How to protect against disaster

The last few weeks have been trying. My leg did not break simply, but dramatically. Both my tibia and fibula snapped in two, and above the breaks, the bones shattered into fragments. I was admitted to the hospital from the emergency room and went into surgery the next morning, where surgeons drilled into the unbroken ends of the bones and my femur to attach an external fixator. Because I was unable to move my leg with the weight of the fixator, I stayed in the hospital until the swelling went down enough that it could be replaced with internal fixation in a second surgery, specifically, a metal plate along the side of my tibia holding the bone fragments in place with a dozen screws. For much of this time I was given doses of narcotics so strong that I could barely string words into sentences. They did not really control the pain. This level of injury is apparently not unusual for people who get hit by cars, whether they are on foot, on a bike, or in another car.

When I was released from the hospital I was told that I could get full function in my leg back if I followed instructions. The most important one is no weight bearing for 12 weeks, with extensive home physical therapy. I initially had hopes that I would be able to work from home. But between the narcotics, which induce narcolepsy every time I try to read anything more detailed than my discharge instructions, and 6+ hours of physical therapy each day, this hasn’t happened and isn’t likely to happen for some time. I was told to stay at home except for medical appointments because the fracture is so fragile still that even being bumped on the sidewalk would be a significant risk. I’ve gone to the grocery store twice after my appointments—I was out anyway, and grocery stores have cool electric carts to ride that keep me off the leg—and passed out after each trip. I can’t work, I can’t take the kids to school, I have difficulty moving around the house, I’m constantly sleepy, and for at least four hours each day I’m stuck in a continuous passive motion machine, lying flat on my back. It’s been 3 weeks and I have 9 to go.

As frustrating as this is, it’s not a complete disaster. That’s because I have good insurance.

I work for a medical center and had a choice of several health insurance plans. Because I work in a medical center, I know how much a serious condition can ring up in expenses. I only considered the two plans that had no lifetime coverage limit. As a result, no matter how much my care costs, the insurance company will not cut me off. And I’m sure it will cost a lot. We haven’t seen many bills yet, but just the ambulance ride to the ER that I took with my son cost $5000. Add two surgeries, two weeks in the hospital, several weeks of home physical therapy, all the assistive technology, and an expected 18 months of follow-up and the numbers become staggering. There will be a financial reckoning for us at the end of this, of course, but there’s no point at which everything becomes solely my personal responsibility.

Because I am a professor, I also had the chance to buy affordable disability insurance. It’s cheap because it takes a lot to get professors to stop working. I like my job and it makes me crazy that I can’t do it. I will get back to work as soon as I’m allowed to drag myself into the office. Disability insurance doesn’t cover my whole salary, but it will ensure that twelve weeks off the job don’t topple us into bankruptcy. Being disabled is expensive. Matt has had to take time off work, we have had to line up sitters to take the kids to and from school, and there has been a lot of takeout. There was a co-pay for our son’s ER visit, I’m taking a dozen new medications, and Matt has had to arrange extra car rentals and rides that ferry me to various medical appointments. It adds up. I never thought I’d need disability insurance. Now I know better.

In a perfect world, the drivers who cause messes like these would be responsible for all of the associated costs. Unfortunately, not everyone is hit in front of dozens of witnesses as I was. Many drivers hit and run. Even drivers who don’t can be laughably underinsured. Most states require low levels of liability insurance, maybe enough to cover the cost of an ambulance ride to the hospital. And the kind of irresponsible driver who rams into a pedestrian or cyclist is probably not the kind of person who chooses anything more than minimum coverage required by law.

So I am very lucky: this situation is awful, but whatever happens with the driver’s insurance, I have coverage for my medical costs and part of my income is replaced when I can’t work. Not everyone is so fortunate. While everyone should have access to affordable health insurance, not everyone does. And disability insurance is even harder to come by: self-employed people often find they can’t buy it for any price. People who have the option to buy either or both kinds of policies would be crazy not to, especially if they have dependents. But what about people who can’t?

