Book summary “Small Steps”: summary

Introduction

You face a sudden medical crisis when an illness abruptly strips away your physical independence and forces you into rigid isolation. Peg Kehret's memoir details her harrowing battle with polio at age twelve in 1949, capturing the terrifying transition from a healthy child to a paralyzed patient confined away from her family.

The central idea is that surviving catastrophic illness and reclaiming your life requires immense personal resilience, specialized therapeutic care, and a step-by-step approach to physical recovery.

The book traces this journey through four key stages. First, you experience the sudden onslaught and strict quarantine of the disease. Second, you enter a rehabilitation facility to undergo revolutionary treatments. Third, you rebuild your strength and independence through gradual milestones. Finally, you return home to face environmental barriers and reflect on historical medical triumphs.

• How do doctors diagnose and treat polio in 1949?
• What daily routines help paralyzed patients regain muscle control?
• How do you maintain hope during months of painful isolation?

1. Diagnosis and Isolation

You find your healthy life upended when a sudden onset of polio strikes. Twelve years old and already five feet, eight inches tall, you must travel one hundred miles from your family home in Austin to a hospital in Minneapolis.

The sudden onslaught of polio turns a healthy child's life upside down, requiring emergency medical intervention, quarantine, and strict isolation rules.

The Onset of Illness

Acute polio muscles require painful stretching twice daily to regain normal length before building strength. During the acute stage, frequent spasms tighten muscles. Therapists straighten legs and push heads toward knees despite intense pain because the spinal cord and hamstrings must be loosened.

Peg nicknames her harsh therapist Mrs. Crab and dreads daily hamstring stretches she calls Torture Time.

Therapists follow a precise physical routine:

• Therapist grasps patient ankle with one hand and knee with the other to keep leg straight.
• Raises leg until it is straight up from the stomach.
• For back and hamstring stretch, sit upright in bed with legs out and feet flat against a board.
• Hold chin to chest and push head down toward knees.

Medical interventions like oxygen tents and respirators, commonly known as iron lungs, were critical life-saving devices for polio patients who lost the ability to breathe on their own. Patients with bulbar polio often faced severe breathing difficulties and paralysis, requiring an oxygen tent or an iron lung—a tube-shaped machine enclosing the body where bellows pumped air to expand and contract the lungs.

Peg was threatened with an iron lung and placed under a plastic oxygen tent that kept the air three feet above her head and chest, making the room look through a foggy windshield.

Hospital Isolation and Rules

Patient advocacy and breaking strict hospital rules can sometimes yield profound psychological and physiological benefits when standard medical care reaches an impasse. Hospital charts strictly prohibited milk and ice cream for bulbar polio patients due to the risk of creating phlegm and choking. However, when Peg refused to eat and her fever persisted, her parents defied the rules and brought her a chocolate milkshake, which she swallowed successfully.

Peg's parents brought her a chocolate milkshake against hospital orders; she drank it without choking, and within an hour her temperature dropped after her fever stayed at 102 degrees for eight days.

Hospitals instituted strict infection control protocols during polio outbreaks, which included destroying patient belongings to prevent the spread of the virus. Items brought into the isolation ward, including get-well cards, books, plants, and stuffed animals, were routinely confiscated and burned to ensure the virus did not spread, whereas metal beds were sterilized instead.

A nurse collected Peg's get-well cards, books like Anne of Green Gables, and a teddy bear sent by her brother Art into a bag to be burned.

2. Rehabilitation at Sheltering Arms

Moving to a rehabilitation facility introduces patients to Sister Kenny's revolutionary hot pack treatments, occupational therapy, and a community of resilient roommates.

Sheltering Arms serves as a long-term rehabilitation facility for patients facing severe physical barriers. You meet diverse roommates who must endure long stays. Some children are orphaned wards of the state.

Alice has lived at Sheltering Arms for ten years. Her parents refused to take her home as a crippled-up child. Renée spent five months in an iron lung at University Hospital. Shirley spent seven months without seeing her family more than twice.

Sister Kenny Method

Sister Kenny's revolutionary treatment for polio relies on applying hot woolen packs to relieve muscle spasms followed by gentle massage and early exercise. This method contrasts sharply with the old method of using rigid casts. Sister Kenny discovered accidentally in Australia that boiling hot wool packs relaxed severe muscle spasms, preventing permanent limb distortion and muscle wasting caused by prolonged immobilization in casts.

