ChezLark

Memorial day. As far as I can tell, people are still dying in Iraq.

Scott from work dropped by today and kindly gave me a copy of Hitchcock’s Rear Window on DVD. People went out for dinner and I decided to putter around at home and watch the movie. The movie is an outstanding suspense film and I had seen it many times before, but I now have a new-found sympathy for the main character, a reporter laid up in his apartment with a broken leg. Since the move was shot in the 50s, the leg is in a huge, pelvis-to-toe cast and the reporter spends his day in a wheelchair by the window. Recurringly, he gets itches under his cast that drive him nuts. A nurse visits him each day to fix him food and give him a backrub, which I guess was considered an integral part of physical recuperation back then. The whole scenario of being stuck inside and immobile felt very familiar. It made things a little better to think that many many people have gone through this before me, under worse circumstances and with much more primitive therapy. At least I can scratch my broken leg!

Follow-up ultrasound to look for blood clots. No blood clots in evidence. This is Good. The scan was at Swedish (we’re transitioning post-op care away from Harborview, since trauma is what they do best), and they were trying out new software for the ultrasound rig. They let me watch the scan as they did it, and it made the whole process more tolerable and interesting.

Doctor visit. Swelling down in the calf but not the foot. Got juice using the walker. Shower. Got in and out of bed a few times. Mobility increasing every day! All praise to my wonderful, loving, supportive, caring wife Laura. I have no idea what I would do without her.

Sometimes the road feels even longer.

Last night at 10PM I noticed that sometime in the previous few hours, the foot and calf on my broken leg had swollen up quite badly; my toes looked like little link sausages and my calf was round like a baloon.

The nurse on the hospital hotline said this didn’t sound too good, so we headed off for the ER.

Harborview at night

Most people know this, but the Harborview ER is not where you want to be at night if you are just a walk-in (wheel-in?) case. This is where all the pill seekers, drunks, drug fiends looking for a warm bed, and other such characters show up after dark. Waiting in line just to check in with the triage nurse, I got chatted up about what kind of painkillers I had gotten given for my leg. The guy talking to me had a broken shoulder and was upset that he had Vicadin instead of Oxycodone.

The floor show provider of the night seemed to be Miguel. Miguel appeared to be coming off a drunk, and had a lot to say about how long the line to check in was, where the nurses parked him while he was waiting, how much the hospital treatment cost, and a number of other topics. He had been in some kind of accident, judging by the fact that some of his clothes were in ribbons and looked to have been made that way by paramedics cutting through his clothes.

While we were waiting to go back into the ER, Miguel seemed to lose some kind of grip on his immediate surroundings and decided he would take off all his clothes in the middle of the ER. Luckily, he was pretty groggy and disoriented, and couldn’t get too much off before a security guard bustled him into a bathroom.

We got hustled off into the ER a short while later, and landed in a pediatrics examining room, where we waited, and waited, and waited, and waited. The doctors were very concerned that I had developed a blood clot in my broken leg, but the dual-sonogram scan they wanted to run couldn’t be performed until 8AM.

We hadn’t seen the last of Miguel, either: he wound up getting brought into the ER and parked on a gurney outside the room we were camped in. It turns out that Miguel is fond of singing, and performed renditions of some 1980s top-40s titles with only moderate slurring of words and getting lost in the chorus.

After some long hours of me snoozing on a gurney and Laura making due in the chairs, I got the sonogram which turned up negative. Much consultation ensued between doctors; they were still suspicious there was a clot in the leg, and sonograms don’t reveal deep tissue blood flow or blood flow through the pelvis, apparently.

While various doctors came and went to look at my leg, we got shuffled into the hall, where we had all kinds of interesting neighbors. I gather that at one stage, the patient behind me was a 13-year-old who was handcuffed to his gurney since he had been brought in by the cops after they broke up a fight at his foster home.

Quite a few plain drunks were being treated, which was interesting. If a drunk got admitted to the ER, the trick seemed to be to figure out whether they needed psychiatric help, and prevent them from going into alcohol withrawal by using IV fluids. The ER doctors showed a great deal of patience and humor in dealing with all these characters.

And, of course, there was always Miguel. Miguel was quiet (not talking) for a few hours while he slept (snoring), but after waking up again, he decided the ER was far too boring a place. When asked if he could stand up, he got up and attempted a set of push-ups, exasperating his nurse. He continued belting out 80s tunes. He complained about everything, like why other people were getting food and he was not. He kept putting on his jacket, picking up his bag, and appearing to leave, only to return to his bed explaining that he can’t leave his bag lying around because it has money in it.

