Thursday, January 12, 2006

Of Motorcycles, Modern Medicine, Evolution and Religious Conversion

Or perhaps more accurately of motorcycle crashes, ...

They say there are two classes of bikers (bikers - it sounds so Hell's Angels doesn't it), those that have crashed and those awaiting their crash. Well, last August a run in with a little ol' lady from Pasadena (technically, I don't know that she came from Pasadena but given the immigration rate of Californians to Idaho, it's certainly not unlikely) resulted in my transfer from the latter to the former motorcyclist (that sounds more civilized) category.

Anyone who rides a bike knows that there is no shortage of drivers ready to run you off the road, if not by design then by their oblivion. But to be fair, based on my painful assessment from the pavement, this woman wasn't so much oblivious to me and my Honda as to ... well, the entire universe around her. The officer assured me, as I was being loaded into an ambulance (or was it later in the ER) that she wouldn't be behind the wheel again without being re-tested - I felt soooo much better.

Ah yes, the ambulance ride - a first for me. It was surreal, lying on the ground self-assessing my injuries as a siren wail, I figured to be destined for my retrieval, drew near. Conscious? Check. Head and neck? Seem okay. Pelvis? Burning sensation, beyond mere pain ... hosed. Appendages? You think I was going to try and move a leg? Right arm and hand appear okay. Left (southpaw that I am) not so hot. So, packed in the ambulance with IV, O2, backboard and neck-brace, I ask the EMT where we were going. St. Al's was the response.

Well, we have two hospitals in Boise and both are very saintly. St. Al (short, of course, for Alphonsus) and St. Luke (short, for well, nothing I suppose as I've never heard him referred to as St. Lucas. Perhaps like me, his mum didn't especially like the formal version of his name. Likewise, our daughter is Abby, not Abigail. Sorry, Ms. Smith Adams. But I digress). Each hospital has its reputation in the community and the reputation of the ER at St. Al's is, how shall I put it ... abysmal.

"How 'bout St. Luke's?", says me. "Well", the EMT responds, "St. Al's is the regional trauma center". At this point we're about 1 minute into what seemed an interminably long ride (which, by the way, followed the cutting up of my favorite jacket - hey, my right arm was still good - I could have taken it off) and I interjected that St. Luke's was closer. He agreed that St. Luke's was indeed closer but said that they always bring severe trauma injuries (I realize at this moment that I've already been reduced to an injury) to St. Al's. Suffice it to say, while I lay attempting to salve my pain by imagining myself on a chaise lounge on some distant beach with a very large straw between my mouth and an endless tequila shot, I didn't have the capacity to force the issue and thus arrived at St. Al's ER.

Talk about a cluster f*&#. At one point, while surrounded by about eight persons who in their collective indecision as to the best way to stabilize my pelvis were holding me in the most painful possible position and, through time and maneuvering, having been released from the temporary anaesthesia provided by shock, I rather forcefully said, "time-out!" "Okay, while you guys contemplate what your doing please leave me on my back, with support beneath and on the outside of my knees". A young doctor standing at my head who was as frustated as I (though not as painfully so) had even commented, in a french accent, "too many cooks, yes?" YES.

The pelvis, despite its imperfections for bipedal locomotion (damn that designer) is quite a remarkable fulcrum. It is most stable when one is standing and while it can bear surprising force and, in the case of us females, retains sufficient flexibility for childbirth, when its tolerance limits are exceeded - it's not a good thing. Without it, there's nothing to hold you together down there. Kinda like plastic man with a lot of pain. Anyway, back to the stabilization thing so I could be tranported for scans and rays and things. As the knuckleheads (knuckleheads from the regional trauma center I remind you -a regional trauma center in a region of the country with large numbers of motorcycles and horses and, concomitantly, pelvic injuries) were jury-rigging bedsheets and pillows in an effort to keep my legs properly spaced and pelvis aligned, I said, "This is the 21st century, are you going to tell me that there's no orthopedic device specifically designed for this? There's something for backs, necks, arms and legs but not pelvises?" The uniform response was that they weren't aware of anything. If I thought I would have lived (okay that may be an exaggeration -my life insofar as I know was never threatened, the desire to live through this on the other hand...) through the transport over to St. Luke's, it's at this point that I would have demanded it.

