Wednesday, March 3, 2010

Motorcycling Memories: Oh Deer!, Eight; The Accident, IV

First published, Open Salon, MARCH 3, 2010 5:29PM


[The University of Virginia Medical Center at Charlottesville. A teaching hospital with schools of Medicine and Nursing and Level One Trauma Center. Stock photo.]

This series is for Mishima666, who has waited longer than I promised he would.

The tease: June 24, 2005 Day Planner entry, after the fact: "Hit deer - totaled bike - ended at Trauma Unit, UVA Hosp, Charlottesville, 2 1/2 days - bad scene all around.

What you may have missed:

Part One:

Part Two:

Part Three:

Part Four:

Part Five:

Part Six:

Part Seven:

This is the final post in this series.

While I was not aware of it, the doctors must have been weaning the pain meds because I was beginning to feel a lot more pain once I was moved to the step down monitoring room, and I never again got to be watch the docs work on me while I was on the ceiling and they were on the floor. I kind of missed that.

I fell into a troubled sleep after they laid me on the bed, still on the board. I had the beginning of what would be with me for several weeks: weird, troubling dreams that caused me to wake in a sweat but which I could not remember other than they were dark and frightening.

A few hours later I woke and desperately had to pee. The nurse came in and said the catheter was working. But she took a look at the setup and said that the catheter was too small for the amount of fluids they were pumping through me. So I had a choice: pull this one and put in a larger one for some relief or live with the feeling of a constantly full bladder.

What a choice. Like most choices in the hospital it was no real choice at all. But she was pretty gentle when she pulled the smaller one and put in a much larger one. That hurt like hell for an instant but in minutes I felt relief.

I then insisted that they take me off of the spine board and the neck brace but the night doctor refused, saying that 'your spines are not cleared," meaning that radiology had not signed off.

I gave up arguing for then, had them elevate the head of the bed and fell back into a troubled sleep. Sue slept on the floor, exhausted. The next day we got them to bring in a roll away bed for her to sleep in.

In the morning, Saturday, I raised hell again about the board and brace and they went into the same song and dance. Finally, after they left I had Sue loosen the neck brace and the board straps without telling them and that helped some.

The Chief Resident of the step down unit came in around noon and I started my complaint all over again. The same answer came back: they were waiting for the Chief Radiologist to "clear my spines."

I blew up: "Don't tell me that in a 600 bed hospital with a Level One Trauma Center only one person in the entire staff has the authority to make that decision, and he isn't even in the building and may not be back until Monday! That is insane and can't be right! I want to speak to the Trauma Chief now!"

About an hour later, after I had told Sue to take off the neck brace, the Chief Resident came back in and said that 'your spines are cleared." If he noticed I was not wearing the neck brace he didn't say so. He and a nurse undid the straps, laid me on the side and removed the board. What a relief.

However, it was at that point that I realized that the outsides of both thighs, but mostly on the right side, were totally numb. I told Sue but did not tell the docs or I would have been right back on the board and sent back for more scans. I was and am convinced that it was laying immobilized on the board for 24 hours that caused the numbness. It took almost a year to get complete feeling in those areas, but they did recover.

By now the hematoma was really starting to hurt all the time and was beginning to harden on the edges. Within three days it would be hard as a rock. I was told that the rock hard feeling was "normal" and that it would soften in two or three weeks and be absorbed back into my body.

They gave me a dispenser button to push on my pain meds that afternoon and I quickly learned that it only dispensed what it wanted to dispense regardless of how many times you pushed it. So the pain in my shoulder, right big toe (which had a compression fracture of the joint and would forever be frozen immobile), and the hematoma just continued to mount.

Meanwhile I started the game of picking out the road rash gravel in my chest as it worked its way to the surface. This would go on for months.

Late Saturday afternoon they told me that I could go home the next afternoon if all continued to go well, and they saw no reason it would not. But how would we get home? We decided to ask my best friend back home, Jeff Stocker, to come and get us with my car and motorcycle trailer so we could get Sue's bike home and do it all in one long trip.

We called and as only a friend would do, he said "Glad to do it." Another angel, but this time not in disguise. We knew that about Jeff all along. I told him where to find the key to get into the house and garage, where to find the extra car key in the house, and how to hook up the trailer and its lights.

We expected him to arrive late Sunday afternoon, but he surprised us, left later that Saturday and stayed overnight in WVA, arriving just a bit after noon on Sunday.

Meanwhile, Saturday night I had to "go number two" and they gave me a bed pan. It was impossible and I gave up. I told them I wanted to be able to walk to the bathroom. They said "no" so when they left I had Sue lift my IV pole out of the socket on the bed and walk with me to the bathroom in the room. That worked. I was very unsteady on my feet, my broken toe hurt like hell, but it was worth it.

