Ageing Focus - Make Balance a Habit!

Introduction

Last week’s post, though perhaps an amusing romp, wasn’t very responsible. I mean, why showcase my bad habits? Whose idea was that, anyway? I hope I didn’t come across as condoning any of those behaviors (though honestly, as odd as they are, you’d have to be some kind of kook to adopt them). This week I hope to provide a whole-grain, high-fiber, wholesome corrective. I’m offering up sincere and helpful advice here and I will try my best to make it amusing somehow.

Some background

My younger daughter is home for the summer and perhaps being around her vivacious youthfulness emphasizes how fricking old I’ve gotten. I guess I’ve reached the age where I worry more about my advancing decrepitude than reveling in whatever vigor I still have left. Sure, I can still make my bike go pretty fast when I dig deep, but I also dread the prospect of, say, my back going out for no good reason. (A buddy of mine, though he is still athletic and does all kinds of yoga, threw out his back putting on a sock.) I contemplate how to preserve my physical faculties over the last few decades of my life.

Strength and heart health are all well and good, but I lately I’m putting more focus on balance. Seventeen years ago I read a fascinating New Yorker article about the role balance plays in graceful ageing, and I’ve been thinking about it ever since. The article, by the doctor/professor/writer Atul Gawande, is called “The Way We Age Now.” (My friend P— and I have a running joke about Atul Gawande. P— is a doctor, and I fancy myself a writer, and we complain to each other how Gawande is a better doctor and writer than both of us, and is also better looking; we naturally assume he’s even seduced our wives at some point.) In the article Gawande describes how he tagged along with a Dr. Bludau, a geriatrician, during a routine physical exam of an 85-year-old woman:

It seemed to me that, with just a forty-minute visit, Bludau needed to triage by zeroing in on either the most potentially life-threatening problem (the possible metastasis) or the problem that bothered her the most (the back pain). But this was evidently not what he thought… The danger for her was losing what she had. The single most serious threat she faced was not the lung nodule or the back pain. It was falling. Each year, about three hundred and fifty thousand Americans fall and break a hip. Of those, forty per cent end up in a nursing home, and twenty per cent are never able to walk again. The three primary risk factors for falling are poor balance, taking more than four prescription medications, and muscle weakness. Elderly people without these risk factors have a twelve-per-cent chance of falling in a year. Those with all three risk factors have almost a hundred-per-cent chance.

What is to be done?

How do I address these three risk factors?

1. Being an athlete is a non-negotiable part of my lifestyle, because cycling is a) fun, b) something I have enough experience in that it’d be a shame not to do it, and c) my number-one way to burn off stress. Cycling addresses the strength part of my ageing, to a point. (I know that ideally I should do core exercises, join a gym, do yoga, etc. and I’m trying to muster the resolve to take those things up.)
2. In terms of prescription medications, I’m not sure how feasible it is for any of us to avoid needing them when we’re old. It’s not like we can just resolve to go without. I’m lucky enough to be blessed with low cholesterol, and my blood pressure is decent, and so far I have no risk factors for diabetes, but you just never know what I may need for this or that ailment in my codger years.
3. Balance: this is the area where I think I can make the biggest difference.

How can we improve our balance?

I’d like to think that being a cyclist automatically gives me great balance, and of course it can’t hurt, but I don’t think it’s actually enough. I learned this when I was doing physical therapy after breaking my femur. As we began my regimen, my physical therapist asked me what my goal was for the therapy. As I’ve explained in these pages, I’m not actually that into goals, but this time I had one. “I want to come out of this better than I was before,” I declared. After all, I had a gym to work in and an expert to guide me … why not dream of shoring up some of the classic deficiencies of the pure cyclist?

To start with I had to learn to walk all over again, and realized in the process just how complicated walking is. With every step, the back leg has to swing forward, the knee bent so your foot doesn’t hit the floor, and then you have to plant that foot and swing the other leg forward, and that swinging is more rhythmic when we realize. But because I didn’t trust my bad leg to bend properly, I was kind of swinging it around sideways so I could keep it straight, and thought I was doing pretty well until my physical therapist, laughing, told me to walk toward a mirror and watch myself. I looked like a drunken zombie.

After relearning how to walk, one of the toughest things I did in that gym was a toe-tapping exercise on a fairly unstable platform. It was basically a square plank of wood with a half-cylinder under it (i.e., a half-circle cross section), kind of like a teeter-totter that you stand on. I would start by standing on the plank, balancing so it wouldn’t tip forward or back. Then I’d tip the plank forward until its front edge tapped the floor, and then rock back until the plank was level again, the slower the better. I’d do this ten times, and then I’d switch to rocking back, to tap the back edge of the plank on the floor, return to level, and do that ten times. Once I mastered that with both feet, I learned how to do it standing on just one foot. Oddly, I was no better at this with my good leg than my recently healed one, but in time I went from incompetent to totally proficient, even after adding in a barbell in one hand to put me slightly off balance. I cannot tell you how stoked I was to have learned a new trick that I couldn’t have done before my accident. I actually was better than before.

So now, with Gawande’s article in mind, I want to continue that trajectory of actually improving my balance. The fun way is to ride indoors with my bike on rollers, when it’s too dark and/or wet to ride outdoors. The less fun, but logistically easier, way—and, more importantly, the way I can recommend to you, albertnet reader—is to do the PT balancing trick on a balance saucer. You can buy one of these (one manufacturer’s product name is “Wobble Balance Board”) for about $20. This is even harder that what I did in physical therapy.

The regimen

The great thing about the balance saucer is that you can do your whole routine in 5-10 minutes. (I suppose this duration will vary as you become more proficient, and based on how much you want to do.) My current regimen consists of the following exercises, in sets of 10 repetitions each:

• Standing on both feet, tap the front edge of the saucer on the floor
• Standing on both feet, tap the rear edge
• Standing on one foot, tap the front edge
• Standing on one foot, tap the rear edge
• Standing on both feet, tap the right edge
• Standing on both feet, tap the left edge

I hold a barbell in one hand, and after the first five reps I pass it to the other hand. If I feel like it, I pump the barbell in the air for extra exercise and instability. (I plan to figure out other cool things to do on this saucer, maybe even incorporating my upper body.)

Since a picture is worth a thousand words, and five movies totaling two minutes at 60 frames per second is therefore worth about 7.5 million words, here are videos showing the exercises:

(Video credit to my daughter, expertly wielding her superfly non-phone camera.)

Don’t be surprised if it takes a while to get good at this. When I started up again (over a decade after my physical therapy days), I was pretty wobbly and struggled for a while.

Make it a habit

Did you notice in that video that I wasn’t in a fancy studio with mirrors and mats, wearing PrAna yoga pants and fancy workout shoes and headphones and a fitness tracker? All you need for this is the saucer and a pair of shoes with good, grippy soles. With worn-out or loose-fitting shoes, I have a lot of trouble, and if I try to do this barefoot my feet slide off. But other than that, no special gear or preparation is required, not even a warm-up. That said, this activity is oddly strenuous given how low-impact (actually, zero-impact) it is. During winter, when I’m working from home and stuck at my desk with my blood congealing, almost like suspended animation, I like to take a break and do my balance regimen to get my blood flowing. It really warms me up.

