Some lessons learned from injury

Sunlight-in-shade“You’ve had an accident on your bike,” a familiar voice gave me something I knew.

“You’re in the hospital,” and the familiarity fled with being awake.

A few more dreams, and I slowly recognised myself lying in bed, surrounded by scrubs and unfortunate people.

I pushed myself upright, and oddly felt the mattress move beyond my arm’s length, and the man opposite me moved from the floor to the ceiling. So, I stayed half-way up for a while, wondering which plane I was on, and where I was supposed to be comfortable. My shoulder suddenly stopped supporting me. I landed face-first in the bed, and the pain in my collar pushed its way into my understanding.

“Bloody hell” didn’t quite make it past my throat, partly thanks to the pillow surrounding my face.

So I fell asleep again, it seems, because my memory kept blinking.

Eventually, I came round more like a morning’s awakening in the dark, and again felt unfamiliar. I kept trying to patch together what was happening, and couldn’t remember anything leading me to here. I remember feeling hungry towards the end of the day, then the blinking of pastel colours, unpleasant smells, and suddenly the sound of someone screaming: “Scratch my bum! Fuck you! Scratch my bum!”

Towards the morning, I started to understand where I was. The familiarity I first experienced came from my wife, who had been by my side all night. I also noticed the number of people around me in medical clothes: nurses, staff, and who I assumed to be doctors. It was comforting that so many people about would look after me. I was able to put a rather disturbed face to the voice asking for his bum to be scratched, too.

I also began to work out which bits hurt more than others, and start to patch together what happened. I was completely deaf in one ear, but fortunately my wife sat on the other side of my bed and helped me understand why I was there. I kept asking her simple questions:

“Where was I? Did I hit anything? When was that?”

Weeks later as I write this down, I am still missing any memory of the reason for waking up in hospital. I remember working from home on something rather exciting, and feeling enthused about the things I’ve been pulling together at work for the past few months. Then, the blinking started and settled slowly into being in hospital. I’ve lost 12 hours. My wife filled in the details for me, and we’ve managed to piece together the rather underwhelming story of what lead me to pastel-coloured blinking, and a lot of pain.

After work, I took our dog for a run alongside my bike up and down the street just outside our house. This had been a bit of a treat for the past couple months for both of us. I enjoy him relishing the speed and bursts of energy as he effortlessly lopes along the wheels having more fun than the boring pace of two legs. Recently, we had taken him round a reservoir and ran him for 8 miles. He loves it. I got him a lead that attaches to the handlebars so he can’t wander into traffic. That evening, this seems to have been a mistake, because he must have paused suddenly, or bolted into a familiar patch, pulling the handlebars to a sudden stop while I kept going.

Some neighbours found me face-down on the road, creating a rather splendid puddle of blood. They knocked on my door and my wife called an ambulance, which sped her and me to the hospital. I was assessed as an emergency, scanned and kept in the resuscitation area while they made sure I wasn’t immediately likely to create a bigger mess. They kept asking me questions, but I kept repeating myself, and demonstrating my inability to think clearly. I was conscious the whole time, but cannot remember a single blink of it.

The next few weeks were occupied with many trips to and from hospitals, and I picked my way through a few important lessons. I learned how good my wife is at looking after people who mostly cause her trouble. She came with me in the ambulance, through the critical area and past weeks of me mostly sleeping and failing to do much housework. She seemed unruffled by my being basically bed-bound, and helped me to smile (even when my face stopped working). She helped me make sense of medical discussions, often using examples she knows from dogs, cats and other mainly quadrupeds. The first lesson—alongside not cycling with a dog tied to your handlebars—was to marry an incredibly gifted and kind person. If they happen to be a vet, that’s an added bonus.

Fortunately, I was also looked after in the form of my colleagues and friends as they supported me. I was sent dozens of messages from the online world of twitter, facebook and my inboxes. My boss informed me in no uncertain terms that he wanted me to go back to bed instead of trying to work, despite my rather bad timing of being ill during the public launch of our project.

Unfortunately another lessons was not pleasant. The comfort I had received from the scrubs and medical uniforms as I woke, wore thin. After coming round to my limited senses, I ended up asking half a dozen people if my collar bone was broken. It was hurting a lot, and I could not lift it properly at all. It seemed obvious to me that it was broken: I could feel the bones moving where there should have only been one, and the big bulge over the most painful bit was a beacon.

