Adapting to life in a wheelchair has never been easy for Doug Calka. Adrenaline junkie who has spent years riding dirt bikes, the Michigan native finds ways to keep moving.

“I always try to do most of the things myself,” he said. “I cut the lawn myself with my zero-turn mower. I just make changes to everything I do.

The 54-year-old weekend warrior lost control on an 80-foot jump he had “done 100 times before” in a race nearly 10 years ago.

“I knew I was going too fast and climbing too high,” Calka said. “While I was in the air, I pushed my bike and landed squarely on my feet. I heard my back crack and I was done.

Instantly, Calka knew what he had lost. It wasn’t until later that he realized that it was so much more than the feeling in his legs.

“It’s a chance that every runner takes, signing a waiver when you come in,” he said. “There is no worse outcome than being paralyzed from a fall because it didn’t just affect me. It affected my wife and my daughter. A mistake I made changed their lives more than I thought.

The T12 vertebral fracture crippled Calka from the waist down. His family home in Romeo needed a complete renovation. Daily activities like working and sleeping have become a chore. His wife, Sue, effectively became his caregiver.

“When you really love someone, you do whatever it takes, for better or for worse,” said Sue, who married Calka in 1993. “We’re still learning to handle it, but we don’t. “Don’t use it as an excuse. You keep moving on and living. I’m so grateful that he’s still with me.”

Slow Pandemic

Years after the adjustment began, and just before hospitals curtailed services at the start of the pandemic, Calka noticed her dog licking her hip. Calka couldn’t feel that a pressure sore had developed on her right side.

“Thank goodness for the dogs,” he joked. “But then the wound got bigger and bigger, to the point that I had to stop working because I was bleeding through my bandage and my clothes, in the car seat on my way home. In the end, I just couldn’t keep working.

Unable to receive proper care for the open wound, Calka developed osteomyelitis, an infection that can occur when a bone is exposed. Patients with spinal cord injuries are more prone to such infections without pain as a protective mechanism, said Jaimo Ahn, MD, Ph.D., orthopedic surgeon at Michigan Medicine.

“We normally think of pain as something unwanted, something that we want to get rid of,” Ahn said. “But the irony, of course, is that once it’s gone to the point where we don’t know something is wrong, then we can’t protect ourselves.”

Calka was treated with several antibiotics before receiving treatment at Michigan Medicine. Bacteria affecting his bones, however, began to develop resistance to the drugs, said Shiwei Zhou, MD, a physician in the Division of Infectious Diseases at Michigan Medicine.

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“He would feel better with the antibiotics, but without solving the problem, we can only generate more resistance,” Zhou said. “It was only a matter of time before we ran out of antibiotics.”

Zhou has a name for it: the overflowing sink. The source of the problem is the open wound, which leads to overflow issues, such as infection. By using antibiotics, she can contain the infection, but someone has to “turn off the tap” before the bacteria become resistant.

“I have a few other patients who weren’t as lucky as Doug,” she said. “They were too advanced in their infection for surgery not to be an option for them, and I manage them with antibiotics almost as a stopgap measure. At some point, I cannot resolve the issue. It is incredibly frustrating and frightening.

The healthcare team went through the options and Calka continued to decline. His daily conversations were interrupted by labored breathing, and he was constantly going to the hospital for further blood transfusions. It was like walking on water