Chapter 15 – Starting to think of life after Craig Hospital

One day, I found myself in my room alone, which was a relatively rare occurrence. Someone was always there, which had a dual effect; on one hand, if there was anything I wanted, I could just ask whoever was there, on the other hand, I had to go through someone else for everything that I wanted. This meant that every embarrassing habit, compulsion, or desire had to be vocalized. Do you have any embarrassing things you do that you keep to yourself? Would you rather just go without or go through someone every time you want to do it? I mean, to be clear, it’s not always something ridiculous, sometimes you just want another piece of chocolate. On that particular day, the chocolate was on the counter underneath the TV.

Finally, I could just eat chocolate and not worry about other people, the only problem is that the counter was at approximately shoulder height, give or take, and without triceps or any wrist or hand control, this meant it might as well have been at the end of a ninja warrior course. Even getting my arm up on the counter was an enormous task. Not having triceps meant that I couldn’t straighten my arm against gravity, making it a puzzle figuring out how to get my hand up on the counter to drag the chocolate closer to the edge. Attempt #1 consisted of getting my elbow on the table in the chicken wing position, arm fully bent from gravity, and then trying to shove my hand and wrist up after. On the rare occasion that I would get my hand up using this method, it didn’t quite go far enough and would end up on the wrong side of the chocolate. Attempt #2 consisted of me scooting back a bit, so I wasn’t parked against the counter but had an arms width gap, and swinging my arm back and forth like a pendulum and at just the right time I’d give a strong swing forward and as soon as my hand was above the counter, I’d try to swing it over and past the chocolate; like swinging a wet noodle attached to your shoulder. Neither method was hyper-effective, and by that I mostly mean that in 20+ attempts over 30+ min I had basically only managed to push the chocolate back and forth and hadn’t made any significant progress. At some point I was basically screaming “OH, COME ON!” internally; seeing something so close and not being able to reach it because of the inability to complete a simple task can be demoralizing. It feels a bit like if the last thing you have to eat in the house is in a jar but you can’t manage to twist that fucking cap off no matter how many tricks you try and you start to consider just destroying the jar, as if that is the solution.

For whatever reason, that failure just made me want it more. In the beginning, I just kinda wanted a piece of chocolate, but after all these attempts, with virtually no energy left, I was desperate. Finally, I managed to get my elbow up on the counter and have my hand flop to the right position and I was able to pull the chocolate off the counter into my lap. In retrospect, if I had misjudged this last move, I could’ve easily missed my lap and knocked the chocolate on the floor, but it worked out that time. It doesn’t always work out, in fact, in the beginning is very rarely works out; a lot of the times you find that jar opens too suddenly and you spill the contents on yourself or it slips out of your hand and shatters on the ground, mixing the last of your food with glass shards.

Even after getting the chocolate in my lap, I had to spend another 10 minutes trying to figure out how to get the chocolate out of the wrapper and the foil, without the use of my hands. If you have ever seen a raccoon try to open something to get to the food inside… It was eerily similar to that, but less coordinated; the lack of opposable thumbs means you hold things between both hands, and the lack of fine motor control means you resort to biting things, A LOT. I eventually managed to get a piece of chocolate and it was unreasonably satisfying, partially because I had recently regained the ability to eat or drink, or really taste anything, and partially because of all the effort that went into getting it. I should note that literally no one would have judged me for eating chocolate, I was simply projecting my own self-criticism on other people. Honestly, I think everyone involved would have encouraged me to eat the chocolate, but such are the quirks of my mind that drive me to learn to do things for myself.

To eat the chocolate, one must first see the chocolate… and when you have poor eyesight as a quadriplegic, putting on or taking off glasses can be difficult or impossible, and contacts are pretty much a hard “no” unless you are ok with someone else poking you in both eyes twice a day. Eventually, I would gain the dexterity and ability to manage glasses but it would take months. In the meantime, it was a nightmare just trying to adjust my glasses, deal with them falling off, or deal with the fact that, as a new quadriplegic prone to attempting things beyond my limits, I face planted, A LOT, on all different surfaces. Even when I was in therapy with trained therapists, when you are falling and someone goes to catch you, your glasses inevitably get smashed into your face, which always feels great. Thankfully, there was Spivack eye care center, which was affiliated with Craig Hospital and provided pro bono Lasik for patients whose eyes met the requirements for the procedure.