Making this a habit is key. Initially you’ll need plenty of repetition to develop the balance needed for these exercises, and then you’ll want to maintain that consistency so that five, ten, and twenty years from now you won’t have lost the ability. It’s kind of interesting to ponder how well we could maintain this, if we do it daily … can you imagine having this kind of balance at 80? Assuming we don’t, at least we’d be declining from a pretty decent height of capability. I think that’s well worth pursuing.

Postscript

A few more notes, as I have used this thing for a couple years now:

Make sure your shoes are not only grippy enough not to slide, but are completely dry before doing your balance regimen. I started in on my routine once, months ago, when my shoes were a bit wet (though I thought I had wiped them enough on the mat). My saucer squirted out from under me and I fell, wanging my wrist. Not all saucers have the same anti-slip texture; my brother has one (from the same manufacturer as mine, but newer) that is much grippier. I will probably buy some of that sandpapery-textured tape you put on stairs and add it to my saucer. So be careful!

Not all these saucers have the same depth, so get one that is appropriate for your balance level (which may have a lot to do with your age). I recently tried my mom’s saucer and it’s far shallower than mine, which makes the exercises vastly easier (too easy in my case, but probably much better for, say, an octogenarian). Mine is four inches deep; I have seen three-inch versions and even 1.5-inch versions available online.

This article (also available in a schlockier form here if you get blocked by a paywall) suggests that a good measure of your body’s effective age is how long you can stand on one leg, especially your non-dominant one. The doctor who wrote the article cites Mayo Clinic research and concludes (as paraphrased by ChatGPT), “While balance tests offer a simple method to gauge physical aging, incorporating balance training into regular exercise routines is crucial for sustaining overall health and mobility.” Running the calculation cited in the article, I have determined that a typical person my age ought to be able to stand on his or her non-dominant leg for about 22 seconds. That seemed way low to me, so I tried it out. I stood on my left leg for a couple of minutes, no problem, and then I started to get bored so I passed the time by doing the Wordle, then added stickers to my Wordle snapshot before sending it to my daughter, and finally, after over eight minutes on one foot, I was really bored and my leg and foot were starting to hurt so I bagged it. Needless to say, this balance regimen really works!

Another postscript

More recently I came across an article suggesting that a good balance challenge is to tie your shoe while standing on one foot. This capability is said to bode well for preserving balance into old age. I didn’t find this much of a challenge, and decided that tying my shoe while standing on the balance saucer would be a better trick. It is, and now I’ve incorporated it into my saucer regimen. Check it out:

If you perceive that the above video ran a bit long—i.e., that it took me longer than necessary to tie my shoe—it’s because of the role vision plays in balancing. As it turns out, where we look has everything to do with balance. If you close your eyes while on the saucer it’s almost impossible to do the taps, etc. described in this post. And I’ve found that looking at my shoe while balancing on the saucer totally messes me up. Something about locating ourselves in space is instrumental to balance. Only if I look out into the room can I tie my shoe while on the saucer.

Give it a shot and let me know how it goes!

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Miracle on Pinehurst Road

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

Introduction

My wife rented “Glee,” the movie.  I’m writing this instead of watching it.  People have asked, “How do you have time to blog?”  The answer is, I don’t get to watch “Glee.”

This is a post about other sacrifices I make, but really it’s about the sacrifices all cyclists make, and it’s a little bit about why we make them.  I include the downside of the cycling lifestyle—the crummy rides you have.  And then, finally, I recount a breakthrough on a recent ride that felt like an apotheosis—a particularly surprising Big Ring Tale (or at least, it could have been, on different terrain—but I’m getting ahead of myself). 

The second kind of suffering

I have written at some length on this blog about the suffering cycling entails.  Hearing my daughter gripe recently about her violin practice helped me realize there’s another level of suffering in life:  drudgery.  Cycling gives you both kinds.  Leg-searing, lung-busting intense suffering is one thing; the tedium of all that day-in-day-out riding is another. 

Drudgery isn’t the same thing as boredom—it’s worse.  It’s the sheer repetition of something difficult.  Playing the violin, my daughter’s hands get tired.  Her neck gets tired.  But most of all her brain gets tired, and that’s a form of suffering.  Anybody who wants to achieve mastery of anything—whether it’s a sport, a craft, art, music, pretty much anything really difficult—must learn to tolerate tedium.  Endless repetition produces the incremental improvements in performance that matter to the diehard.  (And only to the diehard.  This sport is full of poseurs with their über-expensive bikes, who don’t realize that all the technology in the world won’t give them the gumption to actually ride.  As Bernard Hinault said,  “No kind of [technological] progress will ever overcome the loneliness of the long-distance rider.”)

Why would a non-professional cyclist—and especially a forty-something former racer—ever submit to such drudgery?  For those of us who used to race seriously, it’s a former habit that’s not so hard to pick back up.  (If I were starting now there’s no way I’d try to get here.)  The drudgery aspect mostly applies to our younger racing days.  Getting to a high level is what takes the day-after-day no-dinking-around commitment, and interval training (typically something a racer does one day a week) is the epitome of the drudgery I’m talking about.  Along the way to this high level there is a lot of fun, a lot of camaraderie, and once the discipline has been gained, the difficulty of the sport is easier to take.  Besides, the veteran cyclist who no longer races so much can enjoy the payoffs without so many miles and without so much of the relentless effort. (And without the interval training.)

There are other benefits of this sport.  I won’t go into too much detail on them here (they’ll one day get a post of their own), but suffice to say the big payoff for me is gradually getting to know my body better, even after 30 years, and gleaning more performance from this body as an alternative to letting it get old and fat.  These past three years I’ve derived an odd pleasure from training really hard during the six weeks leading up to the Everest Challenge, getting dropped by my pals on the brutal training rides all through August but then gradually finding my form and seeing it subtly insinuate itself just in time for the big event.  And the event itself is a huge payback:  I’m on the last pass of the first stage, in the baking heat, heading towards a 10,000 foot summit, and watching with astonishment as my legs crank along, practically by themselves, doing a far better job than I ever expected, and I look down at them and think, “Damn!  Look at ‘em go!”

My own private Strava

Many cyclists add excitement thru Strava.  Not me.  I have my own private Strava, which is my training diary.  I don’t log my routes via GPS—my ride repertoire isn’t that large anyway—but I log everything that matters:  duration, heart rate, power output, rate of vertical gain, my times on all my favorite climbs.  I put in copious comments.  I don’t compare myself to strangers online:  I compare myself to my younger self, and to a few pals. 