Sister Kenny used strips of wool blankets dipped in boiling water on a child in the Australian bush in 1903, which stopped the child's pain. Australian medical officials issued a report rejecting her methods in 1938. Sister Kenny left Australia and traveled to the United States in 1940. The Sister Kenny Institute was dedicated in Minneapolis in December 1942.

Peg endures twice-daily hot pack treatments where boiling woolen cloths are wrung out and placed on her skin. The cloths feel intensely hot at first but eventually soothe her tight muscles.

Because there was no medicine for polio, treatments focused on minimizing its effects through hot packs twice a day. Nurses placed boiling woolen cloths through a wringer to remove moisture and applied them to the bare back, arms, and legs for an hour.

You follow specific steps to administer these treatments:

• Heat water in a large metal tank.
• Soak large gray woolen cloths in the steaming water.
• Lift the cloths out using tongs to prevent burns.
• Flatten the cloths in a wringer attached to the side of the tank to remove most of the moisture.
• Lay the hot, damp cloths across the patient's bare back, arms, and legs for an hour, replacing them as they cool.
• Place a rolled-up towel under each shoulder if shoulder muscles are weak to keep them from becoming too rounded.

Roommates and Routine

Physical therapy can be effective without inflicting real pain if therapists apply steady pressure and respect patient limits. Unlike acute hospital therapists who force movements regardless of screams, rehabilitation therapists build trust by stopping when pain begins, prompting patients to push themselves further willingly.

Miss Ballard tells Peg she never wants her to feel real pain, which completely transforms Peg's outlook on physical therapy sessions.

You apply physical therapy using these techniques:

• Push slowly, applying gentle, steady pressure.
• Stop when the patient indicates it starts to hurt.
• Allow the patient to let you push a tiny bit beyond the point of pain voluntarily.

Occupational therapy incorporates unconventional craft and dexterity exercises to rehabilitate damaged extremities. Fine motor control and foot articulation are restored through targeted repetitive tasks like picking up small objects with bare toes or crafting leather and woven items.

Jeanette the occupational therapist makes Peg sit bare-footed and pick up seventy-five marbles one by one with her toes to exercise her feet and ankles.

You perform the dexterity exercise with a precise method:

• Remove shoes and socks.
• Curl toes around a marble.
• Move the foot and release the marble to the other foot.
• Repeat the process in reverse using the opposite foot.

3. Rebuilding Strength and Independence

Patients regain mobility through gradual milestones, transitioning from wheelchairs and walking sticks to unaided steps while keeping up with schoolwork.

As back and leg strength improves, you learn to stand unassisted and maneuver wheelchairs independently. This newfound freedom boosts confidence, but it also increases the risk of accidents from reckless behavior.

Peg becomes a wheelchair daredevil who pops wheelies by slamming on hand brakes at top speed. She even tries to dance the hula, causing a room-wide panic when she falls.

You perform standing exercises with a precise method:

• Sit on the edge of the bed with feet over the side.
• Slide off until feet hit the floor.
• Lock knees and stand straight and steady without support.

Miss Ballard assigns Peg the accordion because it requires coordinating a keyboard with one hand, chord buttons with the other, and working the bellows. This instrument serves as an effective occupational therapy tool for strengthening arm and hand muscles affected by polio.

Peg's dad practices the accordion in secret for seven days until he can play "Beer Barrel Polka" flawlessly to surprise the girls.

Shared musical activities and evening routines build deep emotional bonds among hospital roommates facing chronic illness. Singing duets and rounds after lights out provides comfort, emotional release, and a sense of normalcy in an institutional setting.

Peg and Alice harmonize on songs like harvest moon after lights out in Room 202. You follow a nightly routine for these songs:

• Wait until the nine o'clock lights out call.
• Choose familiar songs to sing in harmony or rounds across hospital beds.

From Wheelchair to Sticks

Mrs. West encourages Peg to obtain the exact textbooks used by her school in Austin so she will not fall behind. You study your seventh-grade textbooks independently while at Sheltering Arms, relying on self-study since you spend only two hours a day in school due to hot baths, physical therapy, and O.T., and you are not required to turn in homework.

