Tuesday, April 21, 2009

Confirming: I'm Not Dead

Hello all. Here's a Jim update. WARNING: This update contains some personal and discrete information that I'm choosing to share because this site is primarily visited by family and friends and when they ask how I'm doing they want the unvarnished truth.

Overall my physical condition has improved slightly. My mobility is good and the pain in my pelvis is mild to moderate at any given moment, but is made worse when I try to sit on or rise from the floor. Essentially if I direct energy into my pelvis the pain increases proportionately. Overall, the pelvis is well on the path to recovery.

The ribs are no longer an issue other than occasional soreness. They are likely 85 - 90% healed.

Then there's the shoulder. With little exception my humerus stays at my left side. The exceptions being small deliberate motions intended to initiate the smallest amount of mobility and recovery. I have taken the pendular exercises to the limit and it's not fun. It feels as if a Matchbox car has been inserted into my shoulder socket. I've accidentally bumped it once or twice and David's given it an inadvertent tug as many times. One or twice I've walked it off and once it was remedied by a couple of Kleenex.

I am scared to death of the looming physical therapy, because it's going to hurt and hurt a lot. I am acutely aware that the percentage of my complete recovery is directly proportional to my courage and effort in PT; that's what scares me. I'm hoping that I can leverage my ability to suffer better as I've gotten older - a direct benefit from cycling - to ultimately get back to 100%. I'm willing to do what that's going to take and that is a big commitment.

Narcotic pain relievers cause constipation and I have not been immune to this. Currently I take 10mg of Percoset every four hours. I've had trouble with constipation since the day after my accident. Without too much detail I've suffered pretty badly on this front. The second and third worst problems associated with the constipation are pulled muscles and the irritation of the shoulder. And bear in mind I'm leaving out detail regarding the most painful part of severe constipation. We have implemented EVERY countermeasure and this morning was the first time I was in and out of the WC in less than 45 minutes and without further injury and pain.

Emotionally, this event continues to be a rollercoaster. Bad days are very bad. They are a mixture of guilt, depression, feelings of inadequacy, uselessness, pain and fear. They are remedied by the soft touch of my wife's hand or her shoulder to cry on and constant reminders that we're going to get through this. What's a good day? Having showered within the last 48 hours. Having made a significant contribution at work, albeit from home. Having helped out around the house. Maybe emptied some of the dishwasher. Having taken care of David after Karen gets him out of the tub. Good hugs and kisses from the boys. Developing strategies for having sex with a broken pelvis.

So as you can see by that last sentence, I've not lost my sense of humor. Let's let that be our barometer for now. If you've read this far I appreciate you taking the time to see how I'm doing. I'm in a challenging place and time in my life at present and how wonderful it is to have some of that challenge mitigated by the kindness of friends. Please keep checking back because I promise this story that had such a terrible beginning will have a triumphant conclusion.

Thursday, April 9, 2009

Here's How I'm Doin'

Greetings family, friends. About ten times a day I get a sincere query, 'How ya doing?', so I'm gonna stick an update out here to answer just that and more. And before I go any further how sweet it is to be asked by so many folks that really care about the answer.

Karen put my leash and collar of love on me on Tuesday and took me over to see Dr. Wyker at Raleigh Ortho. I am down to two areas of concern for which we'll track progress; the shoulder and the pelvis. Regarding the shoulder, we took x-rays on Tuesday and my new stainless steel parts are doing their job and all the pieces of Humpty Dumpty's scapula are pretty much where they're supposed to be. There is one fragment whose position isn't precisely optimal, but precisely optimal would be where it was originally had I never had the accident. The implication of this is that there may be some hot spots that we're going to have to push through once physical therapy (PT) is under way. PT will start next week. Everything I've heard, from Dr. Wyker, anecdotally, from others with similar injuries indicates it's going to be a year, in round numbers, before my shoulder gets to feel as good as it's going to feel in the future. A long road yes, but I'm expecting to regain nearly all function so this ain't a bad deal.

