Bill’s Bicycle Accident (and Medical Technology)

Essay Version 3.0 – an update- 12 July 2008

The Scars Heal

Milestones and the Road Back

The bicycle accident was 3 June. I’m amazed at my recovery progress in just five weeks. A major milestone for me last week was drinking a beer from a bottle with my right arm! Just four days ago I started to eat using utensils with the arm. It is still stretch (pun intended!) to do both those activities – I still have a long ways to go to get back range of motion. Not to mention getting back my never-very-large bicep and muscle tone!

Looks like there won’t be much of a scar, thanks to the skill of my surgeon and making the incision along Langer’s Lines, a phenomenon of the body which my daughter Lara brought to my attention.

In the meantime, it will be physical therapy. I’ve started to lift things with a little weight (and more weight than a beer bottle) such as laundry baskets (yes, I do my own laundry!), a small jug of milk (for latte’s, of course) and even my precious tablet/laptop computer. My next physical therapy goals include running a power drill and swinging a hammer to rebuild our deck!

---

Version 2.0 – Updated 15 June 2008

The X-Rays

Bill's broken arm right after the accident

I saw my X-Rays for the first time a on 12 June and here are a couple of selections. Click either one for a larger version. The one on the upper right is the “after the accident” version, from about 2100 hours on Tuesday, 3 June. You can see a few miscellaneous pieces of bone floating around. Ugh.

Bill's broken arm after surgery and stainless steel

The one on the lower left is the “after” the surgery, probably about noon on Wednesday, 4 June. You can see all my new, stainless steel hardware. The dark line on the left is a plate – it is seen edge-on. All the dark lines running into the bone are screws. This hardware is permanent. It should go through an MRI or other imaging just fine (I’d heard that stainless steel in an MRI is like putting metal in a microwave. Not good – also not true fo this mix of metal). Doc also says the TSA will NOT become my best friends – that this amount will probably not set off an airport scanner. But it probably WILL set off Courthouse scanners. I’m not sure what that says about security in either venue, and I don’t think I want to investigate further.

Oh yes – I am NOT getting the Microsoft Vista software upgrade for my new elbow hardware. One blue screen of death (no puns intended) is enough for this incident.

The Post-Mortem on the Perpetrator

I found a broken part on the bicycle front brake. It essentially holds the brake cable to one arm of the brakes – then the cable threads through the other arm. The photo at right illustrates this and is annotated. Click to enlarge.

When the small part broke, the hand-brake cable connecting the two ends of the brake arms together flew loose from the arms. I’m not sure why this should cause the arms to clamp shut unless there is a spring in there someplace. I need to investigate further. But my wife and a witness at the scene both verified the front wheel did not move as they loaded it into the car after the accident. More later on this.

A Few More Thoughts on living One-Handed

Again, I am astounded at how fast the recovery is going. I’m still two to three months away from swinging a hammer. (Why would I want to swing a hammer? Ah, a topic for another time).

•   This week I’m doing much better – still sleeping a lot – 10 to 12 hours a night, but virtually all pain is gone – I’m just taking a few Tylenol on occasion.

•   Every plastic bottle (e.g. cokes) requires two strong hands to twist. I now understand what people with arthritis are going through.

•   A compression bandage and glove really reduced my swelling this week – typing speed two handed is virtually back to normal and I’m using a mouse with my right hand.

•   It is still hard to sit in one place for a period of time or walk more than a few blocks. Backache is the most common result (I’ve never had backaches in my life).

•   I still can’t touch my head with my right hand. Makes scratching, holding a phone, drinking a left-handed operation.

•   Stitches should come out this week.

Now the physical therapy begins!

---

Essay Version 1.0 – 7 June 2008

The Perpetrator Bicycle

I’ve not been able to write a blog entry on this site for the last few days and I have a bad excuse: I shattered one end of my humerous (the upper bone) in my right arm while bicycle-commuting on Tuesday, June 3rd. I am, of course, thinking about all the great technology insights I’ll get while healing and gobbling oxycodone over the next few months!