I don’t want to beat faceless strangers.  Throughout my decades of cycling my goal has always been to beat the guys who I know are better than me.  Some of you reading this know who you are:  the guys who routinely crush me but who, once in a great while, find yourselves unaccountably pwned!  I’ve never been a good time trialist, and Strava is a just great big time trial.  If I succeed at all in spontaneous, real-time throwdowns it’s through cunning or luck, and most often because I’ve been foolishly underestimated, perhaps left for dead.  If I’ve got any chance at all of beating you, it’s because of the complicated dynamics of the head-to-head situation, perhaps some tactics, some psychology, my ability to cheat the wind, or because you crossed me during early September, that brief window when I get some good form.  The all-time record wall on Strava?  I might as well be a swimmer (i.e., “strong like bull, smart like tractor”).

I like group rides, of course, but they’re harder to work in with my overall goal for cycling.  And what is that goal?  It’s not just to be faster, stronger, better, and the next best thing to younger.  It’s to fine-tune the balance of cycling as it intersects the rest of my life.  It’s like a crazy decathlon:  the cycling itself; having time for my wife and kids; having time to read; having time to write; keeping enough meat on my bones that I don’t disgust my wife; doing enough cycling to be good but not so much that I burn out.

The downside of cycling

For the cyclist who doesn’t race regularly and can skip the interval training and not always be worrying about his form, the sport is less arduous than it is for the beginning racer—but that doesn’t mean it’s easy.  The most difficult thing about this sport, at least for me, is that on many a day when you have every expectation of feeling good, you (or at least I) simply don’t.  The Bad Day is the curse of the cyclist.  I mix up two big bottles of energy drink, pack some gels, caffeinate, hit the road with all kinds of big plans, and then discover fifteen minutes in that my legs are crap.  They won’t do what they’re supposed to.  They’re like somebody else’s legs, like they were swapped with a golfer’s in the middle of the night.  My heart rate won’t climb, because there’s so little work for my heart to do.  It sends one of its ventricles home.  “I’ll call you if things pick up.” 

This can happen any time.  There’s no warning.  As many years as I’ve spent trying to learn how this body works, I still never know when the weakness will strike.  The menu isn’t published in advance.  (“Today’s special?  El crotcho grande!”)  The unpredictability is so frustrating.  It makes me superstitious.  I’ll be picking out my socks, wondering which ones I wore on that Diablo ride when I felt so good.  I’m reminded of a quote from “Drugstore Cowboy,” about how the junkie takes drugs to escape the unpredictability of the human experience:  “Most people don't know how they’re gonna feel from one moment to the next.  But a dope fiend has a pretty good idea.  All you gotta do is look at the labels on the little bottles....”  (Combine this notion with David Millar’s statement about EPO—“It’s like having the best day you’ve ever had as an athlete – every day”—and you can start to imagine how those amoral doping cyclists might have started down their cowardly path.)

So when—surprise!—I feel lousy on the bike, I get demoralized, and I’m tempted to head home, and sometimes I actually do.  But usually I think, damn, I carved out time for this, and I need this training, and of course I can’t feel great for every ride, so I should just do it.  So I plod miserably on.  And because I keep such close tabs on my performance, the slow days threaten to drag me into depression and I flirt with self-loathing.  I combat these impulses through a philosophical perspective that I sometimes struggle to maintain.

Then there’s this damaged leg.  Soft-tissue & nerve damage from my broken femur still dogs me.  On a good day, when I’ve got adrenaline and endorphins and I’m riding well—when I’m blessed with what so many pro cyclists quoted on cyclingnews call “positive sensations”—I gush internally with gratitude that I can still do this sport, and that I can do it well enough that it’s not just physical therapy.  It’s easy to be grateful then.  But on a bad day, all I can think of is how deep a hole I’ve been working, for six months, to climb out of.  It’s hard to be grateful then.  It’s hard to be patient.  Friends and family say, “Give yourself some credit—you broke your fricking femur!  You’re doing great for a guy who’s had that serious an injury!”  But I don’t want that “for a guy” trailer—that note, that asterisk.  It’s too much like when I was a kid trying to keep up with my brothers on the bike and would be told, “You’re doing great for your age!”  Right or wrong, I figured if I was only ever good for my age, I’ll never get to be anything but a little brother.  Likewise, I’m tired of being a recovering cripple.  I want to be whole.

Case in point

Sunday was one of those bad days on the bike.  I faked myself out for awhile—under four minutes to Monterey and The Alameda, under six minutes to the Arlington Circle, just over eight minutes to Los Angeles and Spruce—but by Wildcat Canyon Road I knew the legs didn’t have it.  Crap.  On a glorious sunny day I might have retained my spirits, but it was early, and cool, and foggy, and my leg warmers were sagging, and though I hope one day to break eight minutes on South Park again (I used to do this routinely), I clocked a pathetic 10:16.  I rode to the edge of the road, dismounted, and pulled my leg warmers up practically to my groin, just to make them not sag anymore, rolled my shorts back down over them, and with a sigh remounted and continued my ride.  At least I could get some miles.

From there to the intersection of Canyon Road and Pinehurst Road, a distance of 14.6 miles, my heart rate averaged just 116.  If I were a Strava guy you could look online and see that my maximum heart rate for this section was only 144, my peak power a paltry 252 watts.  What Strava couldn’t tell you is what happened on the little climb, South Pinehurst, along the way.  I was poking along like a sleepy beetle when a guy overtook me.  He had pretty good form, was wearing some local club kit, and gave me a little nod as he came by. 

I’m not the kind of ego maniac who automatically gets ticked when somebody passes him—I can take it.  Countless times over the decades I’ve been bested like this, with no ill will toward my chance rival.  This guy wasn’t going that fast, though.  There was a lot I’d have liked to tell him.  Such as, I’m in a 39 x 22 right now but when I came over this hill one day last fall I was in my 53 x 20.  I’d also like to tell him that my latest physical therapy breakthrough, achieved just yesterday, was being able to stand up from the toilet without bracing my hand on the seat.  Or that my current goal is to be able to put on my socks and shoes without sitting on the floor like a toddler.  Or that, my slow healing notwithstanding, just a couple days ago I’d have been taking this hill twice this fast and he’d never have caught me.

Still, I was tranquillo about this tiny defeat.  Philosophical.  Mellow.  This just wasn’t my day.  Still, I was hoping I’d start to feel better—stranger things have happened—and when I came off the short descent before Pinehurst Road hits Canyon Road, and I made a left and began the 2.8-mile, shallow (2%) grade before the Pinehurst climb proper begins, I decided to try harder.  I’d wring whatever I could out of my deflated legs and see if I couldn’t manage some intensity on the climb.  I’d only ridden Pinehurst once since my crash, about a month before, and it had taken me about nine minutes; maybe I could beat that today.

(The run-up to the main climb is the long straight section of Pinehurst, before the twisty, highlighted section of this map.)

Throwdown

As if Fate read my mind and decided to mock me, another cyclist passed me.  This time it was harder to take.  For one thing, he didn’t say hi or anything.  In case you don’t know it, silence in this circumstance makes a statement.  It means either “I consider you one of the little people, not worthy of acknowledging” or “I consider you a rival.”  So right away I was not predisposed to approve of this guy.  And then there was the matter of his cadence:  he was spinning pretty fast, like he’d been watching old Lance Armstrong videos or something, or was some kind of “Prevention” magazine type who thinks cycling is like yoga or Pilates instead of a manly sport where you push a big gear because it’s the next best thing to eating red meat.  To top it off, his jacket was starting to fall out of his jersey pocket, one sleeve hanging lower than the other.  In my grumpy state I found this as offensive as if his balls were hanging out of his shorts.