The hip's going to be a challenge on multiple fronts. At the top of one of my femurs there's a looped part of the pelvic bone. I have two fractures in this loop that are just going to have to heal over time. Try not using your hips for two minutes; not real practical. And no one has instructed me not to use the hips, just to be aware that it's going to be sore for several months. I'm imagining that even after the general soreness abates, certain activities will remind me that trauma was in the house not long ago. I can imagine sitting on a bike is going to take many attempts before I'm comfortable for long periods of time. So that's the manifest concern regarding my pelvis/hips. I don't think I've shared this en masse until now but all of the films of my hip indicate significant arthritis in the hip joint. For many years I have had issues with my hips with respect to biomechanical function, pain during specific motions, and a popping of my hip that once popped felt fine, although getting the pop to happen took some courage against pain for a brief second. I've no doubt that the genesis of all of this noise germane to my hip is the arthritis. I'm only 40 years old and I have many, many active years left in me. This isn't news anyone wants to hear, but again, it's treatable. We'll come up with treatment plans for the arthritis after the fractures heal. Again, this could be far worse and with the knowledge I now have I can fight back and make a fragile situation a tenable one.

I will return to work on 14 April. I will be working from home for the first week and then transitioning back into the office full time incrementally over the next couple of weeks.

I've saved the important people for last. Karen is doing much better and the thing that got her to this point with all her marbles is first her personal strength and then the support of our family and friends. Yes, she was a little bit overwhelmed at first, but we all were and at the end of the day, the greatest burden of responsibility and care fell on her shoulders. I love her so much for the grace and strength with which she is handling this. I can sum up how I feel about my wife in four words, I want for nothing.

David now understands the nature of Daddy's hurt arm a little better and he has once again found safe harbor snuggled up on my right side. I can now help out at the end of David's day with story reading, a lullaby and prayers. It might not sound like a lot, but it means the world to me to be able to spend time with him again and it helps Karen get through the crescendo end of her day. I can also empty the top of the dishwasher :-)

Camden loves his Daddy and just wants to play, read and dance. He has not been cleared for lap time yet, but as my shoulder gets stronger we'll get him back up there ASAP. I miss his hugs so; when he hugs you it feels like someone turned your heart into a Cinnabon.

These last two entries were typed entirely with my right hand so please excuse the abrupt closure to this entry. Thanks to everyone that has expressed their love and caring in whatever way they could.

Friday, April 3, 2009

The Story of My Cycling Accident

This will be the last time I recount the events of my bicycling accident on 22 March, 2009.

I had scheduled a Trip to Hanging Rock State Park (HRSP), the point of departure for a ride known as the Triple Hump, about six weeks ago. The purpose of this trip was to get some real mountain miles in my legs; while we have some nice hills here with some temporarily annoying gradients, you simply can't get steep climb duration in Raleigh or Cary.

The morning of March 22 had descended and at or slightly before 8 AM, I was on the road. The trip was about 113 miles and at about 9:40 I was making the transition from car driver to bike rider in the parking lot of HRSP. It was a little cooler than I had expected at ride start, about 40 degrees, but it was a warm 40. I added knee warmers, another upper body base layer and a pair of thin cotton under gloves. I left HRSP with enough nutrition for about 50 miles and planned to stop at a convenience store on the way back to top off as needed.

The first two miles out of HRSP are a downhill hoot. Giddy fun I say there boy. Despite the giddy fun, I was not strong on this day. I never felt strong. Always felt like I was surviving. I had not done anything inconsistent leading up to this day, but a thin molasses thought of picking a bad day to have a bad day was finding its way in between the muscle fibers of my legs.

The first climb I encountered, Sauratown Mountain punished me beyond my crime. I stopped two or three times up that climb and could not believe the voice in my head, 'You're not this good. You shouldn't be here. You can't even breathe. Ride back to the car and go home, if you can.' As I got closer to the top I started focusing on recovering from the effort. If I had to pick the most improved part of my riding over the last year, it would be my ability to recover from significant efforts. Refocusing got me up. Descending refueled me. Commitment kept me going.

