Category Archives: injury

Two wheels

It’s been 3.5 months since I, in the words of one friend, “got run-ded over.” For all that people worry about the dangers of commuting I actually got hit while riding around Golden Gate Park on a Sunday afternoon. Go figure. You can never tell.

before

After my second surgery–looking much better with the external fixator removed.

I had no idea what I was in for when we were sent to San Francisco General in April. I thought that at worst I’d get a cast on my leg and go home that evening. Maybe I should have been more aware when we jumped the trauma queue—did you know that they don’t even ask your name when you get admitted through trauma? I was Trauma Romeo and our son was Trauma Sierra. I’m still amazed that I spent two weeks in the hospital—nobody spends two weeks in the hospital anymore. Two surgeries later, two months stuck in bed on the continuous passive motion machine, and many physical therapy visits later, and here I am: back to full weight bearing. Admittedly I have a bad limp. That’s okay. I have a cane; it looks very hard core.

Let's draw the curtain of charity over what I looked like getting on and off the bike.

Let’s draw the curtain of charity over what I looked like getting on and off the bike.

Last Friday I got tired of waiting around. We had test rides to do over the weekend (more on that later), and that meant it was time to get back on the bike. My range of motion is not all that it could be, so for now I’m on the Brompton, because it has a nice low step-over.

My right leg is pretty atrophied, and that makes starting from a full stop very hard. But to my surprise I can still make it up a moderate hill unassisted on the Brompton. I’m still kind of nervous on the streets, and the less said about left turns, the better. But I’m back on the bike.

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Filed under Brompton, injury

Two feet

I still can't ride a bike, but I see them all the time: BionX Mundo!

I still can’t ride a bike, but I see them all the time: BionX Mundo!

I was getting a little frustrated the other week. The stress of waiting for the x-rays scheduled for this week was starting to get to me. If they looked good, I’d have to wait one more week before I started partial weight bearing again (July 23rd!) If they didn’t, I’d have to wait seven weeks or more (I preferred not to know!) That kind of uncertainty can really eat away at a person’s composure.

Gas powered scooter: I can't ride this either, and I don't want to.

Gas powered scooter: I can’t ride this either, and I don’t want to.

I asked many times whether there was anything I could do to improve my odds. The answer was basically no. Sure, both smoking and taking NSAIDs reduce bone growth—now you know–but I am tobacco-free and I have plenty of narcotics for pain. My physical therapists were pretty straight-up about the fact that no amount of their suggested exercises would help. Those exercises were to improve my range of motion, and I was doing them so diligently that I got kicked out of physical therapy until I could bear weight again. I have always been the kind of person who does the homework. But bone regrowth, unfortunately, is not the kind of thing that rewards diligence.

On Tuesday, after a sleepless night, I went to the x-rays and my appointment with my surgeon. The x-rays took a long time. The plate in my leg is so large that the technicians couldn’t capture it in one shot, so they ended up taking twice as many x-rays as they had planned. For that kind of thing you get two lead aprons. Lead aprons are heavy.

Happily my surgeon is not the kind of guy to burlesque. He dashed in, checked my range of motion and said I could start partial weight bearing (25%) that very day. One week early! Yes!

It's okay to walk slowly. We get distracted.

It’s okay to walk slowly. We get distracted.

Learning to walk again after three months without my foot touching the ground is harder than I had hoped. After spending Tuesday afternoon limping around I was so tired I spent all of Wednesday passed out in bed. I was warned that my foot would be sensitive, and that was an understatement. At first, putting weight on my right foot felt like walking on shards of glass. I don’t really care. I can now move around at the pace of a distracted toddler, which is perfect, because I have kids. Yesterday I walked across the room carrying a glass of water for the first time in months. I can even go a few steps holding onto a wall. Sure, this is all totally pathetic, but I’m not proud. Next week I can go up to 50% weight bearing. And so on.

I CAN ride the bus by myself now. I'm a big girl!

I CAN ride the bus by myself now. I’m a big girl!

Unfortunately, I still can’t ride a bike. I was told this was a balance issue and I have to be fully-weight bearing.  But a stationary bike is supposedly fine, which whatever, how is a stationary bike going to get me anywhere? So mid-August it is. In the meantime, though, this walking thing? It’s really great.