Blood clots

Anyway, there was much back-and-forth between the doctors on admitting me to the hospital to put me on a blood thinner (apparently they don’t like sending you home with blood-thinner drugs). In the end, they decided to run another test. They ran an angio-CT scan, which involves injecting a constrast agent into an IV tap while running a CT scan to see how the blood spreads.

This also came up negative, so after a little more futzing around, the doctors finally decided that I was very unlikely to have a blood clot, and that the swelling was probably more or less benign. So I got sent home with directions to keep the leg elevated.

So now I’m tired, sore, and slow-motion, and to boot, my right leg has become a baloon.

sigh

• Got up
• Got set up with my laptop to work
• Reassigned a bug, caught up with email
• Discovered I was sore and tired
• Flaked out and went back to bed for a while; wound up sleeping for four hours

The road ahead looks pretty long from here.

On the other hand, I set a new walker-achievement record of walking 15 feet, standing for 5 minutes in place, then walking another 25 feet or so! Woo hoo!

Also, we went up on Buck and Chesty’s (not her real name — some people are wierd about their real names being on the Internet) roof deck and watched the sunset. There were dusty clouds against a royal blue / pink / blood red sky. All I could think of was how overpoweringly thankful I was to still be alive.

So, I suppose (he says wearily) bring on the long days — they will be brighter soon enough.

Library, buses rock!

I took my first trip outside since the crash today, not counting the transfer from the hospital on Friday. Laura and “Buck” (not his real name — some people are a little odd about having their name on the Internet) took me to the public opening of the snazzy new Seattle Library building downtown. We walked all the way to the building from Buck’s apartment. I got full wheeling-service from Laura and Buck, who are unspeakably awesome for taking such good care of me. Obviously, this was the furthest I have ever travelled in my new wheelchair.

On the way to the library, on some level, I guess I was expecting people to stare and point, or double-take, or otherwise think I was an odd sight in my chair. I haven’t shaved since the crash, so I’m looking pretty shaggy, and today I was sporting baggy, red and white-plad, pyjama-style pants, since these are now the only things that I can get on over the knee brace on my left leg.

It was a lovely sunny day in Seattle, though, and nobody seemed to think it was out of the ordinary for a shaggy twenty-something man to be getting wheeled around downtown by some friends. Families smiled at us when we went by. I was kind of instinctively afraid of cars, but they seemed to respect us; a taxi even moved out of the way of a wheelchair ramp when Laura yelled at it.

The new library building is very striking from the outside, but is much more interesting inside. I was struck by how varied and complicated the building is; there is a huge variety of spaces inside, all used for different purposes. There are big open seating areas and warren-like stack of books and artwork cabinets. There is a narrow, spiraling ramp that can take you most of the way from the top of the library to the ground, and places where you can look out over stories and stories of vaulting empty space. The surfaces that aren’t concrete, steel, glass, or aluminum are painted bright, bright, basic colors: bright lime, yellows, reds. I hear the whole place has Wi-Fi coverage.

Visiting the library made me want to live there, or at least work there.

After visiting the library, we had lunch downtown, and took Seattle’s wheelchair-accessible Metro transit buses back to the apartment. I had always known, of course, that all the Metro buses sport wheelchair lifts and an area inside to secure a wheelchair, but this was the first time that meant anything to me personally. The whole process is surprisingly easy, although manoeuvering the inside of the bus is a little tight. We caught the 43 back up to Capitol Hill and were home in no time.

I’m not sure I’ll be going on a trip this size again soon, since I would never have made it so far without people wheeling me, and of course wouldn’t have attempted it, anyway. I am very grateful to Buck and Laura for wheeling me around and making it possible.

Life is harder when you can’t stand up

My morning activities:

• Woke up. Took a bunch of pain medication
• Put on pants

As it turns out, this consumed a whole bunch of energy, so I had to lie back down and have a nap. Eventually I recovered enough to get up again and get in the wheelchair.

Later on, I set my personal world land-distance walker record, which is about 15 feet, or the distance from the bed to the shower. This was an extremely satisfying accomplishment. To top it off, my wonderful wife helped me take a shower, which felt wonderful, and I finally felt halfway civilized again.

[Posted retroactively]

My stay in the hospital was made immeasurably better by the constant stream of visitors, gifts, and notes from, it seemed, everyone I have ever known.

