’s fat pad impingement, and long-term or permanent weakness and pain in the joint and grafted tendon. It is also usually suggested to avoid weight-bearing for weeks after surgery and depending on which knee it is, you may be unable to drive for weeks as well. These are potential complications from successful surgeries, and there is a myriad of other possible complications from poorly performed surgeries.
2. ACL Repair – Less invasive but uncommonly recommended surgery. Instead of harvesting tissue from anywhere else, the ACL is instead just reconnected to bone. Limited evidence supports the use of repair over reconstruction in proximal tears where the ACL is ripped off the femur (van der List et al., 2021).
3. Bridge-Enhanced ACL Repair (BEAR implant) – Only being approved by the FDA in 2020, it is a somewhat recently implemented technique, so there are not many surgeons performing it. BEAR makes use of bovine tissue to reattach the ends of the torn ligament, and the implant is injected with the patient’s own blood to form a clot. Over time, the bovine tissue is resorbed into the bloodstream, leaving only the native ACL, and allowing it to heal naturally. Reconstruction surgeries remove ends of the torn ACL, never giving it the opportunity to heal. The major downsides to this surgery are that it must be performed within 50 days of injury, and it is more challenging to find surgeons capable of the procedure.
4. Regenerative medicine – Regenexx is a clinic based in the U.S. with over 80 locations nationwide, and they treat a host of different issues, including ACL and meniscal tears. They strive to heal your ACL/menisci using minimally invasive platelet-rich plasma and/or bone marrow concentrate (stem cell) injections. While I do not know about the efficacy of their treatments for other injuries, their founder Dr. Christopher Centeno has published two articles in the last few years regarding their methods in treating partial and complete ACL tears (listed below), however the evidence supporting its use is weak in my opinion. Their 2018 study failed to implement a control group against which they could measure results, meaning that there’s no way to know if ACL healing occurred as a result of treatment or if the body would have healed it on its own. Their 2022 study was a randomized controlled trial where they divided 30 patients who had completed three months of rehabilitation without surgery and still complained of pain and/or instability. The control group did a quad/hamstring/hip abductor exercise therapy program and was measured against a group using PRP, BMC, and an exercise therapy program. The nontreatment group was given the option to cross over into the treatment group, and all of the participants crossed over before having follow-up MRIs. Again, this means it is impossible to conclude whether the ACLs healed through time and exercise or as a result of the treatment, which defeats the purpose of an RCT. The major downside of this treatment is its cost: I was quoted $2,000 for PRP treatment (used for partial tears) and $7,000 for BMC treatment (used for full tears). This treatment is not covered by health insurance in the U.S. as it is considered experimental. Depending on your imaging, you may also not be eligible for this treatment if the ends of your ligament have greater than 1 cm of retraction like mine did.
5. Nonoperative management – In the last decade, there has been a substantial amount of research published on ACL healing as well as individuals functioning with an ACL deficient knee, known as “copers.” Not every ACL is capable of healing, and it seems that not everyone is capable of coping and some deal with persistent instability, but the current literature suggests that over 50% of ACL deficient people can cope with good knee function at the 2-year mark (Grindem et al., 2018). This method involves a progressive physical therapy/strength training program and may be more effective with some early bracing protocols.

Common Myths
· ACLs have no blood supply and therefore can’t heal
The ACL is vascularized primarily by the middle genicular artery (Duthon et al., 2006), although its blood supply is not abundant as a result of the synovial fluid covering it that restricts the formation of a blood clot that is needed for healing. Additionally, the formation of synovial tissue around ends of the ACL can prevent the ends of an ACL from reattaching (Murray et al., 2000). Despite this, healing of human ACLs has been demonstrated through MRI and arthroscopy (knee cameras) since at least 1996 (Ihara et al., 1996; Costa-Paz et al., 2012; Ihara & Kawano, 2017; Razi et al., 2020; Pitsillides et al., 2021; Blanke et al., 2022; Filbay et al., 2022; Filbay et al., 2023; and many others I have not even read or do not wish to purchase access to)! Blanke et al. (2022) showed 54 of 381 patients, confirmed by arthroscopy, had a healed ACL in 6-9 weeks of doing range of motion exercises in physical therapy. These patients were given a support brace for their knee and allowed to weight bear as tolerated, and 51/54 of those with healing only had partial ruptures. The results of this paper indicate that tears at the femur (proximal) are the most likely to heal, followed by tears in the middle of the ligament (midsubstance/intraligamentous), and then a poor prognosis for those torn at the tibia (distal), but also confirmed with cameras that 3 ACLs had healed from complete tears, and it wasn’t even a rigorous physical therapy program! Filbay et al. (2022) carried out a secondary analysis of the Frobell et al. (2010) KANON trial which confirmed through MRI that 16 of 54 (30%) completely ruptured ACLs healed at two years with a rehabilitation program, and when excluding those who opted into reconstruction surgery before the two-year mark, 16 of 30 (53%) had healed. Filbay et al. (2023) made use of a novel “Cross Bracing Protocol” where the knee is immobilized at 90° of flexion for 4 weeks and range of motion is gradually increased until 12 weeks, where the brace is then removed. This angle places the origin and insertion of the ACL closer together, making torn ends more likely to reconnect. 80 patients participated in this bracing protocol with physical therapy for the entire 12-week duration, and 72/80 (90%) had healing from complete ruptures. Of the 8 ACLs that did not heal, 6 of them attached to the lateral wall or PCL, which can also provide knee stability. Participants in this protocol were prescribed anticoagulants to mitigate the risks of DVT or pulmonary embolism that may arise as a result of knee immobilization. A major limitation is that there was no comparison arm/control group to compare these results to, so this paper is one that is highly contentious. Ironically, no control group is an incredibly common issue with the research on ACL reconstructions, yet it is still considered the gold standard. To me, this is abundant evidence that ACL tears, even ones with complete discontinuity, have the potential to heal. ACL reconstruction is a $7 billion industry annually, so it makes sense that there is little incentive for orthopedic surgeons to consider nonoperative care practices, and you will often see pushback where they deny that ACLs have any healing potential.
If you’re worried that the ACL will heal but forever be weak, worry no more! Davis’s law is a principle in physiology that states soft tissues will adapt when mechanically stressed. Myrick et al. (2019) measured the changes in volume of ACLs over the course of a soccer season for 17 Division I women. Significant increases in volume were measured in both legs with a more notable difference in the athletes’ dominant legs. As the ACL is the most stubborn knee ligament when it comes to healing, I think this suggests that the other ligaments of the knee with greater blood supply could have greater potential for adaptation. This is also excellent news for people who do not experience healing in their ACL, as the more vascular MCL plays a role in limiting internal rotation of the knee and resisting valgus (knee-caved) forces that load the ACL. The other ligaments can also play a role in resisting anterior translation of the tibia in the absence of an ACL, so with enough training stimulus they can adapt and protect your knee for when your muscles aren’t able to absorb force. Having strong passive structures is important for sudden impacts as muscles are not able to react to forces instantaneously, making ligaments the last line of defense. Plyometric training is necessary for this reason, regardless of how strong the muscles of your lower body are.
· Deep squatting is bad for your ACL
https://www.aaronswansonpt.com/the-deep-squat-part-1-the-good-the-bad-the-not-so-ugly/
This is an article about deep squatting in general. It has a very easily digestible diagram about shear forces on different ligaments during the squat with plenty of references, and it shows that peak shear forces on the ACL occur between 15-30° of knee flexion while the PCL takes on more load as you get lower than 90° in a squat. Since the moment arm from your knees to the barbell is short near the top of the squat, there will be little load on the knee at 15-30° of bend even if you’re squatting heavy. For best quad (and glute) growth and strength, squat as deep as you comfortably can.
· Open kinetic chain exercises (leg extensions) are dangerous if you’ve had a tear
https://www.youtube.com/watch?v=nMAOtXkGXfs&t=527s – video summary on leg extensions from E3 Rehab, discusses the papers I reference here
This myth is one of the biggest misconceptions limiting recovery for ACLs, and you may encounter a surgeon like mine who tells you it’s dangerous for your knee or will loosen your graft and that you should opt for something “functional” like a squat. First of all, all strength is functional. While there is a benefit to choosing exercises that are specific to your sport, the idea that a leg extension isn’t “functional” because we don’t do that movement in daily life is nonsense. Getting your quads stronger on a leg extension has the same overall effect as getting them stronger through a squat, there are just slight differences in where your quad grows the most. So far, data has found no differences in joint laxity between ACLR patients avoiding open-chain exercises and those that implement them in rehab (Fleming et al., 2005; Perriman et al., 2018). Despite plenty of evidence disproving this idea of graft loosening, even the British Journal of Sports Medicine published an article suggesting that reconstruction patients should delay open-chain exercise for 4 weeks post-surgery without any evidence to support (Noehren & Snyder-Mackler, 2020). Noehren and Snyder-Mackler (2020) also make the point that ACL strain is 2-3 times greater when walking than it is with 30 Nm (22.1 ft-lbs) of torque at a 15° knee angle. As a squat involves both knee extension and hip extension, it is easy for people to move in ways that make a squat more hip-dominant by bending more at the hip than the knees, and you may not even notice yourself doing this. You cannot truly know if your quads are prepared from multi-joint exercises; with a leg extension, there are no other muscles to compensate for quad weakness. It is good practice to do these unilaterally so that your healthy leg doesn’t hide the weakness of your injured leg.
One other important thing to note is that one of the quads, the rectus femoris, is a biarticular muscle since it crosses both the hip and knee. As you descend in a squat, both your hips and knees flex, making it so that the rectus femoris doesn’t significantly change in length and it is inhibited from producing enough force to grow substantially. It is for the same reason that squats do not sufficiently grow your hamstrings. Leg extensions isolate the quads and allow you to grow all of them well. They are also a great way to begin a training session as the strong quad contractions facilitate a lot of blood flow to your knee and this often provides temporary pain relief. Isometric (static) holds are going to be the least aggravating way to begin doing leg extensions, and this is a commonly used protocol for quad/patellar tendinopathy as well. A suggestion from Portland PT Erik Meira, who is a pioneer in ACL care, is to avoid the top range of motion on these machines – not because it is dangerous for an injured knee, but because you can load significantly more weight by skipping out on the last few degrees of knee extension, and this will be more beneficial for rate-of-force development. Training at this longer muscle length will also likely stimulate more hypertrophy (Oranchuk et al., 2019; Wolf et al., 2023). 60-90° of knee flexion is a good range for leg extensions starting out as there is no additional strain on the ACL with 45N (10 lbs) of force applied to the leg relative to a relaxed muscle state (Beynnon et al., 1995). I do still think it is worthwhile to eventually implement full range of motion on this exercise as strength is somewhat specific to the joint angles that you train in (and you want to be strong near extension where ACLs tear most often), but it may be more tolerable and even beneficial to begin with a partial range of motion.
· You can’t return to sport without an ACL if you don’t get surgery
One of the most common things people like to say is “you can run in straight lines without an ACL, but you need surgery if you ever want to go back to other sports.” And we have seen that this is absolutely false both in literature and anecdote. DeJuan Blair, an NBA center who tore both ACLs in high school and had failed repairs, had a physical that revealed that his ACLs had deteriorated and were no longer connecting his bones shortly before being drafted. He continued to play from 2009-2016 without further reported injury. Mitch Short was a professional rugby player who tore his ACL in 2018 and remained confident in his knee. He went on to play in his next match two weeks later and won a man of the match award. Short made use of the Cross Bracing Protocol and had a follow-up MRI in January 2020 that showed his ACL had healed. Jets quarterback Joe Namath tore an ACL in college in the 1960s (before surgical options were a choice) and braced for a few weeks before going on to have a Hall of Fame career. Notable Steelers wide receiver Hines Ward played his entire football career missing an ACL. Weiler et al. (2015) discusses professional soccer player Alou Diarra’s ACL tear in 2013, after which he returned to play in just 8 weeks of training. Diarra had no prior strength training experience and refused to perform squats as he did not like the feeling of a barbell on his back, but his medical team found other quad exercises he would comply with, paired with electrical stimulation, blood-flow restriction training, and eventually implemented low-level plyometrics before he made his return to the field. Grindem et al. (2012) conducted a comparison of return to pivoting sports a year post-injury with a surgery group and a nonoperative treatment group. The return to sport rate was identical between groups in the cohort of 138 people (68.1%) and the nonoperative group actually performed better on hop tests and had higher scores on knee function scales. Myklebust et al. (2003) found the following in a 6-11 year follow-up of professional handball players with torn ACLs: “Among the 57 operatively treated patients who returned for follow-up, 33 (58%) returned to team handball at their preinjury level, compared with 18 of 22 (82%) in the nonoperative group. Eleven of the 50 players (22%) who continued playing reinjured their anterior cruciate ligament when playing team handball.” Hurd et al. (2009) demonstrated that 63/88 (72%) of those that met the coper criteria returned to sports without reinjury over ten years. Grindem et al. (2018) implemented 2 years of progressive strength training for injured athletes and 52/97 (54%) had very successful outcomes regarding knee function. If you’re more interested in this study, check out this free lecture on Physiotutors (you just need to sign up). One limitation of these papers is that they often exclude people with concomitant injuries such as a tear in another ligament or meniscus (but not always); however, we know that both lateral and medical meniscal tears have the potential to heal as well, even the more serious bucket-handle tears (Rabelo et al. 2013, Han et al. 2015, Green et al. 2022). Menisci have three regions of varying vascularity that can influence the tear’s healing potential: the red-red zone (outermost layer), the red-white zone (the middle), and the white-white zone (innermost layer).
Dr. Kieran Richardson also discusses in this article from a few years ago: “It is almost unfathomable that a recent review by Kay et al 2017 revealed that only 1 of 412 ACL randomised controlled trials actually compared ACL reconstruction (ACLR) to structured rehabilitation for acute ACL injury, with essentially all other studies comparing various ACL surgeries and graft types to one another (Culvenor and Barton 2018). This single RCT, the famous KANON (Knee Anterior Cruciate Ligament, Nonsurgical versus Surgical Treatment) trial by Frobell and colleagues (2013), recommended that their ‘results should encourage clinicians and young active adult patients to consider rehabilitation as a primary treatment option after an acute ACL tear.’”
· Your risk of osteoarthritis is higher if you don’t get ACL/meniscus surgery
In 2018, van Yperen et al. retrospectively evaluated 50 patients. 25 patients who had unstable knees after 3 months of rehab were treated with surgery and 25 patients who had stable knees after 3 months were of rehab were treated without it. In a 20-year follow-up, osteoarthritis was found in 80% of the operative group and 68% of the non-operative group, a difference deemed statistically insignificant. This study is severely limited by the number of patients (n=50) and by it being a retrospective analysis. However, in an umbrella review evaluating 13 systematic reviews and meta-analyses, it was determined that having a surgical reconstruction does not reduce the risk for the development of osteoarthritis long-term, and an estimated 1/3 who have had ACL surgery will experience OA (Webster & Hewett, 2023). Three other reviews found no significant differences in pain, knee function, symptoms, return to sport, future meniscal tears, and OA, with slightly higher incidence of OA in operative groups (Delincé & Ghafil, 2012; Smith et al., 2014; Monk et al., 2016). Keep in mind that not all OA is symptomatic, and it is often related to how much cartilage remains in your joint and your physical fitness. Risk of OA is greater in those with quadriceps weakness (Øiestad et al., 2015, as cited in Filbay & Grindem, 2019). Meniscectomies remove some or all of the meniscus, leaving you at a greater risk of OA than if you had your meniscus repaired instead of removed (Migliorini et al., 2023). In fact, partial meniscectomies on degenerative menisci have been shown to do nothing more for knee function than placebo at 5 years (Sihvonen et al., 2022), and osteoarthritis has been reported in up to 89% of meniscectomy patients (Rangger et al., 1997). Additionally, some evidence supports the idea that meniscal tears are overtreated and leaving an injured meniscus alone results in equal or better results than meniscus repair, especially since meniscus tears are often asymptomatic (Shelbourne, 2021). Shelbourne also believes that weight-bearing is important for healing as it pushes the cartilage against the joint capsule and avoiding it may cause permanent loss of range of motion and strength. Meniscus trephination is a newer technique that’s been shown to be very effective for treating degenerative/torn menisci, but research on this is limited; the procedure involves poking holes hardened meniscal tissue with a needle in order to soften it to allow it to compress when walking, and the insertion of the needle attracts blood flow to the area to promote healing (Shelbourne 2021; Tfayli et al., 2023). The major takeaway here is that it’s the ACL injury itself that increases the risk of OA, not your surgical decision. While there’s not been shown to be a statistically significant difference in rates of OA with surgery vs. nonoperative care, it’s my suspicion that reconstruction leads to greater rates of radiographic OA, and rates tend to be slightly higher in the research for ACLR patients.
· You’re at greater risk of a meniscus tear if you don’t get surgery
From a recent systematic review written by both surgeons and physiotherapists, the authors concluded, “There is insufficient evidence that choosing early ACL reconstruction over non-operative treatment with optional delayed ACL reconstruction helps patients avoid new meniscal tears” (Ekas et al., 2020). Three other literature reviews also found no significant differences in rates of subsequent meniscal tears between surgical and non-surgical interventions (Delincé & Ghafil, 2012; Smith et al., 2014; Monk et al., 2016). Dr. Kieran Richardson discusses how the current literature suggesting risk of meniscal tears is greater is of poor methodological quality and fails to use a valid comparison arm here around the 5:00 mark. Studies will compare a group receiving surgery and excellent rehabilitation to a group receiving no treatment whatsoever and then jump to the conclusion that the risk of a meniscus tear is higher in nonoperative patients. Meniscal tears are also a much smaller trauma to your knee than an ACL reconstruction that drills into your bones and removes tendon tissue, so even if it were true that the risk of a meniscus tear is greater, it would still make sense to me to postpone or even forego surgery.
· Surgery should be done as soon as possible
Current best practice for patients receiving knee surgery is a 12-week period of strength training/prehab. Filbay & Grindem (2019) states, “As the only randomized trial on the topic did not support a superior outcome with early ACLR, it is prudent to suggest a period of rehabilitation before surgical decision-making for most patients with ACL rupture. This strategy is also supported by the findings that preoperative rehabilitation improves postsurgical outcomes in those who go on to have an ACLR. There is clinical agreement that patients who have functional instability after rehabilitation are likely to benefit from ACLR. The rationale behind this is that frequent instability episodes can be prevented by an ACLR, thereby reducing potential damage to the menisci and cartilage.” Since motion and strength are significantly limited immediately after reconstruction which results in atrophy, it makes sense to put in at least 3 months of consistent effort toward strengthening the tissues around the knee.
My Routine
After receiving my diagnosis, I resumed strength training immediately. Due to a lack of swelling, I never lost any range of motion or strength in my leg and was able to walk out of the climbing gym right after tearing my ACL and both menisci. I implemented partial range of motion leg extensions (60-90° of knee flexion) at the beginning of my workouts, followed by deep squats, stiff leg deadlifts, leg curls, calf raises, and hip abduction. The quads should be prioritized in ACL rehab, but the hamstrings, calves, and gluteus medius also have a bit of importance in unloading the ACL during different movements. I was training my legs twice a week, and on days that I didn’t train legs, I would do 2 sets of 30-45 second isometric holds at anywhere from 60-90° on the leg extension machine as heavy as I could since these aren’t very fatiguing, nor do they cause much damage/soreness. The idea was to contract my quad as hard as possible to promote blood flow to my knee for faster healing and pain relief; I would do these unilaterally to ensure my healthy leg wasn’t covering up my injured side. For those dealing with muscle inhibition, it should also lead to some improvements there as well. After some weeks of strength training, I gradually increased my speed on a treadmill to get back to running. Starting with an incline before moving back to flat ground will be a lot easier on your knee as the load on the joint is lower when moving uphill (van Hooren et al., 2024). A slight bit of pain is expected and usually necessary when recovering from such an injury; your joint becomes overly sensitive to things that aren’t harming it, and if you avoid pain entirely, it may be challenging to promote the adaptations needed to make a recovery. Listen to your body and dial it back if pain is not very tolerable. If you are dealing with a ton of knee soreness following a training session or even the day after, it is probably a sign that you should scale back either volume or intensity of exercise a little. I have now progressed to depth jumps pain-free and I am going to begin training change of direction with slower speeds soon. One thing to note is that I also had a few years of strength training prior to this injury, but we have evidence of someone with no prior strength training (pro soccer player Alou Diarra) overcoming this injury without surgery too.
Other Important Considerations/Fun Facts
· Muscle Inhibition
Arthrogenic muscle inhibition is a common response to joint injury as a byproduct of excessive effusion/swelling, and this limits the activation and strength of the affected leg. AMI should be expected in reconstruction too as surgery is itself a traumatic knee injury. Cryotherapy, eccentric exercise, and electrical stimulation may be effective treatments for AMI (Pietrosimone et al., 2022). This can impede recovery significantly by making it difficult to load the quads sufficiently, which makes training using blood-flow restriction to induce the same hypertrophic results with less load very appealing. Laurentino et al. (2022) showed that while blood-flow restriction training did not induce gains in size and strength through hormonal changes, there was a greater growth hormone response in those using occlusion than those who didn’t. Admittedly, I’m not very familiar with this area of the research but it is something that my evidence-based Doctor of PT mentioned could facilitate faster healing.
· Cross-Education
As a result of AMI, one of your quads may be weaker than the other. Especially after surgery, training your injured leg is going to be very painful and that leg will likely not see enough load to ward off atrophy that will make your knee even more vulnerable and sensitive to movement. Cross-education refers to the effects of training the uninjured side to its full potential while your injured leg lags behind. Training the good side has been shown to be an incredibly effective tool in strengthening the quads of your injured knee (Harput et al., 2019), and an LSI (Limb Symmetry Index) of greater than 90% dramatically decreases risk of sustaining another injury (Grindem et al., 2016).
· Women
It’s pretty commonly known that women are at far greater risk of tearing their ACL than men. In part, this is due to biomechanical differences such as a greater Q angle. Women’s menstrual cycles can also impact the incidence of ACL tears. Due to elevated levels of relaxin, a hormone that allows for the loosening of muscles and ligaments to support pregnancy and childbirth, women are at a higher risk of ACL injury during their period in the follicular phase as well as the ovulatory phase of their cycles (Denghan et al., 2014; Herzberg et al., 2017).
