Under Better Circumstances - Dec 19

We had a wonderful visit with Blase last weekend! Blase and his climbing partner were the first ones who arrived on the scene of my accident after my cousin Jason called for help. Blase also wrote a moving message and account of the rescue (in this blog - "Blase's Message - Sep 2"). It was great to connect with Blase under better circumstances!

Melissa and I had a chance to hear about Blase's work studying Montana's glaciers, his play on rock and snow in the West and stories about important people in his life. Blase and I circumambulated the great Peter's Hill - a towering monolith standing at least 200 feet high and providing a commanding view of downtown Boston. We ate scrumptious thin crust pizza at the local eatery and gabbed into the late evening.

Besides getting to make Blase's acquaintance for the second time, it was instructive and healing to reflect on the accident and rescue and to create a composite picture of what took place. Hearing his perspective helped me to understand how others reacted to the accident. I felt moved to hear that a whole crew of Park Service firefighters had scrambled up - ready to help but possessed of no technical rescue know-how. I stood in others' shoes when Blase depicted the team of 17 rescuers, drenched in sweat and out of water, straining to carry me safely and quickly.

It didn't hurt to hear Blase's perspective on my leg, either. As he noted, it sure looks a lot better than the last time he saw it. Though the rescuers worked diligently, the prospects for my foot had seemed somewhat dim with an eight-hour carry. He was pleased to see that I kept the foot, let alone that I am able to get around smoothly with crutches. The skin on my heal has been out of the woods for a couple of months, and my range of motion and strength returns slowly but surely.

This last point brings me to the aftermath of getting unscrewed. Curiously, the screw removal has left me with an interesting bit of pain at the fracture site that occurs intermittently with weight bearing. With any luck, this pain means that the bones have a little more play which should stimulate bone growth. I also have more flexibility in my ankle - still very limited. This increase in flexibility means that I can try to work my muscles back to life. I am amazingly weak - my right thigh can hardly handle a single-leg squat of even 6 inches! However, through some weight lifting and the contortions concocted by my physical therapist, I hope that this will improve quickly. I am cleared to swim as well, since the stitches were removed today.

Here is the news on the bone front. The orthopedist didn't schedule another visit until April! He said that we wouldn't see much bone growth before that, but we ought to see signs four months out from taking the screws out. He also said that the more important sign is how I progress. If I am able to return to more normal activity and don't feel any pain with weight-bearing, twisting or higher impact movements, that would be a better sign of recovery than an inconclusive x-ray in April.

All this is to say that I am well within a "normal" timeframe and that full recovery is going to take a long time. I continue to be patient and to have a fantastic attitude (except when I don't). In order to stay on the bright side, my latest response to "how are you?" is that I'm doing great considering that my leg almost got hacked off last summer. For the moment, my mantra is "grateful for my life, grateful for this trial."

Unscrewed! Dec 8

Yesterday, I had surgery to remove several screws in my leg. The three locking screws (the blue ones in the picture) were connecting my tibia to the rod. In theory, by removing them, it will "dynamize" the rod - meaning that there will be a little more play in the bone ends. Hopefully, this will stimulate bone growth. The other two screws were holding my tibia and fibula together. They actually had broken, so only the short heads of the screws came out. (We had been told that this might happen). Those screws had been put in place to stabilize my ankle. With them out, we are hoping that I will get more range of motion.

The orthopedist performed the surgery using general anesthesia. Back in August and early September, when I had a surgery nearly every other day, it seemed like no big deal to "go under." I was totally dependent on the medical teams, and it wasn't that hard to surrender my consciousness at times. This time felt harder. I am glad to be "unscrewed," but I wasn't keen on having general anesthesia. I found it unnerving to breathe deeply into the mask and inhale the artificial-smelling gas. Earlier, while sitting in the waiting room, I also thought about the range of caregivers that I had experienced during my stay in the hospital.

Some were excellent - in tune with what I needed. Others brought strange power struggles into the room. One nurse in Colorado helped out when Melissa was at her wit's end trying to negotiate with the company that rented wound vacuums. The nurse spent an hour on the phone convincing the company to deliver a portable version. Frank, the ICU nurse and Rob, the anesthesia PA came to visit me several times after I had left their unit in the CO hospital.