Each time I asked, I watched as they read my chart and assured me it wasn’t, that I just had a concussion and nothing broken.

“Keep it moving, so it doesn’t become stiff.”

I cannot remember a single doctor or nurse looking at my shoulder, just my notes.

I sadly learned not to trust the advice that comes first if it seems wrong. Eight days after the accident, my reluctance to move the arm (in case it went stiff) became clear as a consultant took a few minutes to look at my shoulder and nod to himself: “That’s almost certainly a fracture. It looks painful.” The X-Rays he took did not need much explanation, but made me wince. I was told to keep it still.

This lesson was repetitious, and I cannot list every study-session I had on the topic. I must admit I am still depressed about the treatment I received in hospital. Some of the stories were painful at the time, and funny now; but I am trying to work out the final thesis of the lesson. So I will tell one more story here.

After a few days of being home, I went to bed saying: “My face feels very odd. Half of it feels tired and the other half tingly.”

The next morning, half my face was paralysed, calling for another trip to the hospital. Actually, it called for 4 trips to hospital over the next two weeks. Eventually, I saw a specialist. He was optimistic, though, and I think he half-read from my face that I was shocked by his diagnosis:

“Well, you’ve done an impressive job by breaking the hardest bone in the body!”

He explained that I’d fractured my skull, through my ear canal and pinched the facial nerve. I’d known for a while that my eardrum had ruptured, but this seemed to be the cause. He was reassuring, though, and said that he could see some small movement in my face, and that he did not believe the nerve had been killed but was just impinged, and that my course of action was to let my body put itself back together.

That was my main occupation for around five weeks. Though I did have my shoulder put back together with some screws and a plate, which made it a lot more comfortable. Over the whole time, I was astounded at how tired I was, and a lesson I’ve picked up is that a body needs rest to recover. It was a shocking lesson. It was shocking because it’s obvious, but I’d never known just how much rest my body demanded of me. More weeks later, and I still struggle to stay awake for a whole day, and run into fatigue sometimes quite suddenly.

I now seem to be mostly mended, with only a few niggles remaining. My face is only slightly lopsided now, making my giving a talk to a conference last week a lot more fun than it would have been otherwise. I can now hear about half-way through my right ear too. My arm is supposed to be in a sling for another two weeks, meaning I’ve put my most useful arm out of serious action for a total of around 8 weeks! But I can type and make coffee, so it’s not unsurmountable.

Looking back through this post, I’m struck by how much this has been full of experience alongside a series of painful instances. Before a few weeks ago, I had never broken a bone—so took up an introductory offer and went for 2. I had never had surgery of any sort, and have learned not to be too nervous of general anaesthesia. I also learned not to stand up after surgery too soon. I am hoping that as I get back up to speed with work and life that I don’t become depressed, though the fatigue is beginning to become annoying.

8 Thoughts

  1. A Question from Formspring about this piece, and my response: wear a helmet, it makes sense.

    “I read your blog about your bike injury. I hope you make a full recovery. I was wondering were you wearing a bicycle helmet at the time? I cycle regularly without a helmet. Given the extent of your injuries I am now considering wearing one.”

    Hi,

    No, I was not wearing a helmet, and I would strongly recommend wearing one. This was the first time I didn’t wear protective head gear, and thanks to cracking my skull, I cannot remember why. I assume it was a simple slip of the mind—I always wear a helmet.

    I was excited about the arrival of my new bike. It’d taken me months to choose which make and model of bike I wanted, and ended up investing in something I’m happy with. When it arrived, fully assembled and ready to ride in a huge brown box, I left it three days, while I found a helmet. It was torture, but I had to wait till I went into work and find one before I let myself ride the new wheels. So I have no idea why I decided to head out without wearing it.

    Also, given the skull-bashing, I think a helmut would have meant I would remember what happened, and would have been able to walk to my front door, and ask my wife to drive me to hospital, and get my shoulder looked at. It seems very unlikely I’d have damaged my head, lost memory, and been off work for 5 weeks if I’d worn a helmet. I would probably have broken my collar bone, but would have recovered quicker and been able to tell the story from memory, instead of patching it together from the state of my bike, the splattering of impressive amounts of blood on my road, and the rather unpleasant half-paralysed face to work out what happened.

    I’ll gladly send you a helmet from Amazon if that’d convince you to wear one.

