James Shepherd turned personal tragedy into a wellspring of hope for people with spinal cord injuries the world over

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t 8 a.m., as if on cue, the Peachtree Road Race bottlenecks beneath the incline known as "Heartbreak Hill." This is the most dreaded part of the world's largest 10K; a pitch steep enough to slow the famous "human breeze" created by 55,000 runners to a mere rustling amid moistening temperatures. But as daunting as this asphalt face is (prompting some to chant Marine-like mantras), the argument can be made that "Heartbreak Hill" is misnamed—because the view along the way makes concerns about reaching the summit seem awfully petty. Halfway up the hill, beginning at the Shepherd Center driveway, wheelchair-bound patients line the sidewalk to cheer the racers. Many of these Shepherd Center patients are outdoors for the first time since suffering a spinal cord injury, brain injury, or neurological illness, and though some can't move their necks even a few degrees, they are thrilled to be curbside. For just a couple of hours on this Fourth of July they've replaced beeping medical monitors and the struggle to reuse their arms and legs with sun on their faces and words of motivation for someone else.

"You guys are the real heroes," one runner yells back as she passes the row of cheering wheelchair-bound spectators.

If some of these Shepherd Center patients require extra motivation for the rehabilitation ahead of them, they need only look to the man sitting in a wheelchair next to them waving an American flag. As founder of the Shepherd Center and chairman of the board since its inception, James Shepherd (BBA '73) occupies an Omar Bradley-type position among SC's patients, who say they feel lucky to be in his presence.

Lucky is a strange word to use in regard to spinal cord and brain injuries, but SC patients know they're in good hands at the largest and perhaps best catastrophic care hospital in the U.S.

"We combine top medical and emotional support with realism," says Shepherd. "That realism helps us to have the highest average—at over 50 percent—in the country for getting people back to work after a catastrophic injury." [The national average is 17 percent.]

Most patients and their families know that SC's success is based not just on Shepherd's caring and benevolence, but on his own experience. The story of one man's frustrations with catastrophic health care and the world-famous facility his surfing accident inspired began under the crashing waves of a Brazilian beach 30 years ago when Shepherd decided that if he had "to choose a way to go, drowning wasn't so bad." The fact that Shepherd did not die and has recovered to lead a life full enough to be named a 2003 Terry College of Business Distinguished Alumni is an inspirational story—but it's one that can only be told because of a miraculous series of events few would have been priviledged enough to experience. "Had all the stars not aligned for me," says Shepherd, "I wouldn't be here. We want to make those stars align for everyone and so far we've helped to do that for 30,000 Shepherd Center 'graduates.'"

"God bless you," says a runner who comes up to touch Kristine Alexander's wheelchair. Alexander, an SC graduate who is dressed in a red-white-and-blue skirt she sewed herself, lost the use of her legs four years ago when her deer stand collapsed. She broke her neck at the third cervical vertebra and lay alone in the woods for some time before she was found. Alexander is now a member of SC's wheelchair fencing team and is ranked 16th in the world. She's also an active member of the center's women's peer support group.

"Everybody here either needs to grieve or has gone through some grieving," says Alexander, who shot a nine-point deer the year after she was released from the hospital. A group of runners comes over to slap Alexander's hand. "Looking good," one tells her. "Looking good yourself—keep running—you're almost there!" Alexander responds.

Another runner comes up to Alexander and asks:

"Do you remember talking to my son Cary after his accident?"

"Yes!" says Alexander.

"Well, he drove us to the race today and is now in college."

"Send him my love," says Alexander.

When asked the secret of her rehabilitative success, Alexander takes little time to answer: "No secret, I have to work at it every day—just like anyone who improves at anything in life. I didn't get to where I am today by just sitting in a chair."

ith his parents' enthusiastic support, James Shepherd founded the Shepherd Spinal Center in 1975 as a six-bed unit operating out of leased space in West Paces Ferry Hospital. Immediately, there was a waiting list, but Shepherd had the foresight to recruit David Apple, a young doctor willing to work long hours to care for patients—who had started to fill the corridors—and wrestle with the obligatory headaches of starting a catastrophic care facility from scratch.

