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I was riding my bike on my normal route to work today. Then it happened, like a blink. A car that was not supposed to be there was there, coming at me. No time to change course or apply breaks, just brace for impact.
I was headed west bound on a 2 lane road. Entering a light controlled intersection on a green light. A jeep grand Cherokee, which was in the opposing left-hand, turn lane, crossed traffic and met me.
We hit in an instant. I think I recall my instinct being tuck, get on the hood, and drop head (to roll over). Truthfully I don’t know if those cognitions came during or after the fact. I do remember a sense of hardness, a hardness that meets you and tests your entire will to stay in one piece. In all my years playing football, I have never felt something so strong that it threatened to tear limb from limb. Next came the weightlessness and the spinning. I remember thinking, well this is good. Between the twisting on multiple axes, I was senseless to right myself. This was pleasant. Then came the fall, as I hit the ground all the worldly sensations came rushing back into me. Pain entered hard through the legs, L side of my spine, I instantly felt my entire left side recoiling. Knowing I was somewhere in the middle of the street, where more traffic could meet me I rolled left, saw the car whom hit me turn around, rolled right and attempted some primitive crawling motion, unsuccessful. Then I succumbed to the sensations, put my head on the pavement and breathed. I told myself the damage was done, and in time my body and mind would heal – I just had to breathe through this. The sign of the first responder, I started groaning and screaming, nothing intelligible, he looked scared. I told him to give me his hand, he was reluctant. I said just hold my hand.
Moments later the paramedics were there, an ortho physician assistant was clearing my spine, it appeared that none of my extremities were grossly out of alignment. I have a vague sense of coming down in a crumple, with my left knee coming down underneath me pinned into internal rotation, valgus and flexion—that does not look right. Ambulance, more groaning, all I want to do is groan and move. Not stand up per se, but just escape the onslaught of sensations that were bombarding me.
Before being loaded into the ambulance, I checked the door. Denver Paramedics, I was still going to make it to work today, albeit not in the correct department (I work at the community/trauma hospital, Denver Health which is where Denver Paramedics operates). The ED was an interesting place, my first ambulance ride, my first trip to an ED since probably forever.
It took an abnormal amount of time to get me off the stretcher and out of the neck collar. I knew my neck and lumbar spine were fine, even though my pelvis and l-spine were locked in spasms crawling up my back; I laid there for 30 min or so. They tried to keep my legs straight. Which once the spine is cleared makes absolutely no sense. The only thing my body wanted to do was curl up into a ball, a ball so tight that I could appease my slowly building tension in my abdominals, psoas, and hip muscles. The interns performed there standard procedures, they asked me to rate my pain, I said 1/10. Which is strange, clearly the magnitude of collision would deem a higher level. I just hit a car head on going probably 20mph while the opposing vehicle went at least 15 mph. I flew maybe 10 to 15 feet. My bike was crumpled. The cross bar of my bike which was between my L knee and the car was bent at least 10 degrees. Was I trying to just “be a man”. I don’t know but I knew that what I was feeling at this point was alright. Most of my extremities were fine. I was mildly concerned about a tib plateau fracture and or fibula fracture. But most of my discomforts were telling me to move, and keep moving so to register this as pain did not seem correct.
I was taken to X-rays, everything I was concerned about was x-rayed. I was able to walk—barely but I knew that would rule out an ankle fx—Ottwa ankle rules.
I returned to the ED, waited and waited some more. I turned down taking any pain meds, I wanted to do an n=1 experiment. That experiment being, firstly I wanted to really feel, clearly, moment to moment what my body was going through, secondly I also wanted to take this idea of ideomotion and try it out, thirdly I wanted to experience what it was like to have counseling and how that affected my pain symptoms.
A little background, I am part of a community of people, whom meet regularly to counsel each other. We are not professionals, but more like friends, we do not offer advice but more serve as partners for listening. How this works, is that when individuals meet, we have a timer, and we trade time. Trading time means that one person gets the undivided attention of the other while that person talks, laughs, cries and shares whatever they have going on with them. The goal is to give undivided and nonjudgmental attention to the other. So when I refer to counseling that is what I am referring to (within this post).
So what did I notice, first off, the adrenaline that accompanied the accident was wearing off. I could feel moment by moment tension increasing in my right ankle and knee as they swelled. I also got the sense that my body wanted movement. I found myself doing the proverbial writhing. I shifted to and fro, side to side, at one point I was upside down on the bed with my feat elevated as high as they could get up the wall. I really could just not stay in any position for long.
After a while of this I picked up the phone and called one of my ‘counselors’—so normally you trade time but in cases of pain and death it is allowed to have one way time. I talked with her, walked through the accident step by step in my head, talked through my worries and concerns, moaned, and kept telling her I just wanted to be a little ball (which is ironic, I guess because I am not a little man). It was weird but after I started to do this, and curl up into a ball these bouts of discomfort started to abate and I felt a bit calmer. The sense to move was abating and I could feel myself easing.