My thanks to everyone who showed up at the E.R. on the day of the accident: Carolyn, Emily (who asked where the broken leg was kept), Buck, Chesty (who succumbed to her unflagging instinct to feed people when in doubt), Meg, Nathan, Patrick, Ray and Scott (who presumably showed up to gauge the probability that they would end up having to fix my bugs), Timmy (who explained the four parts of the femur) and Zeynep (who was simply stylish). Along with, of course, my fabulous wife Laura and my poor brother Jonathan, who had simply come for a long-weekend Seattle visit and wound up camped out in an E.R instead. My memory of the hospital on the day of the accident is one big blur, but thank you all for coming and helping Laura cope.

My thanks also to everyone who visited me during the 6 days I was in the hospital: Adam, Buck, Carolyn, CBass, Chesty, Emily, Erica (who came up from California just to see me), Jason, Jeff, Jim, Jonathan, Ken, Mary, Meg, Nancy, Nathan, Patrick, Raju, Ray, Scott, Timmy, Zeynep, and of course Laura and my brother Jon.

My thanks also to everyone who sent flowers and gifts: my untiring Mom, Rebecca, kept up a steady stream of useful supplies: massages for Laura, chocolates and fruits for (as it turned out) the steady flow of visitors, books on tape to keep me entertained, and more things I’ve probably forgotten. Kathryn from the Seattle office thoughtfully sent flowers on behalf of the Seattle team, and a Gameboy Advance to keep me amused. Erica, who works for a video game publisher, helpfully followed up with a bunch of cartridges. Ryan, Jim and Raju contributed poker books so I could sharpen my game while recuperating, and some mystery person from the Redwood City office sent a second round of flowers. By the time everything had arrived, each new nurse that came on rotation would complement me on my extensive collection of gifts and flowers! Jim also sent in his only begotten AirCard, which provides data connectivity over the cellular network, so I could use a laptop from my room!

My thanks also to everyone who wrote email to me while I was in the hospital; Harborview has an amusing system where they print out inbound email messages and volunteers carry them into the wards. It was a lot of fun to get little packets of printed email messages delivered to my bed.

Finally, my thanks to everyone who helped out Laura while she was trying to cope with everything. Laura was my primary support and caregiver, which was quite a load, so things were very hard on her for quite a while. I know that she valued the support and assistance that everyone offered.

The accident has made me realize how tremendously fortunate I am in many different ways. I am truly grateful to know such wonderful, supportive people — thank you all for helping make this experience suck as little as possible!

I’ve almost certainly forgotten somebody in this. For that, my apologies. I blame the morphine.

[Posted retroactively]

I was discharged from the hospital on Friday, May 21st, almost a full week after having been hit by a car.

It was hard to leave.

Specifically, it was scary to leave. At the time of my discharge, it took me about 10 minutes to manoever from a lying position to sitting at the edge of the bed. I could, with great effort, stand up very briefly with a walker, and transfer from the bedside into a chair or wheelchair, as long as it was positioned right next to the bed. I had never managed to walk further than a half-dozen steps, or about 5 feet. Transferring to a wheelchair and then using the bathroom was so much of an exertion that I would overheat and sweat profusely, such that I would create water hazards for myself on the tiled floor from sweat running off my forehead and nose. As soon as I was done, I would become unbearably cold as the sweat started to evaporate, and would require piles of warm blankets to heat me back up again. Such a trip required hours of recovery before I could do anything at all again.

Because my mobility was so limited, the hospital staff (physical therapists and social workers) debated with Laura and I during the last couple of days of my stay about whether it was feasible to discharge me to a private home. Our own house was out of the question, as it’s a tall, skinny townhouse with four flights of stairs, which were out of the question for me to attempt. Our friends Chuck and Busty (not their real names) had suggested that we stay with them until my strength improved; they live in a condo with a wheelchair-friendly, flat layout. Our alternative was a Skilled Nursing Facility (SNF), or other such intermediate-care institution. In the end, we decided that with Laura, Chesty and Buck around, I had enough support to move straight to the condo.

This was a truly daunting prospect for me.

In the hospital, I spent almost all of my time in bed. Except that “bed” doesn’t do this piece of furniture justice.

The bed’s mattress was air-filled, and seemed to be separated into a large number of small, individually controllable compartments. When you loaded down the bed by sitting on the edge of it, or lying in the middle of it, the bed reacted by changing the air pressure in the parts of the mattress you were occupying, to support you properly. On top of this, if you were stationary in the bed, the bed would periodically vary the pressure in the areas you were occupying, just slightly, to prevent pressure points from forming.

