Dance Lessons From the Goddess
2000 was my 40th year on the planet, so I expected to undergo a right of passage into middle-age. I anticipated something that would remind me of my mortality and that life can be full of risks and discomforts. But I expected it to be a rectal exam, not a broken hip!
About 10:40 a.m. Thursday, February 15, 2001, I left my office at Stanford and boarded my scooter, en route to a meeting a few blocks away. I had been using the scooter for a few months to get back and forth to the CalTrain station and to get around on campus. I was running late. For the first time since I started using the scooter, I decided to leave my helmet behind in favor of a jaunty black beret. About halfway to my destination, I had a face-off with a turning vehicle. Guess who lost.
As I was scooting down the sidewalk on right side of Welch Road (the side closest to the hospital), I approached a driveway entrance. It was the parking lot of a bunch of medical suites. Three cars were lined up, turning into the driveway. I tracked alongside the last in line, a white mini-van or SUV, ringing my bell and trying to make eye contact with the driver, who I think was a guy. I was sure he (or she) saw me and would slow to allow me the right of way. But the vehicle kept coming and as it turned toward me I tried to stop. The handlebar-mounted brakes of my scooter are weak, so this requires stepping off the board in a quick stop, a maneuver I have accomplished successfully many times. This time however, I tripped and went flying. My body made a three-point landing on the sidewalk, the right hip hitting first and hardest, followed by my right arm with a whack, and finally the back of my head with light tap. The driver managed to stop just in time he didn't touch me, just came close.
I dragged myself out of the way and pulled the scooter after me. Couldn't get up. Leg in agony. Arm hurt a lot. Luckily no brain damage, other than whatever I already had that led me to believe a 40-year-old doofus on a scooter was a good idea. After a moment, the driver pulled into the parking lot, and as far as I know, I never saw him (or her) again. As I lay writhing on the ground, trying to get up, 6 or 8 different people pulled next to me and asked if I needed help. I waved them all off, with thanks, hoping that it would turn out to be some kind of groin pull. But it didn't get any better, and eventually, a kind, mature lady walked over and offered me her cell phone.
I called my boss, Michael and asked him to come take me to the Emergency room at Stanford's hospital. He was there in minutes, and helped me hobble into his car, then drove me to the ER. A lot of pain, a blood test, insertion of an IV, some morphine and lots of waiting later and I was x-rayed. The ER doc told me that my hip was broken and would need surgery. They looked at my regular health insurance card and decided I'd get better coverage down in San Jose. So they loaded me on a gurney, put me in an ambulance, and down we came. I arrived at O'Connor hospital about 5:30 p.m.
The EMTs put me in a bed in a room I would share with a retired pediatric neurologist who had suffered a mild stroke. No surgery till the morning, the nurses said, and oh have some more morphine. I met my surgeon, Dr. Wall, a mature gentleman who clearly had lots of experience, mostly with senior ladies for this kind of surgery. Robin showed up and things started getting better.
In the morning it turned out the surgery wouldn't occur until evening. The hospital's insurance guy showed up. It appeared that my insurance company had switched me from my designated primary care physician and signed me up with a medical group in Northridge, California (down near LA), so any claim I made would be "out of area." It was so obviously screwed up he said not to worry, it would be straightened out. By then we had a clue that my treatment would be covered by worker's comp, so it was (mostly) to laugh. I went into surgery (after a fascinating lecture on the dangers of botanicals from my anesthesiologist) about 7 p.m., 32 hours after the accident
Then I woke up writhing in agony, and (says Robin) swearing, demanding pain medication and just being ornery. I vaguely remember the recovery room nurse not looking or acting too concerned and being pissed about it. And I sort of remember rolling around in my bed, back in my room. You see, they had me pumped full of morphine, but it became apparent by the next day that morphine doesn't affect me the same way it does most folks. Either I had or developed a tolerance for it. The pain of surgical recovery completely overwhelmed it. I remember Robin's tired face saying she had to go, and falling asleep.
The next day, things got better they switched to Demerol (Robin's idea), a piquant little number injected into my IV that made me sweaty and goofy, but killed most of the pain. The following few days were a march of hours, from one dose to the next, with a constant drip of saline and antibiotics and a squirt of Demerol or a Vicodin pill every 3 hours (when I was lucky). Peeing into a bottle, mostly boring TV, bland meals, fitful nights, but each day was a little better than the one before. I received flowers, several phone calls and visits from friends and family, and was deeply touched by all the caring and support I received. Robin took some time off from work. She was working very hard at her new job, but visited me every day for as long as she could. Between me, the job and lack of sleep it was all pretty hard on her.
In the last two days, they got me up and showed me how to use a walker, and then a pair of crutches. I hadn't "moved the mountain" since the morning of the accident, so it was a major effort to clear the pipes I'll spare you the tragicomic details. Let me tell you though, it really changes your perspective on things when just taking a crap is a major accomplishment.
On the morning of Wednesday, February 21, five days and some change after being admitted, I was released into Robin's custody. We gingerly got me into the car along with the floral arrangement and the walker, and came home. I've spent the days since recovering slowly, mostly laying or sitting on the couch. I've been rolling around on the house's hardwood floors using my home office chair, which is on casters. I also use the walker to stretch and exercise my leg. In a week or so, I'll start using crutches. It will be 6 to 8 weeks before my leg is fully mended and I can walk unassisted. The bruise on my arm is already fading, and it hurts much less. I can compute, although I need to go slowly and take more frequent breaks.