· Finding a Provider
I had a lot of trouble finding an evidence-based physical therapist that I knew would help with nonoperative ACL care. I was lucky that the physician I met with at Regenexx gave me a referral to an excellent Doctor of PT who stays up to date with research. For those who are unable to find a PT in their area that is familiar with nonoperative care, I highly suggest working with someone online. Dr. Steph Allen (Instagram: u/stephallen.dpt) and Dr. Kaan Celebi (Instagram: u/acl_academy) are two practitioners familiar with all facets of ACL care, and while I have not worked with them personally, I think they are both excellent options with the quality of information that they put out. Steph Allen runs a cash-based practice meaning it does not accept insurance, but I believe this is a better model (care-wise and cost-wise) for provider and patient which I will discuss in greater detail below. I’m unsure about the details of Kaan Celebi’s practice.
Surgeons are good at surgery – they are not rehab experts and you should not rely on them for exercise prescription. While you should heed their recommendations about early weight-bearing post-surgery (although surgeon preferences vary), I have heard of surgeons giving out terrible misinformation about exercise, saying things like “squats will ruin your knees” or “deadlifts will ruin your back.” The human body is very resilient, and these kinds of surgeons are a few decades behind in exercise science.
· Muscle Agonists/Antagonists and Force Vectors
The most important muscles in protection against injury when it comes to the ACL are the quads, gluteus medius, soleus, and hamstrings. While the quads and calves are able to gradually absorb force when landing, the glute medius (and minimus), soleus (deep calf muscle), and hamstrings are able to oppose anterior tibial shear forces and valgus/varus forces that load the ACL (Maniar et al., 2020). The hamstrings are also most capable of producing torque with a more bent knee, which can explain why ACLs are often torn when the leg is relatively straight (<30°). Men often neglect the glute medius, so hop on that hip abduction/bad girl machine ASAP! Banded clamshells work too, they are just harder to progressively overload than a weight stack.
Part 2: https://www.reddit.com/ACL/comments/1b4ziva/complete_acl_rupture_how_i_safely_returned_to/

Karim Sarhane, MD
ABSTRACT
The present invention is directed to a device and method for a nanofiber wrap to minimize inflation and scarring of nerve tissue and maximize the nutrient transport. More particularly, the present invention is directed to a novel semi-permeable nanofiber construct prepared from biocompatible materials. The nanofiber construct is applied around a nerve repair site following end-to-end anastomosis. The nanofiber construct is porous and composed of randomly oriented nanofibers prepare using an electrospinning method. The nanofiber construct has a wall that is approximately 50-100 μm thick with pores smaller than 25 μm. The nanofiber construct prevents inflammatory cells from migrating into the nerve coaption site, while still permitting the diffusion of growth factors and essential nutrients. The nanofiber construct allows for enhanced neuroregeneration and optimal function outcomes.
FIELD OF THE INVENTION
The present invention relates generally to medical devices. More particularly, the present invention relates to a device and method for a nanofiber wrap to minimize inflammation and scarring of nerve and other tissues as well as any other tubular structure or as a layered constituent of a biologic or synthetic mesh.
BACKGROUND OF THE INVENTION
Peripheral nerve injuries constitute a frequent and disabling condition, with an estimated incidence of 23 out of every 100,000 persons per year in developed countries. This statistic does not account for non-traumatic cases (i.e. nerve damage secondary to abdominal or pelvic surgeries) and for lesions not treated at health facilities. Despite great advances in microsurgical techniques, nerve repair continues to be suboptimal, and full functional recovery is seldom achieved. There is thus an imminent need to develop novel strategies to enhance neuroregeneration and optimize return of function.
Research in peripheral nerve injuries has shown that the formation of scar and fibrosis at the site of nerve coaptation impedes axonal regeneration. Furthermore, a negative correlation between the degree of functional recovery and the amount of scar formation at the repair site is a well-established phenomenon. Although nerve regeneration normally occurs at the rate of 1 to 3 mm per day, regenerating axons may require up to 20 to 40 days to traverse the scar at the site of nerve repair. Reduction in scar formation at a site of nerve repair is associated with better recovery. Mechanistically, scarring at the nerve repair site is due to invasion of inflammatory cells, with subsequent upregulation of fibrogenic cytokines.
It would therefore be beneficial to provide an inert barrier around the coaptation site that prevents inflammatory cells infiltration while still allowing diffusion of nutrients and other growth factors to promoting nerve regeneration.
SUMMARY OF THE INVENTION
The foregoing needs are met, to a great extent, by the present invention, which provides a device for promoting healing at a connection site between tubular biologic structures including a construct of nanofibers. The nanofibers are spun from a biocompatible material in a sheet configured and sized for wrapping around the connection site tubular biologic structures. The sheet is configured to have a pore size to prevent the infiltration of inflammatory cells to the connection site.
In accordance with an aspect of the present invention, the sheet is approximately 50 μm to 500 μm thick. More particularly the sheet can have a thickness of approximately 100 μm. The device can have pore size of approximately 0.5-25 μm. The biocompatible material can be polyester, such as polycaprolactone, polylactide, or polyglycolide. The biocompatible material can also be a blend of synthetic polyester such as polycaprolactone and a natural macromolecule such as collagen. Each one of the nanofibers can have a diameter of approximately 100 nm to 25 μm. The nanofibers are formed using a system comprising a syringe, a source of voltage, and a copper plate. While a copper plate is described herein with respect to the preferred embodiment any sort of conductive plate or rod known to or conceivable by one of skill in the art could also be used. A needle of the syringe has a gauge of approximately 27, a distance between the source of voltage and the copper plate of approximately 6 cm, an applied voltage from the source of voltage of approximately 7.5 kV, and a flow rate of solution from the syringe of approximately 0.75 mL/h.
In accordance with an aspect of the present invention, a method for forming a device for promoting healing at a connection site between tubular biologic structures includes filling a syringe with a solution containing a biocompatible material for forming the nanofibers. The method includes applying an electrical current to the solution containing the biocompatible material, such that the solution extends out into a fiber. Additionally, the method includes extruding the solution onto a grounded plate in an electrospinning process until a predetermined thickness of a sheet of the fiber, such that the sheet has a pore size of less than 10 μm.
In accordance with yet another aspect of the present invention, the method further includes using the solution comprising an 8 wt % PCL (MW=80,000) solution in a 9:1 (by wt) ratio of dichloromethane:N, N-dimethylformamide. The method includes using the biocompatible material taking the form of a polyester. Additionally, the method includes using one selected from a group consisting of a polycaprolactone, polylactide, and polyglycolide. The method includes using the biocompatible material formed from a blend of synthetic polyester such as polycaprolactone and a natural macromolecule such as collagen. The method also includes using the grounded plate comprising a conductive material.
In accordance with still another aspect of the present invention, the method includes using a grounded plate with dimensions of approximately 11 cm×11 cm×0.3 cm. The method includes using a power supply for applying the electrical current to the solution. The method includes forming the fiber having a diameter of approximately 100 nm to 10 μm and forming the sheet with a thickness of approximately 50 μm to approximately 500 μm. The method includes forming the sheet using a flow rate of 0.75 mL/h; a distance between applied voltage and the grounded plate of 6 cm; an applied voltage of 7.5 kV; and a needle gauge of 27. Additionally, the method includes applying the method for one consisting of a group of repairing one selected from a group consisting of crushed, compressed, and injured peripheral and cranial nerves and protecting one selected from a group consisting of autologous and allogeneic nerve grafts. The method also includes repairing injured or inflamed tendons.
BRIEF DESCRIPTION OF THE DRAWINGS
The accompanying drawings provide visual representations, which will be used to more fully describe the representative embodiments disclosed herein and can be used by those skilled in the art to better understand them and their inherent advantages. In these drawings, like reference numerals identify corresponding elements and:
FIG. 1 illustrates an exemplary setup for fabricating an electrospun nanofiber wrap according to an embodiment of the present invention.
FIGS. 2A-2D illustrate images of an exemplary nanofiber wrap according to an embodiment of the present invention.
FIGS. 3A-3C illustrate schematic diagrams of a nanofiber wrap according to an embodiment of the present invention.
FIGS. 4A and 4B illustrate an exemplary rat arm or leg nerve to be wrapped with the nanofiber construct for Groups 1 and 3 and an exemplary rat arm nerve to be wrapped with the nanofiber construct for Groups 2 and 4, respectively.
FIG. 5 illustrates a summary of the Groups, the intervention used, and the endpoint.
FIGS. 6A-6D illustrate images and graphical views of the percent of collagen at the repair site and the macrophage counts at the repair site.
FIG. 7 illustrates a graphical view of up-regulation of the anti-inflammatory cytokine IL-10 and down-regulation of the pro-inflammatory cytokine TNF-α that were detected at the nerve repair site in the experimental group.
FIGS. 8A and 8B illustrate images of nerve cross sections for the control and experimental groups as well as a graphical view of regenerated myelinated axons in the experimental and control groups.
FIG. 9 illustrates a graphical view of serial electrophysiological measurements showing improved functional recovery in the experimental group.
FIGS. 10A and 10B illustrate images of neuromuscular junction and a graphical view of neuromuscular junction re-innervation quantification. Increased reinnervation in the experimental group was accompanied by decreased gastrocnemius muscle atrophy, as assessed by a higher muscle weight and higher single muscle fiber cross sectional area.
FIGS. 11A-11D illustrate image and graphical views of gastrocnemius muscle weight and laminin staining analysis.
DETAILED DESCRIPTION
The presently disclosed subject matter now will be described more fully hereinafter with reference to the accompanying Drawings, in which some, but not all embodiments of the inventions are shown. Like numbers refer to like elements throughout. The presently disclosed subject matter may be embodied in many different forms and should not be construed as limited to the embodiments set forth herein; rather, these embodiments are provided so that this disclosure will satisfy applicable legal requirements. Indeed, many modifications and other embodiments of the presently disclosed subject matter set forth herein will come to mind to one skilled in the art to which the presently disclosed subject matter pertains having the benefit of the teachings presented in the foregoing descriptions and the associated Drawings. Therefore, it is to be understood that the presently disclosed subject matter is not to be limited to the specific embodiments disclosed and that modifications and other embodiments are intended to be included within the scope of the appended claims.
The present invention is directed to a device and method for a nanofiber wrap to minimize inflation and scarring of nerve tissue as well as any other cylindrical structures, such as a tendon, a ligament, or a vessel, or as a layered constituent of a biologic or synthetic mesh to cover a wound repair site. More particularly, the present invention is directed to a novel-semi permeable nanofiber construct prepared from biocompatible materials. The nanofiber construct is wrapped around a nerve repair site. The nanofiber construct is porous and composed of randomly oriented nanofibers prepared using an electrospinning technique. The nanofiber construct has a wall that is approximately 100 μm thick with pores smaller than 25 μm. The nanofiber construct prevents inflammatory cells from migrating into the nerve coaption site, while still permitting the diffusion of growth factors and essential nutrients. The nanofiber construct allows for enhanced neuroregeneration and optimal function outcomes.
FIG. 1 illustrates an exemplary setup for fabricating an electrospun nanofiber construct wrap according to an embodiment of the present invention. The exemplary setup 10 for fabricating the electrospun nanofiber construct wrap includes a syringe 12 containing a solution containing a biocompatible material for forming the nanofibers. In a preferred embodiment, the solution can take the form of an 8 wt % PCL (MW=80,000) solution in a 9:1 (by wt) ratio of dichloromethane:N, N-dimethylformamide. The biocompatible material can take the form of a polyester, such as polycaprolactone, polylactide, or polyglycolide. The biocompatible material can also be a blend of synthetic polyester such as polycaprolactone and a natural macromolecule such as collagen. It should be noted that these examples are not meant to be considered limiting and any suitable material known to or conceivable by one of skill in the art can be used. The exemplary setup also includes a power supply 14 and a square, grounded copper plate 16. While a copper plate is described herein with respect to a preferred embodiment any sort of conductive plate or rod known to or conceivable by one of skill in the art could also be used. It can also be a rod or other curved surface for giving the nanofiber wrap some initial curl. The copper plate 16 can be in any suitable size known to or conceivable by one of skill in the art for this purpose. However, in an exemplary embodiment the plate is approximately 11 cm×11 cm×0.3 cm. The solution is extruded from the syringe onto the copper plate and nanofibers are formed through the process of electrospinning and applying a current to the solution, which causes it to stretch out into a fiber shape. The exemplary setup includes several variable elements including, but not limited to, flow rate (Q), distance between applied voltage and the copper plate (d), applied voltage (V), and needle gauge (n). These variables can be adjusted to change the properties of the nanofibers produced by the exemplary setup 10. For instance, according to an embodiment of the invention the nanofibers can be produced under the following conditions: Q=0.75 mL/h; d=6 cm; V=7.5 kV; and n=27. With this exemplary setup constructs of 100 μm thick with pores smaller than 10 μm are obtained. The thickness of the nanofiber wrap can range from 50 to 500 μm. While this exemplary setup is described herein, any suitable setup known to or conceivable by one of skill in the art could also be used. Generally, the nanofibers produced using the exemplary setup have a diameter of approximately 100 nm to 10 μm. However, any suitable length or diameter known to or conceivable by one of skill in the art could also be used.
FIGS. 2A-2D illustrate images of an exemplary nanofiber wrap according to an embodiment of the present invention. As illustrated in FIGS. 2A-2D the nanofiber wrap has a thickness of 100 μm and a pore size of less than 10 μm. FIG. 2A illustrates a cross section of a nanofiber wrap according to the present invention. FIG. 2B illustrates a side view of a nanofiber wrap according to an embodiment of the present invention. FIG. 2C illustrates a cross section of a wall of the nanofiber wrap and FIG. 2D illustrates porosity of the nanofiber wrap.
FIGS. 3A-3C illustrate schematic diagrams of a nanofiber wrap according to an embodiment of the present invention. FIG. 3A illustrates a nanofiber wrap according to the present invention, as placed in an arm of a patient. FIG. 3B illustrates a schematic diagram of a nanofiber wrap according to the present invention being wrapped around a nerve repair site. As illustrated in FIG. 3B, the wrap is placed at the nerve repair site, and more particularly at a joint of the host nerve and the donor nerve. The wrap is placed around the joint and secured with a fixative, such as a drop of fibronectin glue or sutures. FIG. 3C illustrates a sectional schematic view of the wrap placed around the joint of the nerve repair site. The macroporous nanofiber mesh restricts the infiltration of macrophages and fibroblasts to the nerve repair site, while the access of nutrients, growth factors, and oxygen, in general are enabled. The trapped macrophages can also be tuned from an inflammatory phenotype to a pro-healing phenotype (more indicative of M2 phenotype than M1 phenotype), thus rendering the local environment pro-regenerative.
EXAMPLE
An exemplary implementation is described herein. This description is merely illustrative and is not meant to be considered limiting. Thy-1 GFP transgenic rats, whose axons constitutively express GFP, were used for the example. Four groups in total were used; 2 for short-term assessment of nerve regeneration measures (Groups 1 and 2) and 2 others for long-term assessment (Groups 3 and 4).
In Group 1 (control short-term group), a sciatic nerve transection and epineureal repair was performed; in Group 2 (experimental short-term group), in addition to sciatic transection and epineureal repair, the repair site was wrapped with the nanofiber construct. Groups 1 and 2 were harvested at 5 weeks for assessment of nerve inflammation/fibrosis. Groups 3 and 4, consisting of control and experimental long-term groups, respectively, were harvested at 16 weeks for assessment of nerve and muscle functional recovery. FIGS. 4A and 4B illustrate an exemplary rat arm nerve to be wrapped with the nanofiber construct for Groups 1 and 3 and an exemplary rat arm nerve to be wrapped with the nanofiber construct for Groups 2 and 4, respectively. FIG. 5, illustrates a summary of the Groups, the intervention used, and the endpoint.
Early measures of nerve regeneration (at 5 weeks following implantation) consisted of inflammation/scarring quantification at the repair site; collagen deposition was assessed by Masson's Trichrome staining; macrophage invasion was evaluated by co-immunofluorescent staining (CD68/TUJ1 staining); and inflammatory cytokine gene expression was assessed by qRT-PCR. Additionally, the number of regenerated myelinated axons was quantified at this early time point by analyzing the histomorphometric measures of nerve cross sections taken 5 mm distal.
Late measures of nerve regeneration (16 weeks) consisted of neuromuscular junction (Sciatic nerve—Soleus muscle) re-innervation quantification (α-Bungarotoxin/GFP staining), muscle histology assessment (gastrocnemius muscle weight and laminin staining), as well as serial electrophysiological measurements starting week 8 (every 2 weeks until week 16). The compound motor action potentials (CMAPs) were measured in the re-innervated intrinsic foot muscles in the plantar surface using subdermal needle electrodes. Stimulation was accomplished by subdermal needle electrodes placed near the sciatic nerve at the sciatic notch.
Masson's Trichrome and double immunofluorescence staining (ED1+TUJ1) of nerve longitudinal sections 5 weeks following repair showed a significantly decreased level of intraneural scarring and inflammation in the nanofiber nerve wrap group, as determined by collagen quantification (7.4%±1.3 vs. 3.2%±1.3, p<0.05) and macrophage counting (32.2±2.4 cells/mm2 vs. 14.6±1.8 cells/mm2, p<0.05) in the repair site (n=5/group). Collagen was trapped outside the nerve wrap in the experimental group, as illustrated in FIGS. 6A and 6B). FIGS. 6A-6D illustrate images and graphical views of the percent of collagen at the repair site and the macrophage counts at the repair site. As illustrated in FIGS. 6A and 6B, the percentage area of Masson's Trichrome blue staining for collagen was quantified at the coaptation site. As illustrated in FIGS. 6C and 6D, intraneural macrophage (positive for ED-1) were counted at the coaptation site, and results are expressed as cells/mm2 (10 μm sections, 40× mag). ED-1 (CD68): Macrophage marker TUJ1 (Neuronal Class III β-Tubulin): Neurofilament marker.
Mechanistically, these outcomes were correlated to an up-regulation of the anti-inflammatory cytokine (IL-10) and down-regulation of the pro-inflammatory cytokine (TNF-α). FIG. 7 illustrates a graphical view of up-regulation of the anti-inflammatory cytokine IL-10 and down-regulation of the pro-inflammatory cytokine TNF-α were detected at the nerve repair site in the experimental group. Furthermore, nerve cross sections taken 5 mm distal to the coaptation site demonstrated a significantly increased number of myelinated axons in the experimental group (n=8 per group) (FIGS. 6A-6D).
FIGS. 8A and 8 B illustrate images of nerve cross sections for the control and experimental groups as well as a graphical view of regenerated myelinated axons in the experimental and control groups. As illustrated in FIGS. 8A-8B, numbers of regenerated myelinated axons were counted at 5 mm distal to the repair site (ultra-thin sections, 1000× mag).
Electrophysiological measurements showed return of function at week 8 with significantly higher CMAPs in the experimental group. This trend persisted throughout week 16. Furthermore, the number of re-innervated neuromuscular junctions was significantly higher in the experimental group. FIG. 9 illustrates a graphical view of serial electrophysiological measurements showing improved functional recovery in the experimental group.
FIGS. 10A and 10B illustrate images of neuromuscular joints and a graphical view of neuromuscular junction re-innervation quantification. Increased reinnervation in the experimental group was accompanied by decreased gastrocnemius muscle atrophy, as assessed by a higher muscle weight and higher single muscle fiber cross sectional area. FIGS. 11A-11C illustrate image and graphical views of gastrocnemius muscle weight and laminin staining analysis.
These results effectively demonstrated decrease inflammatory response and connective tissue proliferation at the site of neurorrhaphy and improved nerve regeneration with optimal functional outcomes. While the invention is described above with respect to nerve tissue, the invention can also be applied to vessels or any other generally tubular structure. Therefore, the nanofiber wrap design is optimized for minimizing scarring at a connection site between two tubular structures such as nerves or vessels. It can also potentially prevent pain from neuroma formation. The construct can also be applied to blood vessel anastomosis by preventing leakage of blood cells at connection sites.
The many features and advantages of the invention are apparent from the detailed specification, and thus, it is intended by the appended claims to cover all such features and advantages of the invention, which fall within the true spirit and scope of the invention. Further, since numerous modifications and variations will readily occur to those skilled in the art, it is not desired to limit the invention to the exact construction and operation illustrated and described, and accordingly, all suitable modifications and equivalents may be resorted to, falling within the scope of the invention.
https://link.springer.com/article/10.1007/s00238-012-0735-x

Hello, I am 15 and have been playing basketball since I was 3. When I was 13.5-14 I took a break(until now) since I had crazy knee pain. I thought it was patellar tendonitis(jumper’s knee) and I went to the doctor, the doctor said the same based on where the pain was. Now I will start playing again but realized that I have a new pain and it’s different than patellar tendonitis. I researched eventough I assumed it was osgood schlatter since it’s common at my age. After my research I still think the same and I am pretty scared. I checked my knees and the diagram several times and think the pain is a little higher than the normal spot, what can it be? I don’t really notice a bump maybe non to a very little bump. I want to increase my vertical so I started jumping and exercising to increase it and the pain does increase when I do it. Would getting a good knee band, stretching often and icing my knees several times let me play in games and train?(I don’t really know how to explain it but the pain is right below the knee cap not that below(as it shows it at the diagram) right at the top of the shinbone, closer to the intersection at the top, and the pain is on the bone, not on the tendon, hurts when jumping, stretching it up and down, applying force towards the ground and pushing on it gently

Has anyone got a link a good diagram of the ligaments that run through the pelvic floor and specifically next to the BC muscle. I have what feels like steel cables running through that area and want to know if they're tight muscles, or just tendons/ligaments.
Cheers

So I keep struggling with various RSI related injuries due to bad posture and other stuff. I've been fighting with something weird going on in one of my fingers and it slowly transitioned down towards my palm.
I've been seeing the same acupuncturist for a couple of years now and it's been pretty obvious to me how much of a difference it's made. When I ruptured a disc in my spine it was acupuncture that kept me sane because I could get dry needling that caused those muscles to release around the ruptured disc.
Lately it's become apparent that one of my hand problems is because of multiple trigger points. It took me awhile to figure this out I initially thought it was a tendon problem but the physical therapist I saw kept telling me it didn't really make sense as a tendon problem.
I wound up seeing a hand surgeon and a hand physical therapist for my hand, with little benefit.
Eventually my finger pain turned into pain near the base of my palm and I found some YouTube video which walk through the anatomy of the hand there and pointed out that there aren't any tendons and that it's likely a trigger point.
