Another Trauma-Rama:  Bob’s Run-In With A Car

Individuals with a low tolerance for accident stories in which bones pop out from where they are supposed to be are invited to cease reading pronto.  Yes, here is what happened to Bob Nelson at about 8:20 p.m. Thursday, July 5th. 

I was headed down Broadway in the Bronx, riding my older bike on my way home from my clinical affiliation at Yonkers General Hospital, where I was learning the basics of working as a physical therapist, after completing the first of two years of school at Columbia.  I will admit I was not five minutes from home, hungry, tired after a 12-hour day, and not as vigilant as I could have been.  The car was a black Acura coming from the opposite direction, making a left onto West 228th St., a trajectory that cut me off.  He and I both made evasive maneuvers, both of us turning to our lefts, with the result that my right forearm was the only part of me or my bike that came into contact with his car.  I ricocheted off the car, fell down, and got up, ready to give this guy a piece of my mind, when I noticed blood spattering onto the pavement.  Looking at my forearm, I saw the blood flowing rather dramatically from my right forearm – and yes, the bone was shining through on the pinky side of the arm, halfway between wrist and elbow.  So I held the bone (the ulna) in with my left hand, determined that there was no further point in standing in the middle of Broadway, and went to sit on the curb. 

This may sound like I was cool and collected, and in fact I was already reviewing in my mind what the physical therapy for a broken ulna would be, but at the same time I was hyperventilating, not so much from the pain, which was not significant, but from the shock of it all.  I was cool enough to memorize the license plate of the vehicle, to note that he did not leave the scene and to holler to him to call an ambulance, since he was the only other person at the intersection.  He went into a grocery store at the corner and I assume did so.  A couple of people gathered and someone flagged down a cop.  One officer took down all the info, including statements from the driver and from me, and the other held my hand until the ambulance came, which seemed an eternity. 

The real Bob, in a moment of high spirits at Jacobi Medical Center.	The Bob the insurance people see.

Though we were not 500 yards from Columbia-Presbyterian’s Allen Pavilion, just across the bridge in Manhattan – I could have crawled there! – the ambulance driver insisted I would have to go to Jacobi Medical Center, a level one trauma center, five miles away in the eastern Bronx.  At the Jacobi ER, they gave me three shots of morphine, which calmed me down quite a bit.  They also cut off all my clothing, tested my neck and extremities, and catheterized me, which I cannot now imagine being a part of any pleasurable sex act. 

They – all young residents who could easily pass for college kids – asked me for the name and phone number of a friend or relative to notify.  In this age of speed dialing, the only number I could remember was that of fellow Front Runner Peg Byron, who has had the same number for the last oh, quite some number of years.  She arrived at the Jacobi emergency room at about 1 a.m. Friday morning and kept me company until I went in for surgery at about 4 a.m.  (Isn’t there some Front Runner Medal of Service Beyond the Call of Duty that we can award this woman?)  Asked who she was, Peg announced, in perfectly even tones, “I’m his wife.”  I successfully choked back a coughing fit, but the surgeons took Peg’s statement entirely at face value. 

Peg and the surgical team proceeded to discuss the merits of the various options open to me.  It transpired that I would have a plate and screws installed permanently to stabilize the bone, and that the accident had opened a flap of tissue on my forearm that could be reattached but posed a high risk of infection. 

X-ray side view of arm.	X-ray closeup showing displaced ulna.

The surgeon supervising the work was Randy Ehrlich, a triathlete, member of Central Park Track Club, Columbia College of Physicians & Surgeons alum and the dude who repaired the medial collateral ligament tear in Paulette Meggoe’s left knee two years ago.  He did a bang-up job, I would later discover, and is the source of the x-rays you see on the right.  I awoke Friday mid-morning and vaguely remember Peg saying she would be back for visitor’s hours over the weekend.  Dr. Ehrlich also provided optical photos of the arm when it was opened up for surgery. Be warned, though, that these photos show blood and gore rather vividly and are not for the faint of heart. Your webmaster, though having some experience with such images, found them hard to look at. If you nonetheless decide you'd like to see these photos, click here.