The Story

Here’s the basic story of my bad breaks (with all puns intended – I will get a lot of bad puns out of this incident!): For about 25 years, I’ve commuted home from work by running. It is a little under six miles one way. I get some exercise and I work out the stresses of the day. I take the King County Metro bus the other way into work.

But all those years of running have taken their toll – despite lots of stretching, I’m now too sore to run two days in a row. So I cycle, which has the added benefit of allowing me to attend those occasional evening meetings expected of me in my job, or to bike to an evening discussion with my political organization here in West Seattle and then bike home, still getting in a bit of exercise.

Tuesday night I was on my commute, helping to “save the planet” by keeping my carbon wheelprint small. I was on the bicycle path at LaFarge Cement, 5400 West Marginal Way SW, and my front tire siezed. It just stopped cold, as if grabbed by a steel vise. I flew over the handlebars and apparently landed on my right forarm. The humerous shattered and pierced my skin from the inside, creating a small hole in the arm.

I did not lose consciousness, but it was pretty obvious the arm was broken. It flopping around, as loose as a roll of uncooked pizza dough. I put it on my stomach using my left hand, pulled out my trusty BlackBerry, and called – no, not 911, but – my wife, Kathy! That’s how important she is to me, that I scare her half-to-death before getting the Seattle Fire Department on the way!

I did call 911 right after talking to Kathy. They arrived expeditiously, splinted the fracture and loaded me into an ambulance. I also need to thank an employee of LaFarge who stayed with me until SFD arrived, and then helped Kathy load the bike and my belongings to our car.

I spent most of the next hour high on adrenalin, thinking about how stupid I was and how skilled my left hand is going to become over the next three months!

The Medicine

Harborview Medical Center, Seattle, aka "Heaven"

Harborview

Although we are long-time members of Group Health, the ambulance folks diverted me to Harborview, the only Level 1 trauma center in four states, due to the nature of the injury. My office is only about four blocks from Harborview. We see Medic One units, ambulances and helicopters bring patients there all the time. Now I’ve seen that event from “the other side”. Harborview Hospital is run by the University of Washington and supports their Medical School training mission.

Kid Doctors

Every physician I saw in the next three days was a kid. Not literally, of course, but they sure looked it. Part of this is that I’m getting old (can it be?) and part of it is the intense nature of Harborview – a good training ground for medical residents and interns. And, as far as I can tell at this point, they did an excellent job in very high stress circumstances. More details below.

Injuries

I was startled to learn Harborview sees 100 injuries of this nature a year! Two a week. I don’t know if those are all bicycle injuries or they are just other folks who try to do cartwheels with their 59 year old bodies.

X-ray technology has advanced phenomenally. First, the Harborview X-ray unit is right across the hall from the trauma ER, so the number of potholes in the floor is minimized (and with a broken bone, you feel every one of them). The X-ray machines are such that minimal movement of broken limbs to get them under the “rays” is required. And the prints are developed in 30 seconds.

The end of the humerous was shattered. It was fractured both vertically and horizontally with at least 14 pieces to be pulled back together and set in place with screws or plates.

One of the most awful feelings during the whole ordeal was feeling of the ends of the bones grinding against each other at various times during the evening as I was moved about. There wasn’t a lot of pain to that because of all the meds, but I could feel it both physically and mentally.

Nevertheless, I am lucky. While I had a few bruises and scrapes, including at least one deep one in my right leg, I had no other broken bones. Not even a cracked one! When you consider all the things people break in such accidents – hips and femurs and pevli (pelvises) and clavicles and ribs, that is lucky.

Reducing

I spent about five hours in ER waiting to be reduced. I’m short enough at 5 foot 9 inches, but this reduction is a bit different: essentially giving me enough pain meds so they could pull the humerous back apart and temporarily splint it in place. The five hour wait was because both the orthopedic docs in the ER were busy working on amputations that evening. It was ok to wait!

Helmets

I repeated my story about the accident at least six times. Every time I was asked if I was wearing a helmet at the time of the crash, even though I did not hit my head, lose consciousness or have a head trauma. I guess that tells one about some of the injuries they get.

