My week 12/14 – 12/21/2010

Last Tuesday morning I got up and took my bike out for a ride.  I was a bit surprised to see a fluttering of drifted snow on the road, but it really was no obstacle to biking.  The pavements were dry, just the gutters or lawns (very few in Jersey City) had snow.  My goal was to bike to a soccer field near an elevated highway where I run sprints around the field and then to bike home.  Also I wanted to test my new bike clothing, as Barbie had bought me a new reflective bike shell and I brought down a sweatshirt and ski gloves because the lack of a sweatshirt and ordinary leather gloves had left me very cold the week before.  Here is the route I followed: 

Montgomery Street through that section is a nice gradual downhill, so it was an easy ride.  The soccer field is actually in the narrow part of the purple piece next to Grand Street.  But it was all white with the snow, so I decided to continue on my ride and find out how long it would take to bike to work.  The thought was they can force me to sit in their seat at their office, but they cannot force me to do it in a clean, showered condition.  So, I turned left onto Grand Street, and stopped at a light, I think where County Road 621 comes in.  Then on startup I noticed the edge of the right lane (2 travel lanes here both directions) was pretty rough.  Recently poured concrete that was quite uneven.  Two cars had passed me as I was getting the bike up to speed, and I had no idea what other traffic was in my vicinity.  So I decided to turn onto a sidewalk ramp that looked as if it has a smooth transition from the pavement I was biking on.

Stop right here.  I’d like to figure out how to turn on the WayBack machine and change that last evaluation/decision.  In retrospect it would be so easy to just put on the brakes and let any traffic flow by me.  Or just brazen my way out into the travel lane and take the rightful place of a bicyclist.  So easy in retrospect.  Where do I buy a WayBack machine, other than from Mr Peabody on the Bulwinkle Show?

At any rate, reality turned out to be different from that it looked like.  The smooth transition was in fact drifted snow.  Underneath the snow was a 1” – 1 ½ “ curb between the pavement and the ramp going up to the sidewalk ramp.  Whatever my angle of attack was, it was not enough for my wheel to ride over the curb.  Instead the curb swept the wheels out from underneath me.  Faster than a flying bullet.  Since my feet were encased in the cadges that hold your feet to the pedals, I was unable (even if I had been quick enough to react, which I probably would not have been) to brake my fall with my foot.  Instead I went down like a ton of bricks on my right side.  Everything, including my bicycle helmet hit the cement sidewalk, which was sloping up at that location.  Time: somewhere between 6:15 and 6:25 AM.

I lay somewhat dazed on the sidewalk.  Probably for 10-15 seconds.  I remarked to myself that I was still warm, so my new duds were good for biking when it was around 15⁰.  From a prone position I surveyed the accident scene and decided what must have happened.  I knew it was a bad fall, but I didn’t really know what had happened.  I decided I’d get back on the bike and ride gingerly back to the apartment.  But the handlebars had become crooked during the fall, and needed to be straightened.  I got up to do that, largely supporting myself with my left leg, as my right leg was sticking awkwardly out to the right.  But when I tried to put the front wheel between my legs to straighten things out, I had to put some weight on the right leg.  I instantly went down again.  Again, I was mystified, as it did not feel as if I had broken anything.  Maybe I had a muscle pull on the inside of my right leg, but certainly nothing broken.

A very nice young couple saw me go down, probably for the second time.  They stopped and he got out and asked me if I needed help.  I decided I did need help.  He came over and helped me up, and we used the bike as a walker to get me over to his car.  I got into the front seat while he put the bike in the back of their van.  I never got their names, but he works as a surveyor at the World Trade Center construction site, and she was 8 months pregnant with their first child.  I hope I can use those 2 clues to locate them to say thank-you when I return to Jersey City.  I was still under the illusion that I could go back to the apartment and just rest to recover from the fall.  So we drove the 5 minutes back to the apartment.  They struggled to get the bike into the apartment, as there is a trick in getting the key to work in the front door.  But it became clear as I was trying to get my right foot out of the car that I was not going up any stairs with that leg.  So we went back down to the accident area, where Jersey City Medical Center was less than a block + a half away.

There was a certain amount of fumbling as she discovered that you don’t deliver injured people through the front door of the hospital, and how to get from the front door to the emergency room entrance.  There a wheelchair came to get me, and I lost touch with those people without ever getting their names.  Then began a series of long waits interrupted by the thrill of moving from one surface to another as you have to go from a wheelchair to a hospital bed, from a hospital bed to an x-ray table (and back), and to have various parts of clothing removed.  Pretty quickly it was determined that I had broken my hip, and they admitted me to the regular hospital.

