October 26th, 2008 3:16 AM / Location: 37.848696,-121.9269
*A note for those sensitive to blood, gore and vulgarity: This praxis is graphic. I also swear quite a bit. And you'll need to put some time in to read this. If you want to take it paragraph at a time, that's cool with me. If you feel that the following deserves a 'tl;dr' tag: I fell and got hurt real bad, but I'm doing o.k. now.*
(*Ash's post-me commentary is denoted by parentheses and asterisks, like this*)
This praxis will be updated over time, as my healing process is not finished. Also, compiling pictures over four and three-quarter months (so far) is a work in progress so they're not all here. Yet.
So I was waiting for a fair amount of time with this task tucked firmly in my pocket for something awful to happen. While I'm a fan of going big on tasks and not backing down, I had no idea that the magnitude of the injury I would sustain to achieve this particular one would nearly kill me. No, seriously. Read that again. The doctors say that by all reasonable estimates, I should be dead. Were it not for the exact way that I landed, I probably wouldn't be here writing this right now. The accident also caused a huge hiatus for me in terms of SF0. Well, the whole of my existence really. I'm only now starting to return to things like school and extracurricular stuff. If you've ever done anything close to what I'm about to tell you (and you're still breathing) then you know how I feel. This changed my life. This is also the first time I've written down the entire account. Ready? I hope I am.
I was out hiking and getting ready to do some rock climbing on Mt. Diablo with one of my best friends, Ash, on a June afternoon. We had already accomplished some great outdoor shenanigans that day, and all was going well. We found a cool ropeswing, did some baby rock climbing stuff, and just explored to our hearts' content. We were gearing up for some bigger rock climbing stuff, but being poor bastards, we didn't have any of the proper harness/rope/belaying tools for 'safe' climbing.
Now, before you call out 'idiot!' and decide that I totally deserve what happened to me, hear this: This was nothing new for us. We were by no means pro rock jocks, but free climbing stuff on Mt. Diablo was something Ash and I had done many many times before, and without incident. I had chalk and my shoes, and that was cool with me.
We were in an area called Boy Scout Rocks, just south of Rock City. The area has a few bolted routes, mostly toprope stuff, and a fair amount of bouldering problems. The geology of the place is pretty much all sandstone. As we approached the wall we had spied earlier, Ash and I slung off our packs and set them on the ground. The wall was big: 70 feet to the top at least. Not a 'big' wall in terms of big-wall climbing, but for two weekend warriors without ropes? Big. We started off slow, each climbing about 15 feet up to a little plateau that was easily accessible by a short path to the right. The next leg of the climb a was the monster that broke me: about 55 feet up to the top of the rock, with a big crack right down the middle. Ash gave it a go first, wedging between the walls of the gap to gain friction. About 10 feet up, he got a little panicky and decided to come back down. Not an unreasonable course of action when rock climbing without ropes. I gave it a try next. I got to where Ash had been, and decided to go a little further. I got about 20 feet up, and decided to come back down. Ash and I both took breathers, and he scouted around to the right and discovered a path that led to the top of the rock. I decided that I wanted to try it the other way, and gave one more crack at the wall. He went around to the top to try and guide me from above. I got to last time's quitting point and thought to myself, "If a bear were chasing me, I bet my survival instinct would kick in and I could top this in no time." I relayed this thought to Ash, who said I should try it. So I imagined a bear behind me. Miraculously, I was able to continue. I got higher and higher, and I was doing fine. Eventually I got to a spot about 45 feet above the plateau. This spot was notable because I couldn't really find any new handholds/footholds, and I lacked the rock climbing skill to do something more complicated like a heel hook this high up without ropes. So instead, I scouted. I looked to my right and saw nothing, so I checked my left. Ash moved as far as he could above me so that he could scout too, and it looked like there were some good holds that way. Climbing laterally, I worked my way out of the crack and to the left onto a big, sloping chunk of sandstone. Shifting my feet, I reached out for a new handhold and