Transitioning from a wheelchair to walking sticks requires retraining balance and carefully coordinating a slow, step-by-step movement sequence. Miss Ballard instructs Peg to take small, deliberate steps, thinking through the sequence of lifting each stick and foot while maintaining balance.

Peg takes her first ten small steps with her new wooden walking sticks before slumping back into her wheelchair in exhaustion. Two weeks pass after getting her sticks before Peg stops using her wheelchair entirely.

You coordinate the movement with a specific sequence:

• Lift right stick and right foot
• Move them forward and put them down
• Lean on the stick for balance
• Lift the left stick and the left foot
• Move them forward and put them down
• Move slowly and take small steps

Progressing from walking sticks to unaided walking requires deliberate heel-to-toe mechanics and strict supervision to ensure stability. Miss Ballard guides Peg to practice walking short distances without her sticks by focusing on heel-to-toe steps and maintaining proper posture.

Peg successfully walks six steps unaided across the physical therapy floor to meet Miss Ballard's hands.

You follow strict guidelines for independent walking:

• Stand by a sturdy handrail and hold on
• Let go of the rail under supervision
• Raise one foot and set it down a few inches ahead
• Step heel first, then toe, using small steps
• Keep head up and shoulders back

To combat Peg's tendency to hunch forward and watch the floor out of fear of tripping, Miss Ballard uses the fashion model technique of balancing a book on the head. Balancing a book on the head serves as an effective training mechanism to improve posture and prevent patients from looking down while walking.

Peg balances Birds of North America on her head while walking across the physical therapy room and mimicking a fashion show. You practice this posture technique with a clear routine:

• Place a book on your head
• Keep shoulders back and eyes ahead
• Walk across the room trying not to drop the book

4. Returning Home and Historical Context

Returning home prematurely for a visit highlights the severe physical limitations and environmental barriers that unadapted houses present to paralyzed patients. Without wheelchair ramps, wide doorways, half-bath accessibility, and sufficient core strength to maintain balance in unbelted cars, home visits can feel discouraging rather than triumphant.

When Peg visits her home for a weekend, she struggles with front steps, cannot fit her wheelchair into the tiny half-bath, lacks carpet mobility, and finds herself exhausted from trying to stay upright during the car ride. This trip takes place during a two-hour car ride between the hospital and Peg's home in Austin using an Oldsmobile.

Going home brings both joy and the realization of environmental barriers, while the broader history of polio reveals the medical triumphs of vaccines and global eradication efforts.

Back to School

Returning home and back to regular school after prolonged hospitalization involves overcoming readjustment challenges, but strong community and peer support ease the transition. After being discharged from Sheltering Arms, Peg manages home routines, deals with well-meaning but prying peer questions, and ultimately receives a warm welcome back at school.

When Peg returns to her Austin school on walking sticks, her classmates in her first-period English class whistle, clap, and cheer to welcome her back. This return follows seven months as the total time Peg spent away from school. Decades after initial recovery, many polio survivors experience post-polio syndrome, causing renewed muscle aches, fatigue, and loss of strength. Forty years after her acute illness, Peg Kehret and other survivors began experiencing muscle weakness, forcing them to reluctantly return to walking sticks, braces, and wheelchairs.

Peg Kehret began having muscle aches, back pain, and weakness in her arms and legs four decades after the events of the book, eventually needing a cane.

The Fight Against Polio

Ironically, improved public sanitation contributed to the dramatic increase in polio epidemics during the twentieth century. Previously, infants acquired the poliovirus through unsanitary conditions while still protected by maternal antibodies, which produced mild infections and lifelong immunity. When clean water supplies and hygiene reduced early exposure, children contracted the virus later in life after maternal immunity had worn off.

A German doctor named the disease infantile paralysis in 1840. A small town in Vermont reported forty-four cases of paralytic polio in 1894. Twenty-seven thousand cases were reported in the United States with six thousand deaths in 1916. The worst year of 1952 saw 57,879 cases as the number of polio cases.

Franklin D. Roosevelt transformed a Georgia spa into a rehabilitation center and founded the National Foundation for Infantile Paralysis to fund research and patient care. After contracting polio in 1921, Roosevelt spent years in rehabilitation at Warm Springs, where buoyant water and swimming helped him build upper body strength. He later established the National Foundation for Infantile Paralysis to finance investigations into prevention and pay for patient care.