The whole process began with a visit from someone from the eye care center who did a preliminary check and made sure I understood and wanted the procedure. From looking at the guy, you would have guessed he was a personal trainer, sold vitamins, or was personally responsible for destroying patient records by punching them into the ground until they cease to exist. The guy was jacked, and before any assumptions are made [too late], he could not have been a nicer guy, was intelligent, and was always professional. It’s just, you don’t expect your eye doctor to have bulging muscles, it’s like finding out the tardigrade [water bear or moss piglet - possibly best name ever and also, by far my favorite living creature] can survive 30 years without food and water, survive the vacuum of space, withstand pressures 6x what is found in the deepest part of the ocean, survive temperatures ranging from above boiling to – 272 °C, and are thought to be able to survive global extinction events such as gamma ray bursts… like, what the fuck? Why? Who hurt you? [I mean, clearly the scientists who found those abilities] Unrelated to the Lasik, these abilities reinforce the phrase “be the tardigrade.” You have to keep rolling forward regardless of what ridiculous shit you are subjected to, survival is the goal. They are not extremophiles, they don’t thrive in extreme environments, they are just really good at surviving things you think would surely kill them… relatable? Anyways, he had A LOT of muscles, did I mention that yet?

Finally, on the day of the procedure, not only was my family coming along but I had 2 CNAs who joined to help with everything including transfers and driving my power chair afterwards, as I was not supposed to open my eyes for a few hours after. We took off from Craig hospital at some point in the afternoon after loading into one of their special vans. The van was one of those Ford E-150 vans with a specialized lift for people in wheelchairs that, again, kinda makes it feel like you are being loaded into a cargo van via forklift. It was a pretty short ride and I really liked both of the people they sent with me so the ride was relatively anxiety free. Speaking of that, after we arrived, got checked in, and ran through what was going to happen again, I was given a Valium, which I didn’t really feel like I needed but figured I might as well; there are not many times I can remember turning down free drugs in my life, aside from opioids and other painkillers, which I never enjoyed… except literal opium… that I did enjoy.

Next, my CNAs helped transfer me over to their surgical table, where I was given some eye drops to numb my eyes. They then use little hooks to hold your eyes open, à la A Clockwork Orange, and they position a machine over your face. At this point you are directed to look at a point of light in the center of your view, the machine then suctions to your eye and creates a flap in the top layer of the cornea (epithelium). The surgeon opens the flap, which makes everything blurry, and uses an excimer laser, or more probably an exciplex laser, basically an ultraviolet laser, to reshape the corneal stroma, the second of the five layers of the cornea. That flap is then closed, providing a protective covering for the part of the cornea that needs to heal. The flap just holds itself in place and begins healing immediately but they gave me sunglasses to wear for the next 4+ hours and also while I sleep for the next two nights, mostly to keep you from rubbing your eyes; slightly ironic as my paralyzed ass couldn’t even reach my face to rub my eyes yet. Before putting them on, they let me take a peek down the hallway and it’s truly amazing how sharp everything is, when just 10 min ago everything was all fuzzy.

There was a day or two where it felt like there was sand in my eyes and I was just supposed to do nothing about it, but after that it was just a bit of dry eye. They gave me eye drops, normal drops for dry eye but also steroidal drops to help with the healing. The fun part comes when you use the steroidal drops and they inevitably make their way over to the lacrimal ducts and seep down into your nasal cavity, from there they creep down the back of your throat and find their way to your taste buds. They aren’t so gross you want to vomit, but that’s about the bar they clear. Like if they just laid a bar on the ground for a high jump and you step over; did you clear the bar? Sure, but no one is impressed. Aside from those mildly annoying side effects, things were smooth sailing. As they warned me, some days are better than others in terms of visual clarity and there are days when some distant things are slightly blurry, but even then, my vision is perfectly functional. 

I can’t thank everyone from Spivack eye center enough. Not only did they remove a huge layer of frustration and anxiety in my life from having to deal with glasses or contacts, but they made the whole process so easy. It’s difficult to quantify the quality-of-life improvement this all made but it is massive, and I am eternally grateful.