"I was working at the Peachtree Orthopedic Clinic when I left for Shepherd," recalls Apple. "My wife and I had three children and one on the way and I had no assurance that leaving my job for a start-up company was a good idea. But I had never shied away from a leadership role (he was president of his class at the University of Virginia) . Also, I knew there was a need for this type of specialized care. The methods of treatment in Georgia and around the country weren't much more advanced than what was done in Warm Springs for FDR in 1944."

In 1982, SC moved to its current location at 2020 Peachtree Road after family friend Scott Hudgens sold Shepherd a piece of property that both Piedmont Hospital (immediately next door) and McDonald's had their eyes on. "He gave us an unbelievable price of $1 million because he supported what we were doing," says Shepherd. "And when we were on the way to the property's closing, he gave me a check for $200,000 as a gift. Essentially, we got a perfect location for only $800,000."

The center became a freestanding 40-bed facility. Ten years later, it doubled in size with the opening of the Billi Marcus building—named for the tenacious SC fundraiser and wife of Home Depot chairman Bernard Marcus, head of the expansion's campaign committee. With the new space, SC increased its outpatient services and secured space for its recently opened Multiple Sclerosis Center. In 1995, SC opened a 20-bed unit for acquired brain injuries (ABI) and added Shepherd Pathways—a rehab center in Decatur with 12 beds, room for 70 outpatients, and a day program for ABI patients. Today, the Shepherd Center is a 300,000-plus-square foot, 100-bed, state-of-the-art complex. It is a Spinal Cord Injury Model Center, as designated by the National Institute on Disability and Rehabilitation Research. It ranks as a top-20 rehabilitation hospital by U.S. News & World Report, and has the nation's best average for return-home patients at 98 percent (national average is 78 percent).

f the Shepherd Center were a cell, the patients would represent the nucleus—the reason for the cell's existence. Extending the metaphor, the physicians, therapists, and staff at SC are the cytoplasm—the support network that protects the nucleus. The nourishment-providing mitochondria would be Shepherd and his family. At this point though, the cell theory falls apart. Unlike cellular organelles that work at controlled levels, the Shepherds supply energy to the center with such unnatural abandon that even when the odds were against them, they kept the nonprofit center in top working order—and, remarkably, convinced others to join in the challenge.

Each Shepherd family member is committed to SC the way religious devotees are to a higher cause. James' father Harold, a relaxed man with an easy laugh, is the founder of the Shepherd Construction Company—one of the largest in Georgia. As an SC board member, he has taken that success and tirelessly converted lifetime friends and business connections into SC supporters. "We have wonderful friends," says Harold. "We didn't and couldn't have done this alone."

Shepherd's mother and SC's board secretary, Alana, whom Harold calls the best fundraiser in the country, is well publicized as the center's grand dame. At 73, she moves like someone half her age and comes into the center every day she's in Atlanta. Her daily routine is marked by laps around the complex, meeting new patients and talking with those making progress. During a recent tour of the facility, when she sees someone in SC's intensive care unit who has been taken off a ventilator (used when a person cannot breathe on their own), she says, without patronage, "See, you're already making progess." When Alana walks into the brain injury unit, she takes a moment to look at a screen that monitors each room and shows many beds empty because the patients are in therapy. Alana's aura is a combination of strength, poise, and confidence—and devoid of words like was and can't. A firm believer in self-determination, she played golf, tennis, and basketball at Stephens College. When asked if she was any good at basketball, she responds without hesitation, "Yeah, I was good."

Shepherd, logically, is a combination of both parents. There's an attractive intensity about him and he has a propensity for slipping dry witticisms between phrases, smiling quickly, and then getting back to business. "Thank goodness we were as naïve as we were when we started—or we wouldn't have had a chance," Shepherd laughs, thinking back 28 years. In his self-effacing presence, one is apt to forget that his family is responsible for building a great deal of Atlanta and for paving many of the state's highways. [Among its assets are a bridge-building company, numerous real estate holdings, and oil wells.] Even more surprising is the propensity to forget that Shepherd splits time either in a wheelchair or walking with an elbow crutch. He personifies SC's unofficial mission that both he and his mother state nearly verbatim and in stereo: "To return patients to the most productive life possible . . . considering their injury." Watching Shepherd work, it's hard to imagine he could be more productive, even with full use of his legs. At 52, he is not only chairman of the Shepherd Center but vice president of Shepherd Construction and chairman and CEO of the family's real estate construction enterprise, Plant Improvement Company.

o keep things humming in SC's two buildings—each with four floors—it's apparent that an infinite amount of energy is needed not just from the Shepherds but from all 900 employees. Besides the patient rooms and nurse and therapist stations, there is an ICU to address critical needs. There's the ABI unit, the MS center, and a cafeteria where patients receive made-to-order meals. There are four gyms, a track, weight room, pool, rec room, and therapy garden. The entire complex has a focused, alive tactility, with every room an impromptu experimental post where methods evolve according to staff and patient epiphanies.

