Sunday, December 11, 2011

The Femur Report - Part I


NOTE: This post is rated R for mild strong language and disturbing images.

Introduction

I had a bad bike wreck on Nov 27. Writing about its aftermath isn’t the most cheerful way I could spend my time, and I wouldn’t expect reading about it to be uplifting. Still, it’s been an extraordinary experience and it would seem a shame not to record it.

Note that though I’ve reported this episode as faithfully as I can, I cannot vouch for the accuracy of every detail. Especially where vast pain is involved, memory gets distorted. But I haven’t deliberately fictionalized anything and in fact have tried to be as plain and simple as possible in the telling.

I’m not going to get into how the wreck happened. That’s a whole other story that makes me angry to think about. So I’ll start with when I hit the ground.

The ground

I’m on the ground. A second earlier I was upright, on my bike, enjoying a mellow, unrushed descent at the end of my ride. I’m astonished at how quickly I was dropped to the ground, like a duck shot right out of the sky. I’ve been cycling competitively for thirty years and this is not how a crash usually unfolds. I’ve written at length at how in a crash situation time seems to slow down and I can easily perceive what is happening and what action to take. Not so today. BAM—like that, I was down. I heard my helmet sliding on the ground but only for a second. I didn’t slide much, but rather ground to a stop.

Every experienced cyclist knows that after you crash the first order of business is getting out of the road. This isn’t a sports field where you have a moment for self pity or mustering your resolve—it’s a road and you could get run over. So you scramble to get up as fast as you can. In the past I’ve started this scramble even before I stopped sliding along the road. But today I cannot begin to get up. Mainly this is because I cannot stop screaming, and the screaming is taking all my energy, all my will. I am screaming louder than I thought possible.

I’m screaming in pain, which is remarkable. Crashing on a bicycle doesn’t usually involve that much pain, at least not up front. Initially our bodies give us a surge of adrenaline and endorphins and the pain is masked almost completely. We can snatch up our bikes, run off the side of the road, check things over, and (if it’s a race) can often straighten out our handlebars, climb back on, and start chasing back to the group. The pain doesn’t arrive until later, when you’re cleaning out your road rash. But today? This was at least twice as much pain as I’d ever felt before in my life.

I can see my bike in the road. The impact has knocked the chain off the front chainwheels, which vexes me inordinately. The water bottle has been knocked out of its cage. Closer to me, I see blood dripping on the ground but I’m not sure what part of me it’s coming from. And the ground, this road—it’s a medieval surface of smooth pebbles imbedded in asphalt. I can start to see why such a relatively low-speed crash has hurt so badly—it’s an incredibly hard surface (pebbles being far harder than asphalt) and doesn’t allow you to slide. Whoever chose this surface material should be tried for a war crime.

Help

With astonishing quickness several people swarm around me. They’re local residents who have heard my screams. “I’ve got to get out of the road,” I tell one. He is crouching next to me. “Don’t worry, we’re stopping traffic,” he said. For a moment I think of asking him to get the Advil out of my toolkit but of course I see the absurdity. “I’m in so much pain,” I tell him, and scream some more. I’ve found what for some reason seems the least painful position: my right leg is straight forward—its hip is the center of the pain—and my left leg is bent double so I’m in a half-squat, leaning forward, supporting as much weight as possible on my left hand. My left arm shakes with the effort. “Who has a signal?” someone asks. “I do, I’m calling,” someone answers. I tell them, “I don’t think I need an ambulance,” but immediately I realize this is wishful thinking. “Actually I do.”

A guy on my left says, “I’m a doctor. You’ve got a broken femur. We called an ambulance.” There’s a cyclist on the scene and he has taken my bike out of the road and leaned it up against something. I can see he’s put the chain back on and I take strange comfort from this. Someone asks me for my home phone number and in a moment I’m talking to my wife. This is the worst call to have to make. I give her the news—my head is fine, but something is broken—and hope that I sound merely miserable, not scared.

A fire truck arrives from a station that is very close by. I beg for pain meds. They work quickly but it could never be quick enough. I get 5 mg of morphine intravenously but it doesn’t do anything. They’re cutting off my clothing. The EMT gets to my right shoe and I ask him to let me undo the rotary buckles and take it off, sparing its life.