President Franklin Delano Roosevelt was diagnosed with polio at age thirty-nine in 1921. He bought Warm Springs in 1926. He established the National Foundation for Infantile Paralysis in 1938. President Franklin D. Roosevelt used hip-high leg braces and a cane during speeches to stand while hiding his wheelchair use from the public.

Mass fundraising campaigns like the March of Dimes engaged ordinary citizens to finance polio treatment and vaccine research. Entertainer Eddie Cantor coined the phrase March of Dimes, urging people to mail silver coins directly to the White House. Later, the Mothers' March on Polio mobilized volunteers who knocked on doors with burning porch lights to collect donations.

During the first few months of the campaign, mailbags containing two million, six hundred eighty thousand dimes arrived in Washington, D.C. Phoenix mothers raised $45,000 on the first night of the Mothers' March on Polio.

Dr. Jonas Salk and Dr. Albert Sabin developed successful killed-virus and live-virus polio vaccines that dramatically reduced and nearly eradicated the disease. Dr. Salk developed a vaccine using killed virus, tested it on 1.8 million children known as Polio Pioneers, and declared it safe and effective in 1955 without patenting it. Dr. Sabin later developed an oral live-virus vaccine approved in the U.S. in 1962.

1.8 million schoolchildren participated in the 1954 Salk vaccine field trials as Polio Pioneers. The Salk vaccine was announced as safe and effective on April 12, 1955. Dr. Sabin's oral vaccine was approved for use in the U.S. in 1962. When asked who owned the patent on his vaccine, Dr. Salk replied that it belonged to the people and asked if one could patent the sun.

International health organizations and dedicated volunteers executed massive vaccination campaigns to drive down polio cases worldwide. Rotary International, the World Health Organization, UNICEF, and the Centers for Disease Control joined forces to eradicate polio globally through cold-storage distribution in remote and war-torn regions.

Polio was declared eliminated in the Western hemisphere in 1994. Rotary International made worldwide eradication its top goal in 1985. Worldwide polio reports reached 350,000 cases in 1988 and dropped to 1,882 cases in 2005. One hundred fifty million children were immunized on a single day in India in 2001.

Conclusion

The harrowing journey from paralysis to recovery shows that resilience, compassionate medical treatment, and unwavering personal determination can overcome seemingly insurmountable physical crises. You can apply these hard-won lessons from a historical health battle to your own daily obstacles, whether you face chronic illness, sudden trauma, or difficult life transitions.

1. Accept strict medical protocols and isolation when necessary to protect your health and the well-being of others around you.
2. Rely on innovative therapies and physical rehabilitation milestones to rebuild your strength step by step without rushing the healing process.
3. Cultivate deep bonds with fellow patients and supporters to maintain the mental fortitude required for long-term recovery.
4. Prepare for the psychological adjustments of returning to a normal environment after a major life interruption.
5. Support global public health initiatives and vaccination programs to protect future generations from preventable diseases.

10 Key Ideas

1. The sudden onset of polio turns a healthy child's life upside down, requiring emergency medical intervention, quarantine, and strict isolation rules.
2. Patient advocacy and breaking strict hospital rules can sometimes yield profound psychological and physiological benefits when standard medical care reaches an impasse.
3. Moving to a rehabilitation facility introduces patients to Sister Kenny's revolutionary hot pack treatments, occupational therapy, and a community of resilient roommates.
4. Sister Kenny's revolutionary treatment for polio relies on applying hot woolen packs to relieve muscle spasms followed by gentle massage and early exercise.
5. Patients regain mobility through gradual milestones, transitioning from wheelchairs and walking sticks to unaided steps while keeping up with schoolwork.
6. Returning home prematurely for a visit highlights the severe physical limitations and environmental barriers that unadapted houses present to paralyzed patients.
7. Returning home and back to regular school after prolonged hospitalization involves overcoming readjustment challenges, but strong community and peer support ease the transition.
8. Ironically, improved public sanitation contributed to the dramatic increase in polio epidemics during the twentieth century.
9. Mass fundraising campaigns like the March of Dimes engaged ordinary citizens to finance polio treatment and vaccine research.
10. Dr. Jonas Salk and Dr. Albert Sabin developed successful killed-virus and live-virus polio vaccines that dramatically reduced and nearly eradicated the disease.