The Shepherd Center also conducts highly formalized reasearch. Above the ABI and MS centers is SC's Crawford Research Institute, where the University of Georgia works with the center in a search for the latest spinal cord injury (SCI) and ABI treatments and rehabilitation techniques. (Harvard and UCLA also work with SC but not as official partners.) The alliance combines SC's clinical strength with UGA's research base to provide each entity with more insight than would have previously existed.

The SC/UGA Disabilities Research and Education Initiative was started by Gary Dudley, director of the Muscle Biology Laboratory in UGA's College of Education, who, ironically, became an SC patient after a serious car accident. Dudley's efforts to partner with SC has enabled a wealth of research possibilities, such as those of UGA Health and Human Performance professor Kevin McCully, who is studying the vascular health of SCIs in order to understand vascular health in a general sense. The SC/UGA collaborative grant that McCully and SC physical therapist Leslie Van Heil received should act as seed money for future grants from entities such as the National Institutes of Health. The partnership has also opened avenues into stem cell research, which may someday provide a regenerative option for SCIs.

"We are getting closer to the day when we can truly collaborate using stem cells for SCIs," says UGA Eminent Scholar and stem cell expert Steve Stice. "When that time comes, the Shepherd Center will be a tremendous resource."

In the therapy kitchen, Shepherd, who is joined by Alana, wheels in and shows where patients learn to cook for themselves before they return home. Alana follows behind and demonstrates simple ideas like how a strap on the handle of the refrigerator allows a disabled person to slip their arm in and pull open the door rather than use uncooperative hand muscles. She pushes a button to lower the spice rack. Another switch adjusts the level of the stovetop. "Regardless of the extent of their injury, this allows people to start figuring out what they can do and what kind of technology they need for everyday living," says Shepherd. Alana adds: "We also have a special lawnmower here at the Shepherd Center that folks learn to use because the grass doesn't stop growing just because you aren't there."

At one of the hospital's therapy gyms, Shepherd stops to play a game of Uno with two rehabbing patients. To Shepherd's left is Edward Mitchell, 16, the victim of a hit-and-run. To Shepherd's right is Greg Brakel, who fell the last 30 feet of a sky dive onto his head and on cement after his parachute collapsed in a random windshear. (Motor vehicle accidents account for 38.5 percent of SCIs, followed by violent acts at 24.5 and falls at 21.7.) Both patients have limited use of their bodies but do what they can to pick up the game cards; by doing so, they are relearning to communicate with their muscles. Mitchell has been at SC since mid-May for the injury he sustained in late March, and he acts like any 16-year-old might, talking competitive "trash" to Shepherd.

"That doesn't count," he says as Shepherd lays down a card. "Doesn't count?" asks Shepherd warily. "Naw, it doesn't count." Shepherd removes the card. Mitchell then plays another card with as much movement as he can muster from fingers that can't quite clasp.

Brakel is a more recent admit and has just come off of his ventilator (a common necessity for high cervical injuries) two weeks earlier. He is so limited in the use of his hands that he must use a wand that looks like a giant stickpin with a bulb the size of a ladybug on its business end, which he labors to put through a hole in the card. Those holes are emblematic of three decades of SC rehab innovation—small wonders due to a staff's attention to detail. Brakel's occupational therapist lines up a new a set of cards along a stand that's similar to a scrabble letter rack. "This is all useful motion," says Brakel, who grimaces. His OT asks him if what he's doing is hard for him. "Oh geez," he winces in obvious pain, emphatically releasing his breath.

