After celebrating her 20th birthday with friends in December, Leah Shrum made a life-altering decision - she got in her Nissan Sentra and headed home after too much to drink.
At some point on a winding road, her car went onto the shoulder and she overcorrected, swerved across the lane of oncoming traffic and was T-boned by a van.
As paramedics cut her contorted body from the vehicle, the Whitwell, Tenn., resident remembers telling them with certainty that she was paralyzed.
She was right.
The former high school cheerleader had broken her shoulder, wrist and eight ribs and severed her spine near the waist, leaving her without any feeling from the belly button down. After two weeks in the trauma unit at Erlanger hospital, and two weeks in intermediate care, she found herself filled with regret and dread and facing a life she wasn't sure she wanted to live.
"I never thought in a million years I would be in a wheelchair at my age," said Ms. Shrum, who had been in school to become a medical assistant. "I have my days where I just cry and cry and cry."
Her healing - physical and emotional - has come through the support of her family and her therapists at Siskin Hospital for Physical Rehabilitation, where she has been a patient since January.
Though she can't walk, she has muscle activation in some muscles below the waist. With the encouragement of her therapists, Ms. Shrum said she has become determined to walk with the assistance of a walker within six months and go even farther in the future.
"They have really, really high hopes for me, so that encourages me and makes me want to work harder," she said last week in Siskin's outpatient therapy room, where she has physical therapy three days a week. "I love them. I really do. I don't know how to say it, but they feel like my family when I come here."
It's a sentiment shared by many former patients at Siskin, a facility that for two decades has provided rehab care to patients in Chattanooga and the surrounding region. The hospital recently celebrated its 20th anniversary with its annual fundraising luncheon, Possibilities.
DECADES OF SERVICE
In 1990, Siskin Hospital opened its doors in Chattanooga as a 50-bed inpatient hospital. Today, with 109 beds, the hospital offers a wide spectrum of services, from intensive inpatient treatments to an outpatient pavilion with a variety of specialized programs, to a fully accessible fitness center where the disabled and able-bodied work out together, said CEO Bob Main.
Vocational training and job placement for former patients, as well as psychological services and specialized support groups, are among the other ways Siskin aims to address the many facets of patients' well-being, he said.
"What we were trying to do was to develop a continuum of care so that, when the patient was referred, we'd put them in the most cost-effective program, whatever their needs were," he said. "We're not treating a leg, we're not treating a broken arm, we're treating the whole person."
But the dedication of the staff is the backbone of Siskin Hospital, Mr. Main said.
Former patients such as Tim Totherow, 42, echoed those thoughts. As he was recovering from crushing multiple vertebrae after a construction accident in 2006, the compassion and enthusiasm of his therapists pushed him to reach his goals to regain some ability to walk and adjust to using his wheelchair, the Signal Mountain resident said.
"They really cared. There's a lot of people there that worked closely with me that are as close to me as some of my family members," he said.
CHANGING MEDICAL WORLD
The medical landscape has changed greatly over the past 20 years as rehab providers are increasingly fighting with payers to keep patients in programs that could allow them to return to the work force and remain as independent as possible, Mr. Main said.
The average length of stay for a patient was 33 days when Siskin opened; today it's 14 or 15 days, he said.
"We have insurance companies that people that have had massive strokes and surgery, you have to fight to get five days certified for rehabilitation and then go back every five days," Mr. Main said.
Particularly in hard economic times, policymakers tend to eye rehabilitation programs for cuts, despite the fact that effective rehab can help people avoid future dependence on government assistance and significantly reduce the need for expensive care to treat complications, he said.
"We have to constantly fight to get rehab on the agenda," Mr. Main said. "Most times, if you don't get rehabilitation, you're not going to die, but you have a terrible life and you have medical complications."
Tennessee's proposed budget for the upcoming fiscal year would cut TennCare coverage for physical therapy, occupational therapy and speech therapy. However, a proposed tax on Tennessee hospitals - which would be used to draw down millions more in Medicaid federal matching funds - could raise enough money to allow state budget officials to avoid that possible cut, Mr. Main said.
The hospital fee proposal is under consideration in the state Legislature.
Through a hospital grant program, Siskin cares for many patients who qualify for free service. Last year, Siskin's program provided $761,000 in free care to patients who otherwise couldn't afford it, hospital officials said.
One of the hospital's first spinal cord patients was Dean Lafferty, who was 28 when he broke three vertebrae in a car accident in June 1990. Uninsured and with a pregnant wife, Mr. Lafferty received his care for free through Siskin's grant program. He came to Siskin unable even to sit up, and he is now fully independent and walks without assistance.
Mr. Lafferty said the hospital brought possibilities to his life he never would have had otherwise.
"Up until Siskin got here (in Chattanooga,) you either got put in a nursing home paid for by Medicare and you didn't get better, or you got shipped off if somebody could find the grant or the money" to a rehabilitation facility in another city, he said.
Still a regular volunteer at Siskin, Mr. Lafferty said the hospital and its staff have become part of his life.
"With me, it's something I can't let go of," he said. "We have a lot of medical facilities here, but nothing like Siskin."
SISKIN SERVICES
* Inpatient hospital
* Outpatient treatments - typically one to three hours a day, up to five days a week
* Day hospital therapy treatments - up to six hours per day, five days a week
* Vocational training and job placement
* Occupational therapy, physical therapy, speech therapy
* Psychological services
* Fitness Center
* Other outpatient services include amputee program, hand therapy, lymphedema program and driving courses
LIVES RECLAIMED
* A.B. Barnes, 45, Fort Oglethorpe, Ga.
* Injury: Hit by a turning vehicle while riding a motorcycle; right leg amputated in 2009
* Recovery: After therapy with the inpatient care in the amputee program, he can walk and jog.
* Outlook: "I had to come to the conclusion that this was my new life and I would never be able to return back to my old life as a person with two legs again. (Siskin therapists) gave me the tools to prepare myself for that mentally and also gave me the physical tools to do just the things we take for granted."
* Tim Totherow, 42, Signal Mountain, Tenn.
* Injury: Fell from a six-foot ladder in 2006 and crushed multiple vertebrae in back; doctors said he'd never walk again
* Recovery: After surgery, 10 weeks inpatient and a year of outpatient therapy, he can walk short distances with assistance of canes and uses a wheelchair. In 2007, he again started dirt-track racing, a long-time hobby.
* Outlook: "They really want you to succeed. The more they want you to succeed, the more you realize you can succeed. ... There's a lot of people there that worked closely with me that are as close to me as some of my family members."
* Dean Lafferty, 48, Chattanooga
* Injury: Broke back in car accident in 1990
* Recovery: He came to Siskin unable to even sit up and is now fully independent and walks without assistance.
* Outlook: "For (Siskin) to have just opened when my accident happened was a godsend for us. ... I was uninsured. Had Siskin not taken me on a grant I was going to a nursing home."