During this time I did notice that my psoas bilaterally, but L greater than R, L hamstring seemed to be stuck in the “on position”. I could feel them ‘bubble’ sometimes as I would try to breathe, perform some Hannah Somatics side lying exercises but they were like in lock down protection mode. Also I had super nerve tension. To look down would send electrical signals down my e-spine. In fact afterwards, I had extreme trouble getting into the car because I could not flex my head due to this.
I went through a phase of nausea, about the time I think my adrenaline was coming down, this was brief but not that intense. After I had relaxed for a bit and gone through about 30-40 min of counseling I started to feel very hungry. So I ate the lunch I packed (for work, not the accident). I also felt very cold in my feet so much so that I could not tell if my feet were cold or painful.
Eventually, x-rays came back clear. I hobbled out of the ED. I could not stand up straight, left knee felt loose—I was apprehensive about putting weight on it and bending it. It also felt like there was corset around my waist that was cinched down super tight.
This part of my experience has led to the following reflections.
I made it back home with the aide of my counselor friends. Eventually, I curled up into a ball and gradually eased into sleep. Throughout the day, I altered between supine, side lying, standing (hobbling). I found myself walking with a straight L leg because of perceived apprehension due to my questions of ligamentous stability (I am guessing a full MCL tear, perhaps an acute meniscus fold as well), and my R leg in max eversion because it hurts to DF through talocrual joint.
At approx. 12 hours post-accident I decided to take 800 mg of ibuprofen, mostly because I wanted to see the effects (they were dramatic, maybe 50% more ease with movement.) Still I walk with a very guarded gait but right now I feel much more comfortable experimenting with different types of gait.
Overall I am fine, I think I have a full thickness MCL tear (which is moderately disconcerting because one I have never had an ortho surgery and two the possible ramifications for the sports I like to do), but we’ll see come Monday. There was a lot of anxiety about financials but the other driver was at fault, he admitted, was cited and has insurance—so that eased one of the biggest anxieties of the day—how much this is going to cost me? I am pretty banged up, my helmet is cracked and with a sizable chunk taken out of it, my bike is done for.
We as therapist rarely get to experience the lives of our patients. I am writing this post from my perspective of both the therapist and the patient to further my insight into the human experience.
I was headed west bound on a 2 lane road. Entering a light controlled intersection on a green light. A jeep grand Cherokee, which was in the opposing left-hand, turn lane, crossed traffic and met me.
We hit in an instant. I think I recall my instinct being tuck, get on the hood, and drop head (to roll over). Truthfully I don’t know if those cognitions came during or after the fact. I do remember a sense of hardness, a hardness that meets you and tests your entire will to stay in one piece. In all my years playing football, I have never felt something so strong that it threatened to tear limb from limb. Next came the weightlessness and the spinning. I remember thinking, well this is good. Between the twisting on multiple axes, I was senseless to right myself. This was pleasant. Then came the fall, as I hit the ground all the worldly sensations came rushing back into me. Pain entered hard through the legs, L side of my spine, I instantly felt my entire left side recoiling. Knowing I was somewhere in the middle of the street, where more traffic could meet me I rolled left, saw the car whom hit me turn around, rolled right and attempted some primitive crawling motion, unsuccessful. Then I succumbed to the sensations, put my head on the pavement and breathed. I told myself the damage was done, and in time my body and mind would heal – I just had to breathe through this. The sign of the first responder, I started groaning and screaming, nothing intelligible, he looked scared. I told him to give me his hand, he was reluctant. I said just hold my hand.
Moments later the paramedics were there, an ortho physician assistant was clearing my spine, it appeared that none of my extremities were grossly out of alignment. I have a vague sense of coming down in a crumple, with my left knee coming down underneath me pinned into internal rotation, valgus and flexion—that does not look right. Ambulance, more groaning, all I want to do is groan and move. Not stand up per se, but just escape the onslaught of sensations that were bombarding me.
Before being loaded into the ambulance, I checked the door. Denver Paramedics, I was still going to make it to work today, albeit not in the correct department (I work at the community/trauma hospital, Denver Health which is where Denver Paramedics operates). The ED was an interesting place, my first ambulance ride, my first trip to an ED since probably forever.
It took an abnormal amount of time to get me off the stretcher and out of the neck collar. I knew my neck and lumbar spine were fine, even though my pelvis and l-spine were locked in spasms crawling up my back; I laid there for 30 min or so. They tried to keep my legs straight. Which once the spine is cleared makes absolutely no sense. The only thing my body wanted to do was curl up into a ball, a ball so tight that I could appease my slowly building tension in my abdominals, psoas, and hip muscles. The interns performed there standard procedures, they asked me to rate my pain, I said 1/10. Which is strange, clearly the magnitude of collision would deem a higher level. I just hit a car head on going probably 20mph while the opposing vehicle went at least 15 mph. I flew maybe 10 to 15 feet. My bike was crumpled. The cross bar of my bike which was between my L knee and the car was bent at least 10 degrees. Was I trying to just “be a man”. I don’t know but I knew that what I was feeling at this point was alright. Most of my extremities were fine. I was mildly concerned about a tib plateau fracture and or fibula fracture. But most of my discomforts were telling me to move, and keep moving so to register this as pain did not seem correct.