"This is only one aspect of what goes into getting people up and going," says Shepherd. "For every patient there's an entire team that gathers for regular conferences about the patient's needs. You have a physician, orthopedist, urologist, occupational therapist, physical therapist, recreational therapist, and an assistive technology expert. We want rehab to be real and something people can do in the future. If someone asked me to rate a rehab center, I'd ask, 'Well, how many sports do they offer?'" The Shepherd Center sponsors eight sports clubs including rugby, water skiing, and riflery.

Standing close by and watching with rapt pride is Mitchell's mother, who has stayed with her son since his accident. Asked if she'd mind answering a few questions, she says, "Absolutely not. I want people to know what happened to my son and I want people to know how this place has helped restore my belief that everything's going to be okay. Who'd ever think you'd need a place like this? But it's always a good day being here. I call this place my good shepherd."

ames Shepherd was an All-American kid. Growing up in Atlanta, he would escape to his family's farm to hunt, fish, and photograph nature. "I bought the entire Time-Life photography series to teach myself," says Shepherd, whose graying hair belies a boyish face that seems to encourage, even anticipate, repartee. He attended Westminister Schools and worked for the family construction business in the summers, running bulldozers, laying TNT, and preparing for the only job he ever wanted. "I knew where I was going to work, so at UGA I took courses in business law," says Shepherd. "I had a lot of fun at Georgia, but I also got a great education to prepare myself."

While Shepherd may have left little to chance with regard to his career, it surprised no one to hear of the chances he took in other areas of life. His daredevil exploits included sky diving, riding motorcycles, SCUBA diving, and drag racing. "Yeah, there's little I didn't think I could do," says Shepherd. "It's true," says Shepherd's wife Linda, who has worked at SC for six years as an operations coordinator. "He's just like his mother: 'We can do anything.'"

Following graduation from UGA, "anything" manifested itself in an around-the-world trip, starting in Africa. For several weeks, Shepherd and a friend, Frank Carter, traveled through Egypt, Ethiopia, Kenya, and South Africa before flying to Brazil to meet another friend, Sherman Olsen, with whom they would tour South America. On his first day on Rio de Janeiro's Copacabana Beach—October 21, 1973—Shepherd was determined to body surf waves the same way he had learned to in Africa. The problem with the South American waves was that they were 12 feet high and crashing into less than three feet of water. The result was not a gradual wave break but a violent drop from crest to sand. Shepherd was victimized by that drop after one of the first waves he attempted. As he lay on the Atlantic Ocean floor, he thought, "I'm in an undertow and I need to get up." His next thought: "I must have broken both my legs." And then, "And I've broken both my arms."

"At that point, I knew I was going to drown," remembers Shepherd without bitterness. "I fought the sensation for a moment but eventually one's autonomic response is to breathe. After your first gulp, you throw up. But then I could feel the texture of the sand in my throat and everything was painless. I relaxed and the fears were gone."

Meanwhile, Olsen and Carter pondered the whereabouts of their friend. It wasn't until they started to walk the beach searching for him that they realized it was Shepherd's body tumbling in the shallow surf. A crowd gathered. "His skin was navy blue," says Olsen. "One of the lifeguards had pitched him up on the beach by the ankles and was doing the old style of resuscitation where you press on someone's back to clear the lungs. I broke into the crowd and gave James mouth-to-mouth and eventually the ambulance came. Frank and I immediately called the American Embassy."

By good fortune, the Shepherds had a family friend nearby, Brazilian senator Adolfo Gentil, who secured for Shepherd the best doctors. But this is where Shepherd's medical luck ran out. Though methods for diagnosing spinal injuries go all the way back to Hippocrates in the fifth century B.C., SCIs were considered untreatable until the 1950s, when, according to SCI Forum Report, "a more aggressive surgical paradigm was established."

"In Brazil, where SCI methods were not advanced, it was fully expected that I would die—it was only a matter of time," Shepherd recalls. When Harold and Alana arrived, they found their oldest child [Shepherd is eight minutes older than his twin sister] on a ventilator with what would be diagnosed as a complete C4. (A "complete" C4 is a break through the spinal cord at the fourth cervical vertebra and results in "complete" paralysis at that spot and lower—in this case, quadriplegia.)