got it. I was now hugging the rock, using two handholds a little higher than head height. And then it happened: My feet went out from under me. I'd been smearing to get the right amount of friction, a technique where you use as much of your shoe as possible to get the greatest amount of surface-to-surface contact. This would have been all well and good, had I been climbing on something other than sandstone. The heat of the day had made the rock on the outside of the crack grittier and more sandy than the stuff I had been climbing before. Smearing my shoes out had loosened the top layer of dry, sand-like rock and as I put pressure on my feet to step up to a new hold, they both slipped. I was now hanging by the arms, 60 feet off the ground. Instantly, my whole body got as close to the rock as possible. Friction is about contact; the more of me touching the rock, the less I was slipping. Struggling to regain my previous footholds, Ash, with a hint of fear in his voice asked me "Are you o.k.?" The only thing I could think to say was "Ash, I'm scared." Instantly he scrambled into his pack for a length of rope, webbing, whatever he had with him. My arms were weary holding my entire body weight to the rock, and I could feel my palms starting to sweat. If you've ever felt a biological rush of fear or have had legitimate anxiety attacks, you know that it's scary as all fuck. Wave after wave of terror swept over my body, rushes of cold and paralyzing energy that I'd never felt before. Ash appeared over the ledge at the top of the rock. He had a rope in his hands! I wasn't even thinking about "Oh no, what if I fall?" at this point. I was reacting on pure self survival. As I held on for (literally) my life, Ash started to lower the rope to me, but he was about 8 feet to the right of me, 10 feet up. He managed to swing it over toward me, but for fear of letting go with one hand to grab it, I couldn't get it. If I let go, my body would've gone. In retrospect, it didn't matter much that I didn't get the rope because I let go shortly thereafter. "I let go" isn't really right...my body let go. I couldn't hold on any longer, so with muscles shaking and my brain in a panic, my body granted me (come to find out) the one path that let me walk away with my life. It let go.
I peeled straight back off of the rock face in a backwards dive, and for a moment, I was flying. I remember trees and rushing air, the sensation of falling, and then...nothing. With what I can only call a touch of divine intervention, my brain turned itself off and I went blank. Unconscious in the air. Limp. The doctors tell me that this is the reason I'm not dead. You see, when people are unconscious, drunk, or otherwise really relaxed, the body doesn't tense and fight things like violent impact. Drunk people who get hit by cars have been known to walk away with only a few scrapes. I wasn't drunk, but I was defintiely out. When my body hit the ground, I was lucky enough to land on one leg instead of my head or torso. This is also one of the reasons I can tell this story myself. Unfortunately it's also the reason my leg snapped in half, but more on that later. Since I was not present for this part of the fiasco, I will relate to you what Ash related to me:
When Ash had scrambled down the rock to see if I was o.k., he was thinking fast: look for life signs, get help. It was about 8:00pm (*actually 7:30pm*) by this point, and it was going to get dark soon. He got to me and right away thought the worst. I wasn't moving. Upon closer inspection, my eyes were in a fixed, forward stare and my hand was twitching slightly. I was breathing too. At this point, Ash knew I wasn't dead, but possibly in a coma or otherwise incapacitated. Blood was everywhere, spattered on the rocks and gushing from my left leg. Quickly, he grabbed the phone from my pocket and started the hike (*also known as a panicked super-climb*) out to the main road. Better to get someone who has the right knowledge to help than to try and do it himself and possibly make things worse. After about 10 minutes (*HA! 30 minutes*) Ash got to the main road, got reception, and got dialing. The shitty thing is that when you call 911 from a cell phone, you get the California Highway Patrol. They figure you're on the road somewhere if you're calling from a cell. I, however, was most certainly at the bottom of a ravine, not on the highway. (*and on top of that, no one answered. I got put on hold*) Again, thinking fast, Ash called my girlfriend at her house, using my contacts. He has informed me that his end of the conversation went something like this: "Help! 911...call! Very...very bad things...LOTS of blood...Call! Soren, he's hurt! CALL 911!"
