59 pages • 1 hour read
Peg KehretSmall Steps: The Year I Got Polio
Nonfiction | Autobiography / Memoir | Middle Grade | Published in 1996A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Prologue-Chapter 3Chapter Summaries & Analyses
Prologue Summary
Peg Kehret introduces readers to a disease called poliomyelitis. Polio was first known as infantile paralysis because it affected children much more frequently than adults. Before the polio vaccine, it resulted in physical disabilities or killed thousands of people annually. As an example, Kehret cites President Franklin D. Roosevelt, who was diagnosed with polio and used a wheelchair for the rest of his life.
Kehret also emphasizes how highly contagious polio is and chronicles the number of diagnoses reported in the United States in 1949—the same year that 12-year-old Peg contracted polio—which stood at a devastating 42,033 cases. Despite this high number of cases, Kehret vividly remembers being the only diagnosed polio case that year in her hometown of Austin, Minnesota. Peg defines polio as a virus that “attacks the nerve cells which control the muscles of the body” (11). If caught early, when the damage is slight, and muscle weakness or paralysis can be temporary. If caught later, when the damage is significant, the effects can be extensive and paralysis might be permanent. Kehret states the facts—there is no cure for polio, nor do treatments exist to reverse its effects. Whatever damage polio inflicts on a survivor’s nerve cells cannot be repaired, but less affected muscles can be strengthened and there are sometimes cases of miraculous recovery.
The Prologue ends with Kehret reflecting on her writing process, which brought back long-forgotten memories and emotions with surprising intensity. Kehret also explains that because there is no written record of these events of her life, and she necessarily reconstructed a somewhat fictionalized version of events using her memories and those of family, friends, fellow patients, and the doctors involved. She warns that while the dialogue might not be spot on, every person within the memoir is a real person who played a role in her treatment and recovery. As an established writer, Kehret admits to using fictional techniques in writing her memoir but assures readers that her inner thoughts and feelings, which she believes to be “the most important part of any story” (12), are authentic.
Chapter 1 Summary: “The Diagnosis”
On a Friday in early September, seventh-grader Peg wakes up for school, eager for the homecoming parade later that day. While in chorus class, the muscles in Peg’s left thigh twitch uncontrollably. After class, Peg’s legs buckle and she collapses. Peg shakily gets to her feet and walks the 12 blocks home for lunch as usual. Two days ago, Peg had a sore throat and a headache, yet today she’s weak and her back hurts. She resolves not to tell her mother, who would force Peg to stay home and miss the homecoming parade. When Peg reaches for her glass of milk, she can’t pick it up due to the severe shaking of her hands. Her mother takes notice and sends her to bed. Peg is relieved to lie down because the pain in her back has intensified and she’s become tired. Peg wakes three hours later to a stiff neck, increased back pain, and leg aches. The muscle spasms she experienced at school have worsened—her legs and toes curl with each series of spasms, and Peg is unable to straighten them until the episode passes.
Peg’s mother calls Dr. Wright, who confirms Peg’s 102-degree temperature. Overcome with extreme fatigue, Peg sleeps through the homecoming parade. She begins to vomit in the middle of the night, and everyone assumes that she has the flu. When Dr. Wright returns in the morning to do a full inspection, Peg’s legs are unresponsive when he taps her knees with a mallet. She also experiences intense pain and high fever; she wishes that Dr. Wright would leave her alone but doesn’t have the energy to pull away or speak. Dr. Wright instructs Peg’s parents to bring her to the hospital for a spinal tap, and the results confirm that Peg has polio. It’s decided that Peg will go to a hospital in Minneapolis designated specifically for polio patients. Peg feels fear and disbelief as she recounts the yearly March of Dimes fundraisers for kids with polio and the posters with children in wheelchairs or with leg braces. Later that morning, Peg walks into the isolation ward of the Sheltering Arms Hospital. She goes to bed in a private room, and when she wakes, she has paralysis.