Here a massive wave of gratitude washes over me. This is the moment when I go from being in charge of my situation—which is to say, being helpless—to when I turn my situation over to those with special training who know exactly what to do. Imagine if I were on a battlefield, or a remote road alone, or on a mountain where my survival meant crawling for miles through my pain and injury. Then I’d really be screwed. I am relieved to be passively placed in good hands, where all I have to do is answer questions.

They get my helmet off. Now the medics are preparing a long scary-looking metal apparatus next to my right leg. The man who earlier identified himself as a doctor tells me, “They’re going to have to put you in traction. This will pull your right leg straight. You’ll have to lie back. It’s going to hurt like hell.” It does. I can’t stop screaming. It seems like nothing they could possibly do to my leg could hurt more than this. The traction device is basically an iron maiden for the leg. I get 5 mg more morphine and that’s all they’re allowed to give me. It’s still not enough, not even close. An ambulance has arrived somewhere along the line and I’m scooped onto a stretcher and into the back of it (more screaming). I’m begging for more pain relief.

(I’m going to pause my story for a moment now to make an observation: I can now speak from experience about the stupidity of torture. To be freed from this pain, I’d have told anybody anything. The fact that I have no secrets simply means that I’d contrive something, anything I thought would satisfy a questioner. If the medics had asked, “Are you part of The Institute?” I’d have said yes. If they’d asked if I knew who masterminded Operation X, I’d have said yes. I’d have begged for a list of suspected operatives and randomly circled names, if it meant being freed from this pain. That is how desperate pain can make you.)

At some point I am given some other drug, perhaps to treat anxiety, and I start to suffer less. But every bump in the road—and there seem to be endless bumps—makes me cry out. The ambulance’s suspension seems to be shot.

Hospital

We arrive at the hospital. I am whisked from place to place, hallways and curtains, and end up in the X-ray department. It’s all huge and industrial and Orwellian and when somebody says, “We have to move you onto the X-ray table” there’s an unmistakable note of apology in his voice. Four of them lift up the whole sheet and move me. It is impossible to set somebody down lightly when he has a broken femur and the table is hard as glass. More bloodcurdling screams. I have a flashback to 1984, when I was fifteen, in a hospital in Wyoming after a car wreck with my mom and two of my brothers, and I suddenly heard my brother screaming his head off from all the way down the hall. The shock of recognition—that’s my brother screaming!—was not so different from the shock I feel now: that’s me screaming!

The X-ray table is my worst enemy for what seems an endless period of one X-ray after another, many with my body arranged in torturous positions. They know my femur is broken but are trying to figure out if my pelvis is broken. Finally another excruciating transition to the gurney, and I’m taken back to a curtained-off row.

They get some more pain meds in me and I’m starting to get some real relief. Presently my wife arrives. Of course I’m glad to see her but also full of remorse at putting her through this. If she were some fiery hot-blooded type who slapped me across the face first thing, I’d probably have felt better. Of course it’s preferable that she’s stable, calm, and strong. She knows she doesn’t have the luxury of getting upset and making this her problem—it’s mine and she’s my support. A team of doctors arrive. “We’re going to drill a hole through your tibia and insert a long screw, so we can get a good purchase on your leg for traction,” one of them explains. I love the idea—if it means getting this barbaric clamp off my leg. “You’ll take the old traction thing off as soon as that’s done, right?” I ask. They assure me they will—soothingly, as if we’re in agreement that the old traction device is the center of all my pain.

The drill

My wife asks why this operation wouldn’t be done in an operating room. “Oh, we don’t need a room for it,” they assure her. “It’s not like a big surgery or anything, it’s just a procedure. And we have to do it right now.” And they’re not joking, there’s no leaving and coming back, no apparent bureaucracy, they’re already preparing. They put on these Plexiglas face shields like a SWAT team would wear. Now, maybe it’s just the pain meds, but suddenly I’m struck by how improbably good-looking they all are. It looks like the cast of an TV show, an eye-candy hospital drama that isn’t even trying to be realistic.