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Filed under injury, San Francisco

With or without me

My kids are evidently getting to be really fast on those scooters.

My kids are evidently getting to be really fast on those scooters.

I have been incapacitated for 12 weeks now, and it is really starting to chafe. Even though I can go into the office now (thanks to my new compression stocking) and that is fun, I find that I am irritable. I can only maintain a good attitude for so long. And when people tell me things like, “You should just be grateful that you’re alive! And that your son is okay!” I kind of want to punch them in the face. Yeah, sure, it could have been worse, but that doesn’t mean I’m happy that my entire summer was ruined and I can’t go out with my kids and that after three months I still have weeks to go before I can try walking again. Maybe I shouldn’t have weaned myself off all of those narcotics.

Going ice skating? Wear cashmere!

Going ice skating? Wear cashmere!

Then again: I have forgotten the entire month of May. Seriously, my son was asking me questions about some things that happened then, things in which evidently I had some involvement, and I had no memory of them whatsoever. I do remember that in June I bought my daughter an entire new wardrobe on eBay after my mom mentioned that a four-year-old probably shouldn’t be showing so much VPL or sporting crop tops. Normally I would go to the local consignment store and pick up stuff in her new size, but I couldn’t leave the house. Luckily for me, there are scads of amazing deals on eBay for people who have nothing but time. She’ll be spending the next year or so in secondhand cashmere. Nonetheless, thank goodness our son goes to a uniform school.

These are the appropriate costumes for 1-legged airplane rides on your parents' bed.

These are the appropriate costumes for 1-legged airplane rides on your parents’ bed.

There are things that I can do, although they are limited. Given that I can only use my left leg, and that university housing still hasn’t gotten around to putting grab bars in the bathroom despite our requests, I can do pistol squats on that leg until I fall asleep from boredom. That means, as I learned recently, that I can give my kids one-legged airplane rides in bed. That’s fun. And we can watch movies, when they’re into that. I can read them bedtime stories.  I can give them rides on the cool electric cart that I use at the grocery store (although the competition for those carts has been fierce lately). That’s about it.

The Bullitt+Roland heading out to Great Highway's Sunday Streets last weekend. They saw lots of friends.

The Bullitt+Roland heading out to Great Highway’s Sunday Streets last weekend. They saw lots of friends.

Matt takes them out to do all the fun things I wish I could do. They’ve been swimming at city pools and ice skating and last weekend, they went to Sunday Streets on the Bullitt with the Roland add+bike attached. Poor Matt is getting worn down by the constant attention the Bullitt draws, and sticking the Roland on the back only adds to the effect. That will be our commute vehicle next year, so with any luck it will get a little more familiar to people on our usual route.

We won't miss her old preschool, although we'll miss her old friends (nearly all of whom are leaving as well).

We won’t miss her old preschool, although we’ll miss her old friends (nearly all of whom are leaving as well).

Some good things have happened, although I get the news secondhand. Our daughter has finally started at her new preschool. After the for-profit takeover of her old preschool I would have been happy with anywhere that let her go to the bathroom when she needed to and anyplace where her teachers didn’t tell her than she was “wasting mommy and daddy’s money” when she didn’t listen and she wasn’t told to “turn and face the wall” any time that she talked to another kid in line. But her new preschool is apparently awesome even by standards much higher than our radically downsized ones. She looks forward to going and she’s surrounded by her future Rosa Parks classmates—it’s a Japanese immersion preschool and a feeder for the school.

On the other hand, if the San Francisco summer continues along these lines, skirts and shorts are a non-issue.

On the other hand, if the San Francisco summer continues along these lines, skirts and shorts are a non-issue.

I am also grateful for my colleagues, who make me happy every time I’m in the office that I work in academic medicine. I have scars on my right leg that look like a giant red zipper running from the ankle to above the knee, and they can’t stop telling me how great they look. Sure, they’re saying that because they’ve seen so much worse, but I don’t mind. One person told me it looked like a shaving accident. This is so far from the truth that when I reported it to Matt, he laughed so hard that he almost stopped breathing. But the person who said it was speaking the truth as he saw it, and that makes me feel okay about wearing skirts to work again one of these days.