When it became clear what the outcome of all this was, I asked for a phone to call Barbie.  Of course, the regular phone did not work for long distance calls.  Eventually the head of nursing for the 6^th floor gave me her blackberry, and I used that to give Barbie the news.  She dropped everything, packed off Colby and headed for Jersey City.  Luckily, she had made the trip the weekend of 12/4 (when she brought down the bike), so the directions were at least familiar.  She made the trip mostly in daylight and missed any horrendous traffic on the NY end.

Meanwhile my ability to zone out, plus my high threshold for pain, held me in good stead.  I don’t really recall much of Tuesday after calling Barbie.  I did get in touch with someone at work to let them know I was not coming in.  That was especially galling as I had an 11AM meeting setup with my supervisor’s boss, who had repeatedly put me off in prior weeks.  I don’t think I ate or drank anything, because it had not been determined when I was going to be operated on, and it might have been that day. 

Meanwhile, Barbie had been in touch with Bridget, our physician daughter-in-law.  She works at Children’s Hospital and Beth Israel Deaconess Medical Center in Boston.  She is in sports medicine, so she knows the people who repair bones well.  Barbie asked Bridget to find out about Jersey City Medical Center and to critique what they planned to do. 

By the time Barbie arrived I had not met any doctor at all.  She shook some trees to get some action on that front.  Around 8 we met with a very nice Physician’s Assistant, who had participated in the evaluation of my case.  He explained what had happened and what they proposed to do.  What happened is that the neck of the femur had broken and the whole bone itself had been displaced and twisted.  If it were a simple break, they would suggest pinning it and relying upon original equipment.  But where it was displaced, the danger is that the blood vessels that maintain life at the head of the femur (the ball that goes into the pelvic socket to form the hip) might have been destroyed and not regenerate.  The statistics are that 50% of the people over 65 have AVN, which stands for a-vascular necrosis, or death of the tissues that form the head.  Given those statistics they proposed a partial hip replacement, which would put metal pieces in place of the top, neck, and head of the femur.  The pelvic socket would still be original equipment, but all else would be new.  The Physician’s Assistant (PA) explained all this quite clearly.  We asked if he could email the x-rays to Bridget for a second opinion.  He couldn’t do that, but he could send them to me.  Brian was able to get onto my email account and forward them on to Bridget.

Bridget forwarded them on to 3 of her orthopedic buddies, who happened to be getting together that night.  Bridget also emphasized that I as a young 66, in pretty good shape, and accustomed to an active lifestyle.  All of which led them to conclude that I should have a procedure that would pin the broken pieces of the top of the femur back together and challenge the regenerative capacity of my body.  This was clearly not what was going to happen in Jersey City.  So Brian contacted the various transportation alternatives to see how to get me from Jersey City to Boston.  Of course for normal stuff (not 911 calls) they were all shut down for the night, so the outcome had to wait until 7AM.  Meanwhile, it came out that the surgeon’s schedule in JC meant that my operation would be on Thursday.  So, the decision was whether to shift venues and to take Bridget’s advice.  I don’t recall exactly what the state of play was on Tuesday night, but it was clear that if we did so, we would be checking out of JCMC “AMA”, which stands for Against Medical Advice.  That doesn’t sound very friendly.

But Bridget’s friend Joe DeAngelis initiated a transfer from BIDMC, and suddenly the flow of information increased.  Instead of “I’ll have to get my supervisor’s approval (who doesn’t come in until tomorrow)” it was “OK, where do I send it?”  The hope was even held out that if I got to Boston early enough, I might be operated on that Wednesday.  So, Barbie went back to the apartment to sleep and to pack up my things.  Unlike me, she does not sleep well when major events are going on, and she never got warm given the lack of an electric blanket in the apartment.  She explained to Khalid, the fellow from whom I rent the room what went on, and he could not have been nicer.  So she packed everything up Wednesday morning, including the bike, putting much of my stuff into garbage bags.  By the time she got to the hospital, Brian had arranged for Ambu Car to furnish transport, so it was just a question of getting discharged and up to Boston.  The Ambu Car people arrived around 9 and we were on the road by 9:30.  There were still pockets of the morning rush hour to avoid, but they knew the tricks, so we made good time.  We went through the Holland Tunnel and up the west side of Manhattan, but we kept moving.  Barbie said the traffic coming the other way was often incredible, but we lucked out.  We made it to Boston by 2PM, which means 4.5 hours, which is as good as you could hope for.

Once it was clear I was not going to be operated on Tuesday, I had gotten some food.  Barbie had even brought some apple pie from an event we have every December 13^th in honor of Meg’s birthday where Karen Martin brings over an apple pie.  But Tuesday I was not taking anything because of the possibility of hitting the operating table.  I was on a pretty effective pain killer, so I was relatively OK.  Except for the fact that I never sleep on my back, and there was no way to get on my side and leave my right leg in a comfortable position.  So periodically my back muscles would cramp up, but generally things were OK.   The guy in the back with me was the son of a Cuban who came over in 1961 in something called Operation Peter Pan.  We had some interesting political conversations, but he did say that most of his family would have been far too right wing to even have a discussion with me.  That and zoning out made the trip go OK.  The roads, especially through the heart of NYC are pretty rough, so there were some times where there were some pretty good bumps.  Thank heaven for narcotics.