On the other hand, after my flap surgery, one nurse was terribly passive aggressive. My catheter was draining improperly, and I was swelling noticeably. However, she gave a variety of excuses that delayed its removal. The next nurse came on shift and removed it immediately. Another nurse delayed giving me the oral pain medication that I was taking (percocet) for almost an hour after I asked for it. When I complained that I was in significant pain, she entered with a loaded syringe saying, "I'm going to give you a shot of morphine." After I protested, she chided me that the oral medication wouldn't take effect for 20 minutes - exactly why I had requested it earlier!

One nurse finally encapsulated it for me. She said that more important than wound or pain management, her top priority was good patient advocacy. Hospitals are complex places, and patients need to be and to have good advocates. Yesterday, I asked to forego "Versed," a medication that commonly is used to diminish anxiety before surgery. However, a medical practitioner had told me that it is actually a diluted amnesia-inducer. The advice helped me self-advocate to skip that medication.

So now, with this surgery finished, I will spend the weekend in bed (not as glamorous as it sounds). Then, we begin to "mobilize" my ankle - starting at my PT appointment on Monday morning. I hope mightily that getting these screws out will accelerate my return to some sense of normal function and activity. I also hope that this surgery will do the trick - stimulating my bones to grow. There is nothing to do but be patient and diligent with optimism and physical therapy. As Melissa said, "I'm looking forward to this being your last surgery."

L'essentiel est invisible pour les x-rays - Nov 15

On ne voit bien qu'avec le coeur. L'essentiel est invisible pour les yeux. (Only with the heart does one see clearly. The essential is invisible to the eyes) - Antoine de Saint-Exupery, Le Petit Prince

On Halloween, I had some long awaited x-rays. Then, last week, I had the chance to go over the x-rays with my physical therapist. She showed me those x-rays side by side with others from August 10, the day that the rod and screws were placed in my tibia. No difference. The same gaping fracture showed up in the middle of my tibia on each slide.

Needless to say, the rest of my week was pretty hard. I couldn't shake the discouragement. Twelve weeks and no sign of the bone healing. My vision of bearing weight on a slowly growing bone crumbled into an image of walking around on a flimsy piece of metal with bone fragments and screws rattling loose. It's the most disheartened that I've been through this ordeal.

Well, there is nothing to do but continue. Melissa gave me a pep talk. Let this be a motivator rather than a de-motivator; this makes it even more important to have the right attitude and do the things that promote healing. Our friend Margot, who is a healer (and a Physician's Assistant by training) said that x-rays are crap. They disempower by dictating success or failure. Instead, we need to be empowered to promote our own healing. Deborah, with whom I stayed after the hospital, said to just deny the outcome of the x-rays and keep on being optimistic.

I think I'm through the slump. Everyone is right; there is nothing to do but stay optimistic. I'm also trying to take care of all bases. I've increased my calcium supplement; I'm heating the fracture area to bring blood flow; I'm bearing weight and promoting circulation on the bike trainer - and swimming, for the first time last week! We'll also try some massage and acupuncture. I'm ready to keep going.

Black and white x-ray images convey such a sense of authority. They seem to be the last word on how my healing is going. Long after viewing them, my mind's eye still traces the fracture lines. Given the apparent objectivity of x-rays, I found it exceedingly difficult to have faith in my body's own timetable for healing. It has been helpful to be reminded that the most important things - hope, determination, love and support from friends - are invisible to the x-ray.

On receiving help - Nov 1

There are times that I think, "what did I do to deserve this?" when faced with the startling kindness of friends.

We have received so many amazing meals in the last few weeks. Our friends Dawnellen and Kurt cooked a magical chickpea curry and frosted Halloween cupcakes right before our eyes. Hondo and Alycia prepared us a medley of salad, quiche and lasagna. Then, Alycia's sister Greta - whom I have never met - treated us to mushroom and pepper quesadillas and chocolate chip pumpkin bread (which actually evaporates at room temperature). Tracey, my colleague at Girls' LEAP, besides loaning me the first two seasons of "The Office," brought over stuffed peppers - with vegetarian "lamb." Margot loaned her crockpot with some starter veggies for convenient stewing. The list goes on for a long time.

I have been transported to appointments. Many friends have lent their healing touch - through massage and energy work. Even the calls and emails buoy my spirits. When first released, I was taken in by Deborah and Phil for two weeks; now, I spend Monday nights at their house to ease the commute to Girls' LEAP. (Okay, I can't fib - it's really for the sci-fi tv shows on Monday night...who am I?) The help has been so valuable; besides spending a lot more time doing mundane tasks and physical therapy homework, we need to know that the community is there for us.