Chapter 2 Summary: “Paralyzed from the Neck Down”
Peg wakes thirsty, but when she attempts to reach for a nearby glass of water, she can’t move. Peg calls for help, and a nurse feeds her water through a straw. The nurse tells her that the paralysis is caused by her progressing polio. A doctor inspects Peg and explains that the muscles that play a part in her breathing are weak. He says that Peg has paralysis from the neck down. Peg is in isolation to contain the spread of her disease, so she can have no visitors and is left alone with her terror. She begins to panic, and she desperately wishes to be cured and to go home. For the next two days, Peg’s fever remains at 102, and it becomes harder to breathe and swallow. On day three, arrangements are made for an ambulance to take her to the University of Minnesota Hospital, where she will have access to a respirator if needed. (The Sheltering Arms, by contrast, is a rehabilitation center that does not have such specialized medical equipment.) The doctor explains that Peg has two types of polio: spinal polio, which causes paralysis, and respiratory polio, which makes breathing difficult.
Peg is transferred via ambulance and reflects on how “backward” her situation is, for her condition is now worse than when she arrived. She falls asleep in the ambulance and when she wakes, she asks for her parents but is told again that she’s in isolation and no visitors are allowed. The nurse mentions that her parents came to sign her papers when she was admitted to the hospital. Peg is angry that she missed the chance to see her parents. She feels isolated and alone, visited only by doctors and nurses. Peg endures another spinal tap, and afterward, a doctor tells her that she has a third type of polio, the least common kind—bulbar polio. As the most serious form, bulbar polio affects the ability to talk or swallow. The doctor tells her about the call button next to her bed, which Peg can’t move to use. Belatedly realizing this, he advises her to call for a nurse if she can’t swallow or starts to choke. Although his words are meant to reassure her, Peg panics, wondering how to call for a nurse if she’s choking.
Chapter 3 Summary: “An Oxygen Tent and a Chocolate”
Peg can’t keep track of time, but days pass. Her parents are eventually allowed to visit dressed in gowns, gloves, and masks. Peg senses their fear and intuitively understands that they have been permitted to see her “because [she] was so sick that the doctors weren’t sure if [she] would live” (31). Peg is glad for their presence regardless, even if only for a few minutes. Peg is put in an oxygen tent—sheets of plastic surrounding her bed—in an attempt to aid her breathing without putting her on a respirator. Peg is horrified to learn what a respirator is: a tube-shaped machine that she recognizes as an iron lung. Peg is terrified because she’s heard that some who go into iron lungs are never able to come out again. Inside the oxygen tent, Peg keeps a teddy bear sent from her brother, Art, who is a first-year student at Carleton College. The tent eases her breathing, yet Peg’s fever and pain continue. One night, she wakes with terrible aches and asks her nurse to turn her, but the nurse refuses and tells Peg not to call her unless it’s an emergency. Peg is stunned and angered by the nurse’s callousness, which fuels her desire to beat polio: “Someday, […] she’ll be sorry. I’ll fight this polio, and I’ll beat it. I’ll walk out of here and I’ll tell the whole world about a mean nurse who would not help a paralyzed child turn over in bed” (36). Peg tells her parents, who are furious, and Peg never has the mean nurse again.
Peg struggles to eat and drink because it becomes harder to swallow. One night, when attempting to drink 7-Up, Peg chokes and struggles to catch her breath. This scares her, as she doesn’t want to be put in an iron lung. After eight days, Peg’s fever remains at 102, her breathing is shallow, her muscle spasms continue, and she’s in immense pain. Fearing that she won’t have the strength to recover unless she eats or drinks something substantial, Peg’s mother asks Peg what she wants. Peg asks for a chocolate milkshake—even though polio patients are not allowed to have milk or ice cream because it creates mucus in the throat and increases the risk of choking. Peg’s parents sneak a milkshake to Peg, who finishes the entire thing without choking. Both her parents and the nurses cheer. Within an hour, her temperature drops and it seems the milkshake may have saved Peg’s life.
Prologue-Chapter 3 Analysis
The introductory chapters of Small Steps are dedicated to educating inexperienced readers about poliomyelitis by using a combination of comprehensive definitions, historical explanations, and illustrative statistics that portray the devastating effects that polio wrought upon the world during the time of Kehret’s personal experience with the disease. The Prologue reads as a promise from Kehret—a promise to remain as authentic and transparent as possible while she recounts this profoundly formative year of her life. Kehret illustrates the depth of her personal knowledge about polio by citing official research and her own experiences, and this powerful combination firmly establishes her ethos on the subject matter, whereby she, as the author, demonstrates herself as a trustworthy source of accurate information.