Twenty hilly, rolling miles later I found myself at the base of Pilot Mountain. I had inadvertently disrespected this climb earlier by considering it might be easier than Sauratown. It was not. A half-dozen stops were needed to get me to the top. I'll never know why I rode so poorly on this day, but I can tell you that this will not be my last Triple Hump. I can also tell you I'm going to ride it until I can, with repeatability, do it confidently and quickly.

And so there I was. 30 miles from finishing. The clock started to crawl and the road seemed to stretch as I rode it. I was tired, but I once again found the silver lining. In a group or when alone and simply trying to achieve an average speed, there is the unrelenting pressure of having to 'put out'. I now had the luxury of jettisoning this unnecessary requirement. From here on in it would be a simple matter getting back to the car, recovering nutritionally and analyzing the ride for lessons learned.

At an intersection with NC 268 and another road, whose name escapes me, there was supposed to be a convenience store, but alas it had long since closed. Some kind folks that lived near the intersection filled my bottles with water and away I pedaled. Soon I made my turn onto NC66. I was tired and only capable of about 85% attention. I probably would have seen the dog earlier had I been more alert, but doubt it would have made any difference. I saw the dog emerge from the background of trees and brush standing in the road perhaps 50 meters ahead of me. I could only categorize it as a medium sized, short-haired dog and in the first few seconds, the dog posed no threat. Then two things changed in an instant; I could now ID the breed as a pit bull and it attacked. I tried evasive maneuvering unsuccessfully. I then tried a tactic of actually slowing down to see if I could get him to simply chase next to me, but his aggression increased. Every time he would dash in front of me, I considered how bad it would be if I hit him, knowing I would go down and go down hard. His aggression increased to the point where he was now taking bites at my feet and lower legs. I decided to sprint for it. I stood up and now had no concerns about him biting me as my legs were too powerful and moving too fast for him to get a good grip. It gets a little foggy here. I recall the dog was on my left and he made an attempt to cross my line of travel. He likely went between the front and rear wheel at a time when I was standing and putting as much power into the pedals as I could. There was no time between that moment and realizing I had hit the road and was now grinding to a stop from about 30 miles per hour. I started out with a very poor level of consciousness, but I was conscious enough to know I was lying in the middle of a paved, traveled road. I struggled to sit up and immediately recognized that the left side of my body was injured too badly to use. This next point is quick but important. In the minute or so it took me to get upright, I clearly recall the dog scampering off into the woods. Had he come back for more I would have been unable to defend myself. I began a primary survey on myself; airway, breathing and circulation and all were 'good'. As I moved on to the secondary survey and a level of consciousness battery, I did not fair so well. I could not recall day or date or home phone numbers. This fog lasted about 10 minutes and then my LOC gradually returned back to 10/10. There were two cars that passed me in the next five minutes. The first did not stop despite traveling only 30 or so miles per hour, with both of the windows on my side of the car down, my waves of desperation made clear and an unabashed cry for help. The next vehicle to pass was a pickup truck containing a father and younger son, the latter being perhaps 10 years old or so. They stopped and then went quickly to the house where the dog came from to summon an ambulance. For about 40 minutes I had the care and support of the father son duo and the gentleman from the house. Thank you God for those three people and the care and fellowship they provided to me. I will not entertain any further discussion about fault, negligence or ill-will beyond this statement. The gentleman that was feeding this dog as a stray put the dog down out of fear for his children's safety. I do not believe that there was any intent to harm me and I never detected a sense from this gentleman that I was in any way culpable for what had just transpired. He offered his apology on the scene for any way in which he may have contributed and I accepted that apology. The forty minutes of waiting was followed up by a forty minute ambulance ride to Baptist Medical Center in Winston-Salem, NC.

The medical care I received at BMC was first aide for the abrasions about my body, l-ankle, r-inner knee, l-outer knee, 1 major patch left arm, 1 focused grind spot left elbow, top back of left shoulder, light abrasions about my head. I always wear a helmet and had I not been wearing one that day, I would without question be dead.