After Jeff arrived on Sunday and went with Sue to get Sue's bike loaded on the trailer I started putting pressure on the docs to release me immediately so we could get home that evening. Well, the same drill happened. The Chief Resident of the step down was off duty and they needed his approval to let me go. I went ballistic again. And the result was the same. Within an hour I was asked to sign the release.

I was getting the feeling that they were just as happy to see me go as I was to get out of there. I have always wondered how long someone would have to stay in a place like that if they were the quiet, mousy type.

When we started to get me dressed Sue noticed that I had blotchy rash areas pretty much all over and blushing areas that came and went. That would go on for weeks and we blamed it on the morphine getting out of my system.

But we learned when we got the bill from the hospital that when I arrived at the Trauma Center they had switched me from morphine to fentanyl, an opioid that is 75-100 times more powerful than morphine. And they gave me another opioid to take for the pain when I got home.

So for about a month I was still reacting to the opioids. Interestingly, I have taken opioids since and have had no adverse reactions to them. It must have been the strength of the dose that passed a threshold for me.

We got home Sunday night, Sue and Jeff taking turns driving, and nothing felt so good as sleeping in my own bed.

The next few weeks were painful. I continued to run a low grade fever for about a month; continued to have the blushing of my face, chest, buttocks, and legs; and, about ten days out started having my feet swell up and turn red in the evenings. Because they quit doing that after a couple of weeks I associated it with the opioids and perhaps it was. But it also could have been unrelated.

In any case we will never know but it could also have been the beginning of my erythromelalgia because I continued, off and on, to have the same phenomena happen after a few of the long, all day, rides we took when touring. The erythromelalgia began in earnest almost three years later in the Spring of 2008 resulting in my forced retirement for medical reasons. It continues today, with at least daily flares every night.

After about three weeks the hematoma was still the same size, still hard as a rock, and had turned to a fluorescent rainbow of colors. We decided to go to a local surgeon I like and have him take a look at it. He too had never seen a hematoma that large, agreed that it would soften at some point, and told me to come in when it started to do that.

At about the five week mark it started softening rapidly and I went in. He said it would take years to get that much blood absorbed so he drew off two huge 6" by 1 1/2" vials of the blood and told me to come back in a week. I told him we were going out of town for a week, so make it two.

When I went back in two weeks he drew off another vial of blood. At the next visit he said that the rest would eventually absorb, but that there would always be clusters of necrotized tissue in the area that would never soften. After almost five years you can still feel those lumps and there is still a tattoo of darker skin where the hematoma was.

Meanwhile, I was told that I should not ride a motorcycle for at least three months. After three weeks I saw an ad in the paper for a 1984 Honda Nighthawk 550 and insisted that we go look at is as a possible interim bike until I decided what kind of more permanent replacement bike to get.

Sue drove me to see it and it was a well kept bike at a good price, but my foot was still in a walking strap on cast and I could not shift. So I talked her into taking it for a test ride.

She could barely get her feet down because of the seat height, but, good trooper that she is, she rode it and said it was fine. We bought it, came back the next day with the trailer, and hauled it to a repair shop for new tires and brake pads, and a complete checkup, carb clean and synchronization, etc.

We got the bike back in a week. So, one month from the accident I was riding locally again, taking my foot out of the walking boot and gingerly putting on my boots. I stuck to the wide four lane roads.

Six weeks from the date of the accident I put a new wind screen on it, and added some old saddlebags. We packed up our seat bags and tank bags, filled the saddlebags with rain gear, tools and sweatshirts and took off for a 1500 mile tour of the western Lake Michigan towns in Michigan, above Holland.

We had a great time. Both bikes ran great. The little 550 cc Honda ran like a top, cruised easily at 70-75 on the interstates, and was an all around good bike. I was in considerable pain the whole trip but covered that as much as possible with Ibuprophen and decided that the joy of riding was far greater than the pain.

But I had nagging fears about deer for a long time. Going to Michigan was not bad because there were many fewer deer than around here. But our hilly, timbered, home county, Tuscarawas, is the deer capital of this part of the country. Every year more deer are harvested here than in any other county in Ohio.

Our deer are known to be some of the largest white tail deer in the country. Mountain deer like the one that ran into my bike are much smaller than our deer and crashes here, even with cars and pickups, can be deadly, and are.

So I was a bit paranoid that entire remaining season, even though I rode almost every day. The paranoia was particularly bad when I rode the narrow back roads in these hills that I love. But every time I rode I insisted that I challenge myself to ride those kinds of roads at least for part of the ride.