For awhile I watched him gradually ride away.  I tried to ignore the silent insult.  I tried to let this be an exercise in humility.  But there’s such a thing as too much humility; just because I’d been passed and dropped by one wanker didn’t mean my soul could handle getting passed and dropped by any wanker who came along.  Meanwhile, I couldn’t bear to disgrace my bike club by getting tooled by this guy while flying the team colors.  So I tried to dig in and see if I could keep the gap down, and just maybe have a crack at this guy later.  The alternative was to have to resist feeling sorry for myself—and I wanted to feel sorry for him!

To my pleasant surprise, my legs started to wake up, and as my heart rate climbed into the 130s and—imagine!—the 140s, the gap to the guy held and actually started to slightly decrease.  He wasn’t smooth enough to keep from bobbing:  a “tell” that showed me he was actually working fairly hard.  There are some little rollers before the main climb, and on the last one the guy got out of the saddle and seemed to struggle a bit, and I saw his gap start to suddenly erode.  What a joke!  Suddenly I was outraged.  Who was this weakling to have passed me in the first place?

Before I knew what I was doing I’d accelerated and cut the gap in half.  Did you know a hippo can run at 20 mph?  My legs ... where had they been all my life?  Doesn’t matter—they’d finally shown up to work.  The guy glanced back and picked up his pace.  Now he was running scared.  We hit the switchback that signals the start of the real climb.  I started my stopwatch.

I was narrowing in, but not as abruptly now.  I couldn’t know how much this guy had been holding back.  I was careful to be patient:  if I passed him too soon, he’d have the whole climb to sit on and bide his time before launching an attack.  Better to hold out until the climb has really drained him, and do something dramatic toward the top where the grade is steeper and can work its own magic on his untested psyche.  Yes, untested:  that’s what this was really about.  I raced a damn bike for years and years.  I paid my dues.  I did countless brutal training rides, I put myself through the wringer in race after race, I trained when I was tired or bored and didn’t want to train.  No half-cocked wannabe deserves to get the better of me, even on my worst day.

I ended up catching up to him before I even wanted to, about a third of the way up.  I decided not to get on his wheel—that would be showing him too much respect.  As I came by, I glanced over and discovered that, like me, he was riding an Orbea.  I scoffed at this because he wasn’t sticking to the script.  The script had him on one of those immensely popular, vulgar bikes whose brands I won’t specify, because I’d hate to insult any of my albertnet readers, and besides, these companies are solid sponsors of pro cycling.  For this guy to be on an Orbea seemed (in my distorted state of mind) an affront to the brand.  I spontaneously decided to shift into a higher gear, and did so under full pedaling pressure:  a nice loud gear change, a little fuck-you to the guy as I dropped him.  (It must be said that though my neocortex cleans up pretty well and manages civilized social interactions, my lizard brain can be a real dick.)

Though I accelerated at this point, I didn’t get out of the saddle.  I didn’t want to be obviously on the attack.  I wanted to Cancellara the guy.  (I’m coining a term here; think of Cancellara dropping Boonen in the 2010 Tour of Flanders without even standing on the pedals.)  I kept on hammering even after I was sure I had the guy.  I approached the really sharp hairpin (about the 2/3 point) and took it wide—I was going fast enough to clip a pedal.  I could have looked down across the switchback to see where he was, but figured it was better not to know the gap, in case it was huge:  for now I was no longer focused on beating this guy.  I was thinking about my time for the climb, and the prospect of beating eight minutes (something I always try to do on Pinehurst but rarely actually achieve).  The phantom behind me was like a whip cracking on my back.

I got toward the top and was underwater, just dying, suffering absolutely terribly.  This was the most intense effort I’d made since the 2010 Mount San Bruno hill climb.  It was the kind of agony that reminds me why I’ve (mostly) quit racing.  The only way to assuage the pain would be to ease up a bit, but of course that would just prolong the misery.  So I dug deep and dug deeper and went crosseyed and on the final pitch tried to accelerate one more time because I was coming up on ... could it be?  A sub-seven-minute ride? 

Almost.  A 7:02.  Certainly my fastest in years ... and yet I’d felt so crappy all day!  As much as I hone my ability, as many miles as I log, as much training data as I pore through, I think I’ll never understand this body.  I guess that helps to keep things interesting.

Epilogue

Of course I couldn’t let up just because the climb was over.  I wanted to make sure that my rival never managed to catch up to me.  I wanted him to never see me again, and to feel utterly schooled.  I wanted him to pedal home in shame, tail between his legs, spinning that useless ineffectual low gear, and then have a good cry, maybe talk things over with a close friend, and then go get a manicure.

The rest of my ride was decent, and when I got home I sifted through my old training diaries to see how long it had been since I’d ridden Pinehurst that fast.  Last year I’d only managed an 8:16.  In 2010 my best was a 7:14.  In 2009, a 7:52.  In 2008, pretty close:  a 7:05.  But I hadn’t actually beaten this time since March 16, 2007 ... over five years ago.  Here is my training diary entry for that day:

I duked  it out with this guy on Pinehurst.  He came by me toward the top after sitting on my wheel, and he was going for it, going a good bit faster.  I’d just decided I was whupped, and was planning to limp over the top in my lowest gear.  After all, I had been feeling tired before the climb even started, and it had taken me miles to catch him.  So I was in the process of pussing out when I noticed that this guy had one of those stems that raise the bars up a bit higher than bars really ought to be, like the guy was looking out for his back or something.  He was an older guy, and I can’t fault him for reading “Prevention” magazine and getting plenty of lycopene for his prostate and such, but that doesn’t mean I have to tolerate his beating me.  So I determined, in a flash calculation, that since he wasn’t in his lowest gear, there was no way to beat him without shifting up, even though I seemed to lack the strength to push a big gear up that top part.  But what did I have to lose?  If I didn’t try, I was surely whupped.  So I senselessly shifted into like fourth and really lit it up.  It was a rush, suddenly accelerating like that.  Totally irresponsible, like writing a $5,000 check and just hoping that it’ll magically go through or something.  Man, the pain was excruciating, but since I was quickly catching him there was no way my body was going to abandon the effort.  And then, a flash of insight:  if I shifted up again, just as I passed him, I might crush his spirit, which couldn’t hurt my chances of besting him.  So this I did.  Man, I died a thousand deaths and thought I might burst my lungs, or blow my lips off by breathing so hard, but it worked.  I schooled that guy!  He probably started crying or something!  I didn’t stick around to watch, though.  I hit the top, stopped my stopwatch (6:50, a new record for the year for Pinehurst, by a significant 12 seconds), and kept hammering because I didn’t want the guy to try again.  It would be like escalating an arms race.  So I kept hammering for the next several miles and never saw him again.  Really, really fun.