And that’s just the mattress. It goes without saying that this bed did all the usual hospital-bed tricks of rising and lowering, and folding itself into interesting shapes, all at the push of a button.

This probably sounds like it’s simply fun, but if you’re not able to sit up in bed without great effort, it means everything in the world to be able to tilt up the top of the bed so you are in a sitting position just by pushing a button.

As silly as it sounds, the prospect of living outside this bed seemed well-nigh impossible.

It would never have been possible for me to get away without a stay in a Skilled Nursing facility if it weren’t for the endless patience of my wonderful wife Laura, and the selfless generosity of Buck and Chesty, who gave up their bedroom and privacy to help us out.

[Posted retroactively]

Be nice to nurses.

Seriously.

If you’ve never logged time in a hospital, you cannot understand how vital skilled nursing is to healthcare for seriously ill or injured patients. At least at Harborview, the surgeons were an elite class; one hardly ever saw them unless one was being operated on (and even then, you’re unconscious). The orthopedic rounds at Harborview were around 6:30AM, so if you had a pressing question for your doctor, it was important to be awake and lucid at that hour to catch the ortho team as they came sweeping through the floor.

Since you hardly ever talk to a doctor, 99% of your healthcare experience is determined by the nurses. Immediately post-op, I wasn’t able to lift or turn myself in bed, reposition my broken leg, or perform other basic manoevers. The nurses make sure you are comfortable, that you’re eating and taking your medication, that you’re staying clean, and anything else that you need done. Nurses helped me get comfortable by lifting and repositioning me, putting pillows under my broken leg, etc.

Having a caring, attentive nurse makes your hospital experience vastly better. The world is a better place because of nurses. I didn’t encounter any actively bad nurses, but I can imagine that they could make life miserable for their patients.

Be nice to nurses!

[Posted retroactively]

Early Sunday morning (the day after the accident) they came for me.

Laura wasn’t even around when they came — she had wandered off to find a cup of coffee.

The modern treatment for a variety of fractures, including femur fractures, is intramedullary nailing. Rather than treating the fracture with traction or a cast (which in the case of a femur fracture has to immobilize the hip and knee joints, making it huge), the broken bone is stabilized and supported by surgically implanting a titanium rod into the center of the broken bone. Human bones have a hollow core that contains blood-producing marrow; when implanting an intramedullary nail, the marrow is removed and the rod forms the core of the bone. This is what the orthopedic surgery team had in store for me on Sunday morning.

They came for me and took me away, with my catheter line and traction weights bumping and swinging. It was earlyish morning — maybe 8AM. Laura had left the hospital only briefly, between about 1AM and 4AM, to get a few hours of sleep in a bed. I suppose I was somewhat more comfortable than she was — at least I had a bed and morphine; while at the hospital, Laura camped out in a chair by my bed.

They wheeled me off to the orthopedic operating room, and I met my anesthesiologist. Strangely, I never met the surgeons before the operation. I get the impression that repairing femur fractures is something they do to warm up at Harborview. Maybe that’s why I was scheduled in the morning — maybe the surgeons patch up a couple straightforward fractures first thing in the work day, and then get on to more serious business, like reconstructing people’s shoulders, knees, or spines.

My anesthesiologist was very attentive. He went through my medical history with me again (to make sure he wasn’t about to kill me by giving me something I was allergic to, I imagine). He asked me if I had questions about the operation — at the time I had none, although I’ve developed a whole slew of them in hindsight, and after poking around the web. At the time, though, my questions were: “How long will the operation take?” and “You’ll make sure someone finds my wife?”. The anesthesiologist explained that they would be inserting a tube into my throat before the operation (but after they knock me out) to help me breathe, and that this may cause my throat to be sore after the operation.

After a few more minutes, they wheeled me into the operating room and started hooking me up to equipment. Curiously, they didn’t have me do the whole “count backwards from 10″ routine. Instead, the anesthesiologist came over and held a mask up to my mouth and told me that it was oxygen and to take deep breaths. I think it was oxygen at first, but my last memory is of the doctors telling me “this is just oxygen; breathe deeply now…”

The operation lasted, I am told, about two and half hours. I am also told that when the surgeon came out to meet Laura, she asked “is he going to be OK?”, to which the answer was “of course!”. Apparently the surgeons said that the femur break was very clean and had been straightforward to repair, and that I should recover quickly. There’s some debate about this (I need to get better specifics the next time I go for a follow-up visit), but Buck, who was around at the end of the surgery, specifically remembers the doctors saying that I may recover within as little as 6 months, which is considerably less than the usual 8-12 month period usually quoted.