I won't list every film or scan I got, but I can tell you what the initial consensus was: a 40/60 broken scapula that would need surgery. Since the surgery was not going to be possible forthwith that night, the Dr's decided to pump me full of morphine and let Karen Taylo drive me home from Winston-Salem so that all further medical attention could be delivered much closer to home.

The next morning I was in excruciating pain and rather than try and get me in the car and risk further damage beyond the known unknown, we called the ambulance. I found myself back in the ER but upon my exit on this particular day we'd leave with three important things. One a referral to see THE preeminent shoulder guy, two, a scan of my pelvis that revealed a fracture and three, more pain meds.

On Tuesday 24 March we saw Dr. Wyker w/Raleigh Orthopedics. What we got there was an excellent Dr., outstanding diagnostics, a complete care plan that included a reconstructive surgery date of Friday 27 March. It was only at this point that we finally got a complete inventory of everything I had broken: One pelvic fracture, two to three broken ribs and a shattered scapula, with partucular concern for the area where the humerus sat in the scapula having been destroyed. The nature of the destruction was two-fold because the receptor part of the scapula was in many pieces and the pieces were not where they were supposed to be. Dr. Wyker admitted that the surgery would be difficult, but he left us with the sense that he could develop a surgical plan and approach that would allow him tackle one of his harder reconstructive challenges of late.

Karen delivered me to Big Wake at around 1PM on Friday 27 March for the surgery. I went into surgery at around 8 o'clock and emerged about two and a half hours later with Dr. Wyker and team claiming complete success. Unfortunately no sooner than we were enjoying the good news than my left lung collapsed unexpectedly. A chest tube was inserted to re-inflate the pneumothorax and now my joyously painful shoulder recovery would be accompanied by some damn tube stuck straight in through my side into my lungs.

I was discharged, sans catheter, chest tube, IV and myriad other OEM equipment on Monday 30 April after four days in the good hands of the great people associated with Dr. Wyker's practice and Wake Med. There were many medical professionals involved with helping me get back to where I am today and while they rendered a service for a price, a lot of them do it for much deeper reasons. To those of you contributed to my care, please accept my thanks for the business part, but more so for the compassion and care that you demonstrated in the delivery of your care.

Today is Friday 3 April. My days consist of feeling a little bit better and gaining nominal amounts of independence. We use the pain medications as directed. When we're late, I feel it rather crisply. I'm guessing that the Oxycontin will get discontinued over the next week and then we'll whittle down the Percocet as well over the next several weeks. I can walk, albeit rather Fred Sandford-ishly and slowly. I have yet to mobilize the left shoulder at all, but that will change next week as well when PT is likely to start. I still need some assistance with basic movements, standing, sitting, to potty, from potty but that's only when the pain is bad or I've been in the recliner for a long stretch. Today was my first shower since March 21st and obviously this would not have been possible without Karen's help.

I'll close this account with a couple of observations.

I'm fortunate that I was able to get help quickly from strangers. And strangers in this case were simply fellow human beings I had yet to have fellowship with. I was fortunate enough to have a close family friend just happen to be near and care about my family enough to drop everything she was doing and assume complete responsibility for all of my care for nearly six hours. I learned that I will always be my mother and father's son and when I need them they'll be here for me and my family for as long as God sees fit. I'm fortunate to work for a company like BlueCross and BlueShield of NC that cares more about me and my family getting back on our feet than the inconvenience and impact of my absence. I am fortunate to have surrounded myself with a talented team at work that picked up the Hidex Project ball and kept running with it as I was escorted to the sidelines. Facebook gets a nod as well for enabling access to a network of friends who walked the talk through prayers, support, laughter and physical assistance to me and my family; we cannot thank you enough friends. Second only to the God that gave me life is my appreciation for my wife. The love that Karen and I share is rare. She is the home that my love and soul come home to every night whether we're spooning tight together before we sleep or if I'm 1,000 miles away. Wife, lover, partner, mentor, confessor capture nothing as a percentage of what it means to me when I call her my wife; it is so much more than that. Without her I would be Jim and that ain't such a bad gig. But with her and because of her I am a loved husband and father.

I have no idea what I ever did to be deserving of so much love from so many people.