Or something like that. (*that sounded like the Joss Whedon version of the call*)
Kristina proceeded to call 911, and got the fire department to hoof it out to the mountain. In the meantime, Ash was still trying to get me more immediate help. In his haste getting up to the road, he forgot to grab his car keys. Not being able to drive to the ranger station, he flagged down a passing bicyclist and told him/her to get the fuck to the ranger station and get some help. Said cyclist then sped out of sight, and Ash eagerly awaited said help. (*although the cyclist never showed me any sign of hearing or seeing me*) He also started to call out over the valley that the road sat above, trying to make contact with anyone who could hear him. Screaming out cries for help, he eventually heard someone yelling back! But they were faint, and their speech sounded garbled over what must've been a very great distance. Frustrated with this mystery asshole, Ash sent one final yell of "English, motherfucker! DO YOU SPEAK IT!?" (*yes, that is what came to mind*) out across the distance, only to realize that said asshole was in fact me, having regained consciousness, screaming for help at the bottom of the ravine.
A lot good that did him.
Cut back to me, five minutes ago, waking up to a bloodbath. I open my eyes and wonder right away what the fuck has just transpired. I'm on the ground breathing heavy, and then it hits me: I just fell way too far to be alive. I sit up, proving to myself that I am in fact alive and adding to my confusion. Seconds later, I realize that if my neck or back had just been broken, or if I moved something critical just then, I may have cut my chances for survival significantly. I pushed myself up to a sitting position, further diminishing any hope that I would walk again if my neck or back was broken. Did I mention yet that I'm the luckiest guy I know? My neck and back turned out to be unharmed. My leg however, was another story. Upon sitting up, I became privy to the knowledge that my left leg had been exploded the fuck in half. Blood was everywhere, and I could see bones sticking out of where my shin should've been. Steeling myself, I gripped my lower leg with both hands just below the knee, and tried to pick my leg up to see the damage. My leg, being very badly mangled, proceeded to fall in half. I'm talking no bone support, leg made out of Silly Putty, oh-holy-shit-body-parts-should-not-bend-this-way, in half. My tibia and fibula had broken clean through. I quickly set my leg down and realized that I was in a fuckload of trouble. Ash was nowhere to be seen, so I figured he was either on his way to get help or on his way back. I thanked my lucky stars that I had him with me. Thinking that whoever was coming for me would need some help finding me, I proceeded to yell my fucking lungs out so that I could be found in the fast approaching darkness. Blood on my hands, lower body and starting to pool on the ground around me, I made a solemn plea for someone, anyone, to come and find me and save me.
Time passed slowly, agonizingly, until at last I heard Ash's voice behind me and breathed a sigh of relief. He'd returned with a park ranger, who had oxygen with him. I was so relieved that Ash had returned at this point, that I just cried. The ranger got me on an oxygen mask and was very cool about the whole ordeal, introducing himself as Scott and making sure I was o.k. Ash wondered if I'd broken my nose, because my voice sounded funny. There was some speculation as to whether I'd ruptured my esophagus or not, but it turned out I had punctured a lung, and the fluid pooling there was what made me sound all weird. (*I didn't know that*) Twisting to get a look at things, Ash told me to stay the fuck still, and that he'd take some pictures of stuff so that I could see it all later. Wanting to take my mind off things, he said "Hey Soren, why don't you tell me a joke?" to which I delivered a prompt "No." I was so happy to have my life in someone else's hands, someone who knew what they were doing, that I was content to just sit there, silent. I answered questions and did the diagnostic stuff, follow the light with your eyes & etc. but other than that, I was pretty much quiet. They didn't even have to give me any painkillers (although Ash has since informed me that yes, I was high on the morphine they snuck into me when I wasn't paying attention; still, I couldn't feel any pain even before they got to me). Truth be told, I couldn't even feel anything until I woke up from surgery. But to find out about that, you'll have to read on...