When I woke up after surgery, my right leg was bandaged and wrapped, and it stayed like that for a few days. When the bandages and such were removed, I was expecting to find a long surgical incision that would take a long time to heal. Instead, I discovered that I had three small cuts in the side of my leg, one near the knee and two at the top of the femur, near the hip joint. None of the incisions were longer than about an inch, and with the stiches they had used to seal them, they looked like large snakebites. Somehow, the surgeons threaded a titanium rod into my leg through a slit about an inch across.

It’s apparently possible to have the hardware removed, eventually, as elective surgery, but apparently this is usually not necessary, so the possibility exists that I will be bionic for the rest of my life.

Also, the mandatory joke about setting off metal detectors at the airport apparently has some truth to it; I may need to have a card issued by my doctors explaning that I have a metal implant in my leg, since the IM nail is apparently sufficient to set of walk-through metal detectors!

[Posted retroactively]

Being wheeled into the Harborview ER as a trauma victim feels very much like starring in an episode of er. In a number of ways, that’s not a good thing. On the plus side, a small squadron of people materialized around my gurney as I entered the ER, and I got to hear the paramedics hand me off to the ER staff the way they always do on TV: “Scooter vs. car, high right femur fracture, such-and-such fluids pushed in the field, complaining of left knee pain, motor control at extremities…”, etc, etc, etc.

On the negative side, I was conscious for all the stuff they do to you in the ER. Some of this is pretty unpleasant. Right at the top of my list of Things You Never Thought About But That Are Really Not Fun is having a catheter inserted. I do not recommend this under any circumstances. On the off chance you ever have a choice, ask if you can be rendered unconscious somehow if it’s necessary to do this to you. Having a catheter inserted comes with the extra bonus drawback that sooner or later, it will have to be removed, which is only slightly more fun than having it put in in the first place.

The other unpleasantness that comes with being in the ER is just that they’re pretty keen on doing a thorough inventory of your body, which involves a lot of lifting and turning and prodding of areas that, as any fool could see, are likely to HURT a lot when you touch them, what with them being fractured, bruised, abraded, or just generally bashed up. Much blood was drawn, and some on-the-spot X-Rays were taken. This yielded a clear image of my right femur neatly snapped into two pieces, high on the bone, not too far from the pelvic socket.

Throughout all this, the ER team kept up a steady chatter, but not with the me. It’s reassuring to see everyone hard at work at figuring out your injuries, but it’s alienating and unnerving to witness your treatment as though from afar.

On the plus side, they’re not shy about morphene use for trauma patients. By the time I was wheeled into the ER, I had been on the spine board for a while, and was starting to get pretty uncomfortable, not to mention that my legs weren’t feeling their best. After a few lifts and rolls, I was getting pretty unhappy. A friendly member of the mob of humanity swarming around me pushed some morphene into my IV tap and immediately, my pain sort of receded behind a curtain, and the world went slightly fuzzy and swimmy. Things weren’t so bad for the following hour or so.

After what seemed like an endless stretch of time, but that must have only been half an hour or so, the ER team was satisfied that I wasn’t about to expire on the table, and that they pretty much knew what was wrong with me. They then dispatched me to the X-Ray lab to get X-Rayed.

As far as I can tell, hospitals in the United States operate under the principle that they must imperatively consider, or carry out, any test, scan or treatment that has ever found to be applicable in any way to the problem you’re experiencing, plus some unrelated ones just for kicks, to guard as much as possible against later malpractice suits alleging negligence.

Consistent with this approach, they X-Rayed my entire body. I’m not exaggerating. They starting with my left foot and worked their way up that side of my body, paused at the top for a while to X-Ray my head and chest, and then worked their way down the right side. I think I was in the X-Ray lab for something like 2 hours, and I don’t believe an inch of my body went unphotographed. I can only assume I have now received ten to twenty times my lifetime expected allotment of medically inflicted radiation.

When the X-Ray fest was over, they had one more surprise in store for me: they were going to put my right leg into skeletal traction. They explained what they were going to do, and then, right in the ER, proceeded to knock me out (not with a general anaesthetic, but with a heavy sedative similar to what’s used for heavy dental surgury like wisdom teeth removal). They then inserted a metal pin into my right knee, to which they attached a cord and twenty-pound weight, on a little pulley system attached to the hospital bed. The pull exerted on the broken leg prevents the broken femur extremities from rubbing against each other, and aligns the bone for surgury. That’s all good, of course. The downside, however, is that whenever the hospital bed gets moved, or even bumped, the suspended traction weight swings or bounces, which makes for another Unexpected But Definitely Not Recommended Experience.