Of course it had been fun.  I’d actually felt good that day!

Physical Therapy

Introduction

My brother told me a story of a trip to the public pool. The staff was moving lane lines around to prepare the pool for the next program. They’d asked everybody to get out, but one guy was lost in his own world and didn’t hear them—he just kept swimming. Finally they pulled in the lane lines next to him anyway, and one of them clipped his hand. He raised a huge stink and was yelling at everybody for hurting his hand and they just ignored him. Finally my brother said to the guy, “Why don’t you go blog about it.”

I think that’s a good cautionary tale for any blogger. In my opinion, the point of a blog shouldn’t be to complain in public to whoever will listen. Feeling sorry for yourself in such a forum is even worse. I promise to keep these ideas in mind as I write about my recent history with physical therapy. I’ve done a lot of PT after breaking my femur fifteen weeks ago. If you’ve done PT yourself you may relate; if not, you’ll get a glimpse into this gloomy realm. I’ll also offer up some thoughts on where life philosophy meets physical therapy.

Beginning

My first exercise, technically, was just getting out of bed to go to the bathroom. At the hospital they encouraged me to be up and about as much as possible, but “possible” was a slippery concept. Just being vertical would make me dizzy, and by the time I’d dragged myself and my walker the twenty or so steps to the bathroom, I felt like I was about to pass out. A couple weeks after my surgery, I learned that it wasn’t worth it to stand to pee: that much exertion significantly increased my pain for the next several hours. A “field trip” down the stairs to entertain guests became possible by the second week or so, but the trip down and back would be my big effort for the day.

My more formal physical therapy began more than a month after my injury. Why so long? Well, the first two weeks I couldn’t really leave the house—I was in too much pain and became exhausted too easily. (I’d lost about 30% of my blood during the operation and was only gradually recovering from severe anemia.) After that, my leg was still in so much pain it seemed cruel to even move or touch it. If legs could talk, it would have said, “Just leave me the hell alone!”

I was also scared. A friend had described a post-surgery machine that forced his leg to bend; not only was this excruciating, but he could hear scar tissue being torn up inside his leg. Letting somebody inflict pain on my already hurting leg was a terrifying prospect. (Pain is much easier to handle when you’re inflicting it on yourself; check out this post for more on that topic.)

By the time I made it to the PT center I could get around on crutches pretty well, but couldn’t bend my leg enough to sit in a chair. (I’d worked hard to get my knee to bend at all. I would sit at the edge of the bed, supporting the bad leg with the good, gradually lowering them until the pain became too great.) My first therapist-prescribed exercise was perhaps the simplest of all of them, but also the worst. I was to sit on the bed, legs stretched out straight in front of me, and flex my thigh muscles. Both legs were atrophied from spending so much time in bed—I’d lost fifteen pounds after my accident—but at least my left leg could still flex and become taut. The right leg wouldn’t do anything. It was like a prosthesis or something. The physical therapist swore she could see a little flicker in the muscle, but I couldn’t. She might as well have been asking me to wiggle my ears.

Not until my wife took me to the pool did I convince myself I didn’t have major nerve damage sufficient to paralyze my leg. In the pool, I could actually lift the leg. This proved that the brain and the leg were still talking. Before that, I really worried that they weren’t.

Tedium

Is it possible to write about the tedium of PT without being tedious? I’ll try. More exercises were added to my regimen. One was to massage what was left of my muscle, pushing it toward the kneecap from either side (above and below). I was also instructed to sit in bed, loop the belt from bathrobe around my ankle, and use the belt to draw my foot toward me, so as to make my knee bend more. This was impossible at first because I couldn’t even bend my leg enough to put my foot flat on the bed. So I looped the belt under the knee and pulled up. Excruciating. I took to lying on my back in bed with my straight up, foot propped against the wall, to let gravity help pull the foot downward. I’d bend the leg as much as I could, then hold this for thirty seconds. Ten sets of this, twice a day, along with the other stuff. Painful, demoralizing, and boring.

Normally I’d satisfy the boredom problem by listening to music. But for the first month or so, I didn’t dare listen to the music I like, for fear of forming unpleasant associations. (Think of the main character in Kubrick’s “A Clockwork Orange,” who is tortured while hearing Beethoven, and afterward can no longer hear Beethoven without freaking out.) So instead I tried to listen to a Top 40 station. This just added insult to injury—I could become sick of a song before I’d even finished hearing it for the first time. So I tuned in to a classic rock station, only to discover that it played Steve Miller’s “The Joker” so regularly I seemed to hear it every time I did my exercises. At first I was amused, what with “pompatus of love” and so forth. But then it got really old. I started to think maybe Steve Miller had died. What else could explain all this airplay? Eventually I got really sick of that song; I doubt I’ll ever find it tolerable again.

Life philosophy meets PT

I saw this caption on cute doggy calendar at the physical therapy office: “If you love life, it will love you back.” I see two problems with this little aphorism. First, it’s demonstrably untrue. After all, I was in the process of loving life when I suffered this crippling accident. Second, this notion is almost exactly backwards. It’s easy to love life when it does seem to love you. I’m more inspired by people who stubbornly love life even when it doesn’t. I think often of something a close friend once said to me: “I ought to be really depressed right now but I won’t take the bait.”

What is the more stirring cinematic moment for you: Leonardo DeCaprio’s character in “Titanic” standing at the prow of the ship yelling, “I’m the King of the World!” or the Black Knight in “Monty Python and the Holy Grail” who’s lost both arms and legs in a battle but yells at his departing opponent, “Come back here and take what’s coming to you! I’ll bite your legs off!”? To be plucky and sanguine when life seems hateful is far more inspirational to me than kidding myself that life is fair.

So it is with physical therapy. In the absence of any sign that I’m getting anywhere, I have to hold out hope, and go through the motions as if I had some guarantee of success. “Success,” of course, is a humble prospect here to begin with: all it means is eventually—after what ... four months, six months, a year?—getting back to the place I started, if I’m lucky. (More immediate goals are even more humble: only recently did I achieve the dream of being able to step into a pair of jeans normally, without holding on to something for balance.)

How do you manage to love life when you’re basically under house arrest and can’t do the things you normally enjoy? Years ago, I made a list of the top 20 things I do for fun, so I dug up that list and discovered I can still do ten of those fun things. Not so bad. Plus, I’ve added to the list: now, when I do my PT, I sometimes have one of my daughters read to me, or we do a Mad Lib. (Here’s a highlight from today’s Mad Lib: “So now you know how illegal politicians learned to murder like cats and dogs—from their ignorant pets!”)

The bike

Using my bike on the indoor trainer has been a useful form of physical therapy. A little over a month after my surgery I was able to climb on my bike (using a shower stool) and put my feet on the pedals. I couldn’t pedal a whole revolution, of course, as my knee wouldn’t bend enough. But through much effort I could get incrementally closer. At first I could only get the right crank to go from 3 o’clock to about 8 o’clock. I’d back-pedal to about 3 and hold it for 30 seconds, rest, and then forward-pedal to about 8, hold it for 30 seconds, and repeat, for about 10 minutes total. Each day I would try to get the pedal a little higher up. It hurt like a mother but at least I was in familiar territory.