There is another way to get insurance for these kinds of worst-case scenarios, although it is more complicated. If you are hit by an uninsured or underinsured driver and have auto insurance of your own, any costs incurred for treatment can be covered through your uninsured motorist coverage, even if you were on foot or on a bike. Even people who don’t own a car can buy a named non-owner auto insurance policy—these policies are cheap, and also cover car rentals. For further insurance, especially for the self-employed who can’t buy disability coverage, an umbrella liability insurance policy will provide up to a million dollars that can be used for expenses that go beyond what any auto insurance policy will pay. These policies pay out after the fact, and that can take a while. But they will protect against bankruptcy and keep your kids off the street. And like named non-owner auto insurance policies, umbrella liability coverage is typically inexpensive.

I didn’t know much about any of this until I got injured. I never thought it would matter: I’m healthy and active and rarely sick. Why would I need disability insurance? I was lucky that my employer more or less defaults everyone into decent coverage. In hindsight, knowing what I know now, I realize that I could have made better choices.

I am bitter about losing time off work and the vacation time I had planned to spend with my children this summer. I am frustrated that I am stuck at home in bed every day and useless, and that there are many more weeks of this to come. I am angry when I’m in pain, which is a lot of the time, and that I haven’t even been able to take a shower for a month. I am depressed that while I can expect full range of motion to return in my right leg, I will probably never get my full strength back—I may not be able to ride an unassisted bike again. But I’m not afraid that we’ll go broke. And because of that, I can usually remind myself that this is temporary, and things will get better eventually. Despite my ignorance, it turns out that we were prepared for disaster. And we’re all still alive. It could have been much worse.

9 Comments

Filed under injury

9 responses to “How to protect against disaster

  1. So glad to see a new post. Sorry the recovery has been so prolonged. You’ve written one of the best summaries I’ve seen of the insurance issues faced by those who have been hurt.

  2. Here I am asking you unimportant questions about a Brompton / IT Chair (on a separate post), and I had not read your latest entires and heard about your injuries. I am very sorry to hear/read about this, and wish you a speedy, full recovery. I am heartened by your positiveness, and that you’re still giving to your readers by continuing to write.

  3. Thank you for stringing words into sentences again. It must be hard not to get lost in the incredible personal challenges you are facing – yet you’ve jujitsued your own experience into thoughtful and useful information for the rest of us, in classic Hum of the City style! It’s terribly sobering to hear that you may not bike unassisted again. A friend who crashed his bike and smashed up his leg six weeks before you were hit has now graduated from crutches to an adult tricycle and is starting to build up his atrophied legs. He will certainly be done with the trike in 9 weeks or whenever you want to start making revolutions with your legs again…I’m going to check and see if he has plans for its future because I suspect he’d be happy to lend it to someone like you.

    Oh, and think how fantastic that first shower is going to feel!

  4. We’ve been figuring out what sort of insurance we want while we’re carfree. This is good information. I hope you do get to ride an unassisted bike again. We’ll be rooting for you!

  5. Dorie, I was referred to your blog by Shannon Dodge. So sorry to hear about your mishap. I’m in a somewhat similar situation. I was riding down Mt Tam on a really wet day and slid out going around a corner. Ended up breaking my femur in a really bad way. Surgery, week in the hospital, and no weight on my leg for supposedly six weeks. Unfortunately due to inadequate healing that has now been extended to at least 10 weeks. But it is getting better. It is just going to take a long, long time.

    I certainly was lucky to have insurance, especially since there was no driver at fault. I’m sure the medical bills will be astronomical and I’m on disability for probably 12 weeks. Plus I got pushed out of my job of 13 years, just 2 weeks after the crash, by phone, while completely drugged up on “pain killers”. And yes, that is shockingly deplorable behavior by the parent company that I worked for.

    So shit happens, sometimes in a really big way. Insurance is absolutely key for surviving these kinds of situations. So is having good support from friends and family. Reach out as much as possible. People really will help with lunches and dinners, errands, etc.