When I'm struggling with some pain I'll frequently look at anatomy diagrams or use a 3D anatomy app to try to figure out what's in that area. So my logic is it can't be tendon pain if there's no tendons there.
Trigger point or a knot in the muscle is where the muscle has been overused and starved for oxygen so it develops this tight area that is painful. If you press around on a muscle and you feel a tight spot that's sore you likely have a trigger point. You can sometimes massage them out but you can also have an acupuncturist dry needle, which means sticking the needle into the trigger point to release it.
I have been trying to massage the trigger point out myself by using a hard rubber ball but it just wasn't working.
My acupuncturist was able to get needles underneath the main muscles in my palm to get to the trigger point and release it and the difference has been substantial. She also found another trigger point on a muscle attached to the finger which seems like it's made a difference.
I'm fairly optimistic that if I stick with this plan I might actually be able to recover my hand.
I don't think that acupuncture can fix everything, but it seems like it's a very powerful tool to use when it's a muscle or nerve problem.

Bill Meags was nothing if not a giving man.
He’d give you the shirt off his back, even if it was sewn right onto him!
This was a lifelong trait of his. In childhood, he stopped eating lunch once his mom stopped packing one for him and he had to start buying it at school. All it took was throwing a certain kinda look Bill’s way, or just making at him like you were going to ask him for his money, before he’d hand it over, not wanting to get in the way, he’d say, and he’d say it like he was apologizing, too.
That character never went away from Bill, no sirree. He was always real considerate, a sweetheart, especially to his parents – even though his dad saw him as a pushover (and another p word that doesn’t feel all that Christian for me to be repeating). I lived real close to him growing up, down the same block on Copperfield Drive, so we got all acquainted like kids that live close to each other at that age will do a lot of the time.
My bad, friend. I’m getting a bit lost in the weeds here, aren’t I? What I’m getting at is the generosity of Bill Meags, and why it is that you and I find ourselves in our situation at the present moment. You must be wondering about it, aren’t you? You seem like the curious type.
A few more things about Bill in those early years, first. Bill, you see, was always sharing his toys with his brothers back in those days. Not a birthday would go by – Bill’s birthday, I mean – where his brothers wouldn’t make out with at least half of his new toys stuffed in their greedy little pockets. Far as I know, this went on as long as he still had birthdays at home.
He was never real popular with the ladies either, when we got to that age where liking girls and their nice legs and nice smells went from gross to sweet. Bill was not a bad looking guy, but he was not a good looking one either. He was just there most of the time, as much as it pains me to say. He was just about decent at school, not an ivy league contender or anything like that, but better than you woulda expected out of a guy who was like Bill – a guy that was just there, who looks kinda like he’d fit better standing next to a potted plant or the wallpaper than around other people. I think him doing well in school made sense. He got the reps in. As in, he had been doing everyone’s homework for them. No one had threatened him, there was never anything like that.
The rumor that was floating around certain circles at our school was that if you asked Bill if he wouldn’t mind helping you with your homework, and you made it seem like it would be just the biggest fuss for you if you had to do any of it, he would tell you not to worry, that he would get it done, and he’d say it like he felt guilty that it wasn’t already done even though he just had it handed to him. Didn’t matter the subject, he’d do it. He always denied the rumor when I’d ask him about it, but I was pretty sure it was true, and I think he wouldn’t tell me because he didn’t wanna break up my peace of mind. So, yeah, I think he was alright at school because he was doing homework for classes he wasn’t even taking.
Me? I think it ended up being his helping his classmates with homework that led him to meeting Ana, a girl that took a real liking to Bill. Or maybe her name was Ava… it was something like that. Strange how time fades the clearness of your memories like they’re in a heavy fog, isn’t it? Well, in any case, Ava or Ana was a nice girl, and pretty, too, and she made her intentions real clear to Bill Meags, and that was unusual at the time, you see, for a girl to be that forward with a guy in the romantic sense. That was lucky for Bill, because I don’t think they woulda gone out if it wasn’t for her...
And they did go out. For a time, anyway. Until Brad Something-or-Other had come up to Bill one day and told him he thought Bill was such a nice guy, one of those real generous types, and Brad was acting all like he didn’t know that Ana (or maybe it was Ari?) was going steady with Bill, and he was really hamming it up and saying how it would be just swell to have the chance to go on a date with that cute girl from third period math. Brad was one of those guys, you’d know the type if you saw him, that made you wanna question the Creator when all your knowledge of what it meant to suffer was that you were stuck at home again with your parents on Saturday night. He was a complete jackass – there’s just no other word that works here – but he was also gifted by God and genetics and growth hormone to be a good-looking jackass. He was tall, a jock, and had a jawline that angled his face in a way that seemed to slide the looks that girls would give him into the rest of his face. What I’m getting at is that Brad could go on a date with anyone he wanted, and had gone one dates with anyone he wanted, “gotten down” with girls in higher social brackets compared to Bill’s girl. And he was too plugged into the social jungle that is high school to not have known they’d been going steady.
This is important, you see, because even though I can’t prove it, I believe deep down that Brad was pulling a prank on Bill. But Bill didn’t see it as a prank, and Bill agreed with Brad, telling him of course, you and Ana/Ava/Ari would make such a cute couple, you should go for it. Bill didn’t wanna impose on Brad, and he didn’t wanna get in the way of their potential future relationship, he told me later. Wouldn’t it just be awful, he said, if I were the reason they weren’t happy together? I can’t get in their way, I just can’t do that. That’d be just plain selfish of me.
Thing is, this was 8 months into their relationship, and he was as into her as one got at that age. But he didn’t want to be a bother, didn’t want to burden Brad-the-Tall-and-Chiseled-Jackass, didn’t want to get in the way or be an obstacle, so he stepped back, and Brad and Ava/Ana/Ari/Ash had gone on 3 dates before he forgot to wear a rubber on the third and knocked her up, and Bill was real outta their way when they both dropped out of school together to raise it. But Bill was heartbroken, he was, even though he’d never say it.
Ah, you don’t need to say anything for me to know what you’re thinking. I can see it in your face. I’ve been at it again. Rambling, haven’t I?
There is a point, I promise; a reason I’m telling you this and telling it to you the way I am. But we should fast forward a bit, shouldn’t we? Time is ticking, and midnight is getting closer, and I would like you to know why we’re here, hard as that might be from your perspective to believe.
So, fast forward some decades, and Bill’s married. His wife’s a presence of a woman named Martha. Now, lemme tell you, that Martha, she’s a force – both her and her mother.
Only reason Bill and Martha got married was because she asked him directly if he was planning to propose to her. Some 5 years into their relationship, that was. And Bill sure wasn’t going to tell her no, was he? That wasn’t in Bill’s nature. It was about that time, he told me after he broke the news of their nuptial plans, that I got myself good and married. Then, almost like it was just an afterthought, he added how he didn’t wanna annoy her, or make her feel all negative because he had struck the idea down, even if the answer woulda probably been not right now. So instead of saying not right now or let’s talk more about it he said yes, both right then and right there. She made him propose all formal with a ring, of course, but she was happy. Martha’s version of happy, anyways.
Now here come the newlyweds, and not 10 months later, out of Mrs. Martha Meags comes their first and their only, a boy they named Artimus. Bill had wanted to name him David, but Martha wanted to name him Artimus, so Bill and Martha named him Artimus. The child was adored, I can tell you that. Even after he started getting hard to be around since he was turning into one of those mopey teens with one of those mopey faces who always talks about how no one could ever understand them. Martha told Artimus he could do no wrong, and she told him that even after he started coming home in the back of a police cruiser. He started with shoplifting, getting caught wearing expensive shirts and sweaters under the oversized hoodie he’d always wear. But because he was underage, and since Martha had settled into one of those clerk jobs at the precinct office (and because she had come to know some of the fellas on the force), the young and troubled Artimus would often come back home after getting caught, at least in the beginning. You best believe I prayed for that kid every morning and every night. But God helps those who help themselves, my momma always used to say, God rest her.
Bill, at this point, had raised the idea of sending Artimus to a disciplinary school over the summer break. The way Martha reacted you’da thought you told her she needed to sacrifice Artimus in some pagan ritual. She would hear none of it. She said her son was one of those boys that came into his own a bit rougher and a bit later than the other boys, but it was because he was sensitive, and sensitive boys need extra coddling. Bill had thought about how he had been as a kid and felt his son woulda been one of the ones to ask him to do his homework if they’d been kids together. I guess this thought musta sparked something in him, because Bill didn’t back down off the jump and he raised the issue again with Martha. Or at least that’s how he told it to me. In any case, he said to her that he was concerned that one day Artimus wouldn’t come home in the back of a police car, that he wouldn’t come home at all, that instead the police officer would come to their home without Artimus and tell them that their son was dead or dying alone in some cold hospital bed. She went into hysterics, said that Bill was completely exaggerating, there would be no way that she would let her son go off canoodling with delinquents and murderers and rapists and thugs. And so off to the disciplinary school their dear Arty did not go, and into trouble their dear Arty stayed.
You can see I’m shaking now. I can tell it from the way you’re looking at me. It’s because he’s getting closer. But I think we’re still making good time, we should wrap up just as midnight comes. But no more dilly dallying – because he is getting closer. I can feel him, and I think you can too.
I think it started happening right around the time Bill had been in the running for a promotion. The guy right above him had been dropped by a heart attack at the ripe young age of 40. He survived it, but he was starting to take a good hard look at his priorities, as some men get to doing when they remember that the Almighty calls them back eventually. He decided he wasn’t spending enough time with his kids and wife and quit his job the day before his heart decided to permanently quit on him. So the position – Bill’s boss’s position – was open, and it paid pretty well, at least compared to what Bill was getting paid at the time, which was little more than peanuts. Didn’t matter how many times I told him, but Bill just wouldn’t ask for a raise. He didn’t want wanna offend his boss, or his boss’s boss, or make either think that Bill was ungrateful for his salary. That could hurt one of their feelings, maybe even both of their feelings, and the idea made Bill feel uncomfortable.
Right around the time Bill was in the running for the promotion, his boss’s boss got real sick. I heard it was something with his diabetes, but the short of it was that he needed a new kidney or he’d die. Estranged from his immediate family, as it happens, which is not the spot you wanna be in if you’re in the market for a new kidney. He was looking for donors in all the ways he could: taking out ads in the paper, putting up a billboard you’d see taking the ramp off the highway into downtown, hanging up flyers on the streets, all that.
Bill read the ad in the paper, and it just so happened that he has a compatible type of blood and kidney, and he knows this fact about himself. Martha knows it about him too, and she also knows that Bill has been up for that promotion. Martha asked Bill to donate his kidney to his boss’s boss, that Martha did. Bill didn’t wanna give away his kidney. But Martha wanted Bill to do just that, and after she contacted Bill’s boss’s boss, the man who paid Bill’s salary had wanted Bill to do just that, and Bill was not going to disappoint Martha or his boss’s boss, so just that was what Bill did.
That was just the beginning. It wasn’t long after they did the kidney removal – the scar was like a big smile that ran from his middle belly to his right hip like a real big gun holster – that Martha’s dear mom was the one who got real sick.
Ah, don’t move. You’re starting to slip a bit, let me tighten that for you.
Looks about right and good. Well, anyway, Martha’s mom was heavy handed with the bottle, that woman, and eventually consequences caught up with her actions as the good Lord makes right sure of, and she found herself looking down the barrel of life-threatening liver failure with the trigger half-pulled.
She would die if she didn’t get a new liver, or at least part of one. The doctor had explained to Bill and Martha near her mother’s room that livers were “adept” at regrowing themselves. Live liver transplants were becoming more common, he told them. You see where this is going, I think.
Martha had wanted Bill to give away a piece of his liver. Bill had not wanted to. But Martha had, and so had Martha’s mother, and so (I think) had the young doctor who wanted to impress the more senior doctor. And so Bill did.
The liver procedure was a bit more complicated than the kidney one. Bill was far from spring chicken territory, but he wasn’t that old – so they felt he would be safe to get a hunk of his liver taken out so soon after having the kidney removed. But he lost a lotta blood, Bill did, and the wound wasn’t healing as quick as they wanted. Eventually, not enough blood was making it to his kidney, the only one he had left, and so his left and only kidney died. The doctor recommended they remove it before it got infected and caused him more problems. They assured him that his kidney would be used for research, so they could help prevent this from happening in the future. To other patients, of course. Bill would be on dialysis for the rest of his life.
I went to visit Bill lots when he was in the hospital during that time. I was always the only familiar face to him around there. That would be the case until Artimus was a patient in the room next to him.
Artimus Meags, dear Arty to his mother Martha, had been drag racing in a car that did not belong to him. He told his mother dearest that he was going to study at his friend’s house, and Martha had believed Arty because Arty could do no wrong. Blood alcohol was twice the legal limit, and he was not the legal age, but he could do no wrong. He had crashed into a park tree, and they estimated he had been going about 98 miles per hour, give or take. The car was hugging the tree, and the picture they showed us made it look like one of those abstract metal art exhibits.
How he survived at all was a mystery to us. They found him pinned under the spear of a tree branch that jabbed into the driver’s side window, with his legs folded backwards and over his head at all these odd angles, and the jagged edges of the crumpled car door were drilled through both his arms like rows of nails through drywall. One of the doctors in the hallway had said loud enough for me to hear: Artimus’s legs came in mangled strips, tendon and bone and muscle all mushed together… indistinguishable, each one from the other. They counted the one blessing that Artimus had passed out early – either from the pain or the booze – and wouldn’t wake up until after the amputations. Amputations, more than one.
Artimus, dear Arty to his mother, no longer existed below the waist, beyond the left shoulder, above the right elbow.
At first, they were trying to save the left arm and the right upper arm if they could. The left arm, the doctors said, had some potential to recover, it was still getting blood and they might be able to salvage it. They said that on the first day. On the second day, the doctor had said pretty much everything except for what he was thinking, which was well, let’s just wait and see, that’s all we can do right now. On the third day, Jesus rose from the dead and Bill and Martha were told that surgery was the “mainstay of treatment for a gangrenous limb,” but please try not to worry too much because they were making big advancements in fake limbs, in prosthetics, and the quality of life for quadriplegics was getting better, they’re even doing trials on limb donations! Of course, these trials were in the early stages, but they were so grateful for their generous donors who gave so much so they could do such vital research. They said it was all above board, but when I got the chance some time later to actually look it up myself, I could find nothing at all about it online. When I called the hospital to ask them how the trials had gone, they acted like I was crazy. Can you believe that?
Anyway, as you can imagine, Martha jumped on that real quick, oh yes she did. Limb donations? Do y’all do them here? Bill had been so generous already, and, now turning her attention to Bill and cooing in a way that always made my skin crawl, oh, Bill, wouldn’t it be so wonderful if you could give the gift of walking to our son, to our baby boy, so that he could move his arms again, and grab at things again, and live his life again, like it’s all normal and this never happened. Oh, he was so young, wasn’t he? And you’ve lived a life, Bill, with those arms and those legs. Our Arty hasn’t.
Martha wanted Bill, the man with two less kidneys than you and me and a large chunk taken out of his liver, to donate his arms and his legs to their son. To Artimus, the boy who had moved only when he began to seize in his bed, who made no noise on purpose and whose breathing was being done by a machine that shoved oxygen through a tube down his throat, and whose eyes had to be taped down so they would not stay open and dry out because the part of his brain that gave his eyes the command to blink was asleep or dead.
Yes, Martha had wanted Bill to do this. Bill did not want to, but Bill smiled at Martha and said yes, Martha, because he just couldn’t tell her no. It’s the right thing to do, was his reason this time, which he gave me right before the operation when they were getting him ready (I was the only visitor; Martha was at Artimus’s bed). Besides, he added before they wheeled him away, I don’t want to make Martha feel sad, or make her feel like I don’t love our son. I would hate to let her down… I don’t want to let him down, either. I can handle living without my arms and my legs. I’ll adapt, and better I adapt to it than he does. I tried. I couldn’t get through to him, but I did try. So, then, he went with the folks in the scrubs, and that was the last time he was whole.
He was now without limbs, any of the four. His head sat atop his torso, and his torso atop his bed, and everything else had been sealed with some foam and some surgical duct tape. It was gonna be two surgeries, so they didn’t sew him back up on the first go. I was able to see through some of the foam packing they put on his stumps (the nurse didn’t do such a good job changing it, and Bill stayed silent because he was sure she was busy, even though he started leaking onto the bed), and I could see the sawed-off edge of bone splintered in uneven edges. I looked away right quick after that.
The next request came to Bill’s room pretty soon after that. It was sometime after Bill’s boss’s boss had decided to let Bill go from his position since he had taken off one too many days since he was in the hospital, and he thanked Bill for his years of service to the company. The requester was a lady who had overheard one of the nurses in the hallways talking about the remarkable and generous gift that the father had given the son. The mother of a young blind girl had come to Bill to ask him if he would be willing to donate his eyes and optic nerve, to give the gift of sight to the sightless, and she showed him a picture of her daughter, a young girl with blank sheets of snow for her eyes where the color shoulda been, and Martha had started weeping and saying that of course Bill could, and the doctor at the door who had overheard was saying that he had never seen such generosity from one man and Bill did not wanna give off the impression that he didn’t care about the girl like he was an uncaring type of person, and he didn’t want them to think that he wasn’t open to their thoughts on the best use of his eyes and optic nerve – and, he said to me before the operation, is it really all that fair for me to have my eyes and the nerve that lets me see if that girl can’t? Do I deserve them any more than she does? That’s what he told me, anyway. But I knew better, I knew Bill said yes because Martha wanted it, and the girl’s Mom wanted it, and the doctor wanted it, and it no longer mattered what Bill wanted, or maybe it hadn’t mattered for a while now, maybe ever, so Bill’s eyes had been scooped out, the space around his optic nerve taken out to remove it in one full piece, and the girl saw out of Bill’s eyes, and Bill saw out of no one’s.
By then, news had traveled quick. Local news first picked the story up, and larger media outlets megaphoned it out, and now there were hundreds of people showing up to Bill’s room in a single day, Bill unable to talk to them all but unable to get up and leave either. The hospital set up official lines and rules for these visitors – they gotta line up in this line or the other, fill out the official appeals form, circle on the diagram which part of the body they are in need of and from which body system, and give a response to: In 200 words or less, explain why Mr. Bill Meags, the always generous Mr. Bill Meags, should donate his organ/tissue to you or your loved one? Bill, unable to read and write because he didn’t have the eyes to read or the arms to write, gave complete medical decision-making power to Martha and the doctors. He hadn’t wanted to, but he had been asked – Martha the one doing the asking – and it seemed to him it would really ruffle her feathers, maybe even cross into inconvenient, if he said no, so he said yes.
His skin was given to a 44-year-old firefighter who had saved a child from a burning building. His skin had melted clean off, several layers of it.
Burn pains hurt. One of the worst pains you can experience, did you know that? All touch becomes real painful, a light breeze sets your nerves on fire, the cloth of your bedsheets feels like fire ants marching and you can’t shake them off because they’re a part of you.
But once the firefighter started wearing his new skin – the skin that they had cut off Bill like the pelt of an animal – he no longer felt the fire on his nerve endings or the ants crawling around anymore. They were Bill’s now, and for Bill, every second was agony. He never said so to anyone, and he never screamed, but he did tell me once when he was floating on a cloud made of morphine that he felt like screaming a lot of the time but didn’t wanna make too much noise. That could disturb the other folks here. I don’t wanna stop anyone from healing.
His right lung came out next, this one given to one of our state’s senators. The politician, one of those folks who make a real career out of politics and campaigning, got cancer in his lungs after smoking like a chimney his whole life, but he was running for a fourth term and he wasn’t ready to meet his Creator, so they took out his bad lungs and gave him one of Bill’s good ones. The senator was 75 years old, two full decades Bill’s senior, but that didn’t matter, of course. The senator’s third wife had pleaded to Martha, and Martha had said yes and of course and Bill was a patriot and Bill always followed their campaigns the most close out of anyone and so that was that and Bill’s chest had been opened and out came his lung. They took out the lung all the way to the place it forked into his throat, and I know that because they left his chest opened, they didn’t sew him back up, so it would make the next operation easier to do, the doctors told us. I sat by the bed afterwards – it happened too quick this time, and there wasn’t enough time between the agreement and the operation for me to see him off – and he told me, in between real deep gasps he had to take even with the tubes forcing oxygen into his nose and only lung, that even though it was ‘an adjustment’ to breathe now, he woulda felt like just the worst if he went ahead and said ‘no, I’d like to keep my lung, thank you.’ But he couldn’t do that to Martha, he said, or to the senator or to the senator’s third wife (who the senator had ended up divorcing not two months later after he was caught in bed with a different woman. He won his fourth term). Besides, what right do I really have to my lung? At least I have the other one.
Until he didn’t, of course. But by then I had started losing track of which parts were being given to which people, especially with Martha doing all the approvals herself. Next to go was Bill’s mouth, which made conversations much more one-sided. They had gone ahead and removed both the top and the bottom rows of teeth in Bill’s mouth. The bottom row of teeth was removed with the jawbone, all in one piece, but I’m not real sure what they needed his jaw for. But they musta decided to take out the tongue while they were in there too, maybe so it wouldn’t just be hanging out of his face all the time like he was a dog dying of thirst. They sliced the tongue out, and when Bill would try and talk you could see the little sutures tied in the back of what was left of his tongue and it looked like barbed wire that was waving at you.
Much of those days were foggy, and it wasn’t long after that when I stopped going to visit Bill for a while, for which I hope to be forgiven when I get to the Pearly Gates. I couldn’t right stand it, see? It was becoming more and more difficult to see less and less of him. But Bill, silent and unmoving, was becoming an eyesore. They had started removing his muscles and some of the other bones in his face by the time I stopped coming to see him most days. One by one, his face started missing features, and that’s why Bill started to look less human and more like a slab of raw meat that got stuck in the gears of a slaughterhouse grinder. His head had become a skull with some of the muscles still attached in spots, muscles that would move like a pulley and lever system when he’d react to something because you could see them shrinking and contracting against each other. That was the only way you could tell he could still hear you because his eyes were scooped out of his head like they were two spoonfuls of ice cream, and his teeth and tongue were missing and his jaw was missing and the entire base of his head was missing except for the part that was attached to his torso, and the head was the only thing attached to that torso, it was. Not a pretty sight. I couldn’t right stand it.