Our friends Rob and Aviva have helped as much as anyone. It has been hard for me to grasp at times. I assume that we are imposing, being a burden by needing this help. Rob and Aviva came bringing arugula, squash and fruit crisp while I stayed with Deborah and Phil. Rob has taken me to a few medical appointments. Lately, Rob has been escorting me on the 3/4 mile walk from Girls' LEAP to his house on Tuesday afternoons. Aya, their 14 month old daughter, rides in the backpack, then coaches me on walking when we arrive at their apartment.

At several points along the way, Rob and Aviva have thanked me for inviting them into my healing journey. Thanked me! I'm starting to let it soak in, though it's not intuitive for me. Rob and Aviva have plenty to do in raising their daughter in a kind and intentional way. I hardly understand how they are thanking me for adding more responsibilities. Other friends have said that it is great that we have communicated what we needed.

A quote on a recognition wall at Simmons College reminds that the point is not to pay back kindness, but to pass it on.

I am overwhelmed with kindness. It makes me look at the times that I have been self-absorbed or ill-attuned to another's needs. Feeling this kindness from friends makes me want to be there when the next person needs help. It makes me want to pass it on.

The Joy of Movement - Oct 25

My father taught me a lesson in creative movement that I will never forget. When I was about 12 years old, my father's knees troubled him, preventing running from being his primary vehicle for exercise. Undaunted, he created a kind of squatting duck-walk that was every bit as aerobic and worked the quads much more than the patellar tendon. I was mortified. I was entering middle school and my father was so uncool - in public!

In recent years, my knees have troubled me also. Unable to run (or do much else) in the dreary Boston winter, I worked out a cemetery routine. Forest Hills Cemetery, directly behind our street, became the forum for hurdles over bushes, invisible chair squats against the walls and dips using adjacent headstones.

Last weekend, I was feeling pretty down. On Friday, my leg throbbed quite a bit, and I spent most of the day in bed. I woke up Saturday dreading a repeat. Finally, it occurred to me that I could be creative with movement. I turned on some jam music - live Poi Dog Pondering - then tossed about on my bed for two hours. I kicked my feet over the bed, created a rowing maching out of an elastic band and did lying down squats on the wall. The joy of movement. Without being active, I felt like Samson having his hair cut off - lost and powerless.

After this spark, Melissa contributed another one. She brought the bike trainer out and hooked up my road bike. Okay, so I wasn't spinning very fast, and my ankle hurt a bit. But I was moving and alive.

The tendon that held on - Oct 24

It is too easy to get pulled into the mechanical paradigm of bones, tight tendons and swollen tissue. There is another dimension to this healing that is less tangible.

Melissa has been working with me using a healing modality called Somatic Experiencing. It is a body-centered or nervous system-centered approach to dealing with trauma that will complement her training in Social Work (plus it will add more letters after her name). The basic theory is that the body has an incredibly strong drive towards healing, and that the nervous system - or the reptilian brain - knows what to do. In a session, she will direct me to notice what is happening in my body and have me repeat motions very slowly. In one session, I felt like I could sense my left arm trying to push the boulder away, my gaze starting to turn to the left. My reptilian brain, such as it is, had initiated a response to the slipping boulder. That response never had a chance to complete. By getting into the experience, then "renegotiating" the trauma and recognizing that I am safe in the present, it gives my nervous system a chance to leave the event behind. A quasi-spiritual exorcism of the trauma.

A couple of nights ago, I awoke with my leg throbbing. I had tried to wean myself off my evening dose of Oxycontin. I flopped and thrashed until Melissa woke up. A line of tightness began at the outside of the bony part of my heel. It extended upwards through the outer muscle in my calf to a painful point on the outer tendon behind my knee. From there, it continued up the outer edge of my hamstring to envelope my right sit bone in a deep ache. Melissa rubbed it for a long while, then laid down to sleep. I still flopped and thrashed. It was painful, but my angst was more than physical. I rubbed and stretched to no avail. Finally, Melissa asked me to lay flat on my back while she held my heels.