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  2. I hadn’t realised what had actually happened, and it’s a pretty shocking read. I’m glad you’re on the mend, but just sorry it’ll take so damned long. You’ll no doubt be the poster boy for cycle helmets now?

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    1. Not sure I’d make a particularly attractive poster, but maybe the half-working face would have helped 😉 I’ve always thought wearing a helmet is a good idea, but hadn’t realised how important they really are.

      Thanks for the message, too. I’m glad to be back online and actually involved again.

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  3. Sorry but it’s quite an unscientific conclusion you come to mate.

    “More generally, concerns have been expressed that helmets may increase the risk of the most serious types of head injury typical of road crashes and which involve rotational forces [9].” – Just one of the more surprising lines from the following website:

    http://www.cyclehelmets.org/1013.html – this particular page is a summary of several academic studies, please read!
    I know it’s a real game of chances, Zach but the evidence does not stack up in favour of helmets; quite the opposite.

    weighing up risks and statistics, it would be clear that the ones who should be wearing helmets are in fact car drivers.

    I do not think that this is a simple health and safety overreaction, but I do think that a wave of assumption has swept the country from the 1980’s that helmets save lives, an intuitive conclusion, which is not supported by statistics.

    Aside from the countries introducing mandatory wearing of cycle helmets seeing a large drop in cycling, the health and safety case alone is flawed.

    I am just very glad that you are recovering well, but I will not be donning a helmet.

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    1. I can see that there are confusing ways of testing the trends, but there are plenty of stats showing effectiveness of helmets in a population. However, the risk and benefit that needs to be compared is in the individual—to make a decision to wear or not—not on the population. It is very different to say that increasing the use of helmet use in a population doesn’t necessarily reduce accidents or damage, than to say it’s not effective for an individual to wear a helmet or not.

      That site seems to make a basic mistake of discussing the effect of legislation, which is a very different set of variables again. The circumstances they’re discussing are in the interaction between numbers of cyclists on the road (more is safer, apparently) due to helmet laws, not on the effects of damage to wearers or not. If you reduce the number of cyclists (which is an unintended effect of the legislation) you see more accidents. (Via Wikipedia source: http://injuryprevention.bmj.com/cgi/content/abstract/9/3/205). This means that it is more debatable about legislation than about wearing a helmet at all. I personally feel that if someone refuses to ride because of a compulsory helmet legislation, that person is wasting the option to ride! (Unless it is a decision based on religious garments, in which case it’s a harder decision for them).

      On top of that, the most important study centre in the world, the Cochrane Collaboration published a very straightforward paper: http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD001855/frame.html. I am a firm truster in the Cochrane method and the organisation.

      So, on balance, I wouldn’t insist someone wears a helmet, but would encourage it. If they’re less likely to cycle with one, I’d suggest they’re missing out on a wonderful ride. Through the Cochrane publication and my own skull fracture thanks to not wearing a helmet (I cannot believe that I’d be worse off or the same if I had worn one) I’ll continue to wear one, as soon as I can get back on the bike.

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    2. I would also add a few additional studies: http://www.bma.org.uk/healthpromotionethics/transport/promotingsafecycling.jsp?page=5, http://www.rospa.com/roadsafety/info/cycle_helmets.pdf,

      Just because there’s a discussion among the community about how good all the studies are doesn’t mean that it’s better not to wear a helmet than not to. It seems mostly overwhelmingly a good personal decision to wear a helmet. Other factors, such as a helmet not preventing accidents (of course it doesn’t), don’t reduce the effectiveness of it in the case of an accident happening. So the conclusion to not wear a helmet, based on studies sounds hard to justify to me.

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  4. You wrote “Each time I asked, I watched as they read my chart and assured me it wasn’t, that I just had a concussion and nothing broken.“Keep it moving, so it doesn’t become stiff.”I cannot remember a single doctor or nurse looking at my shoulder, just my notes.I sadly learned not to trust the advice that comes first if it seems wrong.” 
    I hope no one skims by that section. I have been an RN for over 10 years and I am always looking for more examples of “good care vs bad care” to share with the new nurses I precept, so I hope you won’t mind if I use this.  You are correct and I encourage all people to remind their providers to look again if the chart doesn’t match the patient’s story.

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    1. Hi Jfrodsla, sorry not to reply after nearly a year. I seem to have had some issues with my commenting system. Thank you so much for your comment, and I wish you all the best in a very difficult field.

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