Recovery

I was wheeled into the Operating Room at 9:00 AM Wednesday morning for a five hour surgery to perform the reconstruction of the humerous. I don’t know how many pins or screws or plates were used, although I’ll ask when I see the orthopedic team on June 12th.

Again, I am amazed at the changes in medicine since I was a kid. Now remember – I haven’t stayed overnight in a hospital since the 1950’s and I’ve really never had a serious broken bone (I had a cracked ankle bone once).

The orthopedic team did not use a cast! They made a long incision in my forearm so they could get in and rebuild the bone and the elbow joint. That was wrapped in gauze and an Ace bandage. And I have a sling, although they don’t want me to use it. Rather, they want me to extend and contract the arm as much as I can – using only the arm’s own muscles – no exterior pressure from my other arm.

i am surprised how fast it is all progressing. And it is moving fast because the philosophy is not to “sit” and let it heal, but rather to keep moving, e.g. keep my fingers moving to keep the blood circulating and the swelling down.

Pills

I’m really only taking a few meds – oxycodone for the pain and tylenol for the swelling (THAT is a wonder drug). Plus some laxatives because the oxycodone tends to “bind one up” so to speak.

The main problem with the medications is the mathematics! The oxycodone comes in small pills to be taken every three hours. The tylenol is large pills every four hours. Keeping that straight requires a bit of tracking (gee, can anyone build me a little MSAcess database?). Doing the tracking can be tough when it is the middle of the night, you are in pain and trying to take care of other bodily functions!

Maybe the pharma companies can work on a tylenol you take every three hours or an oxycodone you take every four hours? A suggestion for an entrepeneur!

Pill Bottles

Until this week, I rarely noticed those childproof pill bottles.

Now I do … they take two hands to open! And I’m one hand short at the moment, although Kathy and my daughter or son-in-law are usually around to help. And we do have a three-year-old in the house, so keeping the pills in the Bill-geek-and-granddaughter-proof bottle is probably a good idea.

But having a bottle with a reminder chime would be a nice touch. And maybe the bottle could be equipped with RFID and then linked into the user’s personal area network so a BlackBerry or similar device can open it upon command or at the appropriate medication time. That would also help households who have multiple people on different medications because there appears to be a prescription drug container version of the IEEE which dictates all the bottles and labels must look exactly the same.

Chronology

Tuesday, June 3, 2008, about 6:20 PM – accident

Wednesday about 3:00 AM – stabalization finished in the Emergency Room

Wednesday about 1:00 PM – surgery to rebuild the arm complete

Thursday morning – first meal (other than IV), able to walk to the bathroom alone

Friday about 12:30 PM – discharge from the hospital

Saturday, 6:00 PM – Arts West Auction and Dinner at South Seattle Community College (life returning to normal)

Life – A Life-Changing Event – Not!

Certainly my eyes are opened a bit – as they were ten years ago when I was on crutches with that cracked ankle – to some of the everyday heroes around us. That is, those people who live with this sort of disability permanently, and those who help them. But I am hoping that the only permanently life-changing part of this event is the insights and ideas I’m chronicling on these pages.

The Bicycle

That bicycle is headed for the South Transfer Station, aka (also known as) the DUMP. After I or the bicycle shop can determine what caused this mishap.

When I checked the bike out a few minutes ago, the wheels moved freely and it seemed to have weathered the incident much better than I. Did a piece of road debris lodge in the wheel or did a rock stick between the brake pad and tire rim? What could cause the tire to sieze up so firmly?

i need the Seattle two-wheeled version of the CSI squad.

It was a $400 bike two years ago which seemed enormously expensive at the time I bought it, and frighteningly cheap this week. Its most distinguishing feature was – and remains today – the small white plastic horn molded in the shape of a “kitty”.

The Technology

So the whole purpose of this entire website – chiefseattlegeek.com and blog.chiefseattlegeek.com – is to discuss technology and its use in Seattle’s government, right? This section of the essay is devoted to the technology aspects and insights from my accident.

Typing this Blog

First, I am typing this two-handed. Yeah! All I can say is that physical therapy and recovery recommendations are much different now than they were 40 years ago. Typing actually is supposed to reduce the swelling in my hand by improving circulation. Although at the moment my right hand/arm is twice the size of my left. And I am NOT exaggerating!