With all this done, I got wheeled up to the fifth floor east, and parked in the hospital room that would end up being my home for the next week. I was hooked up to an IV morphine dispenser, which comes with a little pushbutton that dispenses a morphine dose, but not more often than a fixed interval. For the first few days, I spent a lot of time pushing the little button and rooting for the little “beep” that confirms that a shot of morphine was dispensed and the interval has been reset.

[Posted retroactively]

My #1, Primo Numero Uno, greatest and most fervent wish in the world, lying on my back on the sidewalk and wondering how badly I was hurt, was for there to be lots and lots of paramedics swarming around me, immediately. The adrenaline was starting to wear off a little and I was shaking all over. The various people who had assembled around me kept saying things like “they’ll be here soon” or “they’re on their way”, but like I said below, this somehow struck me at the time as a supremely useless observation.

After a few minutes, though, someone made an observation that I was truly thankful for: they said “Can you hear them coming? They’re almost here”. Indeed, I could hear the wail of sirens a few blocks off. It had registered several seconds before, but somehow I didn’t associate this common city noise with the help I was waiting for. I listened to the sirens get louder and louder until they were right on top of me.

Then the Swarm started. This made me unspeakably happy. I’m not sure who arrived first, but it seemed like in short order, there were at least half a dozen voices talking directly to me, and more reassuringly authoritative-sounding voices milling around, talking into radios and herding people. My #1 wish in the world had been granted; people who knew how to fix people had arrived. My field of vision was filled with competent-looking folks in important-looking uniforms: police officers in blue, and an assortment of paramedic-type people in comforting white shirts, dangling stethoscopes and other instruments, and carrying reassuringly big plastic boxes of gear.

Laura arrives

Just as the paramedics were starting their routine, I heard Laura’s voice, and she popped into my field of view away on the right. I was lucid enough to find this quite surprising; some bystanders had asked me if they could call anyone for me, but I don’t know Laura’s cell phone number by heart and nobody (sensibly!) had thought it would be a good idea to fish out my cell phone, which was in my back pocket, underneath me.

Before the accident, Laura, my brother (who was visiting for the weekend) and I were at the Experience Music Project, the blob-shaped interactive music museum in the Seattle Center complex in Seattle. I had taken off on the scooter to meet friends on Capitol Hill. As it turns out, Laura and my brother left shortly after me and were on their way elsewhere, but had taken a bit of a wrong turn and wound up at the scene of the accident!

I can’t imagine what this must have been like for Laura. She told me later that approaching the scene, she saw the scooter lying in the intersection and had felt sad seeing a motorcycle down, since she feels a kinship with bike riders. Then she started noticing things: There was a black basket lying in the intersection like the one she used with her scooter. It had a plastic flower in it, just like hers…

Laura told me afterwards that she stopped the car in the middle of the road and got out of it with the engine still running and ran over to where I was lying. Thankfully, when she got over to me, I was able to talk to her and tell her that I appeared to be in a single, albeit battered, piece.

No nonsense

The paramedics are a no-nonsense crew. At the time of the crash, I was wearing a T-shirt and a zip-up fleece over it, jeans and leather shoes. As the first order of business, they cut every stitch of this off my body with shears, in about 15 seconds flat. They’re good at this: they make straight cuts up pant legs and sleeves, and simply lift you off the clothes when they’re ready to move you. When they found they couldn’t easily unlace my shoes, they cut those off, too.

I assume this is all so they can get a good look at your body, to see if anything is cut open or sticking out. In my case I seemed to still be a closed unit, although my right leg was still lying in its unnatural position.

I noticed almost right away that being a conscious as a trauma patient is an odd experience: the paramedics keep up a constant patter with each other as they work to figure out what’s broken. The questions they do ask you are sharp and to the point: “What’s your name?” “Where do you hurt?” “Does this hurt?” “How about here?” “Can you feel this?” “Can you move your toes?” “Follow the light with your eyes”, etc. Asking questions slows them down.

It became apparent that my right femur was the major injury point when the paramedics got around to straightening my right leg out. Although adrenaline is a very powerful anaesthetic, this is when I started feeling significant pain.

The paramedics inventoried my body: they rolled me and examined my spine inch by inch; they poked, prodded, palpated, peered, and pondered the results. They took the time to put an IV tap into each of my arms before we got moving. In hindsight, this was probably a good sign that they didn’t think I was in imminent danger. They slipped me onto a spine board, strapped me down, lifted me onto a gurney, and loaded me into the ambulance. Laura followed in our car.