With my vision in-check, it was on to mobility and accessibility. The benefits of being in a power wheelchair are undeniable; posture is typically better, less or no effort is needed to move around, weight shifts are easier, you don’t really have to worry about tipping over, etc. I will definitely use my power chair without hesitation when the situation calls for it but the appeal of being in a manual wheelchair will sometimes make you overlook a few drawbacks. Needless to say, I was pretty excited when they set up a chair with the approximate dimensions I needed; much like the powerchair, there are countless different important measurements, any one of which can significantly change the experience of being in the chair and how useable it is. It didn’t fit perfectly because it was just meant to test the general dimensions, seat back, and cushion combination, and I could barely move myself forward, but I couldn’t have been happier to have been in that chair. There were things like being able to get closer to people or objects and not having to worry about destroying said people or objects, but if I’m being honest, the biggest factor, in the beginning, is that you feel just a little less disabled. Ironic, because, in the beginning, you are far less able and actually more dependent on others in that chair. It seems a bit dumb, but also consider that depending on the chair I am in when you meet me, you would most likely not only assume a different level of disability but you would likely treat me slightly differently, maybe without ever being aware of it. Dress for the job you want, not the job you have? [not a consistently sound philosophy for those with handicaps, for people with disabilities, it typically means removing support that you may need]; in this case it might mean being in a chair that is meant for someone less disabled.

I remember burning my arms out after-hours taking laps around the hospital. I had a very specific path that I had to take to avoid people and any sort of incline or carpeted area. The bridge between the two buildings of the hospital connects the 2nd floors and 3rd floors; the bridge across the 2nd floor had a slight arch that basically seemed vertical when I was in that chair, the bridge across the 3rd floor had an imperceptible slope but was still only barely manageable. Even overcoming the transition between the laminate floor and VERY short carpet in my room felt like an enormous accomplishment. The first major issue in pushing myself in a wheelchair when I don’t have triceps is… well, pushing. Seeing as your triceps are generally how you straighten your arm, it’s quite difficult to “push” anything without them. I end up using my shoulders for 98% of the force, swinging them back and forth. The next critical issue is the fact that I can’t use my hands, meaning that my hands just slide past the push rims and transmit a grand total of fuck-all power to the wheels. The solution there is to squeeze in with my arms, use special gloves with a rubberized palm, and use a textured and contoured push rim; all to marginally raise the percentage of power I am able to transmit. It’s all a struggle, but as long as you don’t push yourself so hard you cause damage, it’s probably beneficial, mentally and physically.

Beyond just surviving after Craig Hospital, they want to make sure that you have hobbies and are actually enjoying life. One day, they had me scheduled to meet with the therapeutic recreation department to get an idea of things I might like to do for fun and how they could possibly help me do those things. As part of that, I got to watch a video of people with spinal cord injuries doing just about any outdoor activity that you could imagine; it included a number of different sports for people with paralysis like murderball [quad rugby], quad basketball, quad ice hockey, etc. but also included skiing, sailing, scuba diving, flying, etc. I was super excited when I saw certain demonstrations like flying, skiing, and bike riding… the thing was, they didn’t tell you what level of injury the people in the video were, until the very end. Basically, I got really excited about doing things that I was just not going to be able to do; at least, not in the way that had actually sparked my interest. I had seen all of the things that the paraplegics, with their functional arms and hands, were able to do and started thinking, “holy shit! I can do all of that!? This might not be so bad!” Well, it turns out, I was looking at the part of the menu that I couldn’t actually afford. Once I saw what people with my injury level were doing, my interest dramatically fell off. Instead of someone doing sports, it was like the sports were being done to them. The only thing that didn’t seem like it required a babysitter was the recumbent bike. Recumbent bikes are those 3 [or 4] wheeled bikes that are really close to the ground and put the rider in a laid-back seated position. Normally people still pedal with their legs; however, for people who can’t use their legs, they just set it up so you can pedal and steer with your arms and hands.

Based on the things that piqued my interest, they scheduled an hour or two with my OT Janessa and the therapeutic recreation department. The first thing we did was to head down to the basement where the wheelchair clinic, rehabilitation engineering, and wheelchair cage lived. In the wheelchair cage they had their collection of their demo and donated recumbent bikes, which is a great way to try the wide assortment of bikes without having to buy them first; given that the bikes are basically never cheaper than $10,000, that’s an invaluable resource… scratch that, I literally just described the exact value… you get the point. The different bikes have different seating positions ranging from laid almost entirely flat on your back, to seated nearly vertically but with legs stretched forward, to a forward crouch where your feet are tucked underneath you in a prayer position and your chest rests on a pad in front of you. There are also a few different ways for you to pedal the bike with your arms and hands. The bike they chose for me that day would almost certainly not be the same as they would choose today, just based on functional improvements.