At the PT gym, I managed a full revolution one day. This was on a stationary bike with the saddle jacked way up. Encouraged, I raised my bike saddle at home, and within a day or two was getting so close to a whole revolution that one day I ordered my left (i.e, good) leg to turn all the way around, dragging the right leg through it. Agony, but exhilaration. The next day, I bit the bullet and turned ten whole revolutions in a row. By the end I was in tears, whether from pain or relief I can’t say. Once that feat was accomplished, the return to regular pedaling (and normal saddle height) was a matter of refinement. The basic ability had returned.

Life philosophy meets PT – revisited

“That which does not kill you will make you stronger.” This bit of pop-philosophy, the darling of college freshmen, strikes me as completely false. The more accurate statement, in my opinion, is “That which does not make you stronger will kill you.” Think of all the ways people gradually kill themselves: booze, cigarettes, overeating, sloth ... these activities don’t feel like they’ll kill you, while you’re doing them, but they gradually are. They’re sure not making you stronger.

Of course, I’m being disingenuous here, and doing a disservice to Nietzsche. His point is probably more along the lines that enduring suffering, and living through a painful ordeal, strengthens your character. But I still take issue with this. True, the willingness to suffer is a gateway to mental and emotional fortitude, but the suffering itself can be good or bad. If, for example, you’re stupid about training or PT, and simply ignore all pain (whether it’s the kind that indicates intense effort or the kind that indicates you’re causing damage), you’ll end up hurting yourself—getting tendonitis or worse—and then you’re sidelined and most certainly not getting stronger, either physically or psychologically.

With physical therapy, a systematic approach—under the careful guidance of a physical therapist who knows what he or she is doing—is key to getting better. Suffering alone will not heal you. Often you must do what doesn’t come naturally, and retrain your body to behave itself. Needless to say, doing what doesn’t come naturally can get you into so much trouble if you blindly flail away. Structured, targeted suffering, of a more careful nature than the “that which does not kill you” variety, is needed.

(Re)learning to walk

Over the months my mobility has improved. I’ve gone from the walker (depressing and geriatric) to crutches (less depressing, more suggestive of a sporty injury) to one crutch (Tiny Tim) to a cane (geriatric all over again). Cane shopping was a drag. I looked at the canes at Walgreens and was shocked at how ugly they were. Most were fake wood and one was the color of streaky feces. All of the canes were too short. So I made the rounds of the cane shops: Canes R Us, the World Cane Emporium, and that boutique-y place up in Kensington, Ye Olde Cane Shoppe.

No, there aren’t really any cane shops, but my physical therapist referred me to a crazy medical supply place that looked like the home of a crazy hoarder. Stacks of stuff from floor to ceiling, with narrow walkways carved out. A salesman there, who looked and sounded like Philip Seymour Hoffman, advised another, “The long canes are in the back. We hide them so the short people won’t buy them.” I’d wanted an aluminum and foam rubber cane that looked like a loaner from a hospital, because a nice wooden cane would make my physical infirmity seem permanent. But all they could offer was a wooden cane, cut to size.

The musculature in my leg got so fouled up by the surgery that my brain stem seems to have given up on the whole limb. I guess this makes sense. For most of human history we didn’t have the medical technology to fix a broken femur, so the brain developed tactics for getting by without a working leg. I worked up a host of unconscious compensations.

At first, I would practically lock my right knee when I walked, and swing the right leg around to the side, in an arc, instead of swinging it straight forward, because that way the knee wouldn’t have to bend to keep my toe from hitting the ground. Moreover, my instinct was to put weight on the bad leg very tentatively and for as short a period of time as possible, so the left leg would shoot forward instead of my gait being balanced. I would swing my right arm to help swing the leg forward, rather than using the leg’s muscles. Watching myself in the mirror at the PT gym, I realized I walked like a drunken mummy zombie.

The absurd thing is, these habits have persisted after the leg developed much of the strength and flexibility needed for a normal gait. My brain just doesn’t trust the leg. So I’m in the peculiar position of overriding what comes naturally and applying conscious thought to walking. Normally, thinking while walking makes you more, not less, awkward (try it!) but this is the best I can do for now. There’s still a lot more strength-building and flexibility-gaining left to go.

A final note

My mom has praised me for my determination and doggedness in doing all my exercises. She kind of has to praise me—it’s her job. It’s what moms are for. But in case she actually means it, and in case you yourself had thought anything of the kind, I assure you that anybody in this situation would be just as diligent. When your body is broken, you want it back, and you’ll do anything to get there. Training for sport is totally different: you can always think of worse things than not being perfectly fit for your next big race or group ride. But there’s not much worse, for a relatively young, fit person, than limping his way through the rest of his life

The Femur Report - Part III

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

Introduction

This post finishes up the dark story of my broken femur. (Of course it’s still broken, and it’ll be a long road back, but this will be the last time I’ll write about it.) If you’ve stumbled on this post without reading my last two, click here and here to check out my first and second installments.

As I said of my last post, please 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 straightforward as possible in the telling.

Surprises

During my third day at the hospital (November 29), my pain only got worse. A nurse arrived unbidden at my bed and announced it was time for some pain killers. At first I was pleasantly surprised—this was the first time I hadn’t had to ask for them—but then I saw him popping two rather large white tablets out of a foil pack. “What are those?” I asked. He replied, “This is Tylenol.” I managed not only to keep from snorting but from saying something snide like, “Do you have any placebos I could use instead?” I kept quiet because I sensed I had little goodwill to spare with these nurses, but really the Tylenol was a joke.

The stretches between the real medication grew longer. I was now getting half the dose I had originally been given, and instead of every four hours it was every six. I overhead a nurse talking about a shortage. The pain had strange characteristics unlike anything I’d experienced before. Instead of the leg just aching and throbbing and giving stabs of sharp pain—though I did have all of these—I also had the sensation that my thigh was as big around as a barrel, and that the bandages running along my three incisions were a quarter-inch thick and made of plywood. My left wrist—uninjured in the crash—was also causing me a lot of pain; a nurse unwrapped the bandage from it to reveal that the whole wrist was a deep purple, with a stripe running along it of an even more saturated hue. Nobody could explain what that was about; perhaps it was a botched arterial line.

I was on the phone with a friend when a nurse came around to inspect me. She didn’t seem to need any input from me so I continued my conversation. Suddenly there was an intense, sharp pain in my male unit and I shrieked (into the phone, of course). All at once, the nurse had yanked out my urinary catheter! The pain was accompanied by a sensation of frightening wetness which I took at first to be blood, but which was actually just some leftover urine. My friend on the phone must have feared the worst and asked what happened. “A nurse just ripped my catheter out!” I told him. She looked at me sheepishly. “Sorry, I figured if I did it all at once it wouldn’t bother you so much,” she said. Sort of the ripping-off-the-Band-Aid strategy, I guess.