Kristina, riding with the Danville fire department, showed up next, and by this time it was dark. Ash got a flashlight and guided the helicopter's spotlight over to us, letting everyone have enought light to see by. They couldn't airlift me out of the ravine because of the close proximity to the rocks and trees, so five firefighters and Scott got me onto a backboard, got that onto a stoke (one of those yellow body baskets), and hiked me out. I felt like a sacrifice, borne aloft on a palanquin of yellow metal. Eventually, they got me out to to road and into an ambulance, which took me to a helicopter, which took me John Muir Medical Center's Emergency Department. I woke up the next day and was informed that I'd had surgery performed on my leg. The hit list, as I like to call it, went a little something like this:
-One severely broken left leg; compound tibia/fibula fractures, with a floating piece broken out of the tibia.
-One case of wicked head trauma, with an occipital fracture, blood pooling in my brain and my right eye half filled with blood. Side note, my eye made me look like a James Bond villain for about a week and a half.
-One broken rib, which punctured/collapsed my left lung. Also, I had subcutaneous emphysema, which is when air gets trapped under your skin. For a few days it was like bubble wrap. You could touch it and my skin would crackle underneath. Freaky.
-One case of mild right shoulder trauma.
All in all, not a bad set of injuries for someone who just fell six stories. The surgery they had to perform on me is what gave me the wicked robot leg you can see in my profile picture. It's called an external fixator (mono-lateral for you sticklers out there) and it consisted of four 4-5 inch bolts drilled straight into my shin, with a connecting bar on the outside. Because my bones both broke through the skin, casting the leg wasn't an option. They didn't want to put a cast on it and then risk getting the healing flesh infected. Irony would prevail later on, but we'll talk about that when the time comes. I stayed in the hospital for 5 days ( I think) and then went home. I wasn't able to walk without a walker. Crutches were out, because of the healing chest tube wound under my left arm. Oh yeah! The chest tube! I had a tube between my ribs that helped get the fluid out of my lungs. Whenever I coughed, about a teaspoon of mucillagenous orange/yellow fluid would pour from my lung out the tube. It was sick. Moving on! I couldn't use crutches, so I walker'd and wheelchair'd places, but rested mostly.
Some time after that, I started to complain about pain in my left hand. Come to find out, I'd also fractured my fourth and fifth metacarpals (read: palmbones, just under ring & pinky fingers). I got a short arm cast, and those are doing fine now. All that remains of my chest tube is a tiny scar. The blood in my brain resorbed, my eye-blood left after a little more than a week, and my shoulder clicks but is otherwise fine. My leg...
As part of regular maintenance on my leg, I had to clean the area around the pins with hydrogen peroxide every day to prevent any chances of infection. This went swimmingly for about six and a half weeks. Around the week of August the 10th, I started to notice what looked like pus coming from the third pin site down. I went in to see my primary care physician, who immediately responded with an "Aagh. That looks like pus." We took a culture that day, the 14th, and she sent me on my way. She explained that in order to find out what bacteria was causing the infection, they had to see what grew in a petri dish when my culture was introduced. It would take a few days, she said. Content with this answer, I went about my life until the next day. On the 15th, a Friday, my doctor called me to get a same-day appointment with orthopedics, to get their opinion on the whole thing. Results hadn't come back yet, but she definitely thought that there was something going on, and that orthopedics should know about it.
I show up at orthopedics after calling for a same day appointment, and am introduced to Mark Okawachi, Physician Assisstant. Now I'm sure Mark meant well, and that he knows far more about medicine than me, but I was a little baffled when he told me that what I had coming out of my leg was in fact serous fluid, a benign clear-yellow liquid, and not pus. I informed him of my doctor's request to be seen that day, and he informed me that she was wrong. "Let's get x-rays first, to see if anything is wrong", he said. I got the x-rays, which Mark gave a shining review. "You're doing fine!" he said. "Let me just get one of our orthopedic surgeons to take a look at this." In comes Dr. Von Glinski, far less terrifying than she sounds, but with a very surgical, precise way about her. She takes one look at the x-rays, not even paying attention to my fracture and says to Mark "Look, there's erosion around the pin site. It's infected. We need to take the fixator out today, right now." Mark, foot firmly in mouth, looks at the x-ray and mumbles something to himself. Dr. Von Glinski looked at me just then, her piercing eyes seeming to size me up. She said, and I quote, "I bet those pins are treated with hydro(I couldn't catch the rest). *Looking away* That is gonna hurt like a son-of-a-bitch." Wide eyed, with a "Did I just hear my doctor fucking say that!?" stare, I turn to my Mom, who can't quite believe her ears either. At least she was frank about it.