Harborview

When we were getting ready to leave the scene, they told me they were taking me to Harborview. Of course they were taking me to Harborview. I couldn’t have been happier.

Harborview is where you want to go if you suffer major trauma almost anywhere in Washington, Alaska, Montana and Idaho. Patients are airlifted from that entire territory, as far north as Anchorage, when they need urgent trauma care. Harborview is the only Level I Trauma Center in the four-state region. Harborview is also ranked 10th orthopedic center in the country.

I was really happy to be heading there.

[Posted retroactively; written 5/23/04]

So by now a handful of people have popped into my field of vision and attempted to say reassuring things. Most of them say that the ambulance has been called. Many of them remind me not to move. I thought this was rediculously self-evident at the time, but a few days later a friend told me about how he had once broken his leg and tried to get up and walk immediately, which of course made the injury worse. So it’s probably good to always remind accident victims not to move.

After a few minutes, the adrenaline started to wear off a little and I started to shake all over. I had a bystander help me keep my left leg, which was crooked up, in place.

When you’ve just gotten hit by a car, you see the world through pretty selfish eyes. I remember distinctly being struck by how unconcerned a lot of the people standing over me looked. I suppose it’s not that they looked like they didn’t care at all, but they didn’t look distraught, or upset, or worried, or anxious for the ambulance to arrive. Some of them looked curious. The most attentive ones seemed calm and cool, which I suppose is good.

I guess what I really wanted at this point was to see someone doing something superhuman, or massively compassionate, to help me. Of course, everyone did precisely what they were supposed to, but the world is a lonely place when you’re waiting for an ambulance.

Not everyone is helpful

Nothing egregiously stupid occurred before the ambulance showed up, but a few things were kind of funny.

The suggestion of a couple passers-by that maybe it would be a good idea to remove my helmet were swatted down, thankfully, by people who knew better.

After a half-dozen or so people had shown up in my field of view, a youngish man showed up and appeared to be holding a red First-Aid pak, like you might find in an office or in a bicyle saddle bag. His well-intentioned offer was: “I have gauze…”. This was determined to not be useful for on-site treatment of an apparently broken leg.

Not long before the ambulance showed up, an elderly gentleman showed up. He had a deeply creased face, wore an old-fashioned suit, and looked like he was carrying a cane. He leaned over me, took a look at things, and offered the following observation:

Young man, I broke my leg a few years ago, and I am much older than you are. My leg healed, and yours will too.

Then he wandered off. I wasn’t sure what to make of this.

[Posted retroactively; written 5/23/04]

The first few minutes are the worst

So when last we left our hero, I was lying on a sidewalk after getting clocked by someone running a red light and thrown through the air.

Lying on that sidewalk was probably the worst part of the whole experience. After landing, I was flooded with adrenaline, and basically couldn’t feel anything. I sat up quickly where I was lying, and noticed that:

• I was breathing
• Everything seemed to be attached

On closer inspection, thought, my right leg was lying at kind of a funny angle, and didn’t seem inclined to move at all. Nothing was poking out of it, and it wasn’t a completely impossible position, but somehow it didn’t look too good.

My left leg was doing a little better; I had landed on my back and it was bent up at the knee a little. This struck me as a much more normal possition. I looked down at my legs a couple of times, and it occured to me to try wiggling my toes. I found I could wiggle the toes on both feet, which reassured me a little.

This all makes it sound like I was nice and cool-headed after I landed. In reality, of course, I was freaking right out. The main items going through my head were essentially:

• I just got hit by a freaking car hard enough to throw me through the air
• This is going to seriously ruin my day
• It looks like my right leg is broken
• I feel like I’ll live for the next 10 minutes or so, but what if I have a massively crushed chest cage or something and just can’t feel it thanks to adrenaline?
• I wonder if I will ever walk again
• More than anything in the whole world, I most of all want there to be a supremely confident paramedic crew here, right now, swarming all over me.

All this unrolled in the first few seconds after hitting the ground.

In the role of Freaked Out Accident Victim Lying on City Sidewalk, I figured the situation called for some kind of pronouncement. Here’s what I came up with: “Help!”.

I tried this out at medium volume. It seemed to feel pretty good, so I starting yelling “Help!” with a good assortment of volume, pitch, and decorators: “Oh God, please help!”, “Someone Help”, “Help me”, etc, etc. Not too inspiring, but I hoped it would get the message across to whoever was standing around about my greatest-wish-in-the-whole-world at that moment.