I proceeded to spend a very unmemorable week in Jacoby’s trauma ward, where patients were sandwiched six to a room (six phones, six TV's) and where my closest roommate, a young man with an abdominal wound from a knife fight, spent hours on the phone with his girlfriend, punctuating the conversation with “fuck!” and “bitch!” and, usually at the top of his lungs, “Fuck you, bitch!” the latter providing the background to a telephone chat with my sister-in-law. When I arrived at Jacobi, there was a cop posted at the entrance to the trauma ward 24 hours a day, and I surmised there was a criminal in our midst, possibly an inmate from nearby Rikers Island. As the week wore by and the cops arrived for their shifts with numbing regularity, it occurred to me that perhaps there was not one inmate, but more than one, and that in fact Jacobi, a city hospital, might be the treatment facility for Rikers inmates. If Jacobi felt confining before, it soon came to feel like a prison ward, complete with fellow prisoners growling insults at one another. (Sorry, none of the inmates made me his bitch.)

The food?  Saturday afternoon, July 7th, the college boy doctors came around and told me I could have solid food, since I was stable and not vomiting.  No one told the dieticians, it seemed, since every meal that weekend consisted of the same thing:  two cups of apple juice, a bowl of warm broth, a cup of tea and a container of jello (sorry, Jell-O).  You have no idea how much a 200-pound man, especially one recovering from a broken arm, wants something more substantial than clear fluids. 

Happily, I was well-supplied with contraband:  Peg and my ex Joe Cassidy brought in mortadella sandwiches and pignole cookies from a local Italian deli Saturday, Peg brought me a wonderful salad with roasted vegetables Sunday, and triathlete Gerry Valentine brought me Clif bars, which I love.  Marten den Boer, Fast and Fab’s webmaster, came by to chat and take the pictures of me in bed at Jacobi.  Paulette Meggoe, my beloved Fast and Fab co-chair, brought me grapes and almonds and took me for a walk around the hospital floor.  My guardian angel from Fast and Fab, Cidney Schultz, was working as a nursing student nearby at Montefiore and put on lipstick and nurse’s garb to smuggle me bowls of fresh fruit and big steaming mugs of real coffee.  Flowers be damned, bring me coffee!

(My thanks to all the other friends who called or visited, or tried to get through the Jacobi switchboard.  Your company helped me carry on.)

I did, on one occasion, go out for a cup of coffee myself.  It was Monday morning, July 9th, I hadn’t yet arranged Cidney’s java airlift and the hospital served instant with breakfast – I didn’t think you could still buy instant.  I fished out my backpack, which held the dress clothes I had worn on what turned out to be the last day of my clinical affiliation, and put on my pants and shoes, the minimum, I figured, to appear among the living.  Peg had told me there was a McDonald’s in the lobby of the hospital, which I guess gives you an idea of the aspirations of the clientele, but anything other than hospital food sounded good. 

I fortunately didn’t have an IV attached at that moment, and was on my way out the door when one of the nurses called to me, “Mr. Nelson!  You’re not leaving the floor, are you?”  Drat, I thought.  The fuzz.  Busted.  I made a mental note not to wear pants the next time I ventured off the floor, and replied, “No, of course not.”  I hurried out the door and around the corner to the elevator bank, hoping Nursie was too busy this morning to give chase.  The elevator showed up before she did, and, sure enough, in no time I stood before a gleaming McDonald’s in all its neon glory.

I sauntered up to the counter, wallet firmly in hand.  One of the teenage girls behind the counter, without prompting, announced, “I’m sorry, sir.  We can’t take your order here.  Patients are not supposed to be getting food off the floor.”  But the nurse on line ahead of me took pity.  “I’ll buy you a cup of coffee,” she said.  I slipped a dollar bill into her too-tight jeans and gave them a pat.  Home free!  The counter girl, who witnessed this entire transaction, passed me a cup and I headed for the coffee machine, which held real, brewed coffee.  I never imagined that I would laud McDonald’s coffee, but to me it was the closest thing to ambrosia on that dismal Monday morning at Jacobi Medical Center.

The college boys had intimated Sunday that I might be ready to go home, but one of the residents, a former pole vaulter for U.S.C. with some of the most marvelous shoulders I’ve ever seen, came by Monday to tell me there was yet another surgery to do.  It essentially consisted of reopening the wound, which had been only lightly sutured to allow drainage, cutting away any dead tissue, irrigating the area and suturing it up.  That part of the surgery is called a debridement – check it out and clean it up.