I'm directed to the casting room, where the ortho techs are all gathered around to watch the mayhem presumably. In a process that makes me shudder to describe, I experience the second worst pain of my life, as I basically had self-tapping 1/4 inch diameter screws taken out of my leg. How you ask? Simple. They just *unscrew* them. The pain was the worst when the pins broke free from the bone, as the hydro(whateveryoucallit) had caused the bone to really grow into the threads of the screw. After the "break-free" moment, the sensation was more like a pressure than anything else. The ortho techs had heard it described as a sensation similar to getting a tattoo. The new 5 inch holes in my leg were each flushed with lidocaine to make me forget the pain, and I was also on Percocet (oxycodone with acetaminophen), but trust me when I say that this is something you never want to have to do. Afterwards, Von Glinski pressure tested my fracture and decided that I was healed enough to crutch out of there with a fracture boot on. I would also have to do pin site maintenance for the infected site, a process called wicking that we'll get into later. I was told that I could still put 50% of my weight on my left leg, as I had been able to do when my fixator was in. I decide privately that this is bullshit, and I don't put any weight on it.
The next day, Saturday, my brother, his wife and I are all going to visit my Dad in Fair Oaks, just outside of Sacramento. My Mom, who had seen the wicking procedure done the day before, has to show my brother how to do it so I can continue my treatment up at Dad's. The procedure and rationale goes like this: if we just let my pin site heal up with an infection present, the top will heal over and leave a pocket of infection, eventually causing osteomyelitis, which is a fancy word for bone infection. If you're an art history buff, you may recall Thomas Eakins' oil on canvas painting titled 'The Gross Clinic', which depicts a surgical procedure for osteomyelitis. Anyways, to prevent a pocket from forming, you have to 'wick' the site so it heals from the bottom up. This is achieved by using a long cotton swab to push Iodoform, an iodine soaked 1/4 inch wide ribbon, down to the bottom of the site. You then have to double the ribbon back on itself over and over until it becomes flush with the skin, being sure to tuck edges in and get the ribbon as compact as possible. Let there be no confusion: this shit hurts. I only have to do it once a day, and taking old wicking out is fine. The new stuff is agony. My Mom is too squeamish to finish, so we have to start over and my brother takes the reins, guided by Mom and me. He finishes, and it's off to Dad's house. My leg feels strange in the boot, like all is not right, but I ignore it for now. I figure the doctors know what's best.
The next day, Sunday, my brother is changing my wicking again, this time with my Dad looking over his shoulder. He finishes, and as I lift my leg to put it back in the boot, something funny happens: my leg bends. Not at any joint in particular, you see...in the middle of my shin, it bends. My brother and I exchange WTF glances, and my Dad and I decide it's time to book it to the ER. We get to Roseville ER, get in, get x-rays, and confirm the common sense fact: my leg is still really fucking broken. Roseville ER puts me in a non-removeable splint and tells me that this will get me through the weekend, but to get a cast on Monday.
Monday rolls around, and I call my hometown Kaiser Orthopedics Department again. I tell them that they sent me home with a broken leg, and that I need to get a cast. Today. I come in, and who am I scheduled with? Of course. Mark. He, incredulous, asks me what it is I'm doing here. I, furious, tell him. He, foot firmly in mouth once more, gets me into the cast room. The ortho techs all say "Sup?" to me because they know me by now, and I tell them. I get a full leg cast all the way up to my upper thigh. It was glow-in-the-dark, with a black barber-pole stripe all the way up and a window for wicking. That cast stayed on for a month.