Sorry, friend, guess I didn’t ask if you were the squeamish type. But… I’m getting used to the idea that it won’t matter if you are for too long, and that all this is for real and it’s happening. You woulda thought it gets easier the more times you do it, but it doesn’t.
Bill’s nose, the tissue that made up the full thickness of it, had been lopped off, and he now had no eyes and two almond-shaped holes where his nose used to be. His mouth – which was now a hole in the middle of a lake of exposed muscle – looked so little like a mouth, but it sometimes moved when he tried to mime out words that would come out as grunts instead. But that didn’t matter all too long, because he stopped the grunting and the miming when his vocal cords were out.
Bill, the man, the generous man with emptying insides and with no eyes, no nose, no mouth, who could not scream; who had no skin but the island of it on top of his head which made up the scalp that his hair grew out of like sprouting weeds; that man, Bill, existed here and there on the hospital bed, in pieces, pieces that were getting smaller, pieces made of tissue and organs that were going to be removed soon because some of it was starting to die while it was still on him, decaying and rotting like spoiled meat. Or at least that was what the doctors told him. But by then he couldn’t say or ask much.
I am not sure he woulda asked much of anything anyway.
Once, though, while he still had neck muscles and could still shake his head or nod it, this young lady, some girl from one of the colleges around here, had come and asked him if he really agreed to all of these donations – as in out of his own free will. Willful consent she had called it, or something like that. She was one of those activist types, looking for a cause, and Martha wouldn’t’ve let it happen if she’d been paying attention, but she had been spending a lot of time talking to the doctor about how Artimus was doing. Since it was just Bill and I and the lady and cause his neck muscles were still attached and working at the time, he would nod in agreement to whatever questions she asked.
Martha did find out later, and she was real pissed, you can bet on that. Pretty soon after that, Martha had the fortune of coming across the perfect candidate for the muscles in his neck, and Bill could nod and shake his head no more.
It was maybe 2 months when I saw him next, because I had the occasion to be in the hospital myself. Made it through, God bless, and I knew it had been a while since I had seen Bill, and… well, anyways, I had decided I better find myself paying my dues to make things even and all that. When I entered the room, it took me a good long minute to realize that there hadn’t been a mistake, and that I was in the right one.
Bill wasn’t there, you see.
Well, he was, but he wasn’t.
The bed had been removed from the room, the bed he had spent the large part of a year not moving from. A table, like one of those you’d see in a high school chemistry class, had been put where the bed was before. And on the table were a couple of large devices and a small transparent tub with some water, the tub with a brain sitting at the bottom of it like dead weight. And then I realized it’s not water in that tub, it’s one of those preserving solutions with nutrients and electrolytes and all that, one of those solutions meant to keep the brain alive, to keep the cells in there from dying like they’re supposed to when the brain isn’t connected to the rest of you. The nurse told me in a hushed and awed kinda voice that the rest of Bill had been donated, so generously, and wasn’t he just the most giving person you’ve met? and I couldn’t do that myself, but I have so much respect for him and for the people that do. I asked the nurse if Bill could think and if he would be able to tell that I came to visit, and she looked at me the same way the hospital lady sounded when I called her asked about the trials. No, I don’t think he can.
I stayed in the room a bit, kinda just looking at what was left of Bill. He was just a pink blob, with what looked like a maze carved into its surface. Bill was that blob (or he was in it somewhere) but either way he was an anchor at the bottom of the tub, kept alive by bathing in a liquid and being stimulated with electricity which came from a device on a timer to shock the cells so they wouldn’t die off from not being used, a blob whose body was everywhere and nowhere, a blob which was Bill’s or just Bill and who would stay sunk in this transparent solution until Kingdom Come.
Well, I turned out to be wrong about that last thing. I read in the Times later that week that he had given (with such generosity) the two halves of his brains, the “hemispheres” – like Bill’s brain was a globe, and I guess in a way it was – to the children.
Apparently – and maybe you know more about this than I do, given how folks your age are much more on the internet compared to folks my own – some kids can be born with half their brain missing. And most of the time, those kids – being younger than me and you both – have the ability to regenerate their brain since they’re so young. So the half of their brain that did develop is able to do the tasks that the missing part woulda done normally. You wouldn’t even be able to tell they were missing anything.
But sometimes, the kids aren’t alright, the one hemisphere can’t pick up the missing one’s slack, and those kids with half a brain act like you’d expect a half-brained kid to act. They’re in beds, on life support, and often bleeding their parents’ dry of their savings. Of course, the money isn’t the priority, but you gotta consider it anyway. Bill’s hemispheres, both the left and the right, were separated and placed in the skulls of two young girls who belonged to the second of the two groups and had been on life support since babies, and each of Bill’s hemispheres had been attached to the half of their brain that the young girls were born. Each operation had taken 36 hours and I read they had neurosurgeon on top of neurosurgeon, all wanting a hand in the girls’ heads and their names in their paper and their egos inflated. ‘The Times’ sat down with Martha Meags, the late wife of the generous Bill Meags. She describes the difficult decision Bill Meags had voiced to her in his final days: to donate the rest of his body to those who needed it most. ‘I had to come to peace with it,’ she told us, holding back tears. The picture on the paper showed a black and white Martha with a real solemn look on her face, like she was trynna be brave for everyone.
I can see you’re shaking real bad now. You can feel him, too, can’t you? This part is the worst part – the waiting, especially when he gets close. And he’s terribly close now, no more than a few minutes, but I think I got the time to piece it altogether for you, God willing.

Bill Meags was nothing if not a giving man.
He’d give you the shirt off his back, even if it was sewn right onto him!
This was a lifelong trait of his. In childhood, he stopped eating lunch once his mom stopped packing one for him and he had to start buying it at school. All it took was throwing a certain kinda look Bill’s way, or just making at him like you were going to ask him for his money, before he’d hand it over, not wanting to get in the way, he’d say, and he’d say it like he was apologizing, too.
That character never went away from Bill, no sirree. He was always real considerate, a sweetheart, especially to his parents – even though his dad saw him as a pushover (and another p word that doesn’t feel all that Christian for me to be repeating). I lived real close to him growing up, down the same block on Copperfield Drive, so we got all acquainted like kids that live close to each other at that age will do a lot of the time.
My bad, friend. I’m getting a bit lost in the weeds here, aren’t I? What I’m getting at is the generosity of Bill Meags, and why it is that you and I find ourselves in our situation at the present moment. You must be wondering about it, aren’t you? You seem like the curious type.
A few more things about Bill in those early years, first. Bill, you see, was always sharing his toys with his brothers back in those days. Not a birthday would go by – Bill’s birthday, I mean – where his brothers wouldn’t make out with at least half of his new toys stuffed in their greedy little pockets. Far as I know, this went on as long as he still had birthdays at home.
He was never real popular with the ladies either, when we got to that age where liking girls and their nice legs and nice smells went from gross to sweet. Bill was not a bad looking guy, but he was not a good looking one either. He was just there most of the time, as much as it pains me to say. He was just about decent at school, not an ivy league contender or anything like that, but better than you woulda expected out of a guy who was like Bill – a guy that was just there, who looks kinda like he’d fit better standing next to a potted plant or the wallpaper than around other people. I think him doing well in school made sense. He got the reps in. As in, he had been doing everyone’s homework for them. No one had threatened him, there was never anything like that.
The rumor that was floating around certain circles at our school was that if you asked Bill if he wouldn’t mind helping you with your homework, and you made it seem like it would be just the biggest fuss for you if you had to do any of it, he would tell you not to worry, that he would get it done, and he’d say it like he felt guilty that it wasn’t already done even though he just had it handed to him. Didn’t matter the subject, he’d do it. He always denied the rumor when I’d ask him about it, but I was pretty sure it was true, and I think he wouldn’t tell me because he didn’t wanna break up my peace of mind. So, yeah, I think he was alright at school because he was doing homework for classes he wasn’t even taking.
Me? I think it ended up being his helping his classmates with homework that led him to meeting Ana, a girl that took a real liking to Bill. Or maybe her name was Ava… it was something like that. Strange how time fades the clearness of your memories like they’re in a heavy fog, isn’t it? Well, in any case, Ava or Ana was a nice girl, and pretty, too, and she made her intentions real clear to Bill Meags, and that was unusual at the time, you see, for a girl to be that forward with a guy in the romantic sense. That was lucky for Bill, because I don’t think they woulda gone out if it wasn’t for her...
And they did go out. For a time, anyway. Until Brad Something-or-Other had come up to Bill one day and told him he thought Bill was such a nice guy, one of those real generous types, and Brad was acting all like he didn’t know that Ana (or maybe it was Ari?) was going steady with Bill, and he was really hamming it up and saying how it would be just swell to have the chance to go on a date with that cute girl from third period math. Brad was one of those guys, you’d know the type if you saw him, that made you wanna question the Creator when all your knowledge of what it meant to suffer was that you were stuck at home again with your parents on Saturday night. He was a complete jackass – there’s just no other word that works here – but he was also gifted by God and genetics and growth hormone to be a good-looking jackass. He was tall, a jock, and had a jawline that angled his face in a way that seemed to slide the looks that girls would give him into the rest of his face. What I’m getting at is that Brad could go on a date with anyone he wanted, and had gone one dates with anyone he wanted, “gotten down” with girls in higher social brackets compared to Bill’s girl. And he was too plugged into the social jungle that is high school to not have known they’d been going steady.
This is important, you see, because even though I can’t prove it, I believe deep down that Brad was pulling a prank on Bill. But Bill didn’t see it as a prank, and Bill agreed with Brad, telling him of course, you and Ana/Ava/Ari would make such a cute couple, you should go for it. Bill didn’t wanna impose on Brad, and he didn’t wanna get in the way of their potential future relationship, he told me later. Wouldn’t it just be awful, he said, if I were the reason they weren’t happy together? I can’t get in their way, I just can’t do that. That’d be just plain selfish of me.
Thing is, this was 8 months into their relationship, and he was as into her as one got at that age. But he didn’t want to be a bother, didn’t want to burden Brad-the-Tall-and-Chiseled-Jackass, didn’t want to get in the way or be an obstacle, so he stepped back, and Brad and Ava/Ana/Ari/Ash had gone on 3 dates before he forgot to wear a rubber on the third and knocked her up, and Bill was real outta their way when they both dropped out of school together to raise it. But Bill was heartbroken, he was, even though he’d never say it.
Ah, you don’t need to say anything for me to know what you’re thinking. I can see it in your face. I’ve been at it again. Rambling, haven’t I?
There is a point, I promise; a reason I’m telling you this and telling it to you the way I am. But we should fast forward a bit, shouldn’t we? Time is ticking, and midnight is getting closer, and I would like you to know why we’re here, hard as that might be from your perspective to believe.
So, fast forward some decades, and Bill’s married. His wife’s a presence of a woman named Martha. Now, lemme tell you, that Martha, she’s a force – both her and her mother.
Only reason Bill and Martha got married was because she asked him directly if he was planning to propose to her. Some 5 years into their relationship, that was. And Bill sure wasn’t going to tell her no, was he? That wasn’t in Bill’s nature. It was about that time, he told me after he broke the news of their nuptial plans, that I got myself good and married. Then, almost like it was just an afterthought, he added how he didn’t wanna annoy her, or make her feel all negative because he had struck the idea down, even if the answer woulda probably been not right now. So instead of saying not right now or let’s talk more about it he said yes, both right then and right there. She made him propose all formal with a ring, of course, but she was happy. Martha’s version of happy, anyways.
Now here come the newlyweds, and not 10 months later, out of Mrs. Martha Meags comes their first and their only, a boy they named Artimus. Bill had wanted to name him David, but Martha wanted to name him Artimus, so Bill and Martha named him Artimus. The child was adored, I can tell you that. Even after he started getting hard to be around since he was turning into one of those mopey teens with one of those mopey faces who always talks about how no one could ever understand them. Martha told Artimus he could do no wrong, and she told him that even after he started coming home in the back of a police cruiser. He started with shoplifting, getting caught wearing expensive shirts and sweaters under the oversized hoodie he’d always wear. But because he was underage, and since Martha had settled into one of those clerk jobs at the precinct office (and because she had come to know some of the fellas on the force), the young and troubled Artimus would often come back home after getting caught, at least in the beginning. You best believe I prayed for that kid every morning and every night. But God helps those who help themselves, my momma always used to say, God rest her.
Bill, at this point, had raised the idea of sending Artimus to a disciplinary school over the summer break. The way Martha reacted you’da thought you told her she needed to sacrifice Artimus in some pagan ritual. She would hear none of it. She said her son was one of those boys that came into his own a bit rougher and a bit later than the other boys, but it was because he was sensitive, and sensitive boys need extra coddling. Bill had thought about how he had been as a kid and felt his son woulda been one of the ones to ask him to do his homework if they’d been kids together. I guess this thought musta sparked something in him, because Bill didn’t back down off the jump and he raised the issue again with Martha. Or at least that’s how he told it to me. In any case, he said to her that he was concerned that one day Artimus wouldn’t come home in the back of a police car, that he wouldn’t come home at all, that instead the police officer would come to their home without Artimus and tell them that their son was dead or dying alone in some cold hospital bed. She went into hysterics, said that Bill was completely exaggerating, there would be no way that she would let her son go off canoodling with delinquents and murderers and rapists and thugs. And so off to the disciplinary school their dear Arty did not go, and into trouble their dear Arty stayed.
You can see I’m shaking now. I can tell it from the way you’re looking at me. It’s because he’s getting closer. But I think we’re still making good time, we should wrap up just as midnight comes. But no more dilly dallying – because he is getting closer. I can feel him, and I think you can too.
I think it started happening right around the time Bill had been in the running for a promotion. The guy right above him had been dropped by a heart attack at the ripe young age of 40. He survived it, but he was starting to take a good hard look at his priorities, as some men get to doing when they remember that the Almighty calls them back eventually. He decided he wasn’t spending enough time with his kids and wife and quit his job the day before his heart decided to permanently quit on him. So the position – Bill’s boss’s position – was open, and it paid pretty well, at least compared to what Bill was getting paid at the time, which was little more than peanuts. Didn’t matter how many times I told him, but Bill just wouldn’t ask for a raise. He didn’t want wanna offend his boss, or his boss’s boss, or make either think that Bill was ungrateful for his salary. That could hurt one of their feelings, maybe even both of their feelings, and the idea made Bill feel uncomfortable.
Right around the time Bill was in the running for the promotion, his boss’s boss got real sick. I heard it was something with his diabetes, but the short of it was that he needed a new kidney or he’d die. Estranged from his immediate family, as it happens, which is not the spot you wanna be in if you’re in the market for a new kidney. He was looking for donors in all the ways he could: taking out ads in the paper, putting up a billboard you’d see taking the ramp off the highway into downtown, hanging up flyers on the streets, all that.
Bill read the ad in the paper, and it just so happened that he has a compatible type of blood and kidney, and he knows this fact about himself. Martha knows it about him too, and she also knows that Bill has been up for that promotion. Martha asked Bill to donate his kidney to his boss’s boss, that Martha did. Bill didn’t wanna give away his kidney. But Martha wanted Bill to do just that, and after she contacted Bill’s boss’s boss, the man who paid Bill’s salary had wanted Bill to do just that, and Bill was not going to disappoint Martha or his boss’s boss, so just that was what Bill did.
That was just the beginning. It wasn’t long after they did the kidney removal – the scar was like a big smile that ran from his middle belly to his right hip like a real big gun holster – that Martha’s dear mom was the one who got real sick.
Ah, don’t move. You’re starting to slip a bit, let me tighten that for you.
Looks about right and good. Well, anyway, Martha’s mom was heavy handed with the bottle, that woman, and eventually consequences caught up with her actions as the good Lord makes right sure of, and she found herself looking down the barrel of life-threatening liver failure with the trigger half-pulled.
She would die if she didn’t get a new liver, or at least part of one. The doctor had explained to Bill and Martha near her mother’s room that livers were “adept” at regrowing themselves. Live liver transplants were becoming more common, he told them. You see where this is going, I think.
Martha had wanted Bill to give away a piece of his liver. Bill had not wanted to. But Martha had, and so had Martha’s mother, and so (I think) had the young doctor who wanted to impress the more senior doctor. And so Bill did.
The liver procedure was a bit more complicated than the kidney one. Bill was far from spring chicken territory, but he wasn’t that old – so they felt he would be safe to get a hunk of his liver taken out so soon after having the kidney removed. But he lost a lotta blood, Bill did, and the wound wasn’t healing as quick as they wanted. Eventually, not enough blood was making it to his kidney, the only one he had left, and so his left and only kidney died. The doctor recommended they remove it before it got infected and caused him more problems. They assured him that his kidney would be used for research, so they could help prevent this from happening in the future. To other patients, of course. Bill would be on dialysis for the rest of his life.
I went to visit Bill lots when he was in the hospital during that time. I was always the only familiar face to him around there. That would be the case until Artimus was a patient in the room next to him.
Artimus Meags, dear Arty to his mother Martha, had been drag racing in a car that did not belong to him. He told his mother dearest that he was going to study at his friend’s house, and Martha had believed Arty because Arty could do no wrong. Blood alcohol was twice the legal limit, and he was not the legal age, but he could do no wrong. He had crashed into a park tree, and they estimated he had been going about 98 miles per hour, give or take. The car was hugging the tree, and the picture they showed us made it look like one of those abstract metal art exhibits.
How he survived at all was a mystery to us. They found him pinned under the spear of a tree branch that jabbed into the driver’s side window, with his legs folded backwards and over his head at all these odd angles, and the jagged edges of the crumpled car door were drilled through both his arms like rows of nails through drywall. One of the doctors in the hallway had said loud enough for me to hear: Artimus’s legs came in mangled strips, tendon and bone and muscle all mushed together… indistinguishable, each one from the other. They counted the one blessing that Artimus had passed out early – either from the pain or the booze – and wouldn’t wake up until after the amputations. Amputations, more than one.
Artimus, dear Arty to his mother, no longer existed below the waist, beyond the left shoulder, above the right elbow.
At first, they were trying to save the left arm and the right upper arm if they could. The left arm, the doctors said, had some potential to recover, it was still getting blood and they might be able to salvage it. They said that on the first day. On the second day, the doctor had said pretty much everything except for what he was thinking, which was well, let’s just wait and see, that’s all we can do right now. On the third day, Jesus rose from the dead and Bill and Martha were told that surgery was the “mainstay of treatment for a gangrenous limb,” but please try not to worry too much because they were making big advancements in fake limbs, in prosthetics, and the quality of life for quadriplegics was getting better, they’re even doing trials on limb donations! Of course, these trials were in the early stages, but they were so grateful for their generous donors who gave so much so they could do such vital research. They said it was all above board, but when I got the chance some time later to actually look it up myself, I could find nothing at all about it online. When I called the hospital to ask them how the trials had gone, they acted like I was crazy. Can you believe that?
Anyway, as you can imagine, Martha jumped on that real quick, oh yes she did. Limb donations? Do y’all do them here? Bill had been so generous already, and, now turning her attention to Bill and cooing in a way that always made my skin crawl, oh, Bill, wouldn’t it be so wonderful if you could give the gift of walking to our son, to our baby boy, so that he could move his arms again, and grab at things again, and live his life again, like it’s all normal and this never happened. Oh, he was so young, wasn’t he? And you’ve lived a life, Bill, with those arms and those legs. Our Arty hasn’t.
Martha wanted Bill, the man with two less kidneys than you and me and a large chunk taken out of his liver, to donate his arms and his legs to their son. To Artimus, the boy who had moved only when he began to seize in his bed, who made no noise on purpose and whose breathing was being done by a machine that shoved oxygen through a tube down his throat, and whose eyes had to be taped down so they would not stay open and dry out because the part of his brain that gave his eyes the command to blink was asleep or dead.
Yes, Martha had wanted Bill to do this. Bill did not want to, but Bill smiled at Martha and said yes, Martha, because he just couldn’t tell her no. It’s the right thing to do, was his reason this time, which he gave me right before the operation when they were getting him ready (I was the only visitor; Martha was at Artimus’s bed). Besides, he added before they wheeled him away, I don’t want to make Martha feel sad, or make her feel like I don’t love our son. I would hate to let her down… I don’t want to let him down, either. I can handle living without my arms and my legs. I’ll adapt, and better I adapt to it than he does. I tried. I couldn’t get through to him, but I did try. So, then, he went with the folks in the scrubs, and that was the last time he was whole.
He was now without limbs, any of the four. His head sat atop his torso, and his torso atop his bed, and everything else had been sealed with some foam and some surgical duct tape. It was gonna be two surgeries, so they didn’t sew him back up on the first go. I was able to see through some of the foam packing they put on his stumps (the nurse didn’t do such a good job changing it, and Bill stayed silent because he was sure she was busy, even though he started leaking onto the bed), and I could see the sawed-off edge of bone splintered in uneven edges. I looked away right quick after that.
The next request came to Bill’s room pretty soon after that. It was sometime after Bill’s boss’s boss had decided to let Bill go from his position since he had taken off one too many days since he was in the hospital, and he thanked Bill for his years of service to the company. The requester was a lady who had overheard one of the nurses in the hallways talking about the remarkable and generous gift that the father had given the son. The mother of a young blind girl had come to Bill to ask him if he would be willing to donate his eyes and optic nerve, to give the gift of sight to the sightless, and she showed him a picture of her daughter, a young girl with blank sheets of snow for her eyes where the color shoulda been, and Martha had started weeping and saying that of course Bill could, and the doctor at the door who had overheard was saying that he had never seen such generosity from one man and Bill did not wanna give off the impression that he didn’t care about the girl like he was an uncaring type of person, and he didn’t want them to think that he wasn’t open to their thoughts on the best use of his eyes and optic nerve – and, he said to me before the operation, is it really all that fair for me to have my eyes and the nerve that lets me see if that girl can’t? Do I deserve them any more than she does? That’s what he told me, anyway. But I knew better, I knew Bill said yes because Martha wanted it, and the girl’s Mom wanted it, and the doctor wanted it, and it no longer mattered what Bill wanted, or maybe it hadn’t mattered for a while now, maybe ever, so Bill’s eyes had been scooped out, the space around his optic nerve taken out to remove it in one full piece, and the girl saw out of Bill’s eyes, and Bill saw out of no one’s.