As I was getting on a roll with the “Help” routine, people started gathering around. If you’re lying on the ground injured, this is always fun, because you get an image of people standing against the sky, looking down at you, with all kinds of interesting expressions.

The first couple of people to appear told me calmly that they had called 9-1-1. Some of them were still on the phone and were saying things like “I’m standing by him now; he seems to be breathing”, or “it looks like he’s broken his leg”.

For some reason, people telling me they had called an ambulance didn’t seem very reassuring. I couldn’t do anything with a phone call. A phone call was not going to tell me that I would be able to snowboard again after they patched me up. If these people really cared about me, they would have shown up and said: “I rustled up this ambulance crew from around the corner”, or even better, “we’re a bunch of paramedics and we happened to be passing by….”. I figured paramedic response to where I was, in the middle of the city, had to be something like 5 minutes. This seemed ludicrously, enormously, impossibly long. It felt like I had better stock up on provisions and winter clothes to wait that long.

So to make sure that people didn’t forget their primary mission, I kept up a good “Oh God please help me” routine for good measure.

[Posted retroactively; written 5/23/04]

How I hate getting hit really hard

I’ve decided there is a common misconception about getting badly hurt in a crash, fall, or other kind of impact. People ask to hear about the accident as though at the moment of impact, or shortly thereafter, there is a big, impressive rush of pain. In my experience, this just isn’t true — if you get hit hard enough, you don’t feel jack for at least 10 or 15 minutes. But there’s always the Crunch.

What’s the Crunch?

Again, in my limited experience of getting smacked around, the truly disturbing part of getting hit good and hard is the dull impact sound/feeling at the moment of impact. If you’ve taken a solid fall, say skiing or snowboarding, or run into a wall, or gotten hit by something big and blunt, I think you know what I’m talking about: there is no immediate feeling of pain, and adrenaline makes it impossible to figure out how badly you’re hurt, but you can always tell you’re in trouble if there is a loud, dull thump resonating in your head. It’s the sound and feeling of your body, which is a pretty big and fairly soft structure of bone and muscle, hitting something good and hard. It bounces around your head. It sticks in your brain. I call it the Crunch.

I hate the Crunch.

Getting that big dull Crunch sound means I’m hurt, I just don’t know how badly yet. It also means that I’ve probably got enough adrenaline in me that I won’t really be able to tell how badly I’m hurt for a little while.

The Crunch is the thing that sticks in my mind when I think of the crash. That and the tumbling through the air. Tumbling through the air was bad too. But mostly, I remember the Crunch. Remembering it makes my stomach drop — it’s a sound and feeling I hope I never have to face again.

[Posted retroactively; written 5/23/04]

Today I got hit by a car.
It hurt.

I’m writing this first entry more than a week after the crash. I’ve been meaning to write down the story of what happened and how I felt, and I figured I should start at the beginning.

At about 3:30 today, I was crossing downtown Seattle on my wife’s snazzy Yamaha Zuma scooter. This thing is so much fun — it has a little 50cc engine, which means it can’t go much above 30mph, but it gets like 100mpg in the city and is great fun to drive. Laura lets me borrow it when she’s feeling generous — she uses it for most of her getting-around-town needs.

I stopped at a red traffic light at Howell & Minor on my way to Capitol Hill to meet some friends. After a little while, the light turned green, and I forgot to follow one of the key pieces of advice they give you in motorcycle and bike-safety classes: when entering an intersection right after the light changes, look both ways to make sure some yahoo isn’t running the light.

Anyway, I didn’t check, and just started off into the intersection. Of course, cross traffic does in fact have a nice solid red light at this stage. I crossed the first (left-to-right) cross-traffic lane OK, probably picking up about 10-15mph. As I was starting to cross the second (right-to-left) cross-traffic lane, I remember this sequence of events as a sort of slideshow:

• I saw a car coming towards me from my right. I remember it as being tan or otherwise light-colored but that’s about it.
• I realized we were on a perfect collision course and went for my brakes. I’m not sure if either I or the car managed to apply brakes at all.
• I felt / heard an overwhelming dull thump as I struck the car. I can’t remember where exactly I hit, or how, just the feeling of impact.
• I remember a few seconds of tumbling through the air. This was really scary. I must have done a couple of spins, or somersaults, as I remember the world rotating a couple times around me. I could hear my fast breathing inside my helmet as the world went around.
• I don’t specifically remember landing, but I wound up on the ground.