Little by little I got over my fears and started enjoying the freedom and sense of oneness that I have had all of my life with my bike, God's beautiful world, and the joy that is riding.

It took a season but by the next Spring I had arrived at a "new normal." Nothing would ever be the same, physically or emotionally. I had been through a lot and come out with far less damage than I could have.

I had endured a lot of pain that I thought would be the worst I would experience. I did not know then that the pain I felt would be small compared to the pain I feel every day now from my erythromelalgia and the related neuropathies and vasculitis associated with it.

My shoulder still aches now and then and gets easily strained when I am lifting something, the toe is still frozen and is larger than the other toe, and the hematoma has left its necrotic lumps, scars and discolorations. And I still am especially alert for deer when I ride.

But at age 71 I have learned a lot too. I have learned that as you age "new normals" are part of the way things work. I have learned that we have a choice: we can whine about it or we can get on with life and do the best we can with what we have to work with.

I have learned that there are angels in disguise everywhere in all situations of our lives and that if we don't see them it is because we are not looking. I have learned that there are competent people who care and who dedicate their lives to professions that allow that caring to be expressed.

I have learned that the reason God gave me my wife was so that I would learn that we are never whole until we can wholly give ourselves to another. And, I have learned that God sends guardian angels to take care of fools and Englishmen, just like the saying says. And I am glad that I qualify for that service.

Most of all, I have learned that life is precious, not to be taken as something owed to us or as a random act of chance, but as a sacred gift to be cherished and to be lived to the fullest.

Thank all of you for reading this series.


Tuesday, March 2, 2010

Motorcycling Memories: Oh Deer!, Seven; The Accident, III

First published on Open Salon, MARCH 1, 2010 3:03PM

[The Pegasus Emergency Air Ambulance from the University of Virginia Medical Center. Stock Photo.]

This series is for Mishima666, who has waited longer than I promised he would.

The tease: June 24, 2005 Day Planner entry, after the fact: "Hit deer - totaled bike - ended at Trauma Unit, UVA Hosp, Charlottsville, 2 1/2 days - bad scene all around.

What you may have missed:

Part One:

Part Two:

Part Three:

Part Four:

Part Five:

Part Six:

There are "systems" everywhere. But most of us do not wish to be in the grip of a system wherein we have little to no control. But we often are. And one of the most invasive systems regarding control of our own lives is the medical system. We like to think that we are at least "partners" with our doctors, and that we have some real say in our treatment. And, often we can have that partnership if we insist on it and the physician isn't too arrogant. Usually such partnership cooperation is in non-emergency situations.

Emergency situations are different. Often your doctor is not even available, or defers to specialists. Still, a good medical team will usually keep you informed about what is going on with their treatment of you. They may actually ask you if you agree. Of course, by the time you are in the hospital they will have already had you sign an agreement to do what they have to do.

And the truth is that we are highly unlikely to disagree with their proposed course of action because they always hold the trump card: "He HAS to have this done now." The implication behind language like that is if you don't do it you may die or you may be seriously incapacitated.

From the moment the EMTs arrived I was in the hands of a competent, efficient medical system and, while I protested at first and even later, often and loud, in the end Sue and I always decided to go along with the big decisions. We violated their rules and procedures only when they were not looking. But, mostly, the system had me from start to finish.

Fortunately in my case this was a good system and the outcome was far better than had I been in some medical systems that are not so competent and not so caring. And there were angels in disguise even in this large system. But they were also ultimately making all the important decisions. I held no illusions about that.

I was alert as they wheeled me out from the Bath Hospital to the chopper and put me in it. That is to say that I thought I was alert. Later, at home, reflecting on the entire next 2 1/2 days I was not so sure that was even remotely true. The morphine did more than cause an allergic reaction, it was confusing my judgment even thought I did not know it. Of course it was also doing what it was primarily supposed to do: reduce my pain. I felt little actual pain on the flight to the UVA Medical center or during the tests.


[Pegasus Air Ambulance, close up. Stock photo.]

The chopper was left running while they were loading me in. There was little space in the chopper. Sue could not come with us. At first that upset me. But I was quickly starting to mellow out from the morphine and that worry slipped my mind. The pilot was already in the chopper. The Pegasus EMT got in and the local EMTs handed me in, strapped to the spine board and with the neck collar in place. I was placed head forward and the EMT was in a jump seat to the side of me.

The pilot and the EMT wore headphones so they could talk to each other and were in constant communication with the Emergency Trauma Center in Charlottesville. The EMT freed my right arm from the board and handed me earplugs. I could not get them in right and asked for some Kleenex. I stuffed those in my ears and that worked pretty well.