I was taken to X-rays, everything I was concerned about was x-rayed. I was able to walk—barely but I knew that would rule out an ankle fx—Ottwa ankle rules.
I returned to the ED, waited and waited some more. I turned down taking any pain meds, I wanted to do an n=1 experiment. That experiment being, firstly I wanted to really feel, clearly, moment to moment what my body was going through, secondly I also wanted to take this idea of ideomotion and try it out, thirdly I wanted to experience what it was like to have counseling and how that affected my pain symptoms.
A little background, I am part of a community of people, whom meet regularly to counsel each other. We are not professionals, but more like friends, we do not offer advice but more serve as partners for listening. How this works, is that when individuals meet, we have a timer, and we trade time. Trading time means that one person gets the undivided attention of the other while that person talks, laughs, cries and shares whatever they have going on with them. The goal is to give undivided and nonjudgmental attention to the other. So when I refer to counseling that is what I am referring to (within this post).
So what did I notice, first off, the adrenaline that accompanied the accident was wearing off. I could feel moment by moment tension increasing in my right ankle and knee as they swelled. I also got the sense that my body wanted movement. I found myself doing the proverbial writhing. I shifted to and fro, side to side, at one point I was upside down on the bed with my feat elevated as high as they could get up the wall. I really could just not stay in any position for long.
After a while of this I picked up the phone and called one of my ‘counselors’—so normally you trade time but in cases of pain and death it is allowed to have one way time. I talked with her, walked through the accident step by step in my head, talked through my worries and concerns, moaned, and kept telling her I just wanted to be a little ball (which is ironic, I guess because I am not a little man). It was weird but after I started to do this, and curl up into a ball these bouts of discomfort started to abate and I felt a bit calmer. The sense to move was abating and I could feel myself easing.
During this time I did notice that my psoas bilaterally, but L greater than R, L hamstring seemed to be stuck in the “on position”. I could feel them ‘bubble’ sometimes as I would try to breathe, perform some Hannah Somatics side lying exercises but they were like in lock down protection mode. Also I had super nerve tension. To look down would send electrical signals down my e-spine. In fact afterwards, I had extreme trouble getting into the car because I could not flex my head due to this.
I went through a phase of nausea, about the time I think my adrenaline was coming down, this was brief but not that intense. After I had relaxed for a bit and gone through about 30-40 min of counseling I started to feel very hungry. So I ate the lunch I packed (for work, not the accident). I also felt very cold in my feet so much so that I could not tell if my feet were cold or painful.
Eventually, x-rays came back clear. I hobbled out of the ED. I could not stand up straight, left knee felt loose—I was apprehensive about putting weight on it and bending it. It also felt like there was corset around my waist that was cinched down super tight.
This part of my experience has led to the following reflections.
- My discomfort was worse when I was alone. That having someone there (albeit on the phone mostly) greatly aided my discomfort.
- Expression of that pain through moaning and writhing did help.
- That in my case, after I knew I could move, the movement generally aided the discomfort. Overall I was quite surprised at some of the positions that I ultimately found comfort in. Also, I wonder how many acutely injured people are not implicitly given that authorization at these early stages that yes you can move.
- The general anxiety of the ED is very dreadful. There were people outside my door talking about the shooting in Connecticut. Also, listening to other people in discomfort also greatly increased my anxiety and perceived discomfort.
- I wish I had someone that knew some DNM. I would have loved to experience that during this “session”. Diane seriously, where were you?
- I think we could greatly, appease and decrease the use of opioid based pain meds if patients are given better attention during their time in the ED and providers do a damn good job of answering the question “Am I alright?”. I think much of my own education allowed me to answer this question myself, but I did find it surprising how much I had to pepper the MD’s with questions to determine what they were thinking
I made it back home with the aide of my counselor friends. Eventually, I curled up into a ball and gradually eased into sleep. Throughout the day, I altered between supine, side lying, standing (hobbling). I found myself walking with a straight L leg because of perceived apprehension due to my questions of ligamentous stability (I am guessing a full MCL tear, perhaps an acute meniscus fold as well), and my R leg in max eversion because it hurts to DF through talocrual joint.
At approx. 12 hours post-accident I decided to take 800 mg of ibuprofen, mostly because I wanted to see the effects (they were dramatic, maybe 50% more ease with movement.) Still I walk with a very guarded gait but right now I feel much more comfortable experimenting with different types of gait.
Overall I am fine, I think I have a full thickness MCL tear (which is moderately disconcerting because one I have never had an ortho surgery and two the possible ramifications for the sports I like to do), but we’ll see come Monday. There was a lot of anxiety about financials but the other driver was at fault, he admitted, was cited and has insurance—so that eased one of the biggest anxieties of the day—how much this is going to cost me? I am pretty banged up, my helmet is cracked and with a sizable chunk taken out of it, my bike is done for.
We as therapist rarely get to experience the lives of our patients. I am writing this post from my perspective of both the therapist and the patient to further my insight into the human experience.
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