By then, news had traveled quick. Local news first picked the story up, and larger media outlets megaphoned it out, and now there were hundreds of people showing up to Bill’s room in a single day, Bill unable to talk to them all but unable to get up and leave either. The hospital set up official lines and rules for these visitors – they gotta line up in this line or the other, fill out the official appeals form, circle on the diagram which part of the body they are in need of and from which body system, and give a response to: In 200 words or less, explain why Mr. Bill Meags, the always generous Mr. Bill Meags, should donate his organ/tissue to you or your loved one? Bill, unable to read and write because he didn’t have the eyes to read or the arms to write, gave complete medical decision-making power to Martha and the doctors. He hadn’t wanted to, but he had been asked – Martha the one doing the asking – and it seemed to him it would really ruffle her feathers, maybe even cross into inconvenient, if he said no, so he said yes.
His skin was given to a 44-year-old firefighter who had saved a child from a burning building. His skin had melted clean off, several layers of it.
Burn pains hurt. One of the worst pains you can experience, did you know that? All touch becomes real painful, a light breeze sets your nerves on fire, the cloth of your bedsheets feels like fire ants marching and you can’t shake them off because they’re a part of you.
But once the firefighter started wearing his new skin – the skin that they had cut off Bill like the pelt of an animal – he no longer felt the fire on his nerve endings or the ants crawling around anymore. They were Bill’s now, and for Bill, every second was agony. He never said so to anyone, and he never screamed, but he did tell me once when he was floating on a cloud made of morphine that he felt like screaming a lot of the time but didn’t wanna make too much noise. That could disturb the other folks here. I don’t wanna stop anyone from healing.
His right lung came out next, this one given to one of our state’s senators. The politician, one of those folks who make a real career out of politics and campaigning, got cancer in his lungs after smoking like a chimney his whole life, but he was running for a fourth term and he wasn’t ready to meet his Creator, so they took out his bad lungs and gave him one of Bill’s good ones. The senator was 75 years old, two full decades Bill’s senior, but that didn’t matter, of course. The senator’s third wife had pleaded to Martha, and Martha had said yes and of course and Bill was a patriot and Bill always followed their campaigns the most close out of anyone and so that was that and Bill’s chest had been opened and out came his lung. They took out the lung all the way to the place it forked into his throat, and I know that because they left his chest opened, they didn’t sew him back up, so it would make the next operation easier to do, the doctors told us. I sat by the bed afterwards – it happened too quick this time, and there wasn’t enough time between the agreement and the operation for me to see him off – and he told me, in between real deep gasps he had to take even with the tubes forcing oxygen into his nose and only lung, that even though it was ‘an adjustment’ to breathe now, he woulda felt like just the worst if he went ahead and said ‘no, I’d like to keep my lung, thank you.’ But he couldn’t do that to Martha, he said, or to the senator or to the senator’s third wife (who the senator had ended up divorcing not two months later after he was caught in bed with a different woman. He won his fourth term). Besides, what right do I really have to my lung? At least I have the other one.
Until he didn’t, of course. But by then I had started losing track of which parts were being given to which people, especially with Martha doing all the approvals herself. Next to go was Bill’s mouth, which made conversations much more one-sided. They had gone ahead and removed both the top and the bottom rows of teeth in Bill’s mouth. The bottom row of teeth was removed with the jawbone, all in one piece, but I’m not real sure what they needed his jaw for. But they musta decided to take out the tongue while they were in there too, maybe so it wouldn’t just be hanging out of his face all the time like he was a dog dying of thirst. They sliced the tongue out, and when Bill would try and talk you could see the little sutures tied in the back of what was left of his tongue and it looked like barbed wire that was waving at you.
Much of those days were foggy, and it wasn’t long after that when I stopped going to visit Bill for a while, for which I hope to be forgiven when I get to the Pearly Gates. I couldn’t right stand it, see? It was becoming more and more difficult to see less and less of him. But Bill, silent and unmoving, was becoming an eyesore. They had started removing his muscles and some of the other bones in his face by the time I stopped coming to see him most days. One by one, his face started missing features, and that’s why Bill started to look less human and more like a slab of raw meat that got stuck in the gears of a slaughterhouse grinder. His head had become a skull with some of the muscles still attached in spots, muscles that would move like a pulley and lever system when he’d react to something because you could see them shrinking and contracting against each other. That was the only way you could tell he could still hear you because his eyes were scooped out of his head like they were two spoonfuls of ice cream, and his teeth and tongue were missing and his jaw was missing and the entire base of his head was missing except for the part that was attached to his torso, and the head was the only thing attached to that torso, it was. Not a pretty sight. I couldn’t right stand it.
Sorry, friend, guess I didn’t ask if you were the squeamish type. But… I’m getting used to the idea that it won’t matter if you are for too long, and that all this is for real and it’s happening. You woulda thought it gets easier the more times you do it, but it doesn’t.
Bill’s nose, the tissue that made up the full thickness of it, had been lopped off, and he now had no eyes and two almond-shaped holes where his nose used to be. His mouth – which was now a hole in the middle of a lake of exposed muscle – looked so little like a mouth, but it sometimes moved when he tried to mime out words that would come out as grunts instead. But that didn’t matter all too long, because he stopped the grunting and the miming when his vocal cords were out.
Bill, the man, the generous man with emptying insides and with no eyes, no nose, no mouth, who could not scream; who had no skin but the island of it on top of his head which made up the scalp that his hair grew out of like sprouting weeds; that man, Bill, existed here and there on the hospital bed, in pieces, pieces that were getting smaller, pieces made of tissue and organs that were going to be removed soon because some of it was starting to die while it was still on him, decaying and rotting like spoiled meat. Or at least that was what the doctors told him. But by then he couldn’t say or ask much.
I am not sure he woulda asked much of anything anyway.
Once, though, while he still had neck muscles and could still shake his head or nod it, this young lady, some girl from one of the colleges around here, had come and asked him if he really agreed to all of these donations – as in out of his own free will. Willful consent she had called it, or something like that. She was one of those activist types, looking for a cause, and Martha wouldn’t’ve let it happen if she’d been paying attention, but she had been spending a lot of time talking to the doctor about how Artimus was doing. Since it was just Bill and I and the lady and cause his neck muscles were still attached and working at the time, he would nod in agreement to whatever questions she asked.
Martha did find out later, and she was real pissed, you can bet on that. Pretty soon after that, Martha had the fortune of coming across the perfect candidate for the muscles in his neck, and Bill could nod and shake his head no more.
It was maybe 2 months when I saw him next, because I had the occasion to be in the hospital myself. Made it through, God bless, and I knew it had been a while since I had seen Bill, and… well, anyways, I had decided I better find myself paying my dues to make things even and all that. When I entered the room, it took me a good long minute to realize that there hadn’t been a mistake, and that I was in the right one.
Bill wasn’t there, you see.
Well, he was, but he wasn’t.
The bed had been removed from the room, the bed he had spent the large part of a year not moving from. A table, like one of those you’d see in a high school chemistry class, had been put where the bed was before. And on the table were a couple of large devices and a small transparent tub with some water, the tub with a brain sitting at the bottom of it like dead weight. And then I realized it’s not water in that tub, it’s one of those preserving solutions with nutrients and electrolytes and all that, one of those solutions meant to keep the brain alive, to keep the cells in there from dying like they’re supposed to when the brain isn’t connected to the rest of you. The nurse told me in a hushed and awed kinda voice that the rest of Bill had been donated, so generously, and wasn’t he just the most giving person you’ve met? and I couldn’t do that myself, but I have so much respect for him and for the people that do. I asked the nurse if Bill could think and if he would be able to tell that I came to visit, and she looked at me the same way the hospital lady sounded when I called her asked about the trials. No, I don’t think he can.
I stayed in the room a bit, kinda just looking at what was left of Bill. He was just a pink blob, with what looked like a maze carved into its surface. Bill was that blob (or he was in it somewhere) but either way he was an anchor at the bottom of the tub, kept alive by bathing in a liquid and being stimulated with electricity which came from a device on a timer to shock the cells so they wouldn’t die off from not being used, a blob whose body was everywhere and nowhere, a blob which was Bill’s or just Bill and who would stay sunk in this transparent solution until Kingdom Come.
Well, I turned out to be wrong about that last thing. I read in the Times later that week that he had given (with such generosity) the two halves of his brains, the “hemispheres” – like Bill’s brain was a globe, and I guess in a way it was – to the children.
Apparently – and maybe you know more about this than I do, given how folks your age are much more on the internet compared to folks my own – some kids can be born with half their brain missing. And most of the time, those kids – being younger than me and you both – have the ability to regenerate their brain since they’re so young. So the half of their brain that did develop is able to do the tasks that the missing part woulda done normally. You wouldn’t even be able to tell they were missing anything.
But sometimes, the kids aren’t alright, the one hemisphere can’t pick up the missing one’s slack, and those kids with half a brain act like you’d expect a half-brained kid to act. They’re in beds, on life support, and often bleeding their parents’ dry of their savings. Of course, the money isn’t the priority, but you gotta consider it anyway. Bill’s hemispheres, both the left and the right, were separated and placed in the skulls of two young girls who belonged to the second of the two groups and had been on life support since babies, and each of Bill’s hemispheres had been attached to the half of their brain that the young girls were born. Each operation had taken 36 hours and I read they had neurosurgeon on top of neurosurgeon, all wanting a hand in the girls’ heads and their names in their paper and their egos inflated. ‘The Times’ sat down with Martha Meags, the late wife of the generous Bill Meags. She describes the difficult decision Bill Meags had voiced to her in his final days: to donate the rest of his body to those who needed it most. ‘I had to come to peace with it,’ she told us, holding back tears. The picture on the paper showed a black and white Martha with a real solemn look on her face, like she was trynna be brave for everyone.
I can see you’re shaking real bad now. You can feel him, too, can’t you? This part is the worst part – the waiting, especially when he gets close. And he’s terribly close now, no more than a few minutes, but I think I got the time to piece it altogether for you, God willing.

Bill Meags was nothing if not a giving man.
He’d give you the shirt off his back, even if it was sewn right onto him!
This was a lifelong trait of his. In childhood, he stopped eating lunch once his mom stopped packing one for him and he had to start buying it at school. All it took was throwing a certain kinda look Bill’s way, or just making at him like you were going to ask him for his money, before he’d hand it over, not wanting to get in the way, he’d say, and he’d say it like he was apologizing, too.
That character never went away from Bill, no sirree. He was always real considerate, a sweetheart, especially to his parents – even though his dad saw him as a pushover (and another p word that doesn’t feel all that Christian for me to be repeating). I lived real close to him growing up, down the same block on Copperfield Drive, so we got all acquainted like kids that live close to each other at that age will do a lot of the time.
My bad, friend. I’m getting a bit lost in the weeds here, aren’t I? What I’m getting at is the generosity of Bill Meags, and why it is that you and I find ourselves in our situation at the present moment. You must be wondering about it, aren’t you? You seem like the curious type.
A few more things about Bill in those early years, first. Bill, you see, was always sharing his toys with his brothers back in those days. Not a birthday would go by – Bill’s birthday, I mean – where his brothers wouldn’t make out with at least half of his new toys stuffed in their greedy little pockets. Far as I know, this went on as long as he still had birthdays at home.
He was never real popular with the ladies either, when we got to that age where liking girls and their nice legs and nice smells went from gross to sweet. Bill was not a bad looking guy, but he was not a good looking one either. He was just there most of the time, as much as it pains me to say. He was just about decent at school, not an ivy league contender or anything like that, but better than you woulda expected out of a guy who was like Bill – a guy that was just there, who looks kinda like he’d fit better standing next to a potted plant or the wallpaper than around other people. I think him doing well in school made sense. He got the reps in. As in, he had been doing everyone’s homework for them. No one had threatened him, there was never anything like that.
The rumor that was floating around certain circles at our school was that if you asked Bill if he wouldn’t mind helping you with your homework, and you made it seem like it would be just the biggest fuss for you if you had to do any of it, he would tell you not to worry, that he would get it done, and he’d say it like he felt guilty that it wasn’t already done even though he just had it handed to him. Didn’t matter the subject, he’d do it. He always denied the rumor when I’d ask him about it, but I was pretty sure it was true, and I think he wouldn’t tell me because he didn’t wanna break up my peace of mind. So, yeah, I think he was alright at school because he was doing homework for classes he wasn’t even taking.
Me? I think it ended up being his helping his classmates with homework that led him to meeting Ana, a girl that took a real liking to Bill. Or maybe her name was Ava… it was something like that. Strange how time fades the clearness of your memories like they’re in a heavy fog, isn’t it? Well, in any case, Ava or Ana was a nice girl, and pretty, too, and she made her intentions real clear to Bill Meags, and that was unusual at the time, you see, for a girl to be that forward with a guy in the romantic sense. That was lucky for Bill, because I don’t think they woulda gone out if it wasn’t for her...
And they did go out. For a time, anyway. Until Brad Something-or-Other had come up to Bill one day and told him he thought Bill was such a nice guy, one of those real generous types, and Brad was acting all like he didn’t know that Ana (or maybe it was Ari?) was going steady with Bill, and he was really hamming it up and saying how it would be just swell to have the chance to go on a date with that cute girl from third period math. Brad was one of those guys, you’d know the type if you saw him, that made you wanna question the Creator when all your knowledge of what it meant to suffer was that you were stuck at home again with your parents on Saturday night. He was a complete jackass – there’s just no other word that works here – but he was also gifted by God and genetics and growth hormone to be a good-looking jackass. He was tall, a jock, and had a jawline that angled his face in a way that seemed to slide the looks that girls would give him into the rest of his face. What I’m getting at is that Brad could go on a date with anyone he wanted, and had gone one dates with anyone he wanted, “gotten down” with girls in higher social brackets compared to Bill’s girl. And he was too plugged into the social jungle that is high school to not have known they’d been going steady.
This is important, you see, because even though I can’t prove it, I believe deep down that Brad was pulling a prank on Bill. But Bill didn’t see it as a prank, and Bill agreed with Brad, telling him of course, you and Ana/Ava/Ari would make such a cute couple, you should go for it. Bill didn’t wanna impose on Brad, and he didn’t wanna get in the way of their potential future relationship, he told me later. Wouldn’t it just be awful, he said, if I were the reason they weren’t happy together? I can’t get in their way, I just can’t do that. That’d be just plain selfish of me.
Thing is, this was 8 months into their relationship, and he was as into her as one got at that age. But he didn’t want to be a bother, didn’t want to burden Brad-the-Tall-and-Chiseled-Jackass, didn’t want to get in the way or be an obstacle, so he stepped back, and Brad and Ava/Ana/Ari/Ash had gone on 3 dates before he forgot to wear a rubber on the third and knocked her up, and Bill was real outta their way when they both dropped out of school together to raise it. But Bill was heartbroken, he was, even though he’d never say it.
Ah, you don’t need to say anything for me to know what you’re thinking. I can see it in your face. I’ve been at it again. Rambling, haven’t I?
There is a point, I promise; a reason I’m telling you this and telling it to you the way I am. But we should fast forward a bit, shouldn’t we? Time is ticking, and midnight is getting closer, and I would like you to know why we’re here, hard as that might be from your perspective to believe.
So, fast forward some decades, and Bill’s married. His wife’s a presence of a woman named Martha. Now, lemme tell you, that Martha, she’s a force – both her and her mother.
Only reason Bill and Martha got married was because she asked him directly if he was planning to propose to her. Some 5 years into their relationship, that was. And Bill sure wasn’t going to tell her no, was he? That wasn’t in Bill’s nature. It was about that time, he told me after he broke the news of their nuptial plans, that I got myself good and married. Then, almost like it was just an afterthought, he added how he didn’t wanna annoy her, or make her feel all negative because he had struck the idea down, even if the answer woulda probably been not right now. So instead of saying not right now or let’s talk more about it he said yes, both right then and right there. She made him propose all formal with a ring, of course, but she was happy. Martha’s version of happy, anyways.
Now here come the newlyweds, and not 10 months later, out of Mrs. Martha Meags comes their first and their only, a boy they named Artimus. Bill had wanted to name him David, but Martha wanted to name him Artimus, so Bill and Martha named him Artimus. The child was adored, I can tell you that. Even after he started getting hard to be around since he was turning into one of those mopey teens with one of those mopey faces who always talks about how no one could ever understand them. Martha told Artimus he could do no wrong, and she told him that even after he started coming home in the back of a police cruiser. He started with shoplifting, getting caught wearing expensive shirts and sweaters under the oversized hoodie he’d always wear. But because he was underage, and since Martha had settled into one of those clerk jobs at the precinct office (and because she had come to know some of the fellas on the force), the young and troubled Artimus would often come back home after getting caught, at least in the beginning. You best believe I prayed for that kid every morning and every night. But God helps those who help themselves, my momma always used to say, God rest her.
Bill, at this point, had raised the idea of sending Artimus to a disciplinary school over the summer break. The way Martha reacted you’da thought you told her she needed to sacrifice Artimus in some pagan ritual. She would hear none of it. She said her son was one of those boys that came into his own a bit rougher and a bit later than the other boys, but it was because he was sensitive, and sensitive boys need extra coddling. Bill had thought about how he had been as a kid and felt his son woulda been one of the ones to ask him to do his homework if they’d been kids together. I guess this thought musta sparked something in him, because Bill didn’t back down off the jump and he raised the issue again with Martha. Or at least that’s how he told it to me. In any case, he said to her that he was concerned that one day Artimus wouldn’t come home in the back of a police car, that he wouldn’t come home at all, that instead the police officer would come to their home without Artimus and tell them that their son was dead or dying alone in some cold hospital bed. She went into hysterics, said that Bill was completely exaggerating, there would be no way that she would let her son go off canoodling with delinquents and murderers and rapists and thugs. And so off to the disciplinary school their dear Arty did not go, and into trouble their dear Arty stayed.
You can see I’m shaking now. I can tell it from the way you’re looking at me. It’s because he’s getting closer. But I think we’re still making good time, we should wrap up just as midnight comes. But no more dilly dallying – because he is getting closer. I can feel him, and I think you can too.
I think it started happening right around the time Bill had been in the running for a promotion. The guy right above him had been dropped by a heart attack at the ripe young age of 40. He survived it, but he was starting to take a good hard look at his priorities, as some men get to doing when they remember that the Almighty calls them back eventually. He decided he wasn’t spending enough time with his kids and wife and quit his job the day before his heart decided to permanently quit on him. So the position – Bill’s boss’s position – was open, and it paid pretty well, at least compared to what Bill was getting paid at the time, which was little more than peanuts. Didn’t matter how many times I told him, but Bill just wouldn’t ask for a raise. He didn’t want wanna offend his boss, or his boss’s boss, or make either think that Bill was ungrateful for his salary. That could hurt one of their feelings, maybe even both of their feelings, and the idea made Bill feel uncomfortable.
Right around the time Bill was in the running for the promotion, his boss’s boss got real sick. I heard it was something with his diabetes, but the short of it was that he needed a new kidney or he’d die. Estranged from his immediate family, as it happens, which is not the spot you wanna be in if you’re in the market for a new kidney. He was looking for donors in all the ways he could: taking out ads in the paper, putting up a billboard you’d see taking the ramp off the highway into downtown, hanging up flyers on the streets, all that.
Bill read the ad in the paper, and it just so happened that he has a compatible type of blood and kidney, and he knows this fact about himself. Martha knows it about him too, and she also knows that Bill has been up for that promotion. Martha asked Bill to donate his kidney to his boss’s boss, that Martha did. Bill didn’t wanna give away his kidney. But Martha wanted Bill to do just that, and after she contacted Bill’s boss’s boss, the man who paid Bill’s salary had wanted Bill to do just that, and Bill was not going to disappoint Martha or his boss’s boss, so just that was what Bill did.
That was just the beginning. It wasn’t long after they did the kidney removal – the scar was like a big smile that ran from his middle belly to his right hip like a real big gun holster – that Martha’s dear mom was the one who got real sick.
Ah, don’t move. You’re starting to slip a bit, let me tighten that for you.
Looks about right and good. Well, anyway, Martha’s mom was heavy handed with the bottle, that woman, and eventually consequences caught up with her actions as the good Lord makes right sure of, and she found herself looking down the barrel of life-threatening liver failure with the trigger half-pulled.
She would die if she didn’t get a new liver, or at least part of one. The doctor had explained to Bill and Martha near her mother’s room that livers were “adept” at regrowing themselves. Live liver transplants were becoming more common, he told them. You see where this is going, I think.
Martha had wanted Bill to give away a piece of his liver. Bill had not wanted to. But Martha had, and so had Martha’s mother, and so (I think) had the young doctor who wanted to impress the more senior doctor. And so Bill did.
The liver procedure was a bit more complicated than the kidney one. Bill was far from spring chicken territory, but he wasn’t that old – so they felt he would be safe to get a hunk of his liver taken out so soon after having the kidney removed. But he lost a lotta blood, Bill did, and the wound wasn’t healing as quick as they wanted. Eventually, not enough blood was making it to his kidney, the only one he had left, and so his left and only kidney died. The doctor recommended they remove it before it got infected and caused him more problems. They assured him that his kidney would be used for research, so they could help prevent this from happening in the future. To other patients, of course. Bill would be on dialysis for the rest of his life.
I went to visit Bill lots when he was in the hospital during that time. I was always the only familiar face to him around there. That would be the case until Artimus was a patient in the room next to him.
Artimus Meags, dear Arty to his mother Martha, had been drag racing in a car that did not belong to him. He told his mother dearest that he was going to study at his friend’s house, and Martha had believed Arty because Arty could do no wrong. Blood alcohol was twice the legal limit, and he was not the legal age, but he could do no wrong. He had crashed into a park tree, and they estimated he had been going about 98 miles per hour, give or take. The car was hugging the tree, and the picture they showed us made it look like one of those abstract metal art exhibits.
How he survived at all was a mystery to us. They found him pinned under the spear of a tree branch that jabbed into the driver’s side window, with his legs folded backwards and over his head at all these odd angles, and the jagged edges of the crumpled car door were drilled through both his arms like rows of nails through drywall. One of the doctors in the hallway had said loud enough for me to hear: Artimus’s legs came in mangled strips, tendon and bone and muscle all mushed together… indistinguishable, each one from the other. They counted the one blessing that Artimus had passed out early – either from the pain or the booze – and wouldn’t wake up until after the amputations. Amputations, more than one.
Artimus, dear Arty to his mother, no longer existed below the waist, beyond the left shoulder, above the right elbow.