Later, another nurse expressed surprise that I’d filled my bedside urine receptacle. “A lot of patients find they’re unable to urinate the normal way after they’ve been catheterized,” she explained. I hadn’t known this and now I was greatly relieved. From this moment forward, successfully peeing into that thing felt like a triumph. In fact, whenever I did it I got Homer Simpson’s voice in my head yelling, “Yes! Yes! Ohhh, Yes!”

Presently the physical therapist arrived for my second session of the day. Again, this consisted of taking a short march, with my walker, from my curtained-off cubicle down the row of other cubicles and back. It was oddly exhausting but I guess I did well enough, for she announced that I’d have one more session the next morning, and if I could manage a short flight of stairs, she would sign me off as complete—meaning I could go home.

This great news was followed by another challenge: after two and a half days, I had to defecate. I steeled my resolve and figured that based on the success of my expeditions with the walker, I could handle the restroom. I’d need help, of course. I asked a nurse, and she responded as if I’d asked her to help me rob a bank. “I’m not allowed to assist you with that,” she said. “You have to get a physical therapist.” Of course I had no way to summon the physical therapist, so I asked for a bedpan. The nurse looked at me with disbelief, as if she’d thought bedpans were a best-kept-secret of the hospital. “A what?” she asked. Nice try. “A bedpan,” I persisted. She stalled for time. “What size?” she finally asked. What answer was she expecting? “Small”? “Never mind”? I told her Large, and a bit later she came back with what I suppose was the large size bedpan, though it didn’t seem very large to me. Not that I was an expert: it had been sixteen years since I’d last seen one, when my brother Geoff was in the hospital. And of course I’d never seen him actually use it, so I had no idea what to do. Not that I was about to ask for a tutorial at this point. I had to wing it.

When I’d done my damage—serious damage, I might add—I found I couldn’t get the nurse to come over. With great effort I held myself suspended over that foul, fouled bedpan for what seemed like a very long time. Finally the nurse came over and I asked for help getting rid of it. She said she’d have to come back. They always say that. I asked her to please hurry.

She didn’t. To make matters worse, a couple of friends had arrived to visit. I could hear them being denied access, based on me being “detained,” and I think I heard them chuckling. And yet the nurse still wouldn’t come back. Finally she showed up, her face awash in reluctance, and she gave an Oscar-worthy performance of having never in her entire career seen a patient actually use a bedpan. Where I was desperate, she was hesitant. The two of us grappled haplessly there, trying hard to keep the sheet from getting soiled during the disposal process. It was like Tweedledum and Tweedledee trying to clean up after a grisly murder. Thus was my last shred of dignity finally expunged.

Visit

As the patient across the curtain from me asked for some air freshener, my friends were finally admitted to my cubicle. They’d come straight from work, which reminded me that there was still a world out there in which people worked in office buildings. Not long after, four more friends arrived—all of these bike people—bearing Zachary’s pizza and (for themselves) wine. Needless to say my spirits were buoyed; actually, I think salvaged would be the better word. At first I didn’t think I’d be able to eat any pizza, as my appetite had been absolutely nonexistent since the previous morning. I had one slice, and then, to my own astonishment (but nobody else’s), had another. Looking back, those two slices and a third one the following morning were almost all I ate while at that hospital.



Of course we all had much to discuss, such as the events I related to you in Part I of this tale. Before long we had a full-fledged, rollicking dinner party going. All this was of course good distraction from my physical pain; when I think of the visit I don’t remember suffering during it. As a bonus, for the first time in two days I couldn’t hear that infernal TV across the curtain in the cubicle next to mine—we were drowning it out. By the end of the visit I was pretty exhausted but was sorry to see my friends go.

My worst night

The evening dragged on and on. There was a violent action movie playing on the TV, four feet from my head. My leg was killing me. My head felt vacuumed out, my mouth completely dry. My mind wasn’t calm enough to allow reading. I was tired of listening to music and didn’t want to ruin any more of my favorite tunes through future association with this bleak time.

Then there was a shrill alarm from a nearby cubicle. I knew what it was, from my brother’s hospital days: an I.V. drip had gone dry, or was on the verge of it. It’s an important alarm, because if an I.V. goes completely dry, the vein collapses and can no longer be used. But what else did this alarm suggest to me, with its absolute ear-splitting, incessant shriek? It took awhile but I figured it out: it was just as piercing and intolerable as a newborn baby crying. That well might have been the design intent of this alarm, just to make completely sure it would be impossible to ignore. And yet, astonishingly, the nurses—all four of them—were actually managing to ignore it. Where were these people? I pressed my call button. Eventually a nurse arrived, looking put-upon. “What is it?” she asked. “Well, are you ever going to do something about that alarm?” I asked. She looked startled, as if she simply hadn’t heard it until now. Unbelievable. (Why hadn’t the patient in that cubicle summoned her? I have no idea. Maybe he was dead, or maybe that cubicle was empty and it was just a malfunction.)

With the shrieking finally silenced all I had to contend with was the sound of people being shot, run over, and tortured to death. The TV movie didn’t bother with music or dialog or anything: just nonstop killing. My wife hadn’t called, and I was getting worried that the hour would come when I couldn’t take phone calls, or that my calls weren’t making it through. I had to tell my wife about the prospect of being released the next day, so she could find somebody to watch our kids while she picked me up. When a nurse happened by I asked her if I could please borrow her phone, just for a couple of minutes, to call my wife. (My own cell phone was with the police, along with my bike and other stuff gathered at the accident scene.) The nurse looked down at the cell phone clipped to her waist, as if it had betrayed her with its visibility. “Well, maybe a little later, when I come back,” she said. Translation: “No, and just to be sure, I’m never showing my face back here again.” (Obviously if she’d been willing to loan her phone to me, she’d have just said yes.)

Suddenly, an object came sailing at me from behind the curtain across the aisle. Amazingly, I managed to catch it. It was a cell phone. “Call your wife,” came a voice from behind the curtain. “Talk as long as you want.” I was filled with a sense of camaraderie with this unseen fellow inmate. I called Erin, made some quick arrangements for my Great Escape, and then asked the nurse very sweetly if she could possibly return the cell phone to its owner.

As I tried to fall asleep I start to feel really, really bad. My pain escalated and my heart was racing. I could hear my pulse pounding in my ears. Meanwhile, the wind was picking up outside and howling right through the leaky windows on my right, chilling me to the bone. I even started to feel delirious: I was having increasing difficulty convincing myself that the screams from the TV weren’t coming from actual people in the next cubicle, and that the wind through the window wasn’t going to spin me off into the night.

Somebody came by to take my vital signs. Every one of them was bad. I had a fever of 102; my blood pressure was crazy high; my pulse was 90 (compared to mid-40s normally). The person taking these readings looked a bit concerned and commented on my fever, but then left. She wasn’t one of the regular nurses. Another hour crept endlessly by, my pain continuing to increase. I was starting to feel frantic. I pressed my call button. A nurse came over. I explained that my pain was through the ceiling and all my vital signs were bad, and that I didn’t feel right. She said, “Well what do you want me to do?!” I said I wanted a doctor. She left.