    And as Shannon mentioned, I did indeed get a tricycle. See http://www.amazon.com/Schwinn-Meridian-Adult-26-Inch-3-Wheel/dp/B000IORU06/ref=sr_1_cc_2?s=aps&ie=UTF8&qid=1369182445&sr=1-2-catcorr&keywords=Scwinn+meridian . Since it uses regular sized wheel it would be pretty easy to add an electric assist. It is heavy and only has one speed but I can pedal it by only exerting my good leg. The other leg is basically just spinning around as physical therapy. I’m really glad I have it since it allows me to get around flat places like the Panhandle and the east end of Golden Gate Park. It is great to get outside and get some exercise.

    Let me know if you want to try it out sometime. Once your physical therapy includes riding a stationary bicycle then you can most likely ride the tricycle. My email is msmithtransit at gmail.com .

    Best of luck in your rather long and arduous recovery.

    • Thanks for writing, Michael. I am so sorry to hear about your job; that is terrible news. I realize that I’m really fortunate in many ways, and (so far, knock on wood) that’s another one.

      I’m not yet able to leave the house, really, because my fracture is fragile (I go out about once a week for medical appointments and that’s pretty much it), but when I am allowed out again I would love to try it out. I’m not yet at the point where I can ride a stationary bike (no weight bearing means foot doesn’t touch anything but air for now) but I hope it will be soon.

      I hope that your healing improves and you get back on track. I can’t imagine how depressing it would be to hear that the wait to use my leg was extended. I hope I don’t have to–I have an X-ray in two weeks where I’ll get the news about how it’s healing, and I have been assuming that the news will be good because it is so awful to imagine it being bad news.

      It’s sort of reassuring to know that I’m not the only one in this position, though, as much as I wouldn’t wish it on anyone. Good luck to you.

      • Michael Smith

        Doris,

        Good to hear from you. Once you are riding a stationary bike as part of your physical therapy I definitely recommend trying out the trike. I’m so glad I have it because I find using crutches really difficult and unpleasant. But riding the trike in the Panhandle and Golden Gate Park has been a great way to enjoy being outdoors. Perhaps you doing it on a Sunday during the road closure in Golden Gate Park would be the ideal place to try it out. In fact, today my wife and I along with a bunch of friends, including bike riding kids, had a picnic by the Conservatory of Flowers as part of my trike riding activities. Let me know when you are ready.

        Another big thing for me is that as of a couple of days ago I’m completely off of the narcotic pain killers. It took a while to reduce my usage and I still can hurt a lot but I’m so glad to be off of them. I feel like my IQ increased by about 20 points and am more engaged with other people. Something for you to look forward to if you are still taking them.

        And have you heard of forearm crutches? A good friend broke his leg bicycling a couple of years ago and switched to them and is now the forearm crutch evangelist. So I tried them too. Way easier to use. You can see them at http://www.amazon.com/Medline-Aluminum-Forearm-Crutches-Adult/dp/B00083DFOW/ref=sr_1_2? . And there is a fun video of why they can be better at http://m.youtube.com/watch?v=Zkm6zmY8X8g . And even a video on how to carry things with them at http://m.youtube.com/watch?v=4TEfM5Y8S5M .

        Mike

  6. Wow. Bless your heart. So glad to hear you are on the mend. So sorry to hear what a trial it has been and will continue to be.
    Great tips and information with regard to the insurance. I am self employed and my husband is, too. We currently have decent health coverage but no disability, which is a constant source of worry for me.
    Best of luck to you for a speedy recovery.

  7. Matt Biggar

    Hi Dorie,
    Thanks for writing again and letting us know how you are doing, as well as all the wisdom about insurance. What a challenging time for you. Your perspective on your situation is admirable and I’m sure, with your determination, you will recover well. Hopefully, the days will start to get less painful and better soon. Sending you good thoughts for your recovery and improved health.

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