911

City of Seattle’s new Fire and Emergency Ops Centers

 A few weeks ago I attended and spoke at two opening ceremonies for the City of Seattle’s new fire alarm center and emergency operations center (EOC). I blogged about those functions here:   Dedication to a Safer Seattle.

At those dedications I talked about disasters. Some disasters are large or regional, such as an earthquake or the Mariners going to the World Series. (The latter is not a disaster in-and-of-itself, but it would require regional mobilization of resources for traffic management and anti-terrorism. It is certainly not likely to happen any time soon, given their present cellar status!).

I went on to say most disasters are personal – car thefts, a heart attack, an accident. It is those disasters which unfortunately touch everyone’s lives sooner or later.

I had no idea I’d be using the FAC service myself so soon after dedication. It was as prompt and efficient as I’d always hoped – a call to 911, a brief discussion with a police dispatcher, hot transfer to the FAC for a medical emergency, and within four minutes the crew from Engine 36 pulls up next to me and my bike.

I know about a lot of the technology which made that dispatch possible – phones, trunked radio, computer aided dispatch. But seeing those three skilled firefighters with their aid kit was wonderful. It is great to live in Seattle knowing those firefighters – and the technology behind them – is only a 911 call away when you need them.

BlackBerry

RIM’s BlackBerries are godsend. I was able to type my first BlackBerry response to an e-mail early Wednesday afternoon. Not that I should be doing e-mail less than 24 hours after a bicycle accident. But the BlackBerry allows one to stay in touch both during work hours and while “on breaks”!

Toilet Seats

Our house has a recently remodeled bathroom and it came with a new Bemis toilet seat.

Somehow that seat is designed so that when it is up and you drop it, it falls very slowly rather than crashing to the bowl. Which is wonderful when you are arm-impaired, using the device in the middle of the night, and don’t want to wake the entire house!

Voice-Activated Computer Technology

I am not using voice-activated technology with either my home or work computers right now. Gee, it has only been about 3 days since the accident! No time to get it installed and trained (to my voice). But I’ll almost undoubtedly get some installed very soon, especially at work, in order to keep up with the e-mail deluges. Do you have any suggestions for products?

Left-handed Mice

I know they make them and i know I need one, but my left hand quickly got used to using the right-handed mouse. I’ve had a wireless mouse and keypad for years, both of which are wonderful in this situation. The wires at the hospital bed (IV, morphine, telephone, nurse call button, TV) were continually getting crossed and often fell to the floor in a pile together.

Future Security Challenges

 

I look forward to my first encounter with the Transportation Safety Administration and Airport Security with my new “on board” hardware. The King County Courthouse and Seattle Municipal Court will provide similar opportunities to have my name added to new lists and for watching security technology in action as applied to my right arm.

 

 

Summary

The three dominating features of the last week for me (other than pain, of course) are the advances in medicine, the advances in communication and great people.

A week ago I mentally lived in a world with plaster casts and long hospital stays. Today, five days after an arm-shattering injury, I’ve just typed a whole article with two hands/arms, took and processed photos, and can perform most routine daily tasks.

Communications technologies I knew about, but this week really brought home all the interconnected threads of communications in our lives – 911 and blogs and BlackBerries and e-mail and phones and web posting and integrated software management of everything from 911 dispatch to hospital operations. With medical advances, healing happens fast, but having all this communications at ones fingertips* forces it to happen fast.

And great people. Each of our lives has webs of people upon which we all depend. Some are personal and others are “in the wings” springing into action when we need them: nurses and firefighters and 911 dispatchers and emergency medical techs and ER docs and my wife Kathy and daughters and co-workers and family and friends. This set of people-webs becomes very visible and active, just when you need it most!

Version Changes

I wrote this blog entry as an essay because it is really a whole series of related thoughts around one topic. I do expect I’ll add some ideas to it as my recovery progresses and as you all send me comments or make comments on my blog which trigger new ideas. I’ll change the versions and the dates on these paragraphs as I make updates. You make make comments on my blog here (if you want all readers to see the comments) or you can send me an e-mail here.

 

An Essay