The surgeons also believed there were three severed tendons that had to be reattached, but I could see that having that surgery done at Jacobi would lead to another week of listening to “Fuck you, bitch!” so I asked the surgeons to do the debridement only.  One of my physical therapy professors from Columbia, Ken Harwood, had come in to see me Saturday and had said he was available to help me out in any way necessary, so I called his office number and asked him to locate me a surgeon at Columbia who could do the tendon reattachment.  He called back Tuesday morning before I went into the second surgery with the name Robert Strauch, a Columbia hand and forearm specialist whose father is the chairman of plastic surgery at Montefiore.  I figured anyone exposed to surgery for that long had to be O.K., so I called and got an appointment for Thursday afternoon.

Two surgical residents, the U.S.C. pole vaulter and a cute young Columbia alumnus, were my company for the second surgery July 10th, which thankfully did not include a catheterization.  The prep nurse took the precaution of writing in ink on my right upper arm “YES” and on my left arm, “NO.”  (It’s those little touches that give patients faith in the medical profession.)  The anesthesiologist was a jolly sort who joked with me a bit.  He was about to put me under when the surgeon came in, and told the anesthesiologist to hold off a bit so he could ask me some questions.  He did, then an OR nurse asked him, “So, doctor, what are we doing today?”  Replied the surgeon, “Debridement, exploration and maybe some tendon reattachment.”  At that, the Columbia boy came over and said, in a tone of voice he probably thought I couldn’t hear, “He hasn’t consented to the tendon surgery.”  They both walked quickly out of the room, and I could year the surgeon bellow from the next room, “That’s ridiculous!”  More news to inspire faith in the medical profession!

The recovery from that surgery was quick.  The anesthesia did disrupt my sleep somewhat, so I was awake at 10:30 p.m. Tuesday when the U.S.C. pole vaulter came by my cubicle to let me know the surgery had been successful and nothing unusual had been found.  I was trying to think of some blandishment that would prolong his stay – share a Clif bar, sir? – but decided I wouldn’t be able to handle this much horsepower in my current condition, even had he been willing.

I did have enough steam to inform the college boys on Wednesday that I would be checking out of the hospital the next day, come hell or high water.  Some were supportive, telling me Dr. Strauch was an excellent choice.  The resident who came by Thursday morning with my discharge papers was less encouraging, and had to read a long list of the dangers I risked by checking myself out against medical advice:  non-union of the fracture, infection of the wound, recurrent bleeding, etc.  Nevertheless, he told the IV nurse to come by and unhook me so I could travel among mortals.  She yanked the tape off my forearm, leaving a bruise and a hairless patch of skin that persisted for a week, my going-away present from Jacobi.

I took a gypsy cab home, showered and shaved, and made it in to see Dr. Strauch Thursday by 2 p.m. I had packed a bag in case he wanted to sign me in as a patient, but he just unwrapped the dressing and had me do some hand exercises. I didn't have much finger movement on the right hand, after a week of not moving it, but made considerable progress in the next week. Indeed, I now have close to full function, though I will need to do strengthening and flexibility exercises for a while yet. I don't have full flexion in my right pinky, and my wrist flexion and extension and still somewhat limited. Dr. Strauch, who's a really nice guy and a super physician, thinks we could repair the flexor digitorum profundis and flexor carpi ulnaris tendons (nonmedical types can safely ignore the lingo). The surgery would be outpatient and would involve shaving off a bit of the palmares tendon and using it to repair the others. Because of insurance complications, that surgery has been delayed, probably until December. But it's not completely obvious that I even need the surgery, and giving the arm time to heal, and even getting back to swimming, should help us figure out whether to do it or not.

After six weeks, the ulna has begun to heal. The titanium plate is 6 cm long, a bit more than two inches.

Aside from the scar, which I'm sure will scare small children, I am lacking some muscle mass on the pinky side of the forearm. Whether that is just deconditioning or a result of a damaged tendon remains to be seen. Some of my friends and fellow cyclists have asked whether the plate in my arm, which is permanent, will set off metal detectors. My deductive answer has always been no, since it weighs about the same as a belt buckle -- not the Texas turkey platters, but a normal, East Coast belt buckle. And standard belt buckles don't set off metal detectors. But I served on jury duty at New York State Supreme Court in July, and the plate did set off a metal detector, the empirical finding that contradicts my deductive reasoning. So you can now all rest comfortably in the knowledge that whenever I get on a plane, I will be frisked. By someone frisky, I hope.