They describe the local anesthesia they’ll be using: Novocain and something else. I warn them that I historically metabolize Novocain very quickly, so it usually starts to wear off by the time the doctor thinks it should be kicking in. The doctors offer a blandly reassuring response. They’re putting the bit into the drill. I swear the bit must be a foot long. I crane to see what kind of drill it is. I’m hoping for Mikita or Skil. If it’s Black and Decker, I’m out of here. It turns out to be Craftsman, which is just barely satisfactory. I relate to them a story from my dad about a fleck of chrome from a Craftsman tool that befouled a photocell in a satellite and sent it way off-course. (At that time I may have thought I was only thinking about this anecdote, but Erin assures me I actually told it.) Now they’re ready to start.

“Erin, you may want to make yourself scarce for this,” I tell my wife, but she’s sticking around. I suppose she feels a duty to stand by me, but it also wouldn’t surprise me if she had feelings similar to my own: as horrible as this is, it’s fascinating. How often do you get a chance to watch something like this?

A resident will be doing the drilling. She lines up the drill. Her eye and her hands are as steady as a pool shark’s as he lines up a shot. She looks to be about twenty years old. The others are giving her advice and encouragement. The bit goes in. My head flops back on the gurney and I scream. Of course the pain is bloody murder but with it comes a strange feeling of vindication. Sure, this hurts like hell, but of course it hurts like hell—it should hurt like hell, I’m having a drill go through my leg! The pain in the bone is only part of it, though—the vibration along my whole leg is just as bad. As for the local anesthetic, it’s not quite up to snuff: I can feel the drill well enough to recognize when its direction changes and it’s being drawn back out of my leg. I get a huge sense of relief from this, knowing the procedure is almost over.

Then the drill is out and the resident is getting a pat on the back. I ask her, “Is this the first time you’ve done this?” She replies, “No, it’s my second. The first one was a disaster. Halfway in the drill died, and everybody had to run around looking for another drill before we could get the bit out!” Now I’m even more impressed with the calm she had beforehand. You know the saying: “Learn one, do one, teach one.”

Relief

To the screw in my tibia they attach, on either side, cables that run through little pulleys on an apparatus attached to the foot of the gurney. From these cables they hang water-filled plastic weights. With the cables pulling the tibia screw forward and thus pulling my leg straight, they no longer need the original traction device, and finally remove it. What a relief. Somebody notices that one of the weights is leaking and sends for a replacement.

Now they set about giving me a nerve block. This is kind of like the epidural that pregnant women get. I don’t know the exact science but it involves injection of drugs right into or near to nerves. To pinpoint where to administer this, they use ultrasound. One watches the monitor while the other administers the drug. “Okay, you’re right in position, drop some right there. Good. Go a little deeper here. Drop some more.” The guy has the depths of my leg mapped like some high-tech mining operation. “Okay, a little deeper, little more, okay—right there—drop the rest.” The sense of competence of this team thrills me, and then when the nerve block takes effect, the pain in my leg quiets down some more.

(Note: having read this, Erin wonders about the sequence of tibia screw vs. nerve block. She doesn’t remember which came first, but thinks it more logical that they’d have started with the nerve block. I distinctly remember the screw being first based on the pain, and based on my understanding that the screw was essential whereas the nerve block was just a nice-to-have. But as I said earlier, memory can be distorted.)

They move me to a hospital room and say “No food until after surgery tomorrow.” Not a problem. For once in my life I have no appetite.

To be continued...

That’s about all I care to write for now. If you feel like this was something worth reading, stay tuned because of course there’s more to tell.

Other chapters

2014 update:  it occurred to me to add links to all the chapters of this tale now that they're available.  Here you go:

The Femur Report - Part II (posted Dec 19, 2011)
The Femur Report - Part III (posted Dec 28, 2011)
Physical Therapy (posted March 11, 2012)
Bike vs. Car - How I Broke My Femur (posted Nov 27, 2013)

2 comments:

  1. Wow, I am so sorry! Thanks for blogging your story. I pray that I will never ever have to experience such pain as I can hardly bear to read about. Hang in there!

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