We got checked into Beth Israel Deconess Medical Center (BIDMC) pretty quickly.  It did involve another surface shift from the stretcher I rode up on in the ambulance to the hospital bed, but the guys were pretty good at doing it all at one go, so I lay there like a dummy with my hands folded across my chest (so I would not reach out to grab anything) and they pulled the sheet I was lying on across.  Tolerable.  BIDMC had to take their own x-rays, which also involved a surface shift.  All the more tolerable since I was aware they were probably redundant with those that had put me through similar pain in JCMC.  It became clear around supper time that I was not on the operating schedule for that day.  So I got to order BIDMC food.  I should have been famished.  But what the hospital called food was completely inedible.  Brian ended up eating it, and even he said it was lousy.  I did have some soup and some fruit, but I didn’t eat all that much.

The next morning a BIDMC Physician’s Assistant came by to have me sign a form saying they had my permission to do a complete hip replacement or a partial hip replacement.  Not what we came to Boston for.  Bridget was there to make sure things all worked out correctly, so she called in Edward Rodriquez, the head of the Orthopaedics Trauma Team, who was going to perform the surgery.  He explained once again the alternatives, drawing an impressive diagram of what things would look like if they repaired the neck of the femur.  But the question was still about the risk of avn leading to the death of the head of the femur.  K-Rod (the surgeon’s nickname) left us to decide amongst ourselves which procedure to choose.  Bridget called Joe DeAngelis on her cell and put him on speaker.  He reiterated his reasons for suggesting the pin-and-repair option and offered the replacement variants as options down the road if my blood vessels do not regenerate.  That was one tough call.  But everybody was pretty quick to say I was unlikely to stay within the guidelines suggested for people with artificial hips (no running, no contact sports, nothing where you might fall on it, no going up on ladders, no roofs, no bumping into things), so that route had its drawbacks as well.  Finally, around 9:30, the decision was made and communicated to the surgeons.  Then Bridget could go to her office in Chelsea where she had 30 patients waiting for her arrival (normally at 7AM). 

A couple of other more traumatic operations pushed me off until late afternoon.  But finally around 4:30 they took me to pre-op.  There you get to spend more time waiting.  This was just around the time that Andrew was landing at Logan, having flown back from The Hague, where he was installing one of his company’s devices.  Jess had driven down with Tyler in a car seat to visit me in the hospital.  But I was not there, so they and Barbie went to Brian’s place in Jamaica Plain for supper.  Meanwhile the last thing I remember is them wheeling me out of the preop area into 1 of 17 operating rooms.  They must have given me something by the drip on the way, as I don’t even remember arriving at the operating room.

The next thing I was aware of was 2-3 hours later waking up in the post-op room.  Freezing.  They gave me lots of nice warm blankets to clutch to warm up, but it felt like my body temperature was way down there.  Dr K-Rod assured me that I had done well, and eventually I got back to my room.  Brian + Bridget + Barbie were there and one of the operating team brought in the before and after x-rays shown below.  I don’t really remember much of that night, other than the awe at what they had done to me.  I was pretty much a basket case.

Here is the pre-operation x-ray:

The head of the femur is still in the pelvic socket, but it is detatched from the rest of the femur because of a break in the neck.  The actual placement of the neck is not visible because the bone is rotated so the neck is perpendicular to the direction of the x-ray view.  [Effectively my leg was twisted 90⁰ to the right.  But it felt like it was pointing straight ahead.]  But clearly everything is broken and in the wrong place.  As K-Rod said, the cards were dealt at the time of the accident that will determine whether my blood vessels grow back. 

Here is the post-operation x-ray:

The triangle in the middle-upper section of the image is the doctor explaining how putting too much weight on the leg during healing may result in the pins being pushed out of the left of the femur and the leg getting shorter.  In other words, I am not supposed to put ANY weight on that leg for a good long while.

Post operative hospital life is a major pain.  Suffice it to say, I got discharged late Sunday night, and it was a great relief to get home and away from the hospital.  Don’t get me wrong, BIDMC is a great place for what it does.  But it is not a place you choose to linger in.

You’ve heard enough of this rambling.  It is WONDERFUL to be home, and the leg feels 100% better than one week ago.  The only odd thing is that I still am not very interested in eating.  I am taking some soup and bread, but without any gusto whatsoever.  Clearly, I am not my normal self yet. 

Be cautious while riding your bike.  There is a lot of potential energy in your forward momentum and your height off the ground.  Try to find a soft spot when you crash.