There really wasn’t an elegant way of getting into the chair even with help, and no real way that I have seen to do it solo; I’m sure someone out there without triceps is doing it. We had to use the portable Hoyer lift, which is the super flattering sling that hangs you like a deli sausage waiting for pap smear. To make things even more awkward, as I was getting lifted over, I started to get an erection. I’ll talk about the specifics of sexual function and everything involved with that later, but as a quick explanation, for me, there is no mental connection between my genitals and my brain; basically, thoughts no longer cause erections, only physical stimulation, however, I can still feel most of what is happening, albeit in a slightly different way. This meant that I could feel it happening but couldn’t do anything about it; all the usual methods someone might use to hide or get rid of an erection were simply not available. It definitely didn’t help that I was always wearing yoga pants without underwear. Part of the problem with that is that it took up a lot of my mental space and focus, so when I think back and try to remember how the bike was, I mostly remember embarrassment and anxiety. Moving past all that, once I was settled in the bike and my legs were strapped in, I was given a set of stiff leather gloves that were like mittens with the tops cut off and short pipes sticking out of the palms. The pipes were the attachment point for the handles, which was one way of allowing people without hand function to pedal using their arms.   

Once I was ready and had attached my hands to the cranks, I got to take a short ride through the halls. I remember it being very uncomfortable, not just because of the erection, and was riddled with flaws but still seemed exciting and promising. It was like seeing a new idea that was being attempted by someone who just wasn’t super talented. This reminds me of all of those wheelchairs that you see able-bodied people designing and building to solve some issue that standard wheelchairs have, except they generally create more issues than they solve and they make normal functions worse. I couldn’t help but think, “this could be great if a, b, and c could be addressed…” For example, the way I was positioned in the chair and how you are supposed to pedal the bike, every time you would go to turn you would have to stop pedaling or you would just run into your legs. I’m sure you would get used to it, but any system that makes you choose between pedaling, braking, and turning, could probably be workshopped a bit more.

In any case, I got a little taste of what it might be like to ride a bike and have since seen a number of bike designs that seem to solve all of the issues that I had with that initial trial bike. There are a surprising number of companies making different styles of bikes, so you should be able to find something that fits your specific needs, if you are willing to put in a decent amount of time and effort into searching through all the different companies.

If you ever plan on traveling for those recreational activities or for any other reason and will need to get on an airplane, there are a number of issues that you will run into as a wheelchair user. As with most things, the particular issues that you run into are dependent on your abilities and disabilities. I’ll run through a few of the most common problems, just know that this list is neither exhaustive nor comprehensive. First and foremost, except in very rare cases, you are not allowed to take your wheelchair on the plane and it needs to be checked and put in the cargo hold. This comes with a number of problems by itself. If you have a power wheelchair, you are instructed by therapists to remove everything you can from the chair, especially things that stick out, because true to the stereotype, airport employees are neither careful nor gentle even with medical equipment. It is incredibly expensive and time consuming to have wheelchairs repaired, there are not many places you can call to fix them and they don’t typically have the parts on hand, not to mention that some of the parts are thousands of dollars. Also, it’s not like you have a back-up with you, so if they damage it to the point where it is not useable, you are left without a way to move, or at best you get a standard cheap loaner that likely doesn’t fit and therefore causes discomfort, pain, skin issues, etc. Imagine checking your legs as baggage and hoping they arrive in the right location and are in functioning order. To really emphasize how serious the issue is, you should know that people have died after having their chair destroyed by an airline; the broken chair means they had to use a generic loaner chair, the loaner chair caused pressure sores that subsequently became infected, and the infected wound lead to their death.

Sometimes you can take your chair up to the plane before handing it over to the airline, which greatly increases the chance that it is on the same flight as you. However, given that you need the chair to move around, the trip from the door to your seat presents a bit of an issue. Additionally, the aisles are too narrow to fit a normal wheelchair so even if you could take your chair in, you wouldn’t make it very far. The solution is apparently to use what looks like one of those hand trucks people use to move heavy boxes, except it has four wheels instead of two and the flat part is raised and padded. Given that there are no sides, so it can fit down the aisle, arms and legs don’t tend to stay in place. To solve that, they basically wrap you up like a burrito with handles and sling you around by that, a very dignified way to get around. Once you are appropriately burritoed and strapped to the seat, they roll you down the aisle like a drink cart. At that point you can transfer yourself or have the airline or airport staff help; I should mention that these people are not necessarily trained to do all of this and it’s pretty ridiculous to put that responsibility on them. Sometimes the airline or airport will have people who have not only been trained but also do it often enough that they actually feel comfortable doing it; it’s a bit of a roll of the dice.