Because of the high risk of osteomyelitis associated with my infection, Mark did something right and called an infectious diseases specialist to consult about a PICC line for antibiotics. The specialist gave the thumbs up, and I got my line in on that Thursday, the 21st. Let's break it down: PICC stands for Peripherally Inserted Central Catheter. Peripheral stands for my left arm. Inserted stands for inserted. Central stands for my superior vena cava, the vein that drops right into the top of your heart on the right side. Catheter stands for tube in my body. That's right, a PICC line is a tube that goes from your arm to your heart --inside of you-- so that you can inject medication. Straight to your fucking heart. It may be normal as pie for some (nurses, doctors), but this shit was freaky for me. This is an interesting procedure, but if you're really really squeamish, skip ahead.
PICC insertion went something like this: first, using ultrasound, my nurse found my basilic vein. She then had me mark the spot with a ball point pen. After numbing the site with a few injections of lidocaine, she slid what's called a guide wire into my vein. The guide wire looked like the small E string on a guitar. I couldn't feel it traveling up my veins or anything like that, and so far the procedure was pretty painless. Then came the dialator. The dialator can't fit into the first hole without a little help in the form of an incision. The incision is normally painless thanks to the lidocaine, but only my skin was numb and not my arm. The nurse went a little deep, and it felt like she cut right into a nerve. My body jerked at the shock but somehow I was able to keep my arm still, lest the blade slip deeper. The nurse was apologetic, saying that she should've checked to make sure I was numb. With a chuckle I told her that I thought I was. After the incision, the dialator had enough room to slip into my vein and spread it open for the actual tube. The tube slid in over the guide wire and under the dialator. Once it was the tube was inserted, the guide wire was backed out through it and the dialator backed out over it. And that was it. My line was in.
An x-ray upstairs confirmed that the tube was sitting right over my heart, and that placement was optimal. I used the catheter to give myself injections of antibiotics three times a day for six weeks. The line wasn't uncomfortable in my arm or anything like that, but it turns out that I was allergic to the adhesives they used to stick the protective dressing to your arm. If it's not one thing, it's another. The itching got intense sometimes. Worse than cast itch even, it felt like there was a malevolent force in my arm that wanted to kill me. And since it was a topical allergy and under the adhesives that were causing it, I couldn't use anything like topical Benadryl. It was awful.
But back to the leg...my full leg cast stayed on for 34 days, and did it's job well. My leg was immobile, but there was a slight problem. When I went in for x-rays on September 19th, my tibia looked like it hadn't been knitting at all. It was a possibility that because of the infection the healing would be delayed, but stopped altogether? Unlikely. My bone was exhibiting symptoms of nonunion, a permanent break. Bones don't always grow back together. It's not common in properly set and maintained fractures, but it does happen. On the 19th they decided to take my full leg cast off and put me in a patellar tendon cast, which lets me bend my knee but allows no torsion of the lower leg. To stimulate bone knitting, I got an ultrasound emitter that fits into a port on my cast above the fracture.
This almost brings us up to the present. Last Thursday, the 2nd, I finished my course of antibiotics. On Friday my line came out, a surprisingly simple procedure. You just pull, and it slides right out. I do my bone treatments every day and I get x-rays again on the 20th to see if they're working. If they arent, then I may need more surgery to put a rod inside which would really be a bummer. Mostly because my scar looks like a pretty wicked phoenix right now, but also because of more surgery/recovery time.
I really hope I can start putting weight on it soon, because the muscle atrophy is distressing. I've learned to be very patient though, and to be thankful for what I do have. Please, if you've managed to read this far, take to heart what I'm about to say: life is precious. Don't squander it, and don't take it for granted. Love the people around you and try as hard as you can to make the best of life.
And never rock climb without ropes.
*UPDATE #1, 10/31/08* New pictures, including my first and second patellar tendon bracing casts and PICC line removal. I finally figured out how to send photos from my phone to the interwebs, so here they are!
*UPDATE #2, 11/17/08* I went to see the my orthopedist today and got new x-rays! They don't look much different, but my doctor assures me that I'm on the right track. Two weeks until new x-rays, and I get to try weight bearing for the second time in five months! I'll be sure and let everyone know how it goes. Also, there are more new pictures, including my newest cast and a comparison to illustrate the atrophy in my left leg. It's weird.