Last weekend, I set up an EtherNet hub and connected my iBook so I can surf the net, exchange email, develop web sites, most of the things I could do from my home office or my office at Stanford, all from the comfort of my living room couch. I should be physically able to start doing work from home within a week or so, depending on how the arm does.
What I've learned
For most of my life I've been a skeptic. The older I get, the more willing I am to consider that there may be an organizing force at work in the universe. Wise people say that every experience, good or bad, teaches us something. Life changes are dance lessons from the goddess. Here are some of the things I learned from this:
Many thanks to Robin, Dr. Wall, my boss Michael, the ER staff at Stanford Hospital, the staff of O'Connor Hospital, to Zurich Insurance and to all the friends and family who visited, called and sent cards and flowers. All of the support especially Robin's are helping me get through this.
I had my one-week follow-up with my surgeon Wednesday, February 28. I learned that I suffered a high femoral neck fracture with displacement. This means the neck of the femur broke close to the pelvis, and the pieces of bone separated. There was significant damage to the bone's blood supply. Dr. Wall did an internal fixation using a compression screw, a plate with screws, and a knowles pin. The compression screw is a large shaft inserted through the center of the femoral neck. It's end is attached to a plate that runs down the femur, and the plate is fixed to the bone with three screws. A screw is placed above and at a slight angle to the compression screw to resist shear force on the bone.
In a couple of years, I will need to have another surgery to remove the hardware. The big issue is vascularization. If my body fails to grow enough blood vessels to replace those damaged by the accident and the surgery, the bone will die, a condition called avascular necrosis (AVN). This is a fairly common complication of femoral neck fracture, and could require a later full hip replacement.
But that is only a possibility at this point. There's better than an 50/50 chance that my bone will heal completely and serve me for the rest of my life. Only time will tell...
I doubt if I'll be riding the scooter again anytime soon, if at all. I won't say that nobody should be using them, but obviously they can be quite dangerous. Perhaps if, in a few years, if someone perfects the technology so that they are easier to stop quickly and safer to ride, I'll consider using one again. Until then, I'm a driver or a pedestrian.
... Oh, and I still have that rectal exam to look forward to!
Within a week and a half after coming home from the hospital, I was able to begin working from home. Robin helped me clear the house of obstacles and tripping hazards, especially the rugs and carpets on our hardwood floors. I used a walker to get up and lurch around for the first few weeks, before graduating to the crutches. I think Dr. Wall thought I was a bit of a wuss for that, but it felt more comfortable to me. I used the crutches until about 8 or 10 weeks after the surgery, at which point I switched to a cane. I recommend a lightweight one with a padded grip, as the el cheapo drug store cane I used at first bruised my palm.
If you're injured, get the paperwork moving as quickly as possible for your disabled parking sticker...it takes a while. Also, make sure the entire form is filled out. Dr. Wall left off the name of the condition (femoral neck fracture), so they sent it back, taking an extra week or two. I was able to start driving myself to work and back (off-rush hour) at about 6 weeks. Thank god for cruise control and disabled parking. That sticker is like gold!
I read some research on the Web seems to indicate that post-surgery protein supplements reduced the incidence of avascular necrosis in seniors with femoral neck fractures. | reference 1 | reference 2 | reference 3 | reference 4 | It also appears that vegetable protein may be superior to animal protein. | reference 1 | reference 2 | So I've increased my intake of protein since the surgery. I've also taken bone-builder supplements with boron, calcium, vitamin D and a good multivitamin.
My last day in the hospital, I started bugging Dr. Wall about physical therapy. His response was "Get up and walk around." And for the first few weeks, that was good advice, as just walking was difficult and painful. I used Vicadin the first few weeks to control the pain. Vicadin is codine and Tylenol, and 4000mg per day is the max. I kept a log of my medication and gradually reduced the Vicadin and increased the Tylenol, but always stayed under the 4000mg limit.
A month after surgery, Dr. Wall agreed to prescribe physical therapy, so I found a therapist, Stanford Rehabilitation Services (HealthSouth) and made an appointment. I did about 14 sessions, up until about 4 months after surgery. The young therapists showed me a series of exercises. These really kicked my ass, but as I kept with them my strength and endurance increased dramatically while the pain decreased steadily.
I started with the following program of exercises*:
(Note: I'm not a doctor, I just play one on TV. Your physical therapy needs may differ from mine. Do your physical therapy under the supervision of a licensed physical therapist. Don't overdo it. If it's painful, stop it!)
As I improved, I increased the number of reps to sets of 12 and 15 or more when I could tolerate them. After a couple of weeks, we added:
Toward the end of the sessions, we added:
I also tried to do various stretches when I could. I iced the leg after the longer exercise sessions.
I got to about 85% of normal function within a month or so of starting the exercises. The next 10% came much slower, and I'm still lingering at about 95% normal, now about 7 months after surgery, though I believe I'd be closer to 100% if I weren't so damn lazy! In fact, Ive noticed that function - strength, endurance and absence of pain - decreases when I don't get exercise.
I hope you have enjoyed my broken hip Web page. Please email if you have any other tips I should include on this page.
The Story of Adam's Second Broken Hip - A informative narrative - Robin found it, printed it and gave it to me my first day in the hospital.
Hip Fracture - A general outline of info
Wheeless' Textbook of Orthopaedics - Technical manual for bone mechanics
Avascular Necrosis - Questions and Answers
Avascular Necrosis - What It's All About - The name says it all
Darwin Awards - I coulda been a contender!
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