Fast forward (Please!). The scans and x-rays complete (I have no idea how much time had transpired) -my pelvis, as I surmised earlier, was indeed hosed. My left hand and wrist were also fractured and I had a tear in my bladder (but it was small and there didn't appear to be any other internal injury/bleeding). I was then brought up to the orthopedic ward to await assessment of the films by the orthopedic surgeon on call in the region's trauma center. Of course, to this point, I was NPO (nothing by mouth, not even ice chips to suck on -in case I had to be rushed into surgery) and hadn't been given anything for pain (so symptoms would not be masked). So, how fractured was my pelvis? Enough that the orthopedic surgeon on call believed the repair(s) to be beyond his capabilities. Now don't get me wrong, I'm glad he decided this before hand but this is the regional trauma center for chrissakes -that's why I was taken there -or so I'd been told.

Shortly after the surgeon's bow out, I was informed that I wouldn't be going to surgery until Thursday a.m. (it was now sometime Tuesday afternoon/evening). I was then immediately given a morphine I.V. drip as well as a little self-medicating device (it had some cute little acronym like PCA for patient controlled administration or something). Morphine is a wonderful drug and, along with all of my senses, it dulled the pain to a certain extent. I don't remember great details about that evening other than the blood-red of my urine being somewhat disconcerting and the faces of AJ (our son) and Mr. CJ's clearly confirming I didn't look too hot.

Pain, did I mention pain? I knew it was bad, if for no other reason because I could feel it above all of the morphine but also because all of the nurses kept checking the computer reading and telling me that I should be using my PCA more often -so evidently it was even painful for them. Undeterred but still jury-rigged I thought nurses ... orthopedic nurses. Forget doctors, but certainly orthopedic nurses would know. So I asked, hopefully, "Isn't there some device for pelvic stabilization?" Nope. Not that she (Nicole) knew of but she would ask around. True to her word, Nicole did continue her inquiries even though she was not my assigned nurse after that first night.

I don't remember much of following day or night, Mr. CJ's face, too many phone calls, continous sleep that seemed like none at all (vital signs taken at what seemed to be 15-minute intervals but were in reality hourly I believe). Two surgeons visited: one an orthopedic surgeon who skills were presumably up to the task (I was relieved when I saw his USC sweatshirt and he confirmed that he'd gone there for med school) and a female urologist who explained that the bladder tear was minor and that had I not been scheduled for pelvic surgery she would likely have let it heal on its own but under the circumstances she'd go in and throw in a few stitches (not quite what she said but you get the gist). End result, I was going to be the recipient of a nice shiny stainless steel plate and several screws. We also were informed that he wouldn't know the extent of additional repairs necessary until he got in there but something about a not good (small) sacral structure and lots of nerve bundles -and hoping not to have to ... see you tomorrow morning (Hey, give me a break, I'd been on morphine for over 24 hours. At least I'd understood enough of what he said that it seemed the surgery would be a breeze unless he had to do the second thing in which case it would not be, a breeze -but I didn't think it a good thing to reflect on too much at the time).

6 a.m. Thursday (I'm scheduled for surgery at 10). Nicole (remember Nicole, inquiring mind Nicole) walked in accompanied by a handsome young black guy in scrubs carrying one of these. Imagine. A device specifically designed for pelvic stabilization. What do you suppose you might call such a device? Well, a t-pod of course -for trauma pelvic orthotic device. He put that puppy on and it was instant relief. I was in love, I was teary-eyed and I thought I could've gotten up and walked home at that point. Of course I would not have been able to but it felt as though I could and that was good enough at that point. Granted it would have been infinitely better to have had the t-pod about 40 hours earlier. So, for the few hours preceding surgery, I was, at last, comfortable - there was no pain above the morphine. To see what this little device does, check out the before and after x-rays here (scroll down). And folks, the separation seen on the lefthand film is nothin' compared to my pre-op films - you could've driven a Mack truck through the separation in my pelvis.