Next, once you manage to find your way into your seat you need to start thinking about skin issues because the seats definitely aren’t as good as your wheelchair cushion. There is also the fact that, without trunk muscles, it’s pretty hard to stay upright in the seat; maybe you fall into the people next to you? Or maybe you aggressively slump into the window? Maybe you just flop over the armrest into the aisle? Or best yet, maybe you dive forward and either fold in half or mash your face on the seat in front of you like a slow dumb zombie trying to get through a glass door. The solution to that might be to loop a gait belt around your seat back and your chest, but the thing is, it is up to the airline if you are allowed to do that and many do not allow it; I assume it is a liability issue?

One solution would be to have the bulkhead seats [the first row with no seats in front] be removable and underneath, on the floor is a lockdown system similar to what goes in cars, trucks, and vans. This could allow someone to bring their wheelchair on board and stay in it and be comfortable for the flight, but the economics of catering to people with handicaps means businesses aren’t incentivized to do anything about the situation. Also, there is the threat that the chair comes loose somehow and you have a 500 lb. bowling ball unsecured in the cabin, which is likely undesirable for all concerned. However, the lockdown systems have been thoroughly tested to well above aviation crash standards; like, if the chair breaks loose, you probably didn’t survive long enough to notice… Recently, there have been a few significant advancements towards getting wheelchairs on planes; systems have been developed and tested, now it’s just about getting airlines to put them on planes.

For basically anything you want to do, there is some sort of transfer and positioning required; whether that be fully assisted or fully independent, but that would take quite a while to figure out. Figuring out how to change positions in bed, or to sit up, is a bit of a puzzle when you can only kind of move your arm at the shoulder and do a bit of a bicep curl. There are a few different ways it can be done, and the best method is highly dependent on not only the person’s body type but also their specific presentation of paralysis. Even someone with the same description of injury level as me [C5-C6 ASIA B incomplete quadriplegic], can have a very different set of abilities. The first method I was introduced to is still probably the easiest method I know, but it does require special equipment and a bit of set-up. It’s not as intense as it may sound, I basically just need to attach a chain of loops to the side of the bed. They allow me to hook my hand through one of the loops, plant my elbow, and do a bicep curl while keeping my shoulder tense, which means I can pull myself up enough to prop up on my elbows or turn on my side. However, in the beginning, basically all of the muscles required to do this are still far too weak. Have you ever had that dream where you try to run or punch something and you realize you have the strength and coordination of a small child but are trying to pilot an adult body? Just me? Well, that’s how pretty much any physical task feels when you are first recovering. Honestly, just the weight of my arm felt like a lot some days. Given how weak I was, the main objective of the session is to learn good technique and so you run through the motion of sitting up over and over, while your therapist basically does everything for you. Slowly, all of your straining and effort starts to have an effect and your therapist helps less and less, though it still typically feels like they are doing everything.

I am not the type of patient who likes bullshit encouragement. If I’m doing something wrong or doing a shitty job, that’s what I want to hear. Whenever a therapist would give me praise or encouragement, I would typically just assume they were being overly positive and motivating. My PT Mary was great, it didn’t take me too long to realize that even when it felt like she was doing more than she was saying, she really wasn’t the type to say things just to make you feel better; if she gave you encouragement, it was because you deserved it. Given how difficult it seemed to even get my shoulders to come up off of the bed or mat, independence did not seem like something that was in my future. She never over promised my future, but she constantly kept me pushing forward and making the most out of what I had. That was generally the philosophy of the entire hospital, but I think her straightforward manner just made me have more faith in what she said. To be clear, much like everyone having unique physical presentations for their injuries, everyone has their own nuanced needs in terms of support and encouragement. Hell, even what is most beneficial to me changes based on the situation. Sometimes a little bull shit encouragement does feel… not entirely unpleasant.  