We took off and there was a window in the top of the chopper through which I could see out. I yelled a conversation with the EMT for a while. When we got to altitude the EMT told me that they could not fly directly over the mountains to the hospital because there were clouds too close to the tops and they needed more clearance. They said we would fly south to a place where there were fewer, lower, mountains, and then cut across there into the Shenandoah valley. They said it might add 15 minutes to the ride, for a total of about 40 minutes. I didn't care. My fear of flying was turned off. Mr. Morphine was hard at work.

When I next looked out the window in the top of the chopper I could see the mountains, the valleys, the houses, and roads, with cars moving on them. I watched us pass over small clouds now and then, and saw the sun break through. I saw everything. I saw the interstate, which I know was I-64.

We turned east when we got to it and followed it for a while, then cut north in a valley, came over a low mountain and turned north again at I-81 for a few miles. We cut over a lower area of the Blue Ridge Parkway, swung east diagonally to Charlottesville, flew over the urban area for a short while and landed at the helipad at the Medical Center. It was a nice trip with only a few bumps as we caught up and down drafts crossing mountains.

It was a good ride and I enjoyed watching the ground from that height. The only odd thing about it is that I was on my back looking UP! And I knew it at some level but found it not strange at all, only interesting.


[The University of Virginia Medical Center at Charlottesville. A teaching hospital with schools of Medicine and Nursing and Level One Trauma Center. Stock photo.]

Oddly, I remember nothing about being carried out of the chopper and going down to the Emergency Trauma Unit. I do remembering talking to some doctors, one of whom said he was the Chief Resident. He said I would meet the Trauma Chief later. Meanwhile I was going to have some more tests.

He looked at the hematoma, which was now about 6" in diameter and had raised over my chest to over an inch high. He palpated it and I about went through the roof. The morphine was wearing off. He said that he would have the nurse give me something IV to take the edge off the pain. I said, "Good. The sooner the better." The nurse came in shortly and added another bag to my IV stand.

The resident came back, introduced me to a cardiologist who hooked up some leads to some round conductors that were already on my chest. I don't remember when they were put on, but it had to be at the Bath hospital. These leads connected to a monitor I carried with me, which in turn sent a signal to a monitoring station somewhere in the building.

Next a phlebotimist came in and took some blood and left. They would end up taking blood every two or three hours for the entire stay. An orderly came in and said that he was going to take me for some tests. What I did not know until I got the summary of my bill, was that they did all the same tests that were done at Bath, primarily CAT scans and Xrays, plus some ultrasounds. Test, test, and test again.

They first wheeled me down to get some CAT scans. I remember being apprehensive about doing that because I am claustrophobic. But one of the technicians said that this was not a narrow tube like an MRI, but was a "donut" that was less than 2' deep and he would run me through it and back out before he started so I could get a sense of how it worked. He did. And I realized, as I had with the chopper flight, that I was not actually afraid. The IV med the Chief Resident prescribed was workng.

The technicians had placed me up on the pad on the machine when someone came in and told them that there had been a really bad automobile accident and that this CAT scan machine and all of the others were needed for that. Apparently they had decided I was stable enough so they wheeled me into the hall. They said I would not have to wait very long.

That was cool to me and I said "OK." What I really wanted to do anyway was to try to figure out how they could work on me with me on the ceiling and them on the floor. And I wanted to know how they managed to get all that equipment nailed to the ceiling. Nor could I figure out what kept me from falling down on them.

Before I could work that out they wheeled me back in and did the scans and sent me to have my ultrasounds done and then the XRays. I was fascinated that the entire Trauma Center was set up the same way as the CAT scan area! The entire place was upside down. But I still could not figure out how they did it. I was having a great time pondering the design of the place and the amazing ability of these doctors and staff to do all they did while I was hanging from the ceiling! There must be some advantage to doing it that way but I couldn't think what that would be.

Eventually they hauled me back to a curtained off room in the trauma emergency area. Shortly thereafter Sue showed up. I was really glad to see her. She looked tired and worried. And I was starting to feel a lot of pain. I needed that nurse to put some more of that no pain juice in the IV.

Interestingly, when I realized I was in pain I also noticed that they had set up in this part of the Trauma Center normally. I was on the spine board, on a gurney, and I was on the floor, not the ceiling. So was Sue. I wondered why they did this part of the Center that way. But I never said anything to Sue about it. I was more interested to know where she had been.

I had told her back at the Bath County Hospital that I thought she ought to ride her bike down to Covington and rent a car, leaving the bike there. It turns out she did nothing of the sort. She, like me, can be a bit adventurous. In this case it also took a certain amount of courage.