The kids collected jellyfish at Ocean Beach over the weekend. I couldn't go.

The kids collected jellyfish at Ocean Beach over the weekend. I couldn’t go.

I have x-rays next week and if they look good I will get permission to start putting weight on my leg the week afterward. And according to my surgeon, who is also a bike commuter, if I can walk, I can ride. Sure, there’s the minor matter of what bike—I suspect I won’t have the strength to get the Brompton up our hill for a while, I know I don’t have the range of motion to get on the Kona because the top tube is so high and the stoker bars mean I can’t swing my leg around the back, and Matt sometimes needs the Bullitt so I can’t ride it every day. Maybe I could put an assist on the Brompton?

Thanks for the electric carts and the cargo bike parking, Rainbow.

Thanks for the electric carts and the cargo bike parking, Rainbow.

And one more piece of good news: just before I was hit, I wrote to Rainbow Grocery after a difficult Bullitt parking experience asking them if they’d reserve the end spots on their racks for cargo bikes and bikes with trailers. A friend of mine sent me a picture of the racks just the other day, and the new sign on them that gently requests that the big spaces be saved for big bikes. So life goes on, with or without me.

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Filed under advocacy, Bullitt, family biking, injury, San Francisco, trailer-bike

Coming back to life

Shortly before I was hit, we marched in the Cherry Blossom Parade with our son's school.

Shortly before I was hit, we marched in the Cherry Blossom Parade with our son’s school.

This week, for the first time in two months, I headed back to the office. There’s a lot that I still can’t do, and among those things is going out two days in a row. Nonetheless, it is great to be out of the house and moving around.

The good news is that I am now more than halfway through the non-weight bearing weeks (assuming my x-rays continue to show bone regrowth). As soon I as can walk again in late July, my surgeon says I can ride a bike again as well.

I’ve now met a few people who’ve had similar injuries. I am really happy that all of them are walking again, and none with visible limps. There are evidently long term consequences: I will never be able to wear high heels again (whatever), I’m unlikely to get my full strength back (still hoping that this one is wrong), and I’ll get early-onset arthritis (which I’ll deal with when the time comes). It could have been worse.

Interestingly enough, I am the only person anyone knows of who’s been hurt this way on a bicycle. A couple of people got similar injuries on motorcycles, but the vast majority had their legs shattered while riding in cars. They have asked me whether I’m afraid to ride a bicycle again, because they themselves were afraid to get in their cars. This is a hard question to answer.

The photos of my leg are too gruesome to post, but my son had scrapes like these all over his right side.

The photos of my leg are too gruesome to post, but my son had scrapes like these all over the right side of his body.

I was rear ended by a driver who claims he did not see me or the stop sign a few feet in front of us–I was coming to a stop, while he’d evidently planned to whiz right through the intersection at 15 mph. This is pretty bad, and although it probably would have been less bad if we were in a car, part of the reason he was going only 15mph is because it was on a street with lots of pedestrians (one of whom was a sheriff’s deputy in the crosswalk) and a protected bike lane. I had only gotten out of that protected lane to make a left turn at the stop sign. If we were hurt in a car, statistically speaking, it would likely have been on a different kind of street at a much higher speed. The NHTSA estimates that the average American driver has a 30% chance of being in a serious car accident in their lifetimes. Those are terrible odds.

That said I suspect that I’ll be making Copenhagen left turns exclusively for a long time to come. The way that I was hurt was the least likely car-on-bike collision on the books, but the thought of stopping at an intersection in front of cars now makes me edgy.

A commuter bike with two Bobike seats, just like Family Ride! I'm still jealous.

A commuter bike with two Bobike seats, just like Family Ride! I’m still jealous.

I still would like to be back on a bike though. Most of my rare trips out now involve riding in a car or a bus (my right leg is the hurt one, so I can’t drive myself) and they’re fine, but it’s seeing other people riding bicycles that makes me wistful. Heck, I’d like to walk again. It has been so long that I wonder whether I will have forgotten how.

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Filed under car-free, injury, San Francisco

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.

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Filed under injury