At first, they were trying to save the left arm and the right upper arm if they could. The left arm, the doctors said, had some potential to recover, it was still getting blood and they might be able to salvage it. They said that on the first day. On the second day, the doctor had said pretty much everything except for what he was thinking, which was well, let’s just wait and see, that’s all we can do right now. On the third day, Jesus rose from the dead and Bill and Martha were told that surgery was the “mainstay of treatment for a gangrenous limb,” but please try not to worry too much because they were making big advancements in fake limbs, in prosthetics, and the quality of life for quadriplegics was getting better, they’re even doing trials on limb donations! Of course, these trials were in the early stages, but they were so grateful for their generous donors who gave so much so they could do such vital research. They said it was all above board, but when I got the chance some time later to actually look it up myself, I could find nothing at all about it online. When I called the hospital to ask them how the trials had gone, they acted like I was crazy. Can you believe that?
Anyway, as you can imagine, Martha jumped on that real quick, oh yes she did. Limb donations? Do y’all do them here? Bill had been so generous already, and, now turning her attention to Bill and cooing in a way that always made my skin crawl, oh, Bill, wouldn’t it be so wonderful if you could give the gift of walking to our son, to our baby boy, so that he could move his arms again, and grab at things again, and live his life again, like it’s all normal and this never happened. Oh, he was so young, wasn’t he? And you’ve lived a life, Bill, with those arms and those legs. Our Arty hasn’t.
Martha wanted Bill, the man with two less kidneys than you and me and a large chunk taken out of his liver, to donate his arms and his legs to their son. To Artimus, the boy who had moved only when he began to seize in his bed, who made no noise on purpose and whose breathing was being done by a machine that shoved oxygen through a tube down his throat, and whose eyes had to be taped down so they would not stay open and dry out because the part of his brain that gave his eyes the command to blink was asleep or dead.
Yes, Martha had wanted Bill to do this. Bill did not want to, but Bill smiled at Martha and said yes, Martha, because he just couldn’t tell her no. It’s the right thing to do, was his reason this time, which he gave me right before the operation when they were getting him ready (I was the only visitor; Martha was at Artimus’s bed). Besides, he added before they wheeled him away, I don’t want to make Martha feel sad, or make her feel like I don’t love our son. I would hate to let her down… I don’t want to let him down, either. I can handle living without my arms and my legs. I’ll adapt, and better I adapt to it than he does. I tried. I couldn’t get through to him, but I did try. So, then, he went with the folks in the scrubs, and that was the last time he was whole.
He was now without limbs, any of the four. His head sat atop his torso, and his torso atop his bed, and everything else had been sealed with some foam and some surgical duct tape. It was gonna be two surgeries, so they didn’t sew him back up on the first go. I was able to see through some of the foam packing they put on his stumps (the nurse didn’t do such a good job changing it, and Bill stayed silent because he was sure she was busy, even though he started leaking onto the bed), and I could see the sawed-off edge of bone splintered in uneven edges. I looked away right quick after that.
The next request came to Bill’s room pretty soon after that. It was sometime after Bill’s boss’s boss had decided to let Bill go from his position since he had taken off one too many days since he was in the hospital, and he thanked Bill for his years of service to the company. The requester was a lady who had overheard one of the nurses in the hallways talking about the remarkable and generous gift that the father had given the son. The mother of a young blind girl had come to Bill to ask him if he would be willing to donate his eyes and optic nerve, to give the gift of sight to the sightless, and she showed him a picture of her daughter, a young girl with blank sheets of snow for her eyes where the color shoulda been, and Martha had started weeping and saying that of course Bill could, and the doctor at the door who had overheard was saying that he had never seen such generosity from one man and Bill did not wanna give off the impression that he didn’t care about the girl like he was an uncaring type of person, and he didn’t want them to think that he wasn’t open to their thoughts on the best use of his eyes and optic nerve – and, he said to me before the operation, is it really all that fair for me to have my eyes and the nerve that lets me see if that girl can’t? Do I deserve them any more than she does? That’s what he told me, anyway. But I knew better, I knew Bill said yes because Martha wanted it, and the girl’s Mom wanted it, and the doctor wanted it, and it no longer mattered what Bill wanted, or maybe it hadn’t mattered for a while now, maybe ever, so Bill’s eyes had been scooped out, the space around his optic nerve taken out to remove it in one full piece, and the girl saw out of Bill’s eyes, and Bill saw out of no one’s.
By then, news had traveled quick. Local news first picked the story up, and larger media outlets megaphoned it out, and now there were hundreds of people showing up to Bill’s room in a single day, Bill unable to talk to them all but unable to get up and leave either. The hospital set up official lines and rules for these visitors – they gotta line up in this line or the other, fill out the official appeals form, circle on the diagram which part of the body they are in need of and from which body system, and give a response to: In 200 words or less, explain why Mr. Bill Meags, the always generous Mr. Bill Meags, should donate his organ/tissue to you or your loved one? Bill, unable to read and write because he didn’t have the eyes to read or the arms to write, gave complete medical decision-making power to Martha and the doctors. He hadn’t wanted to, but he had been asked – Martha the one doing the asking – and it seemed to him it would really ruffle her feathers, maybe even cross into inconvenient, if he said no, so he said yes.
His skin was given to a 44-year-old firefighter who had saved a child from a burning building. His skin had melted clean off, several layers of it.
Burn pains hurt. One of the worst pains you can experience, did you know that? All touch becomes real painful, a light breeze sets your nerves on fire, the cloth of your bedsheets feels like fire ants marching and you can’t shake them off because they’re a part of you.
But once the firefighter started wearing his new skin – the skin that they had cut off Bill like the pelt of an animal – he no longer felt the fire on his nerve endings or the ants crawling around anymore. They were Bill’s now, and for Bill, every second was agony. He never said so to anyone, and he never screamed, but he did tell me once when he was floating on a cloud made of morphine that he felt like screaming a lot of the time but didn’t wanna make too much noise. That could disturb the other folks here. I don’t wanna stop anyone from healing.
His right lung came out next, this one given to one of our state’s senators. The politician, one of those folks who make a real career out of politics and campaigning, got cancer in his lungs after smoking like a chimney his whole life, but he was running for a fourth term and he wasn’t ready to meet his Creator, so they took out his bad lungs and gave him one of Bill’s good ones. The senator was 75 years old, two full decades Bill’s senior, but that didn’t matter, of course. The senator’s third wife had pleaded to Martha, and Martha had said yes and of course and Bill was a patriot and Bill always followed their campaigns the most close out of anyone and so that was that and Bill’s chest had been opened and out came his lung. They took out the lung all the way to the place it forked into his throat, and I know that because they left his chest opened, they didn’t sew him back up, so it would make the next operation easier to do, the doctors told us. I sat by the bed afterwards – it happened too quick this time, and there wasn’t enough time between the agreement and the operation for me to see him off – and he told me, in between real deep gasps he had to take even with the tubes forcing oxygen into his nose and only lung, that even though it was ‘an adjustment’ to breathe now, he woulda felt like just the worst if he went ahead and said ‘no, I’d like to keep my lung, thank you.’ But he couldn’t do that to Martha, he said, or to the senator or to the senator’s third wife (who the senator had ended up divorcing not two months later after he was caught in bed with a different woman. He won his fourth term). Besides, what right do I really have to my lung? At least I have the other one.
Until he didn’t, of course. But by then I had started losing track of which parts were being given to which people, especially with Martha doing all the approvals herself. Next to go was Bill’s mouth, which made conversations much more one-sided. They had gone ahead and removed both the top and the bottom rows of teeth in Bill’s mouth. The bottom row of teeth was removed with the jawbone, all in one piece, but I’m not real sure what they needed his jaw for. But they musta decided to take out the tongue while they were in there too, maybe so it wouldn’t just be hanging out of his face all the time like he was a dog dying of thirst. They sliced the tongue out, and when Bill would try and talk you could see the little sutures tied in the back of what was left of his tongue and it looked like barbed wire that was waving at you.
Much of those days were foggy, and it wasn’t long after that when I stopped going to visit Bill for a while, for which I hope to be forgiven when I get to the Pearly Gates. I couldn’t right stand it, see? It was becoming more and more difficult to see less and less of him. But Bill, silent and unmoving, was becoming an eyesore. They had started removing his muscles and some of the other bones in his face by the time I stopped coming to see him most days. One by one, his face started missing features, and that’s why Bill started to look less human and more like a slab of raw meat that got stuck in the gears of a slaughterhouse grinder. His head had become a skull with some of the muscles still attached in spots, muscles that would move like a pulley and lever system when he’d react to something because you could see them shrinking and contracting against each other. That was the only way you could tell he could still hear you because his eyes were scooped out of his head like they were two spoonfuls of ice cream, and his teeth and tongue were missing and his jaw was missing and the entire base of his head was missing except for the part that was attached to his torso, and the head was the only thing attached to that torso, it was. Not a pretty sight. I couldn’t right stand it.
Sorry, friend, guess I didn’t ask if you were the squeamish type. But… I’m getting used to the idea that it won’t matter if you are for too long, and that all this is for real and it’s happening. You woulda thought it gets easier the more times you do it, but it doesn’t.
Bill’s nose, the tissue that made up the full thickness of it, had been lopped off, and he now had no eyes and two almond-shaped holes where his nose used to be. His mouth – which was now a hole in the middle of a lake of exposed muscle – looked so little like a mouth, but it sometimes moved when he tried to mime out words that would come out as grunts instead. But that didn’t matter all too long, because he stopped the grunting and the miming when his vocal cords were out.
Bill, the man, the generous man with emptying insides and with no eyes, no nose, no mouth, who could not scream; who had no skin but the island of it on top of his head which made up the scalp that his hair grew out of like sprouting weeds; that man, Bill, existed here and there on the hospital bed, in pieces, pieces that were getting smaller, pieces made of tissue and organs that were going to be removed soon because some of it was starting to die while it was still on him, decaying and rotting like spoiled meat. Or at least that was what the doctors told him. But by then he couldn’t say or ask much.
I am not sure he woulda asked much of anything anyway.
Once, though, while he still had neck muscles and could still shake his head or nod it, this young lady, some girl from one of the colleges around here, had come and asked him if he really agreed to all of these donations – as in out of his own free will. Willful consent she had called it, or something like that. She was one of those activist types, looking for a cause, and Martha wouldn’t’ve let it happen if she’d been paying attention, but she had been spending a lot of time talking to the doctor about how Artimus was doing. Since it was just Bill and I and the lady and cause his neck muscles were still attached and working at the time, he would nod in agreement to whatever questions she asked.
Martha did find out later, and she was real pissed, you can bet on that. Pretty soon after that, Martha had the fortune of coming across the perfect candidate for the muscles in his neck, and Bill could nod and shake his head no more.
It was maybe 2 months when I saw him next, because I had the occasion to be in the hospital myself. Made it through, God bless, and I knew it had been a while since I had seen Bill, and… well, anyways, I had decided I better find myself paying my dues to make things even and all that. When I entered the room, it took me a good long minute to realize that there hadn’t been a mistake, and that I was in the right one.
Bill wasn’t there, you see.
Well, he was, but he wasn’t.
The bed had been removed from the room, the bed he had spent the large part of a year not moving from. A table, like one of those you’d see in a high school chemistry class, had been put where the bed was before. And on the table were a couple of large devices and a small transparent tub with some water, the tub with a brain sitting at the bottom of it like dead weight. And then I realized it’s not water in that tub, it’s one of those preserving solutions with nutrients and electrolytes and all that, one of those solutions meant to keep the brain alive, to keep the cells in there from dying like they’re supposed to when the brain isn’t connected to the rest of you. The nurse told me in a hushed and awed kinda voice that the rest of Bill had been donated, so generously, and wasn’t he just the most giving person you’ve met? and I couldn’t do that myself, but I have so much respect for him and for the people that do. I asked the nurse if Bill could think and if he would be able to tell that I came to visit, and she looked at me the same way the hospital lady sounded when I called her asked about the trials. No, I don’t think he can.
I stayed in the room a bit, kinda just looking at what was left of Bill. He was just a pink blob, with what looked like a maze carved into its surface. Bill was that blob (or he was in it somewhere) but either way he was an anchor at the bottom of the tub, kept alive by bathing in a liquid and being stimulated with electricity which came from a device on a timer to shock the cells so they wouldn’t die off from not being used, a blob whose body was everywhere and nowhere, a blob which was Bill’s or just Bill and who would stay sunk in this transparent solution until Kingdom Come.
Well, I turned out to be wrong about that last thing. I read in the Times later that week that he had given (with such generosity) the two halves of his brains, the “hemispheres” – like Bill’s brain was a globe, and I guess in a way it was – to the children.
Apparently – and maybe you know more about this than I do, given how folks your age are much more on the internet compared to folks my own – some kids can be born with half their brain missing. And most of the time, those kids – being younger than me and you both – have the ability to regenerate their brain since they’re so young. So the half of their brain that did develop is able to do the tasks that the missing part woulda done normally. You wouldn’t even be able to tell they were missing anything.
But sometimes, the kids aren’t alright, the one hemisphere can’t pick up the missing one’s slack, and those kids with half a brain act like you’d expect a half-brained kid to act. They’re in beds, on life support, and often bleeding their parents’ dry of their savings. Of course, the money isn’t the priority, but you gotta consider it anyway. Bill’s hemispheres, both the left and the right, were separated and placed in the skulls of two young girls who belonged to the second of the two groups and had been on life support since babies, and each of Bill’s hemispheres had been attached to the half of their brain that the young girls were born. Each operation had taken 36 hours and I read they had neurosurgeon on top of neurosurgeon, all wanting a hand in the girls’ heads and their names in their paper and their egos inflated. ‘The Times’ sat down with Martha Meags, the late wife of the generous Bill Meags. She describes the difficult decision Bill Meags had voiced to her in his final days: to donate the rest of his body to those who needed it most. ‘I had to come to peace with it,’ she told us, holding back tears. The picture on the paper showed a black and white Martha with a real solemn look on her face, like she was trynna be brave for everyone.
I can see you’re shaking real bad now. You can feel him, too, can’t you? This part is the worst part – the waiting, especially when he gets close. And he’s terribly close now, no more than a few minutes, but I think I got the time to piece it altogether for you, God willing.

Bill Meags was nothing if not a giving man.
He’d give you the shirt off his back, even if it was sewn right onto him!
This was a lifelong trait of his. In childhood, he stopped eating lunch once his mom stopped packing one for him and he had to start buying it at school. All it took was throwing a certain kinda look Bill’s way, or just making at him like you were going to ask him for his money, before he’d hand it over, not wanting to get in the way, he’d say, and he’d say it like he was apologizing, too.
That character never went away from Bill, no sirree. He was always real considerate, a sweetheart, especially to his parents – even though his dad saw him as a pushover (and another p word that doesn’t feel all that Christian for me to be repeating). I lived real close to him growing up, down the same block on Copperfield Drive, so we got all acquainted like kids that live close to each other at that age will do a lot of the time.
My bad, friend. I’m getting a bit lost in the weeds here, aren’t I? What I’m getting at is the generosity of Bill Meags, and why it is that you and I find ourselves in our situation at the present moment. You must be wondering about it, aren’t you? You seem like the curious type.
A few more things about Bill in those early years, first. Bill, you see, was always sharing his toys with his brothers back in those days. Not a birthday would go by – Bill’s birthday, I mean – where his brothers wouldn’t make out with at least half of his new toys stuffed in their greedy little pockets. Far as I know, this went on as long as he still had birthdays at home.
He was never real popular with the ladies either, when we got to that age where liking girls and their nice legs and nice smells went from gross to sweet. Bill was not a bad looking guy, but he was not a good looking one either. He was just there most of the time, as much as it pains me to say. He was just about decent at school, not an ivy league contender or anything like that, but better than you woulda expected out of a guy who was like Bill – a guy that was just there, who looks kinda like he’d fit better standing next to a potted plant or the wallpaper than around other people. I think him doing well in school made sense. He got the reps in. As in, he had been doing everyone’s homework for them. No one had threatened him, there was never anything like that.
The rumor that was floating around certain circles at our school was that if you asked Bill if he wouldn’t mind helping you with your homework, and you made it seem like it would be just the biggest fuss for you if you had to do any of it, he would tell you not to worry, that he would get it done, and he’d say it like he felt guilty that it wasn’t already done even though he just had it handed to him. Didn’t matter the subject, he’d do it. He always denied the rumor when I’d ask him about it, but I was pretty sure it was true, and I think he wouldn’t tell me because he didn’t wanna break up my peace of mind. So, yeah, I think he was alright at school because he was doing homework for classes he wasn’t even taking.
Me? I think it ended up being his helping his classmates with homework that led him to meeting Ana, a girl that took a real liking to Bill. Or maybe her name was Ava… it was something like that. Strange how time fades the clearness of your memories like they’re in a heavy fog, isn’t it? Well, in any case, Ava or Ana was a nice girl, and pretty, too, and she made her intentions real clear to Bill Meags, and that was unusual at the time, you see, for a girl to be that forward with a guy in the romantic sense. That was lucky for Bill, because I don’t think they woulda gone out if it wasn’t for her...
And they did go out. For a time, anyway. Until Brad Something-or-Other had come up to Bill one day and told him he thought Bill was such a nice guy, one of those real generous types, and Brad was acting all like he didn’t know that Ana (or maybe it was Ari?) was going steady with Bill, and he was really hamming it up and saying how it would be just swell to have the chance to go on a date with that cute girl from third period math. Brad was one of those guys, you’d know the type if you saw him, that made you wanna question the Creator when all your knowledge of what it meant to suffer was that you were stuck at home again with your parents on Saturday night. He was a complete jackass – there’s just no other word that works here – but he was also gifted by God and genetics and growth hormone to be a good-looking jackass. He was tall, a jock, and had a jawline that angled his face in a way that seemed to slide the looks that girls would give him into the rest of his face. What I’m getting at is that Brad could go on a date with anyone he wanted, and had gone one dates with anyone he wanted, “gotten down” with girls in higher social brackets compared to Bill’s girl. And he was too plugged into the social jungle that is high school to not have known they’d been going steady.
This is important, you see, because even though I can’t prove it, I believe deep down that Brad was pulling a prank on Bill. But Bill didn’t see it as a prank, and Bill agreed with Brad, telling him of course, you and Ana/Ava/Ari would make such a cute couple, you should go for it. Bill didn’t wanna impose on Brad, and he didn’t wanna get in the way of their potential future relationship, he told me later. Wouldn’t it just be awful, he said, if I were the reason they weren’t happy together? I can’t get in their way, I just can’t do that. That’d be just plain selfish of me.
Thing is, this was 8 months into their relationship, and he was as into her as one got at that age. But he didn’t want to be a bother, didn’t want to burden Brad-the-Tall-and-Chiseled-Jackass, didn’t want to get in the way or be an obstacle, so he stepped back, and Brad and Ava/Ana/Ari/Ash had gone on 3 dates before he forgot to wear a rubber on the third and knocked her up, and Bill was real outta their way when they both dropped out of school together to raise it. But Bill was heartbroken, he was, even though he’d never say it.
Ah, you don’t need to say anything for me to know what you’re thinking. I can see it in your face. I’ve been at it again. Rambling, haven’t I?
There is a point, I promise; a reason I’m telling you this and telling it to you the way I am. But we should fast forward a bit, shouldn’t we? Time is ticking, and midnight is getting closer, and I would like you to know why we’re here, hard as that might be from your perspective to believe.
So, fast forward some decades, and Bill’s married. His wife’s a presence of a woman named Martha. Now, lemme tell you, that Martha, she’s a force – both her and her mother.
Only reason Bill and Martha got married was because she asked him directly if he was planning to propose to her. Some 5 years into their relationship, that was. And Bill sure wasn’t going to tell her no, was he? That wasn’t in Bill’s nature. It was about that time, he told me after he broke the news of their nuptial plans, that I got myself good and married. Then, almost like it was just an afterthought, he added how he didn’t wanna annoy her, or make her feel all negative because he had struck the idea down, even if the answer woulda probably been not right now. So instead of saying not right now or let’s talk more about it he said yes, both right then and right there. She made him propose all formal with a ring, of course, but she was happy. Martha’s version of happy, anyways.
Now here come the newlyweds, and not 10 months later, out of Mrs. Martha Meags comes their first and their only, a boy they named Artimus. Bill had wanted to name him David, but Martha wanted to name him Artimus, so Bill and Martha named him Artimus. The child was adored, I can tell you that. Even after he started getting hard to be around since he was turning into one of those mopey teens with one of those mopey faces who always talks about how no one could ever understand them. Martha told Artimus he could do no wrong, and she told him that even after he started coming home in the back of a police cruiser. He started with shoplifting, getting caught wearing expensive shirts and sweaters under the oversized hoodie he’d always wear. But because he was underage, and since Martha had settled into one of those clerk jobs at the precinct office (and because she had come to know some of the fellas on the force), the young and troubled Artimus would often come back home after getting caught, at least in the beginning. You best believe I prayed for that kid every morning and every night. But God helps those who help themselves, my momma always used to say, God rest her.
Bill, at this point, had raised the idea of sending Artimus to a disciplinary school over the summer break. The way Martha reacted you’da thought you told her she needed to sacrifice Artimus in some pagan ritual. She would hear none of it. She said her son was one of those boys that came into his own a bit rougher and a bit later than the other boys, but it was because he was sensitive, and sensitive boys need extra coddling. Bill had thought about how he had been as a kid and felt his son woulda been one of the ones to ask him to do his homework if they’d been kids together. I guess this thought musta sparked something in him, because Bill didn’t back down off the jump and he raised the issue again with Martha. Or at least that’s how he told it to me. In any case, he said to her that he was concerned that one day Artimus wouldn’t come home in the back of a police car, that he wouldn’t come home at all, that instead the police officer would come to their home without Artimus and tell them that their son was dead or dying alone in some cold hospital bed. She went into hysterics, said that Bill was completely exaggerating, there would be no way that she would let her son go off canoodling with delinquents and murderers and rapists and thugs. And so off to the disciplinary school their dear Arty did not go, and into trouble their dear Arty stayed.
You can see I’m shaking now. I can tell it from the way you’re looking at me. It’s because he’s getting closer. But I think we’re still making good time, we should wrap up just as midnight comes. But no more dilly dallying – because he is getting closer. I can feel him, and I think you can too.
I think it started happening right around the time Bill had been in the running for a promotion. The guy right above him had been dropped by a heart attack at the ripe young age of 40. He survived it, but he was starting to take a good hard look at his priorities, as some men get to doing when they remember that the Almighty calls them back eventually. He decided he wasn’t spending enough time with his kids and wife and quit his job the day before his heart decided to permanently quit on him. So the position – Bill’s boss’s position – was open, and it paid pretty well, at least compared to what Bill was getting paid at the time, which was little more than peanuts. Didn’t matter how many times I told him, but Bill just wouldn’t ask for a raise. He didn’t want wanna offend his boss, or his boss’s boss, or make either think that Bill was ungrateful for his salary. That could hurt one of their feelings, maybe even both of their feelings, and the idea made Bill feel uncomfortable.
