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By JEANNIE KEVER
Houston Chronicle
HOUSTON -- Sweat soaked his Aggie baseball cap as Eugene Alford lurched upright over the parallel bars. Suddenly, he was once again the tallest person in the room.
"Man," he said, as his daughter flashed a thumbs-up. "This feels so good. This is the first time I've been standing upright since December 30."
The thrill didn't last long. After about 10 minutes, his blood pressure began to drop, and he was lowered into his wheelchair.
No matter. That moment in spring provided a sign that Alford, a surgeon accustomed to working 14-hour days and lecturing around the world, was on his way back from an accident that fractured his spine and left him paralyzed below the waist.
Back to what, however, remains uncertain.
The bravado of the weeks after the accident has faded. Maybe he will walk again. Maybe he won't. The real dream, it turns out, is independence and a return to the operating room.
But that, too, may prove elusive.
It's certainly possible to perform surgery from a wheelchair -- surgeons use their hands, their knowledge and their judgment, not their legs. But can he balance work and rehabilitation? Will people want a surgeon in a wheelchair? How will returning to work affect his disability insurance and his future ability to support his family?
What he's left behind
Several times, he set a date to resume seeing patients, only to push it back. He even began to consider, reluctantly, the possibility of doing something else.
"If I have to retrain or do administration or teach, I'll do it," he said. "But in my heart of hearts, I'm a very skilled surgeon. That's my gift."
For the past six months, Alford's recovery has been all-consuming. In early May, he entered the NeuroRecovery Network, a clinical program designed to rewire the autonomic nervous system.
Alford had just turned 48 when he was injured by a falling tree in late December.
He had performed more than 800 surgeries at The Methodist Hospital in 2007, his services as a plastic and reconstructive surgeon in such demand that patients waited months for elective operations.
Among his best-known cases was the 2005 facial reconstruction of Carolyn Thomas, a young woman from Waco whose boyfriend shot her in the face in 2003.
After a month in the hospital, Alford was sent home for his broken bones to heal before beginning the next phase of his therapy. There, the maelstrom of family life proved a bittersweet distraction as he experienced some of what he had missed over the years.
Before the accident, the family used a lawn service in Houston, unwilling to risk an injury to Alford's hands. Working at their 86-acre farm in Bellville, however, seemed different. The farm was just for fun.
So, Alford climbed atop his tractor, a 20th anniversary present from his wife, Mary, shortly after noon Dec. 30.
He began to nudge a dead oak tree. The top split and fell backward, trapping him against the tractor. His cell phone holster was knocked out of reach.
But for some reason -- "It was a real God thing," he said later -- he had slipped the phone into his shirt pocket. He called Mary at home in Houston.
She called a neighbor in Bellville. "Gene's hurt," she said. "Call 911 and go find him."
Another neighbor heard the call on a police scanner and began canvassing the farm on foot as he called Life Flight.
Half an hour later, neighbors called to say Alford had been found.
Alford doesn't remember any of that. The helicopter landed at Memorial Hermann Hospital, and he was soon transferred to Methodist, where he had worked for 16 years. He underwent surgery the following day.
He was sedated and on a ventilator for a week. In addition to a compression fracture of two vertebrae, he had six broken ribs, a broken collarbone and a broken scapula. He spent 12 days in the intensive care unit.
The tractor was fine.
Life in the Alford household, however, was not.
He described himself in those early days as a 190-pound baby, able to do almost nothing for himself.
"It's all very humbling. You can laugh or you can cry."
He has done both.
Weathering the storm
His brother, David Alford, started a Web update on Alford's condition on Carepages.com a few days after the accident; friends and patients left thousands of messages. Others sent cards and delivered meals.
All was much appreciated, Alford assured readers when he took over the Web site in mid-January. But in April, after three months of upbeat postings recounting his progress, the reports slowed. Between May 1 and May 23, he didn't post at all.
Depression had hit.
Meanwhile, the cost of recovery mounted.
Alford has good health insurance, although he worried about being dropped as bills approached $800,000.
He continued to pay his office staff, although he wasn't seeing patients. He bought a pickup that could be fitted with hand controls and a lift, allowing him to slide into the driver's seat and stow his wheelchair behind.
He waited for two months before the state's Department of Assistive and Rehabilitative Services agreed to pay for the retrofitting.
He hired a contractor to install an elevator, ramps and a wheelchair-accessible bathroom in the family's century-old house in Montrose. The work went slowly, leaving Alford stuck with a hospital bed and a makeshift shower in the garage, previously used to bathe the family dogs.
Mary Alford eventually returned to work part time at a dental clinic for HIV patients. She still had to juggle helping her husband recover with deciding how much responsibility to place on Charles, 15, and Bess, who turned 18 in June. Their oldest child, John, is a student at Texas A&M University.
Her primary role was to remain steady, gauging when to push and when to offer sympathy as life continued in this strange limbo. Her background -- she was a nurse before going to dental school -- prepared her for the basic care she had to offer.
Rehabilitation
If Born on the Fourth of July and other movies inform your idea of spinal cord treatment, today's rehab units would be a surprise.
Traditionally, patients stayed in bed, heads and spines immobilized, while the fractures healed. Over the past decade, said Dr. Robert Grossman, chairman of neurosurgery at The Methodist Hospital, the trend has been to surgically reduce pressure on the spinal cord and, if needed, reinforce broken vertebrae with a titanium rod or similar material before sending patients to rehab as soon as possible. Alford moved to TIRR, a rehabilitation hospital in the Medical Center, on Jan. 10, less than two weeks after his accident.
Traditionally, people with an "incomplete" injury such as Alford's -- meaning there is some motor or sensory function below the injury -- regain most of the ability they will recover within a year, said Dr. Teodoro A. Castillo, co-director of the spinal cord injury program at TIRR.
Alford's hands were unaffected by the injury, but Castillo said that alone can't ensure his successful return to a surgical suite.
Some patients regain the ability to walk after the therapy, said Dan Graves, director of spinal cord injury research at TIRR. For others, benefits include core muscle strength, improved circulation and other functions. "We're finding many things that people don't want to talk about -- bladder, bowel, sexual function -- are being improved," he said.
The network offers a bridge between loss and hope, even if there are no promises about where it all will lead.
"Rehab is lifelong," Castillo said. "It can't be an hour of therapy. It's a lifestyle."
But surgery had been Alford's lifestyle for decades. And surgery is often viewed as macho.
No one tracks the number of surgeons who work from wheelchairs, but Krizek said he has successfully trained several surgeons with disabilities.
"There's nothing we would expect of a plastic surgeon that he couldn't do in a wheelchair," Krizek said.
Alford hopes to resume surgery with short procedures that can be done from his wheelchair, working up to the complex operations for which he is known. "I won't compromise patient safety," he said.