She somehow packed up everything onto her bike and rode some 3 hours to the hospital. Now that was not easy. First there was a lot of stuff, which she managed to compress in a black plastic lawn bag she got from the hospital custodian. Then she used bungie cords to tie all of that over her luggage rack and the back seat. She got directions from the State Trooper, squeezed herself between the bundle of stuff and the handlebars and took off.

Neither she nor I had ever ridden the roads she was about to ride. She crossed three mountains, negotiated a long canyon, rode a long valley, bypassed a middle sized city, and entered Charlottesville on I-64. She didn't see the sign the Trooper said she would see saying "Trauma Center," and rode past the Medical Center exit. (It turned out that there was no sign saying "Trauma Center.") She got off at a hospital sign, and stopped at a gas station near another hospital on the east side of town.

They said there was no trauma center at that hospital and sent her back west on I-64 to another highway going north. She went back, found the northbound highway, but was still looking for a sign to the Trauma Center and went too far again. It was in the middle of rush hour, and traffic was backed up. So she got off at the next exit, crept along the shoulder hoping to see a stopped car where someone had their window down.

She saw a guy on a motorcycle and asked him where they would take someone in a helicopter who was in a motorcycle accident. He said that it was too complicated to give her directions from there, but that he lead her there. Yet another angel in disguise! She followed him through a bunch of back streets to the Trauma Center. She thanked him. He rode off and she came in to find me.

She found me in the Emergency patient area. My tests were over. She talked to me a while and then moved her bike to long term parking. A sign in the hospital long term parking garage said "No Motorcycles." She ignored the sign and parked there anyway. See what I mean?

She had spent at least an hour trying to negotiate Friday evening rush hour traffic in an urban area she had never been in before. And, she had done this without riding with me in the lead. That is a big deal. Just ask anyone who has ridden a bike. This was her first "solo" ride, and normally first solo rides are not like this one. As the good ole boys down here in the village say, "She done good."

After she came back, the Trauma Center Chief came in, introduced himself, and told us that I now seemed fairly stable and that I would be moved to a room in a unit where trauma patients could be monitored carefully. I asked him what all the tests were about and whether there was anything permanently bad they had found. He said that there were three main things they were concerned about.

First was whether I had any previously undiscovered trauma to my head. Second was whether there were problems with my spine from the crash. They found nothing to indicate either, but the Chief Radiologist had not yet read my results, and therefore, had not "cleared my spines." I should have asked him what that meant because it was a term I would come to hate.

And third, and the most problematic, was whether the hemotoma was not only on the outside of my chest but whether it was leaking blood inward beyond my ribs. That could be big trouble because it could put pressure on my heart and/or the blood vessels that ran from and to the heart. He said the tests did not indicate any damage beyond bruised ribs, heavily bruised muscle and significant crushing and tearing of the same.

He said that the hematoma had continued to grow while I was there, but in the last hour and a half had begun to stabilize. It appeared to them that the artery or arteries that had split open from the impact were sealing. He said that this was particularly good news because they did not have to do surgery to dig around for the sources of the bleeding.

He mentioned that it was the largest chest hematoma anyone there had seen. By that point it was over 8" wide by 7" long and stuck up 2" high on the normal surface of my chest, with more damage and bleeding done between the surface and the ribs. Well, when I do things I do them big time!

They wanted to monitor it constantly for "a while," maybe a couple of days, to be sure the bleeding had stopped and would stay stopped. I only wanted three things: some more IV pain killer and to get out of the neck brace and off the spine board. He sent the nurse for the pain killer; she came with a new IV bag, and I forgot about the spine board and the neck brace shortly after.

They wheeled me down a long, long hallway to an elevator. Sue was by my side. It felt really good that she was there. I was proud of her solo ride, and irritated that she did it because I don't want to think of the trouble she could have gotten into had she had an accident. But the meds were doing their thing and it was hard for me to concentrate enough to continue being irritated.

We went up an elevator to the 6th floor of one of the Medical Center buildings. That floor was dedicated to trauma patients and had all the high tech monitoring devices you can think of.

All I could think of was how they had managed to set up the Trauma Center so that the patients were on the ceiling and the doctors were on the floor. But it still didn't seem either odd or unusual.

They wheeled me into a room, picked me up on the spine board and laid it on the bed. I was just glad all the testing was over and never thought about them not taking me off of the board or removing the neck brace. That would come later.


Next: Another catheter? Will I ever get off this spine board? Cheating the rules. What about getting out of here? Why all the continued rashes? Numb thighs? How will we get home? Going home. Post trauma problems. Local surgeon. Let's buy another bike. Fears. And, finally, finding a "new normal."