Right around the time Bill was in the running for the promotion, his boss’s boss got real sick. I heard it was something with his diabetes, but the short of it was that he needed a new kidney or he’d die. Estranged from his immediate family, as it happens, which is not the spot you wanna be in if you’re in the market for a new kidney. He was looking for donors in all the ways he could: taking out ads in the paper, putting up a billboard you’d see taking the ramp off the highway into downtown, hanging up flyers on the streets, all that.
Bill read the ad in the paper, and it just so happened that he has a compatible type of blood and kidney, and he knows this fact about himself. Martha knows it about him too, and she also knows that Bill has been up for that promotion. Martha asked Bill to donate his kidney to his boss’s boss, that Martha did. Bill didn’t wanna give away his kidney. But Martha wanted Bill to do just that, and after she contacted Bill’s boss’s boss, the man who paid Bill’s salary had wanted Bill to do just that, and Bill was not going to disappoint Martha or his boss’s boss, so just that was what Bill did.
That was just the beginning. It wasn’t long after they did the kidney removal – the scar was like a big smile that ran from his middle belly to his right hip like a real big gun holster – that Martha’s dear mom was the one who got real sick.
Ah, don’t move. You’re starting to slip a bit, let me tighten that for you.
Looks about right and good. Well, anyway, Martha’s mom was heavy handed with the bottle, that woman, and eventually consequences caught up with her actions as the good Lord makes right sure of, and she found herself looking down the barrel of life-threatening liver failure with the trigger half-pulled.
She would die if she didn’t get a new liver, or at least part of one. The doctor had explained to Bill and Martha near her mother’s room that livers were “adept” at regrowing themselves. Live liver transplants were becoming more common, he told them. You see where this is going, I think.
Martha had wanted Bill to give away a piece of his liver. Bill had not wanted to. But Martha had, and so had Martha’s mother, and so (I think) had the young doctor who wanted to impress the more senior doctor. And so Bill did.
The liver procedure was a bit more complicated than the kidney one. Bill was far from spring chicken territory, but he wasn’t that old – so they felt he would be safe to get a hunk of his liver taken out so soon after having the kidney removed. But he lost a lotta blood, Bill did, and the wound wasn’t healing as quick as they wanted. Eventually, not enough blood was making it to his kidney, the only one he had left, and so his left and only kidney died. The doctor recommended they remove it before it got infected and caused him more problems. They assured him that his kidney would be used for research, so they could help prevent this from happening in the future. To other patients, of course. Bill would be on dialysis for the rest of his life.
I went to visit Bill lots when he was in the hospital during that time. I was always the only familiar face to him around there. That would be the case until Artimus was a patient in the room next to him.
Artimus Meags, dear Arty to his mother Martha, had been drag racing in a car that did not belong to him. He told his mother dearest that he was going to study at his friend’s house, and Martha had believed Arty because Arty could do no wrong. Blood alcohol was twice the legal limit, and he was not the legal age, but he could do no wrong. He had crashed into a park tree, and they estimated he had been going about 98 miles per hour, give or take. The car was hugging the tree, and the picture they showed us made it look like one of those abstract metal art exhibits.
How he survived at all was a mystery to us. They found him pinned under the spear of a tree branch that jabbed into the driver’s side window, with his legs folded backwards and over his head at all these odd angles, and the jagged edges of the crumpled car door were drilled through both his arms like rows of nails through drywall. One of the doctors in the hallway had said loud enough for me to hear: Artimus’s legs came in mangled strips, tendon and bone and muscle all mushed together… indistinguishable, each one from the other. They counted the one blessing that Artimus had passed out early – either from the pain or the booze – and wouldn’t wake up until after the amputations. Amputations, more than one.
Artimus, dear Arty to his mother, no longer existed below the waist, beyond the left shoulder, above the right elbow.
At first, they were trying to save the left arm and the right upper arm if they could. The left arm, the doctors said, had some potential to recover, it was still getting blood and they might be able to salvage it. They said that on the first day. On the second day, the doctor had said pretty much everything except for what he was thinking, which was well, let’s just wait and see, that’s all we can do right now. On the third day, Jesus rose from the dead and Bill and Martha were told that surgery was the “mainstay of treatment for a gangrenous limb,” but please try not to worry too much because they were making big advancements in fake limbs, in prosthetics, and the quality of life for quadriplegics was getting better, they’re even doing trials on limb donations! Of course, these trials were in the early stages, but they were so grateful for their generous donors who gave so much so they could do such vital research. They said it was all above board, but when I got the chance some time later to actually look it up myself, I could find nothing at all about it online. When I called the hospital to ask them how the trials had gone, they acted like I was crazy. Can you believe that?
Anyway, as you can imagine, Martha jumped on that real quick, oh yes she did. Limb donations? Do y’all do them here? Bill had been so generous already, and, now turning her attention to Bill and cooing in a way that always made my skin crawl, oh, Bill, wouldn’t it be so wonderful if you could give the gift of walking to our son, to our baby boy, so that he could move his arms again, and grab at things again, and live his life again, like it’s all normal and this never happened. Oh, he was so young, wasn’t he? And you’ve lived a life, Bill, with those arms and those legs. Our Arty hasn’t.
Martha wanted Bill, the man with two less kidneys than you and me and a large chunk taken out of his liver, to donate his arms and his legs to their son. To Artimus, the boy who had moved only when he began to seize in his bed, who made no noise on purpose and whose breathing was being done by a machine that shoved oxygen through a tube down his throat, and whose eyes had to be taped down so they would not stay open and dry out because the part of his brain that gave his eyes the command to blink was asleep or dead.
Yes, Martha had wanted Bill to do this. Bill did not want to, but Bill smiled at Martha and said yes, Martha, because he just couldn’t tell her no. It’s the right thing to do, was his reason this time, which he gave me right before the operation when they were getting him ready (I was the only visitor; Martha was at Artimus’s bed). Besides, he added before they wheeled him away, I don’t want to make Martha feel sad, or make her feel like I don’t love our son. I would hate to let her down… I don’t want to let him down, either. I can handle living without my arms and my legs. I’ll adapt, and better I adapt to it than he does. I tried. I couldn’t get through to him, but I did try. So, then, he went with the folks in the scrubs, and that was the last time he was whole.
He was now without limbs, any of the four. His head sat atop his torso, and his torso atop his bed, and everything else had been sealed with some foam and some surgical duct tape. It was gonna be two surgeries, so they didn’t sew him back up on the first go. I was able to see through some of the foam packing they put on his stumps (the nurse didn’t do such a good job changing it, and Bill stayed silent because he was sure she was busy, even though he started leaking onto the bed), and I could see the sawed-off edge of bone splintered in uneven edges. I looked away right quick after that.
The next request came to Bill’s room pretty soon after that. It was sometime after Bill’s boss’s boss had decided to let Bill go from his position since he had taken off one too many days since he was in the hospital, and he thanked Bill for his years of service to the company. The requester was a lady who had overheard one of the nurses in the hallways talking about the remarkable and generous gift that the father had given the son. The mother of a young blind girl had come to Bill to ask him if he would be willing to donate his eyes and optic nerve, to give the gift of sight to the sightless, and she showed him a picture of her daughter, a young girl with blank sheets of snow for her eyes where the color shoulda been, and Martha had started weeping and saying that of course Bill could, and the doctor at the door who had overheard was saying that he had never seen such generosity from one man and Bill did not wanna give off the impression that he didn’t care about the girl like he was an uncaring type of person, and he didn’t want them to think that he wasn’t open to their thoughts on the best use of his eyes and optic nerve – and, he said to me before the operation, is it really all that fair for me to have my eyes and the nerve that lets me see if that girl can’t? Do I deserve them any more than she does? That’s what he told me, anyway. But I knew better, I knew Bill said yes because Martha wanted it, and the girl’s Mom wanted it, and the doctor wanted it, and it no longer mattered what Bill wanted, or maybe it hadn’t mattered for a while now, maybe ever, so Bill’s eyes had been scooped out, the space around his optic nerve taken out to remove it in one full piece, and the girl saw out of Bill’s eyes, and Bill saw out of no one’s.
By then, news had traveled quick. Local news first picked the story up, and larger media outlets megaphoned it out, and now there were hundreds of people showing up to Bill’s room in a single day, Bill unable to talk to them all but unable to get up and leave either. The hospital set up official lines and rules for these visitors – they gotta line up in this line or the other, fill out the official appeals form, circle on the diagram which part of the body they are in need of and from which body system, and give a response to: In 200 words or less, explain why Mr. Bill Meags, the always generous Mr. Bill Meags, should donate his organ/tissue to you or your loved one? Bill, unable to read and write because he didn’t have the eyes to read or the arms to write, gave complete medical decision-making power to Martha and the doctors. He hadn’t wanted to, but he had been asked – Martha the one doing the asking – and it seemed to him it would really ruffle her feathers, maybe even cross into inconvenient, if he said no, so he said yes.
His skin was given to a 44-year-old firefighter who had saved a child from a burning building. His skin had melted clean off, several layers of it.
Burn pains hurt. One of the worst pains you can experience, did you know that? All touch becomes real painful, a light breeze sets your nerves on fire, the cloth of your bedsheets feels like fire ants marching and you can’t shake them off because they’re a part of you.
But once the firefighter started wearing his new skin – the skin that they had cut off Bill like the pelt of an animal – he no longer felt the fire on his nerve endings or the ants crawling around anymore. They were Bill’s now, and for Bill, every second was agony. He never said so to anyone, and he never screamed, but he did tell me once when he was floating on a cloud made of morphine that he felt like screaming a lot of the time but didn’t wanna make too much noise. That could disturb the other folks here. I don’t wanna stop anyone from healing.
His right lung came out next, this one given to one of our state’s senators. The politician, one of those folks who make a real career out of politics and campaigning, got cancer in his lungs after smoking like a chimney his whole life, but he was running for a fourth term and he wasn’t ready to meet his Creator, so they took out his bad lungs and gave him one of Bill’s good ones. The senator was 75 years old, two full decades Bill’s senior, but that didn’t matter, of course. The senator’s third wife had pleaded to Martha, and Martha had said yes and of course and Bill was a patriot and Bill always followed their campaigns the most close out of anyone and so that was that and Bill’s chest had been opened and out came his lung. They took out the lung all the way to the place it forked into his throat, and I know that because they left his chest opened, they didn’t sew him back up, so it would make the next operation easier to do, the doctors told us. I sat by the bed afterwards – it happened too quick this time, and there wasn’t enough time between the agreement and the operation for me to see him off – and he told me, in between real deep gasps he had to take even with the tubes forcing oxygen into his nose and only lung, that even though it was ‘an adjustment’ to breathe now, he woulda felt like just the worst if he went ahead and said ‘no, I’d like to keep my lung, thank you.’ But he couldn’t do that to Martha, he said, or to the senator or to the senator’s third wife (who the senator had ended up divorcing not two months later after he was caught in bed with a different woman. He won his fourth term). Besides, what right do I really have to my lung? At least I have the other one.
Until he didn’t, of course. But by then I had started losing track of which parts were being given to which people, especially with Martha doing all the approvals herself. Next to go was Bill’s mouth, which made conversations much more one-sided. They had gone ahead and removed both the top and the bottom rows of teeth in Bill’s mouth. The bottom row of teeth was removed with the jawbone, all in one piece, but I’m not real sure what they needed his jaw for. But they musta decided to take out the tongue while they were in there too, maybe so it wouldn’t just be hanging out of his face all the time like he was a dog dying of thirst. They sliced the tongue out, and when Bill would try and talk you could see the little sutures tied in the back of what was left of his tongue and it looked like barbed wire that was waving at you.
Much of those days were foggy, and it wasn’t long after that when I stopped going to visit Bill for a while, for which I hope to be forgiven when I get to the Pearly Gates. I couldn’t right stand it, see? It was becoming more and more difficult to see less and less of him. But Bill, silent and unmoving, was becoming an eyesore. They had started removing his muscles and some of the other bones in his face by the time I stopped coming to see him most days. One by one, his face started missing features, and that’s why Bill started to look less human and more like a slab of raw meat that got stuck in the gears of a slaughterhouse grinder. His head had become a skull with some of the muscles still attached in spots, muscles that would move like a pulley and lever system when he’d react to something because you could see them shrinking and contracting against each other. That was the only way you could tell he could still hear you because his eyes were scooped out of his head like they were two spoonfuls of ice cream, and his teeth and tongue were missing and his jaw was missing and the entire base of his head was missing except for the part that was attached to his torso, and the head was the only thing attached to that torso, it was. Not a pretty sight. I couldn’t right stand it.
Sorry, friend, guess I didn’t ask if you were the squeamish type. But… I’m getting used to the idea that it won’t matter if you are for too long, and that all this is for real and it’s happening. You woulda thought it gets easier the more times you do it, but it doesn’t.
Bill’s nose, the tissue that made up the full thickness of it, had been lopped off, and he now had no eyes and two almond-shaped holes where his nose used to be. His mouth – which was now a hole in the middle of a lake of exposed muscle – looked so little like a mouth, but it sometimes moved when he tried to mime out words that would come out as grunts instead. But that didn’t matter all too long, because he stopped the grunting and the miming when his vocal cords were out.
Bill, the man, the generous man with emptying insides and with no eyes, no nose, no mouth, who could not scream; who had no skin but the island of it on top of his head which made up the scalp that his hair grew out of like sprouting weeds; that man, Bill, existed here and there on the hospital bed, in pieces, pieces that were getting smaller, pieces made of tissue and organs that were going to be removed soon because some of it was starting to die while it was still on him, decaying and rotting like spoiled meat. Or at least that was what the doctors told him. But by then he couldn’t say or ask much.
I am not sure he woulda asked much of anything anyway.
Once, though, while he still had neck muscles and could still shake his head or nod it, this young lady, some girl from one of the colleges around here, had come and asked him if he really agreed to all of these donations – as in out of his own free will. Willful consent she had called it, or something like that. She was one of those activist types, looking for a cause, and Martha wouldn’t’ve let it happen if she’d been paying attention, but she had been spending a lot of time talking to the doctor about how Artimus was doing. Since it was just Bill and I and the lady and cause his neck muscles were still attached and working at the time, he would nod in agreement to whatever questions she asked.
Martha did find out later, and she was real pissed, you can bet on that. Pretty soon after that, Martha had the fortune of coming across the perfect candidate for the muscles in his neck, and Bill could nod and shake his head no more.
It was maybe 2 months when I saw him next, because I had the occasion to be in the hospital myself. Made it through, God bless, and I knew it had been a while since I had seen Bill, and… well, anyways, I had decided I better find myself paying my dues to make things even and all that. When I entered the room, it took me a good long minute to realize that there hadn’t been a mistake, and that I was in the right one.
Bill wasn’t there, you see.
Well, he was, but he wasn’t.
The bed had been removed from the room, the bed he had spent the large part of a year not moving from. A table, like one of those you’d see in a high school chemistry class, had been put where the bed was before. And on the table were a couple of large devices and a small transparent tub with some water, the tub with a brain sitting at the bottom of it like dead weight. And then I realized it’s not water in that tub, it’s one of those preserving solutions with nutrients and electrolytes and all that, one of those solutions meant to keep the brain alive, to keep the cells in there from dying like they’re supposed to when the brain isn’t connected to the rest of you. The nurse told me in a hushed and awed kinda voice that the rest of Bill had been donated, so generously, and wasn’t he just the most giving person you’ve met? and I couldn’t do that myself, but I have so much respect for him and for the people that do. I asked the nurse if Bill could think and if he would be able to tell that I came to visit, and she looked at me the same way the hospital lady sounded when I called her asked about the trials. No, I don’t think he can.
I stayed in the room a bit, kinda just looking at what was left of Bill. He was just a pink blob, with what looked like a maze carved into its surface. Bill was that blob (or he was in it somewhere) but either way he was an anchor at the bottom of the tub, kept alive by bathing in a liquid and being stimulated with electricity which came from a device on a timer to shock the cells so they wouldn’t die off from not being used, a blob whose body was everywhere and nowhere, a blob which was Bill’s or just Bill and who would stay sunk in this transparent solution until Kingdom Come.
Well, I turned out to be wrong about that last thing. I read in the Times later that week that he had given (with such generosity) the two halves of his brains, the “hemispheres” – like Bill’s brain was a globe, and I guess in a way it was – to the children.
Apparently – and maybe you know more about this than I do, given how folks your age are much more on the internet compared to folks my own – some kids can be born with half their brain missing. And most of the time, those kids – being younger than me and you both – have the ability to regenerate their brain since they’re so young. So the half of their brain that did develop is able to do the tasks that the missing part woulda done normally. You wouldn’t even be able to tell they were missing anything.
But sometimes, the kids aren’t alright, the one hemisphere can’t pick up the missing one’s slack, and those kids with half a brain act like you’d expect a half-brained kid to act. They’re in beds, on life support, and often bleeding their parents’ dry of their savings. Of course, the money isn’t the priority, but you gotta consider it anyway. Bill’s hemispheres, both the left and the right, were separated and placed in the skulls of two young girls who belonged to the second of the two groups and had been on life support since babies, and each of Bill’s hemispheres had been attached to the half of their brain that the young girls were born. Each operation had taken 36 hours and I read they had neurosurgeon on top of neurosurgeon, all wanting a hand in the girls’ heads and their names in their paper and their egos inflated. ‘The Times’ sat down with Martha Meags, the late wife of the generous Bill Meags. She describes the difficult decision Bill Meags had voiced to her in his final days: to donate the rest of his body to those who needed it most. ‘I had to come to peace with it,’ she told us, holding back tears. The picture on the paper showed a black and white Martha with a real solemn look on her face, like she was trynna be brave for everyone.
I can see you’re shaking real bad now. You can feel him, too, can’t you? This part is the worst part – the waiting, especially when he gets close. And he’s terribly close now, no more than a few minutes, but I think I got the time to piece it altogether for you, God willing.

Bill Meags was nothing if not a giving man.
He’d give you the shirt off his back, even if it was sewn right onto him!
This was a lifelong trait of his. In childhood, he stopped eating lunch once his mom stopped packing one for him and he had to start buying it at school. All it took was throwing a certain kinda look Bill’s way, or just making at him like you were going to ask him for his money, before he’d hand it over, not wanting to get in the way, he’d say, and he’d say it like he was apologizing, too.
That character never went away from Bill, no sirree. He was always real considerate, a sweetheart, especially to his parents – even though his dad saw him as a pushover (and another p word that doesn’t feel all that Christian for me to be repeating). I lived real close to him growing up, down the same block on Copperfield Drive, so we got all acquainted like kids that live close to each other at that age will do a lot of the time.
My bad, friend. I’m getting a bit lost in the weeds here, aren’t I? What I’m getting at is the generosity of Bill Meags, and why it is that you and I find ourselves in our situation at the present moment. You must be wondering about it, aren’t you? You seem like the curious type.
A few more things about Bill in those early years, first. Bill, you see, was always sharing his toys with his brothers back in those days. Not a birthday would go by – Bill’s birthday, I mean – where his brothers wouldn’t make out with at least half of his new toys stuffed in their greedy little pockets. Far as I know, this went on as long as he still had birthdays at home.
He was never real popular with the ladies either, when we got to that age where liking girls and their nice legs and nice smells went from gross to sweet. Bill was not a bad looking guy, but he was not a good looking one either. He was just there most of the time, as much as it pains me to say. He was just about decent at school, not an ivy league contender or anything like that, but better than you woulda expected out of a guy who was like Bill – a guy that was just there, who looks kinda like he’d fit better standing next to a potted plant or the wallpaper than around other people. I think him doing well in school made sense. He got the reps in. As in, he had been doing everyone’s homework for them. No one had threatened him, there was never anything like that.
The rumor that was floating around certain circles at our school was that if you asked Bill if he wouldn’t mind helping you with your homework, and you made it seem like it would be just the biggest fuss for you if you had to do any of it, he would tell you not to worry, that he would get it done, and he’d say it like he felt guilty that it wasn’t already done even though he just had it handed to him. Didn’t matter the subject, he’d do it. He always denied the rumor when I’d ask him about it, but I was pretty sure it was true, and I think he wouldn’t tell me because he didn’t wanna break up my peace of mind. So, yeah, I think he was alright at school because he was doing homework for classes he wasn’t even taking.
Me? I think it ended up being his helping his classmates with homework that led him to meeting Ana, a girl that took a real liking to Bill. Or maybe her name was Ava… it was something like that. Strange how time fades the clearness of your memories like they’re in a heavy fog, isn’t it? Well, in any case, Ava or Ana was a nice girl, and pretty, too, and she made her intentions real clear to Bill Meags, and that was unusual at the time, you see, for a girl to be that forward with a guy in the romantic sense. That was lucky for Bill, because I don’t think they woulda gone out if it wasn’t for her...
And they did go out. For a time, anyway. Until Brad Something-or-Other had come up to Bill one day and told him he thought Bill was such a nice guy, one of those real generous types, and Brad was acting all like he didn’t know that Ana (or maybe it was Ari?) was going steady with Bill, and he was really hamming it up and saying how it would be just swell to have the chance to go on a date with that cute girl from third period math. Brad was one of those guys, you’d know the type if you saw him, that made you wanna question the Creator when all your knowledge of what it meant to suffer was that you were stuck at home again with your parents on Saturday night. He was a complete jackass – there’s just no other word that works here – but he was also gifted by God and genetics and growth hormone to be a good-looking jackass. He was tall, a jock, and had a jawline that angled his face in a way that seemed to slide the looks that girls would give him into the rest of his face. What I’m getting at is that Brad could go on a date with anyone he wanted, and had gone one dates with anyone he wanted, “gotten down” with girls in higher social brackets compared to Bill’s girl. And he was too plugged into the social jungle that is high school to not have known they’d been going steady.
This is important, you see, because even though I can’t prove it, I believe deep down that Brad was pulling a prank on Bill. But Bill didn’t see it as a prank, and Bill agreed with Brad, telling him of course, you and Ana/Ava/Ari would make such a cute couple, you should go for it. Bill didn’t wanna impose on Brad, and he didn’t wanna get in the way of their potential future relationship, he told me later. Wouldn’t it just be awful, he said, if I were the reason they weren’t happy together? I can’t get in their way, I just can’t do that. That’d be just plain selfish of me.