Some floodgate opened, and I started to relive the experience. Melissa holding my heels must have provided enough safety to go there. I can't quite explain what occurred. I didn't exactly remember the sights or motions of my accident. I didn't reexperience the sensations of injury. Instead, I had the *sense* of what had been happening beneath a conscious level during the moments of falling and impact. As soon as Melissa put her hands on my heels, I started wailing and hyperventilating. My hands first went to my left leg, as though taking inventory of remaining resources. Then I felt the pulling in my right leg. The line from my heel to sit bone felt like tight piano strings pulled to the limit of their tensile strength. Without the bone maintaining structure, my tendons held on as though Armageddon were approaching.

I cried and rocked and rubbed my leg. Eventually words came. I found myself telling those tendons, "you did a good job." Then, "what would happen if you let go now?" At the same time, I felt sensation at the point of my fracture. I could almost imagine my tibia waking up, telling the tendons that they could relax, returning to the work of maintaining structure. It was cathartic. After two hours, the sun came up, and my tendons stopped aching.

Was it real? My achilles was a notch softer in the days following, and I am walking with a bit more ease. I don't know whether my tibia actually woke up. Unfortunately, the Orthopedist's x-ray machine was not working this morning, so I don't know whether the fracture is fusing. Revisiting the accident a few nights ago was real enough to expand the dimensions of healing a little bit more. Enough to rock the healing, I suppose. And at the risk of undue personification, I am glad that my tendons had the courage to hold on.

Two steps forward, One step back - Oct 14

Last Wednesday, I went to my second outpatient physical therapy appointment. I like my PT, whose name is Amy. She is exuberant and positive about my progress. She also spends time talking to me as a person, not just as an injured leg. Because the Orthopedist prescribed full weight bearing, she has worked with me on standing and walking.

One immediate priority was to find footwear. My Berkenstocks did a tolerable job of containing my foot. Unfortunately, the straps pressed into my pitting edema. (Pitting edema is the congealed swelling in my foot and ankle. It has turned waxy, and can be moved around under the skin. Herein lies my latest party trick; I can press my finger into my ankle leaving a deep depression much as one might do in soft wax). The sandals also made it hard to practice the normal movements of walking.

On the way up to Maine (to pick up the pooches at Melissa's parents house), we stopped in Freeport at the L.L. Bean mothership store. A very eager and sympathetic saleswoman helped me out. She empathized and told me about her three toe surgeries. She was a thin Southern woman with big, round eyeglass frames. After a myriad of unsuccessful attempts, we found a shoe that fit me and allowed me to practice walking. I am now the proud owner of some size 11, 4E New Balance sneakers. Essentially, I live in a double-wide.

The two steps forward part is this:
I found that I could bear more weight with the shoes. In Maine last weekend, I walked a quarter mile loop around Melissa's house, including a portion along a trail in a field. (A quarter mile isn't that long - think high school track). A few days ago, I walked in and out of MGH to go to my physical therapy appointment. I walked in and out of the mall to deliver my haywire MacBook to the Apple Store. I walked with Melissa and the dogs in Forest Hills Cemetery, an exquisite green space for walking and contemplation. The more I tried to put weight on my foot, the more I felt like I was handling it.

Then one step back:
That evening, my ankle throbbed and throbbed. Melissa tells me that I groaned a lot in my sleep. When I tried to walk on it the next day, I could hardly manage slight weight bearing. I have spent the last few days sitting in bed. Making the journey to the bathroom felt like the limit of my endurance.

The psychological journey was much longer than any of the walks that I took. When I was able to stand and walk on my foot, I felt so hopeful. My mind quickly skipped to the future and extrapolated a quick recovery. The world was bright and sunny.

Then, the pain in my ankle coincided with a few overcast, rainy days in Boston. The outlook of the world seemed grim. I was sure that I had done inexorable damage to my ankle. There was a discrepancy in professional opinion between the orthopedist in Colorado and the one in Massachusetts. The CO doc didn't want me weight bearing until 10 weeks (mid-October); he was concerned that my ankle had been compromised. Please tell me I'm not the only one who jumps to the worst conclusion. Has anyone else had a passing pain in their chest and assumed that a major artery was blocked? Has anyone experienced back pain and assumed slipped disc or worse? Not that those worst case fears overwhelm me; they're just the first messages to flash on the screen.

I am happy to say that my outlook has swung back to the middle. I spoke to both orthopedists (in CO and MA). It turns out that the discrepancy in opinion is not as large as I had interpreted. I have not done damage to my ankle; I simply pushed a little farther than I was ready for (which is what Mark's do best). Today, I have been able to put more weight on my foot again, and the gap between my current function and hiking a mountain is a little less vast.