Depending on the situation, there were generally two ways that I would get transferred from one place to another when in the hospital. There was the overhead crane that lifts you using the sling that basically leaves you dangling from the ceiling, spread eagle. This was the safest transfer, as long as everything is connected correctly, and it could be used regardless of what you are wearing, or aren’t wearing. The other method used a slide board, basically just a 2 ft long piece of smooth wood that looks like it is a piece of a bowling lane, with a bit of grippy material on the bottom. This method didn’t require as much setup or the bulky equipment, which is obviously useful if you ever want to transfer somewhere that isn’t your house or a specialized hospital. To be fair, at 6’ tall weighing a grand total of 130 lbs. on a good day, I’ve found that people don’t have much hesitance to just pick me up and move me like a bag of fragile potatoes. However, from my perspective this is less than ideal and I’d much rather be able to do the transfer with as little reliance on the competence of the other people involved… cause, ya know.

The slide board is used as a bridge between where you are and where you want to go. The board is placed under your leading thigh and you either get leaned forward or folded in half and slid across the board to your new resting spot. If you were leaned forward, you obviously can’t support yourself without trunk muscles and propping on your arms is difficult without triceps to keep your arm straight. Eventually, you learn tricks to keep your arm locked out in a straight line to help prop, but I was only mildly capable of doing it at the time, and always in a static position, never in dynamic situations. Being leaned forward usually meant my face was smashed into someone’s shoulder or chest, without any way to move my face, as I was still in the neck brace. At first, your hands are just in the right place and the therapist slides you across the board. Little by little, you add more force through your arms, learning how to move your arms to make use of what strength you have and gravity to make up for all of the key muscles you are missing.

It never really felt like I was doing all that much to help transfer, and that’s leaving out the whole sitting up, getting to the edge of the bed, and getting the board in place thing, where I was a complete passenger. One day, my PT Mary introduced me to one of her old patients who was back for a reevaluation and he was putting pants on, taking them off, and then transferring back to his chair on his own. At the time, it basically seemed like witchcraft, and to be clear, he couldn’t really do either completely, but it was so far beyond what I was picturing as possible he might as well have been David Blain levitation while regurgitating a small amphibian [worth a watch]. When I saw him kiiiinda get the board under his leg and then slide over with very little help [he needed help with the board, little help sliding, and a lot of help sitting up], he might as well have started flying. I think that really sparked my motivation to do everything myself and try everything, even if it didn’t seem possible at the time.

Years later, while I was visiting a patient as a peer mentor, I remember him seeing me open my bottle of Gatorade and take a drink, and his eyes lit up; I got a solid, “Yo… you just did that!?” Another time, I was talking to a patient who was working with my former outpatient PT and I was trying to look up a picture of a Quokka [they are perhaps the cutest creatures alive] and he was blown away that I could quickly type on my phone without using awkward aids. Sometimes you just need to see one small bit of inspiration that lets you know, holy shit, I can still do things, let’s see how far that goes…

If you are able to get around in a manual wheelchair, the ability to get yourself into a normal car can be really useful. More than anything, buying a normal car is much more economically viable than buying a modified van or having a vehicle modified, and you have a lot more options to choose from. Also, I’m going to go out on a limb and say your friends don’t have wheelchair accessible vehicles, so catching a ride from someone is going to involve finding a way to drag that ole malfunctioning meat suit into the car with you in some fashion. Oddly, getting the wheelchair in the car is the easy part; for my manual chair, the wheels come off, the seat cushion comes off, and the back folds down, making it relatively easy to get into the majority of cars. One of the problems is the size and shape of the doorway and how it essentially demands a certain body positioning that is difficult to accomplish as a quadriplegic, even with help. Of course, each person’s experience is highly dependent on their body type and specific dimensions, the car that they are trying to get into, and their level of injury and available muscles. Apparently, I have a longer than average torso, which meant that as I tried to lean forward so I could swing my hips from my chair into the car, my face would just get smashed into the door; but, because that was the most efficient way to transfer, it became a game of finding how best to smash together the two ill-fitting puzzle pieces that were my face and the door, as to cause the least amount of discomfort. The whole process was about as elegant as watching someone who is too drunk to support their own body weight attempt to melt their way into a car. The best part is when you become comfortable with the transfer and do it in public, having people see the struggle only to eventually realize that they are getting in the driver’s side of the car and they will soon be sharing the road with you. I have still not really mastered or even become mildly proficient at that transfer, I’m only good enough to get it done if the situation absolutely calls for it. Transfers are one of those things where practice and repetition really pay off; it might still look awkward and sketchy, but you build little mitigation strategies for everything that could go wrong with the transfer and your confidence grows.