Thing is, this was 8 months into their relationship, and he was as into her as one got at that age. But he didn’t want to be a bother, didn’t want to burden Brad-the-Tall-and-Chiseled-Jackass, didn’t want to get in the way or be an obstacle, so he stepped back, and Brad and Ava/Ana/Ari/Ash had gone on 3 dates before he forgot to wear a rubber on the third and knocked her up, and Bill was real outta their way when they both dropped out of school together to raise it. But Bill was heartbroken, he was, even though he’d never say it.
Ah, you don’t need to say anything for me to know what you’re thinking. I can see it in your face. I’ve been at it again. Rambling, haven’t I?
There is a point, I promise; a reason I’m telling you this and telling it to you the way I am. But we should fast forward a bit, shouldn’t we? Time is ticking, and midnight is getting closer, and I would like you to know why we’re here, hard as that might be from your perspective to believe.
So, fast forward some decades, and Bill’s married. His wife’s a presence of a woman named Martha. Now, lemme tell you, that Martha, she’s a force – both her and her mother.
Only reason Bill and Martha got married was because she asked him directly if he was planning to propose to her. Some 5 years into their relationship, that was. And Bill sure wasn’t going to tell her no, was he? That wasn’t in Bill’s nature. It was about that time, he told me after he broke the news of their nuptial plans, that I got myself good and married. Then, almost like it was just an afterthought, he added how he didn’t wanna annoy her, or make her feel all negative because he had struck the idea down, even if the answer woulda probably been not right now. So instead of saying not right now or let’s talk more about it he said yes, both right then and right there. She made him propose all formal with a ring, of course, but she was happy. Martha’s version of happy, anyways.
Now here come the newlyweds, and not 10 months later, out of Mrs. Martha Meags comes their first and their only, a boy they named Artimus. Bill had wanted to name him David, but Martha wanted to name him Artimus, so Bill and Martha named him Artimus. The child was adored, I can tell you that. Even after he started getting hard to be around since he was turning into one of those mopey teens with one of those mopey faces who always talks about how no one could ever understand them. Martha told Artimus he could do no wrong, and she told him that even after he started coming home in the back of a police cruiser. He started with shoplifting, getting caught wearing expensive shirts and sweaters under the oversized hoodie he’d always wear. But because he was underage, and since Martha had settled into one of those clerk jobs at the precinct office (and because she had come to know some of the fellas on the force), the young and troubled Artimus would often come back home after getting caught, at least in the beginning. You best believe I prayed for that kid every morning and every night. But God helps those who help themselves, my momma always used to say, God rest her.
Bill, at this point, had raised the idea of sending Artimus to a disciplinary school over the summer break. The way Martha reacted you’da thought you told her she needed to sacrifice Artimus in some pagan ritual. She would hear none of it. She said her son was one of those boys that came into his own a bit rougher and a bit later than the other boys, but it was because he was sensitive, and sensitive boys need extra coddling. Bill had thought about how he had been as a kid and felt his son woulda been one of the ones to ask him to do his homework if they’d been kids together. I guess this thought musta sparked something in him, because Bill didn’t back down off the jump and he raised the issue again with Martha. Or at least that’s how he told it to me. In any case, he said to her that he was concerned that one day Artimus wouldn’t come home in the back of a police car, that he wouldn’t come home at all, that instead the police officer would come to their home without Artimus and tell them that their son was dead or dying alone in some cold hospital bed. She went into hysterics, said that Bill was completely exaggerating, there would be no way that she would let her son go off canoodling with delinquents and murderers and rapists and thugs. And so off to the disciplinary school their dear Arty did not go, and into trouble their dear Arty stayed.
You can see I’m shaking now. I can tell it from the way you’re looking at me. It’s because he’s getting closer. But I think we’re still making good time, we should wrap up just as midnight comes. But no more dilly dallying – because he is getting closer. I can feel him, and I think you can too.
I think it started happening right around the time Bill had been in the running for a promotion. The guy right above him had been dropped by a heart attack at the ripe young age of 40. He survived it, but he was starting to take a good hard look at his priorities, as some men get to doing when they remember that the Almighty calls them back eventually. He decided he wasn’t spending enough time with his kids and wife and quit his job the day before his heart decided to permanently quit on him. So the position – Bill’s boss’s position – was open, and it paid pretty well, at least compared to what Bill was getting paid at the time, which was little more than peanuts. Didn’t matter how many times I told him, but Bill just wouldn’t ask for a raise. He didn’t want wanna offend his boss, or his boss’s boss, or make either think that Bill was ungrateful for his salary. That could hurt one of their feelings, maybe even both of their feelings, and the idea made Bill feel uncomfortable.
Right around the time Bill was in the running for the promotion, his boss’s boss got real sick. I heard it was something with his diabetes, but the short of it was that he needed a new kidney or he’d die. Estranged from his immediate family, as it happens, which is not the spot you wanna be in if you’re in the market for a new kidney. He was looking for donors in all the ways he could: taking out ads in the paper, putting up a billboard you’d see taking the ramp off the highway into downtown, hanging up flyers on the streets, all that.
Bill read the ad in the paper, and it just so happened that he has a compatible type of blood and kidney, and he knows this fact about himself. Martha knows it about him too, and she also knows that Bill has been up for that promotion. Martha asked Bill to donate his kidney to his boss’s boss, that Martha did. Bill didn’t wanna give away his kidney. But Martha wanted Bill to do just that, and after she contacted Bill’s boss’s boss, the man who paid Bill’s salary had wanted Bill to do just that, and Bill was not going to disappoint Martha or his boss’s boss, so just that was what Bill did.
That was just the beginning. It wasn’t long after they did the kidney removal – the scar was like a big smile that ran from his middle belly to his right hip like a real big gun holster – that Martha’s dear mom was the one who got real sick.
Ah, don’t move. You’re starting to slip a bit, let me tighten that for you.
Looks about right and good. Well, anyway, Martha’s mom was heavy handed with the bottle, that woman, and eventually consequences caught up with her actions as the good Lord makes right sure of, and she found herself looking down the barrel of life-threatening liver failure with the trigger half-pulled.
She would die if she didn’t get a new liver, or at least part of one. The doctor had explained to Bill and Martha near her mother’s room that livers were “adept” at regrowing themselves. Live liver transplants were becoming more common, he told them. You see where this is going, I think.
Martha had wanted Bill to give away a piece of his liver. Bill had not wanted to. But Martha had, and so had Martha’s mother, and so (I think) had the young doctor who wanted to impress the more senior doctor. And so Bill did.
The liver procedure was a bit more complicated than the kidney one. Bill was far from spring chicken territory, but he wasn’t that old – so they felt he would be safe to get a hunk of his liver taken out so soon after having the kidney removed. But he lost a lotta blood, Bill did, and the wound wasn’t healing as quick as they wanted. Eventually, not enough blood was making it to his kidney, the only one he had left, and so his left and only kidney died. The doctor recommended they remove it before it got infected and caused him more problems. They assured him that his kidney would be used for research, so they could help prevent this from happening in the future. To other patients, of course. Bill would be on dialysis for the rest of his life.
I went to visit Bill lots when he was in the hospital during that time. I was always the only familiar face to him around there. That would be the case until Artimus was a patient in the room next to him.
Artimus Meags, dear Arty to his mother Martha, had been drag racing in a car that did not belong to him. He told his mother dearest that he was going to study at his friend’s house, and Martha had believed Arty because Arty could do no wrong. Blood alcohol was twice the legal limit, and he was not the legal age, but he could do no wrong. He had crashed into a park tree, and they estimated he had been going about 98 miles per hour, give or take. The car was hugging the tree, and the picture they showed us made it look like one of those abstract metal art exhibits.
How he survived at all was a mystery to us. They found him pinned under the spear of a tree branch that jabbed into the driver’s side window, with his legs folded backwards and over his head at all these odd angles, and the jagged edges of the crumpled car door were drilled through both his arms like rows of nails through drywall. One of the doctors in the hallway had said loud enough for me to hear: Artimus’s legs came in mangled strips, tendon and bone and muscle all mushed together… indistinguishable, each one from the other. They counted the one blessing that Artimus had passed out early – either from the pain or the booze – and wouldn’t wake up until after the amputations. Amputations, more than one.
Artimus, dear Arty to his mother, no longer existed below the waist, beyond the left shoulder, above the right elbow.
At first, they were trying to save the left arm and the right upper arm if they could. The left arm, the doctors said, had some potential to recover, it was still getting blood and they might be able to salvage it. They said that on the first day. On the second day, the doctor had said pretty much everything except for what he was thinking, which was well, let’s just wait and see, that’s all we can do right now. On the third day, Jesus rose from the dead and Bill and Martha were told that surgery was the “mainstay of treatment for a gangrenous limb,” but please try not to worry too much because they were making big advancements in fake limbs, in prosthetics, and the quality of life for quadriplegics was getting better, they’re even doing trials on limb donations! Of course, these trials were in the early stages, but they were so grateful for their generous donors who gave so much so they could do such vital research. They said it was all above board, but when I got the chance some time later to actually look it up myself, I could find nothing at all about it online. When I called the hospital to ask them how the trials had gone, they acted like I was crazy. Can you believe that?
Anyway, as you can imagine, Martha jumped on that real quick, oh yes she did. Limb donations? Do y’all do them here? Bill had been so generous already, and, now turning her attention to Bill and cooing in a way that always made my skin crawl, oh, Bill, wouldn’t it be so wonderful if you could give the gift of walking to our son, to our baby boy, so that he could move his arms again, and grab at things again, and live his life again, like it’s all normal and this never happened. Oh, he was so young, wasn’t he? And you’ve lived a life, Bill, with those arms and those legs. Our Arty hasn’t.
Martha wanted Bill, the man with two less kidneys than you and me and a large chunk taken out of his liver, to donate his arms and his legs to their son. To Artimus, the boy who had moved only when he began to seize in his bed, who made no noise on purpose and whose breathing was being done by a machine that shoved oxygen through a tube down his throat, and whose eyes had to be taped down so they would not stay open and dry out because the part of his brain that gave his eyes the command to blink was asleep or dead.
Yes, Martha had wanted Bill to do this. Bill did not want to, but Bill smiled at Martha and said yes, Martha, because he just couldn’t tell her no. It’s the right thing to do, was his reason this time, which he gave me right before the operation when they were getting him ready (I was the only visitor; Martha was at Artimus’s bed). Besides, he added before they wheeled him away, I don’t want to make Martha feel sad, or make her feel like I don’t love our son. I would hate to let her down… I don’t want to let him down, either. I can handle living without my arms and my legs. I’ll adapt, and better I adapt to it than he does. I tried. I couldn’t get through to him, but I did try. So, then, he went with the folks in the scrubs, and that was the last time he was whole.
He was now without limbs, any of the four. His head sat atop his torso, and his torso atop his bed, and everything else had been sealed with some foam and some surgical duct tape. It was gonna be two surgeries, so they didn’t sew him back up on the first go. I was able to see through some of the foam packing they put on his stumps (the nurse didn’t do such a good job changing it, and Bill stayed silent because he was sure she was busy, even though he started leaking onto the bed), and I could see the sawed-off edge of bone splintered in uneven edges. I looked away right quick after that.
The next request came to Bill’s room pretty soon after that. It was sometime after Bill’s boss’s boss had decided to let Bill go from his position since he had taken off one too many days since he was in the hospital, and he thanked Bill for his years of service to the company. The requester was a lady who had overheard one of the nurses in the hallways talking about the remarkable and generous gift that the father had given the son. The mother of a young blind girl had come to Bill to ask him if he would be willing to donate his eyes and optic nerve, to give the gift of sight to the sightless, and she showed him a picture of her daughter, a young girl with blank sheets of snow for her eyes where the color shoulda been, and Martha had started weeping and saying that of course Bill could, and the doctor at the door who had overheard was saying that he had never seen such generosity from one man and Bill did not wanna give off the impression that he didn’t care about the girl like he was an uncaring type of person, and he didn’t want them to think that he wasn’t open to their thoughts on the best use of his eyes and optic nerve – and, he said to me before the operation, is it really all that fair for me to have my eyes and the nerve that lets me see if that girl can’t? Do I deserve them any more than she does? That’s what he told me, anyway. But I knew better, I knew Bill said yes because Martha wanted it, and the girl’s Mom wanted it, and the doctor wanted it, and it no longer mattered what Bill wanted, or maybe it hadn’t mattered for a while now, maybe ever, so Bill’s eyes had been scooped out, the space around his optic nerve taken out to remove it in one full piece, and the girl saw out of Bill’s eyes, and Bill saw out of no one’s.
By then, news had traveled quick. Local news first picked the story up, and larger media outlets megaphoned it out, and now there were hundreds of people showing up to Bill’s room in a single day, Bill unable to talk to them all but unable to get up and leave either. The hospital set up official lines and rules for these visitors – they gotta line up in this line or the other, fill out the official appeals form, circle on the diagram which part of the body they are in need of and from which body system, and give a response to: In 200 words or less, explain why Mr. Bill Meags, the always generous Mr. Bill Meags, should donate his organ/tissue to you or your loved one? Bill, unable to read and write because he didn’t have the eyes to read or the arms to write, gave complete medical decision-making power to Martha and the doctors. He hadn’t wanted to, but he had been asked – Martha the one doing the asking – and it seemed to him it would really ruffle her feathers, maybe even cross into inconvenient, if he said no, so he said yes.
His skin was given to a 44-year-old firefighter who had saved a child from a burning building. His skin had melted clean off, several layers of it.
Burn pains hurt. One of the worst pains you can experience, did you know that? All touch becomes real painful, a light breeze sets your nerves on fire, the cloth of your bedsheets feels like fire ants marching and you can’t shake them off because they’re a part of you.
But once the firefighter started wearing his new skin – the skin that they had cut off Bill like the pelt of an animal – he no longer felt the fire on his nerve endings or the ants crawling around anymore. They were Bill’s now, and for Bill, every second was agony. He never said so to anyone, and he never screamed, but he did tell me once when he was floating on a cloud made of morphine that he felt like screaming a lot of the time but didn’t wanna make too much noise. That could disturb the other folks here. I don’t wanna stop anyone from healing.
His right lung came out next, this one given to one of our state’s senators. The politician, one of those folks who make a real career out of politics and campaigning, got cancer in his lungs after smoking like a chimney his whole life, but he was running for a fourth term and he wasn’t ready to meet his Creator, so they took out his bad lungs and gave him one of Bill’s good ones. The senator was 75 years old, two full decades Bill’s senior, but that didn’t matter, of course. The senator’s third wife had pleaded to Martha, and Martha had said yes and of course and Bill was a patriot and Bill always followed their campaigns the most close out of anyone and so that was that and Bill’s chest had been opened and out came his lung. They took out the lung all the way to the place it forked into his throat, and I know that because they left his chest opened, they didn’t sew him back up, so it would make the next operation easier to do, the doctors told us. I sat by the bed afterwards – it happened too quick this time, and there wasn’t enough time between the agreement and the operation for me to see him off – and he told me, in between real deep gasps he had to take even with the tubes forcing oxygen into his nose and only lung, that even though it was ‘an adjustment’ to breathe now, he woulda felt like just the worst if he went ahead and said ‘no, I’d like to keep my lung, thank you.’ But he couldn’t do that to Martha, he said, or to the senator or to the senator’s third wife (who the senator had ended up divorcing not two months later after he was caught in bed with a different woman. He won his fourth term). Besides, what right do I really have to my lung? At least I have the other one.
Until he didn’t, of course. But by then I had started losing track of which parts were being given to which people, especially with Martha doing all the approvals herself. Next to go was Bill’s mouth, which made conversations much more one-sided. They had gone ahead and removed both the top and the bottom rows of teeth in Bill’s mouth. The bottom row of teeth was removed with the jawbone, all in one piece, but I’m not real sure what they needed his jaw for. But they musta decided to take out the tongue while they were in there too, maybe so it wouldn’t just be hanging out of his face all the time like he was a dog dying of thirst. They sliced the tongue out, and when Bill would try and talk you could see the little sutures tied in the back of what was left of his tongue and it looked like barbed wire that was waving at you.
Much of those days were foggy, and it wasn’t long after that when I stopped going to visit Bill for a while, for which I hope to be forgiven when I get to the Pearly Gates. I couldn’t right stand it, see? It was becoming more and more difficult to see less and less of him. But Bill, silent and unmoving, was becoming an eyesore. They had started removing his muscles and some of the other bones in his face by the time I stopped coming to see him most days. One by one, his face started missing features, and that’s why Bill started to look less human and more like a slab of raw meat that got stuck in the gears of a slaughterhouse grinder. His head had become a skull with some of the muscles still attached in spots, muscles that would move like a pulley and lever system when he’d react to something because you could see them shrinking and contracting against each other. That was the only way you could tell he could still hear you because his eyes were scooped out of his head like they were two spoonfuls of ice cream, and his teeth and tongue were missing and his jaw was missing and the entire base of his head was missing except for the part that was attached to his torso, and the head was the only thing attached to that torso, it was. Not a pretty sight. I couldn’t right stand it.
Sorry, friend, guess I didn’t ask if you were the squeamish type. But… I’m getting used to the idea that it won’t matter if you are for too long, and that all this is for real and it’s happening. You woulda thought it gets easier the more times you do it, but it doesn’t.
Bill’s nose, the tissue that made up the full thickness of it, had been lopped off, and he now had no eyes and two almond-shaped holes where his nose used to be. His mouth – which was now a hole in the middle of a lake of exposed muscle – looked so little like a mouth, but it sometimes moved when he tried to mime out words that would come out as grunts instead. But that didn’t matter all too long, because he stopped the grunting and the miming when his vocal cords were out.
Bill, the man, the generous man with emptying insides and with no eyes, no nose, no mouth, who could not scream; who had no skin but the island of it on top of his head which made up the scalp that his hair grew out of like sprouting weeds; that man, Bill, existed here and there on the hospital bed, in pieces, pieces that were getting smaller, pieces made of tissue and organs that were going to be removed soon because some of it was starting to die while it was still on him, decaying and rotting like spoiled meat. Or at least that was what the doctors told him. But by then he couldn’t say or ask much.
I am not sure he woulda asked much of anything anyway.
Once, though, while he still had neck muscles and could still shake his head or nod it, this young lady, some girl from one of the colleges around here, had come and asked him if he really agreed to all of these donations – as in out of his own free will. Willful consent she had called it, or something like that. She was one of those activist types, looking for a cause, and Martha wouldn’t’ve let it happen if she’d been paying attention, but she had been spending a lot of time talking to the doctor about how Artimus was doing. Since it was just Bill and I and the lady and cause his neck muscles were still attached and working at the time, he would nod in agreement to whatever questions she asked.
Martha did find out later, and she was real pissed, you can bet on that. Pretty soon after that, Martha had the fortune of coming across the perfect candidate for the muscles in his neck, and Bill could nod and shake his head no more.
It was maybe 2 months when I saw him next, because I had the occasion to be in the hospital myself. Made it through, God bless, and I knew it had been a while since I had seen Bill, and… well, anyways, I had decided I better find myself paying my dues to make things even and all that. When I entered the room, it took me a good long minute to realize that there hadn’t been a mistake, and that I was in the right one.
Bill wasn’t there, you see.
Well, he was, but he wasn’t.
The bed had been removed from the room, the bed he had spent the large part of a year not moving from. A table, like one of those you’d see in a high school chemistry class, had been put where the bed was before. And on the table were a couple of large devices and a small transparent tub with some water, the tub with a brain sitting at the bottom of it like dead weight. And then I realized it’s not water in that tub, it’s one of those preserving solutions with nutrients and electrolytes and all that, one of those solutions meant to keep the brain alive, to keep the cells in there from dying like they’re supposed to when the brain isn’t connected to the rest of you. The nurse told me in a hushed and awed kinda voice that the rest of Bill had been donated, so generously, and wasn’t he just the most giving person you’ve met? and I couldn’t do that myself, but I have so much respect for him and for the people that do. I asked the nurse if Bill could think and if he would be able to tell that I came to visit, and she looked at me the same way the hospital lady sounded when I called her asked about the trials. No, I don’t think he can.
I stayed in the room a bit, kinda just looking at what was left of Bill. He was just a pink blob, with what looked like a maze carved into its surface. Bill was that blob (or he was in it somewhere) but either way he was an anchor at the bottom of the tub, kept alive by bathing in a liquid and being stimulated with electricity which came from a device on a timer to shock the cells so they wouldn’t die off from not being used, a blob whose body was everywhere and nowhere, a blob which was Bill’s or just Bill and who would stay sunk in this transparent solution until Kingdom Come.
Well, I turned out to be wrong about that last thing. I read in the Times later that week that he had given (with such generosity) the two halves of his brains, the “hemispheres” – like Bill’s brain was a globe, and I guess in a way it was – to the children.
Apparently – and maybe you know more about this than I do, given how folks your age are much more on the internet compared to folks my own – some kids can be born with half their brain missing. And most of the time, those kids – being younger than me and you both – have the ability to regenerate their brain since they’re so young. So the half of their brain that did develop is able to do the tasks that the missing part woulda done normally. You wouldn’t even be able to tell they were missing anything.
But sometimes, the kids aren’t alright, the one hemisphere can’t pick up the missing one’s slack, and those kids with half a brain act like you’d expect a half-brained kid to act. They’re in beds, on life support, and often bleeding their parents’ dry of their savings. Of course, the money isn’t the priority, but you gotta consider it anyway. Bill’s hemispheres, both the left and the right, were separated and placed in the skulls of two young girls who belonged to the second of the two groups and had been on life support since babies, and each of Bill’s hemispheres had been attached to the half of their brain that the young girls were born. Each operation had taken 36 hours and I read they had neurosurgeon on top of neurosurgeon, all wanting a hand in the girls’ heads and their names in their paper and their egos inflated. ‘The Times’ sat down with Martha Meags, the late wife of the generous Bill Meags. She describes the difficult decision Bill Meags had voiced to her in his final days: to donate the rest of his body to those who needed it most. ‘I had to come to peace with it,’ she told us, holding back tears. The picture on the paper showed a black and white Martha with a real solemn look on her face, like she was trynna be brave for everyone.
I can see you’re shaking real bad now. You can feel him, too, can’t you? This part is the worst part – the waiting, especially when he gets close. And he’s terribly close now, no more than a few minutes, but I think I got the time to piece it altogether for you, God willing.