After five weeks, Shepherd was alive but struggling and in need of transport to the States for more assertive care. But flying in a normal plane was out of the question. The Shepherds cashed in another favor with an influential friend by securing a U.S. Air Force C-141 medivac plane with the help of Senator Herman Talmage. The plane had to be flown at sea level because of cabin pressure concerns with Shepherd's ventilator. And as an extra headache due to increased air resistance at lower altitude, the plane had to refuel in Puerto Rico before it could land at Dobbins Air Force Base. Shepherd's next stop was Piedmont Hospital, where he stayed until Feb. 5. "I remember an intern at the hospital saying, 'Just let him die,' after I'd had respiratory failure," says Shepherd. "After I recovered, I found the intern [who had become a doctor] and I told him I'd heard what he said."

With Shepherd's weight down to 82 pounds, the family decided to transfer him to the most advanced SCI facility in the country, which at that time was Craig Hospital in Denver. "I can only remember two bad, 'why me' days from February to June," says Shepherd. "Although there were lots of extremely hard times at Craig, they were also filled with the euphoria of making advancements—like the day when you 'get your wrist back' and you can grip again." As was more often the case 30 years ago, Shepherd's original "complete" diagnosis was incorrect. His injury was actually incomplete and by the time he came home to Atlanta in June, he was able to walk with the assistance of a cane and a leg brace.

Almost immediately upon returning to Atlanta, the Shepherds realized that a facility like Craig was needed in the Southeast. With the help of SC co-founding board members Clark Harrison, the former DeKalb County commission chairman who'd been paralyzed since being shot by a German sniper in 1944, and David Webb, chairman of President Carter's White House Conference on Handicapped Individuals, the Shepherds hurled themselves headlong into the task. "What we wanted to do was take away all the red tape I had to go through to get proper care," says Shepherd. "We wanted to make it so that an ordinary person did not have to go through such extraordinary lengths to get the treatment necessary."

Because of his persistence—not just during rehab but in establishing the facility that bears his name—Shepherd was named one of the U.S. Jaycees "Ten Outstanding Young Men" in America in 1985. That same year, he flew back to South America for the first time since his accident to receive the Jaycees International "Outstanding Young Persons of the World" award in Colombia. In 2003, UGA's Terry College of Business honored Shepherd with its Distinguished Alumni Award. "The honor," says Shepherd, whose son Jamie (BBA '02) and daughter Julie are a Georgia grad and UGA social work student respectively, "means a lot because it's not for big donors but for personal accomplishments and community service."

ust before runners overtake Peachtree on the morning of July 4, 100 wheelchair division athletes (some wearing Shepherd Center team jerseys) churn their chairs over pavement and toward the top of "Heartbreak Hill." As they pass, the Shepherd Center patients cheer wildly. They do this with a kind of proprietary pride and wonder—this is more than merely rooting for the home team. The race that has become one of the world's finest wheelchair events and has been sponsored by the Shepherd Center since its inception in 1982 [SC was also the founding sponsor of Atlanta's 1996 Paralympic Games], represents a highwater mark for the recovery that lies ahead.

Chip and Mike, both in their twenties, are whistling and clapping from their chairs beneath a thermometer-type sign showing that SC's most recent capital campaign—which will expand the Center to half again its present size—is just shy of its $60 million goal. "What is thrilling for me to see is the courage these athletes have to keep on going up that hill," says Chip, a T7 (seventh thoracic vertebra) from Memphis whose car was hit by a truck after he fell asleep at the wheel. "Watching how hard they work and seeing the heart they have to get up that hill inspires me." Asked what he was looking forward to most after his discharge from SC the next day, he said, "Man, I just can't wait to see my friends."

A few feet away, Harold and Alana are seated next to one another and leading the cheers. Alana waves an American flag and Harold has a single earphone that enables him to hear the cheering and follow the radio broadcast. "I'm of the opinion that some day there will be a way to successfully treat SCI's with stem cells and the like," says Harold. "Once, while I was talking about that, someone asked me, 'After all the work y'all've done, what would you do if we ever did find a cure?' I thought about it for a second and said, 'We'd have one hell of a party.'"

In the midst of the largest group of patients in the SC driveway, Shepherd is speaking earnestly and also joking with patients, staff, and family members. "If what happened to me hadn't happened," he says, "I wouldn't have had the opportunity to meet so many wonderful people—and life would be different for the 30,000 we've helped. Every month or so I leave here with tears streaming down my face. When I feel those tears coming down, I know I'm alive."

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