The initial chapters recount aspects of Peg’s daily life just before her diagnosis, and these details provide a sharp contrast with her harrowing experiences in the hospital and the Sheltering Arms rehabilitation facility. Such details also provide readers with a solid understanding of all she stands to lose if her health does not recover. Peg’s excitement about homecoming and her plan to hide her flu-like symptoms from her seemingly “overbearing” mother illustrates her childish and innocent perception of life. These scenes will remain important pages of inspection as Peg’s later experiences with polio exemplify The Impact of Adversity on Perspective. She will no longer care about trivial things such as a homecoming float or classroom drama, for the struggle to regain her mobility supersedes all such frivolous concerns. By illustrating her pre-polio life, Kehret provides a way for readers to form a clearer picture of the ways she changes during recovery and in the years after recovery. These scenes also remain important reminders of Peg’s young age, as she will be required to mature quickly in order to endure both treatment and the recovery process. Her young age, coupled with her impressive stubbornness, rebelliousness, and determination, only add to the wonder of the miraculous recovery process that forms the premise of Small Steps.
Peg delivers on her belief that emotions are the most important part of any story by deliberately employing pathos—the ability to evoke a specific emotional response in readers for persuasive purposes. As Peg continues to experience Emotional Turmoil Throughout Recovery, Kehret employs a sarcastic, rebellious, and determined tone while depicting her younger self; her aim with this technique is to create a sense of sympathy, connection, and compassion in readers. The speed at which Peg’s polio progresses and the whirlwind of activity and monumental change that she undergoes throughout these chapters provide intense insight into Peg’s experiences and illustrate how quickly some debilitating and life-threatening diseases can take hold. The section also reflects Peg’s shifting emotional and mental reality during this traumatic time in her life. Such rapid change is terrifying even for a grown adult, and in the midst of her health crisis, Peg often struggles to keep pace and adjust with each new development. The internal chaos of her thoughts and emotions is exemplified by her reaction to her paralysis: “The doctor’s words played over and over in [her] mind like a broken record. ‘The patient is paralyzed from the neck down. The patient is paralyzed from the neck down’” (23). Her paralysis is both literal and metaphorical, for doctors talk about her as if she isn’t in the room and use terms that she can’t understand, contributing to her overwhelming feelings of helplessness due to her paralysis. In Peg’s isolation and loneliness, she longs for any companionship she can find and comes to understand The Value of Connection in Recovery. The connections that Peg will make in coming months will eventually reduce her isolation and negative thoughts, allowing her to remain motivated and optimistic.
Just as Kehret employs a sophisticated approach to narrative description, her strategic use of simile serves many purposes throughout these chapters. In Chapter 1, for example, she states, “That fear, unspoken, settled over us like a blanket, smothering further conversation” (18-19). The use of a blanket to symbolize fear resembles the attempts of Peg’s parents to show bravery and comfort after her diagnosis, Kehret’s decision to use the hospital-appropriate image of a blanket as a representation of fear is no accident, for even the items meant to convey aid and comfort in the hospital setting often become a source of terror. A prime example of this is when the doctor realizes that the normally reassuring presence of the call button is no comfort at all to a patient who doesn’t have the mobility to use it. Similarly, the sensation of smothering later becomes relevant when Peg nearly loses her ability to breathe on her own. Kehret also employs vivid similes to convey the impossibility of trying to manipulate her frozen limbs; she later describes her arm flopping “like the Raggedy Ann doll [she’d] left on [her] bed at home” (21). The comparison simultaneously conveys her feelings of helplessness while also evoking poignant images of her innocent childhood lifestyle at home with her family: an innocence that she was forced to abandon along with Raggedy Ann when polio struck. When faced with the possibility of being put into an iron lung to help her breathe, Peg panics, thinking, “it would be like being put in a coffin while you were still alive” (32). Peg’s comparison of an iron lung to a coffin serves as a potent motivator to keep her breathing on her own in order to avoid such a fate. By viewing the iron lung as “a gray octopus ready to swallow [her] at any moment” (33), Peg is aware of the precariousness of her health, but instead of becoming resigned to a dire fate, Peg taps into her determination and her stubborn rebelliousness, both of which ultimately save her life.
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