Surgery went well, and according to Mr. CJ lasted only about 1 1/2 hours. I only recall waking up in recovery. There wasn't any, "well, Mrs. CJ we're going to put you under now" or words to that effect, no countdown from one hundred ... nothin'. They must have slipped me my mickey through the I.V. as they rolled me to surgery - I never even saw the operating theatre. Rehab began the following morning (and continues today) when a physical therapist arrived to have me practice standing. The PT staff were excellent though somewhat sadistic (sure ... it was for my own good). One was even kind enough to share with me a tidbit from her education - for instance, did I know that a pelvic fracture was the most painful fracture a human could sustain? Seriously, I encountered 3 different PTs and several aides and all were wonderful.

Where was I? I covered the motorcycle and modern medicine parts and I'll gloss over the part about being so out of it and in so much pain that the humiliation that would have otherwise accompanied having someone (let alone cute young males) help you turn in bed, change your bedding or empty your catheter while you lie helpless and exposed, was eliminated. All told, even though I was pushing to get out, I spent two weeks in the hospital which, in this day and age, should give you an indication of the shape I was in. It was the worst time to be confined and immobile. The hospital had cable but, well ... Katrina ... 24/7. That, classic movies and Texas Hold 'em poker -once again confirming our (Mr. CJ's and my) decision not to have cable TV, why scroll through 100 channels before turning the TV off when you can scroll through 10, was a good one. I couldn't escape it - I didn't yet have the concentration to read -more reason to be depressed.

Adding insult to injury (this is where evolution comes in to play) on the second or third day in the hospital an aid (an incredibly nice young girl woman, Kaley(sp?) who will make a tremendous RN when she finishes her studies) asked me if I was expecting my period and I replied that I was not. Come to find out this (menstruation) is a common occurrence following trauma in females. Now this makes sense from an evolutionary standpoint - you don't want to be expending energy that could be beneficial to your healing/survival on an offspring that isn't going to make it if you don't. On the other hand, they've seen this happen even with post menopausal woman so it's a tad imperfect. Anyway, the point is, I am of an age (okay, I admit it - I turned the big 5-0 a week ago) where my menstrual cycle was diminishing (something I had been anxiously awaiting since I was 13), occuring every 45-60 days or so and now - well since it's traumatic appearance it seems to have made a return to its normal monthly periodicity. That sucks. Thus, my religious conversion. At least that way I'd have someone to blame. I mean you can hardly blame an evolutionary process -there's no satisfaction in that. Oh, wait. I forgot, God only gets the attribution for good outcomes, for miracles ... never the blame. Well, so much for my religious conversion.

It's been months now and I was released from my crutches before Christmas the holidays. While I'm no longer discolored from waist to knees, my muscles still feel bruised to the touch and I have a ways to go before I have some semblance of my normal strength, flexibility, mobility and, hopefully, a relatively pain-free existence. My left hand/wrist, that was not operated on, should begin to heal now that I'm no longer using it for weight-bearing as I was when on crutches. New Orleans and I will rehab together - of course I have a slight edge in that I don't have to rely on Bush Administration and a Republican-controlled congress and I have my family and many wonderful friends and the kind words of several bloggers who have made the past several months bearable. So, that's what I've been up to - how 'bout you?

Before this interruption I had been attempting to return to blogging after having been burnt out on the current state of affairs and commenting on it over here while Terry had been otherwise occupied in Afghanistan. Well, as we await the insertion of another nail in the coffin of our constitution and country things aren't looking any brighter but, its capacity exceeded, my outrage scale remains broken. However, at least one decision has been made easier [thanks to TBogg]. If Mr. CJ sees this, our countries of choice for expatriation list will be reduced to a single country.