I started to worry that I was actually going to die. Looking back, this wasn’t exactly rational, but then I was half out of my mind. I had a vision of a sensor moving through the room, beaming a red line that picked up everything and recorded it, and how quickly it would pass over me, how insignificant my form would be. It would register even less then the bed I was in. Moreover, my small existence was confined to the immediate present: the fact that I’ve walked the earth for forty-two years was immaterial, a flash in the pan, and the future was completely up for grabs. If I died right now, I thought, I would be erased so thoroughly I might as well have never existed. It was the closest I’ve ever come to believing in my own mortality.

I pushed my button again. A different nurse came. I repeated my complaints and again asked for a doctor. Instead I got the head nurse, but at least he was sympathetic. He also seemed as disgusted with the other nurses as I was. The first thing he did was give me more pain meds. “You’re allowed to ask for these,” he said. “The nurses have guidelines but they’re only guidelines. They act like they’re rules but they can always consult with the doctor and they know it.” Then he stripped off my bedding. It was all tangled and knotted up, doing me no good. Then he started pulling up and discarding the absorbent pads from beneath me. These pads are basically the same thing as what you get with store-bought chicken, that sit between the chicken and the Styrofoam tray, to absorb drippings. “Don’t let the nurses use these,” he said. “They’re disgusting and uncomfortable.” I couldn’t have agreed more. The guy put my bedding back in shape and gave me an extra blanket.

After that I felt much better—just to have been paid attention to was greatly comforting—but the pain was still awful. So I tucked my blankets in all around myself, thinking of how I used to swaddle my daughters when they were babies. In my delirium my cubicle had seemed to grow and grow, to where it was the size of a handball court, then ever larger, like I was Alice in some Wonderland scenario. I decided to try using these illusory sensations to my own benefit, and imagined I was a little Asian doll, wrapped tightly in a paper dress that was like origami. I held absolutely still in my bed and soon began to feel I was rising up out of my paper-doll body, looking down at it, tiny but perfect in its symmetry. I rode this perception as long as I could and the next thing I knew, it was hours later and I’d actually managed to sleep. My head and body had that vacuumed-out, dried-out sensation and the pain was awful, but morning was that much closer, and it was finally time for more pain meds. I even managed a couple more hours of sleep before dawn, and by morning the TV channel had switched to something merely asinine, rather than ultraviolent.

Final Push

Late the next morning (November 30), the physical therapist returned for my “final exam.” She reiterated the plan: I would use the walker to leave the hospital room, go down a hallway, and stop at the stairs. Then I’d switch to crutches, go up a short flight and come back down, and then switch back to the walker and return to my bed. If I could do all this, I’d be a free man.

It took a great while, perhaps ten minutes, to make it to the stairs. Finally I got to the landing, but suddenly started to feel incredibly dizzy. I told this to the PT, who had me turn so my back faced the wall, and said to lean back a little bit to rest against the wall. She supported me at the waist. I felt dizzier and dizzier.

Suddenly I awoke. Holy shit, where was I? How long had I been out? Amazingly, I was still standing. My vision returned and I saw the PT looking up at me, her face a picture of great concern. There was also a nurse looking at me worriedly. The nurse had brought a chair. “Are you okay?” asked the PT. “Did you pass out?” Imagining another night in this hospital, I lied. “No, I didn’t pass out, I’m okay, just a bit dizzy,” I said. They sat me down in the chair and the nurse slapped a blood pressure cuff on my arm. “You are really pale,” she said. My blood pressure was extremely low. I was taken back to my bed in a wheelchair. Needless to say I’d totally flunked my final exam. But to my surprise and relief, the PT said she’d give me another chance later in the day.

Not long after she left, I got a phone call from an MD friend of mine. Hearing what had happened, he asked how long before my physical therapy I’d had pain meds. I said not long before. He advised that the pain meds can lower your blood pressure and lead to dizziness. Remarkably, another MD friend of mine called not long after, and gave the same advice. So I stopped asking for pain meds, and when the PT returned, a few hours later, I felt more confident. Hedging her own bet, she’d brought a wheelchair. “This time, I’m wheeling you to and from the stairs,” she announced. At the stairs, I got up on the crutches, and heeded the PT’s advice: “Up with the good, down with the bad.” That is, I planted my good foot on the higher step and brought the crutches and bad leg up to meet it, and then at the top turned around and came back down leading with my bad foot. It worked, and I passed.

From there, many hours passed in bureaucratic hassles. The nurse wasn’t allowed to give me pain meds within an hour of departure, and since my departure time got dragged out two hours, I was in great pain when it was finally time to leave. (I know: waah, waah, waah.) I was wheeled through the halls, into an elevator, down into the crowded lobby, and Erin went to get the car. She pulled up and I was wheeled out there. Getting into the car was really, really hard. I had to lower the parking brake handle and grab the steering wheel and slide myself almost into the driver’s seat to get my right leg—which wouldn’t bend—into the car. Erin got me all settled in and then, reflexively, gave me a little pat on the leg. I yelped in pain. Some homeless dude standing on the curb called out, “Man, you can pretend you’re embarrassed now, but when you get home you’re gonna want her to be pettin’ you!” This was amusing, but then the guy repeated his quip continuously while Erin loaded my walker and crutches in the car and we slowly rolled away. He wasn’t quite right, that guy.

Three friends had arranged to meet us at our house, mainly just for a visit but also to help moving me in from the car. It was tricky extricating myself, Erin carefully moving my leg like a piece of rotting lumber. It was like a contortionist’s act in reverse. It’s a good thing my friends were there, because I’d forgotten our street is on a slope that ran perpendicular to my trajectory with the walker. The walker is a spindly thing and surely would have buckled and collapsed like a crappy tin cheese grater had my friend not bolstered it from the side.

I made the ten or twelve feet to the porch steps in possibly less than two minutes. I switched to the crutches, and here I had intended to rest for a minute. But suddenly I felt really dizzy, just like during my ill-fated PT exercise, and I feared I would faint. So I pressed on, getting past the stairs and continuing, on my crutches, in a sort of slow-motion sprint to the door. Erin had it open already, and somehow I made the couch. I was so relieved. I had made it. I was actually home.

Now

It’s been a month since the crash. I can get around the house pretty adroitly with the walker and on crutches now; I generally use the crutches because I feel they present a slightly less pathetic sight for my family. Sleeping is really difficult—I’ve never been good at sleeping on my back, and my leg still hurts—but it’s so nice and quiet here. The only sounds are conversation, my daughters playing, the clatter of dishes, and my daughters practicing their instruments. Fortunately my job allows me to work from home, so I’ve been back at that. My right leg can bend almost ninety degrees if I dangle it from the edge of the bed and push on it with my other foot. I have lost fifteen pounds and get chilled easily. I have a long recovery ahead of me but I’m on my way.

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