I'm home! With a small complication . . .

Last Saturday, twenty-four weeks since the fall, I moved back home from The Ballard Landmark Assisted Living Facility.  This was my first time back home, . . . it's been a while! 

Because our home has steps leading up from the sidewalk to the front yard and more steps to the front door (with similar obstacles approaching the back door) there was no way to make it wheel chair assessable and so returning home was dependent on safely traversing steps & stairs.  I am now doing this (carefully) in spades.  When I get up from my desk and head to the break room for coffee I tack on a couple laps up & down the indoor flight of steps to The Mountaineers top-floor meeting room.

Marijane moved my clothes and the other stuff that fit in boxes, and Dolly.com moved the bed, night stands, table, and chairs.  Thanks again Marijane!!  Dolly.com deserves a shout out as well.  If you haven't used them yet, it is like Uber for folks who own a truck and for folks who need a truck.  It was incredibly easy (and cost effective) to schedule a micro move, and the two helpers who did the "heavy lifting" were timely, friendly, and professional.  Couldn't ask for better.  If you need a truck and folks to move stuff for you, Dolly.com is a great way to go.

The complication has to do with one of the things I talked with the back doctors about at my six month visit last week.  Everything with the back is fine (and they were pleased with the most recent set of x-rays), but there is a lump/bulge on the side of my abdomen close to the 6" incision which allowed access to the blown out vertebra (so they could pull out the shards, and replace it with a titanium cage).  The bulge doesn't hurt at all, but it has altered the shape of my torso enough so that pant waists no longer fit. 

It could be that the nerves in the vicinity disturbed by the surgery aren't yet firing and so muscle tone isn't consistent across my abdomen, but more likely it is the result of me doing too much in-bed leg-lift physical therapy with leg casts which caused a hernia.  Yikes!  The back doctors gave me a referral to the side-opening doctors (interesting note, . . . as it turns out a different set of doctors actually opened me up and moved all the internals out of the way so the back doctors could do the vertebra replacement work) who are also familiar with hernia repair and I'll visit with them next week.  Once again under the knife!

It ain't over 'til its over . . .

The long ascent ahead

In the last several weeks at physical therapy I have moved from basic skills (walking, balance, stairs) to kinetic strength building (more sets and more reps), finally getting my heart pumping again with perspiration streaming down my face.  I can transition back and forth from standing upright to lying on the floor, so have increased the range of exercises I can accomplish.  Feels good! 

And not a moment too soon, . . . I've regained all the weight I'd lost during the first several weeks of surgery & convalescence, and there's no way that it is all muscle (although hardware remaining inside definitely contributes) so it must be chub and that just won't do.  No more desserts for Bill.

Doctors & PT folks encourage me to walk to tolerance, so I leave the power wheelchair at work and walk as much as possible while away from work.  The power chair allows me to keep my feet elevated for the majority of the day while at my desk, and I use it when traversing further distances around The Mountaineers Program Center.  My feet and ankles swell after PT and extended walking episodes so I've taken to icing them afterward, and because feeling is still limited throughout the damaged areas the cold doesn't really distract me.

That lack of feeling in my left ankle / foot is the biggest distraction at this point.  It feels very similar to the pins & needles sensations you get when a joint has gone to sleep after being restricted for too long and when you begin to move it again.  Rather than lasting a minute or so this feeling has been with me over these last several months and will be with me for many months more while nerves slowly mend (one millimeter per day or an inch per month).

Pain remains a minor distraction.  Feet & ankles are "tender" when walking, but in no way eye-watering. The back has never been anything other than stiff and maybe just a little sore.   Hands/wrists/forearms respond typically to PT range extension exercises (ouch) but during day-to-day activities they report just an occasional dull ache.  The doctors assure me that arthritis will be a constant friend going forward and the ache is likely a precursor.

Good news!  I've been able to remove tight compression socks by myself and with the help of a "sock donning device" I'm now able to put them on by myself as well (just five months after the accident).  Had worried that insufficient flexibility would forever limit my ability to dress myself!  This minor victory is especially satisfying, as it is the last vestige of being unable to fend for myself and it allows me to shower at my whim rather than scheduling assistance to remove and replace socks before and after showering.  (Thanks Marijane!!!)

Yesterday morning I dropped off all the other convalescence aids (slide boards, etc.) at Anderson House (the skilled nursing center I stayed at after departing Harborview) to assist others on their way to recovery.  Still holding onto a couple of walkers and a portable wheelchair just in case, but those will eventually find a new home as well.

From here on it's just a matter of remaining resolved to push hard and keep going, walking further and faster, increasing strength building reps, . . . typical Mountaineering stuff and Ashby protocol. 

Onward.

Pictures worth a thousand words

Pictures are worth a thousand words . . . but not for the faint of heart.

In service of this being a cautionary tale, I offer the before & after film of the injuries I sustained as a result of taking a 40 ft fall from a climbing gym wall.  All of this is the result of literally two seconds of distraction as I began climbing my last route of the day using auto-belays where I failed to use my standard safety protocol of double checking that I had clipped into the auto-belay, and as a result I climbed the route unprotected. 

I fell at a 45 degree angle back first, so my feet hit first, then butt, then hands, and finally face (must have been looking over my shoulder on the way down, . . . I have this fleeting memory of checking to make certain I wasn't about to land on somebody by mistake!) 

As it was the last thing that hit, there was nothing broken on my face/skull, . . . just a concussion, black & blue bruising all over, and a bloody nose.  I exploded one vertebra (which was replaced as can be seen in the film below ) and had four others fused to my hip bone (titanium train tracks running down my back).  Lots of snap, crackle pop in both hands, wrists, forearms, feet, heels, ankles, and shins. 

The pictures below are a representative set from the many hundreds taken over the last several months.  I've definitely received more than the usual dose of x-rays!

Hand repairs viewed from top down

Hand repairs viewed from side on

Back repair viewed from front & side (the block is the replaced vertebra)

Shins before repair - left & right

Left shin before repair

Left shin after repair

Right ankle/heel before repair

Right ankle/heel after repair

The Harborview trauma teams definitely know their stuff!  What great fortune to be put back together by folks who have done it thousands of times!

I climbed stairs, . . . and drove

Now, when walking at PT I carry trekking poles only as insurance, dragging them along behind me around the PT room.  Also my PT person encouraged me to arrive early and put in time on their peddling machine, so I'm building on balance and a little cardio capability

Between PT sessions I have been walking on my own around the office at The Mountaineers or up & down Ballard Landmark hallways.  Last weekend I overdid it by walking two full circuits around the ground floor of the Ballard Landmark, which resulted in a swollen left ankle, so I reigned it in this week to get the swelling down in time for a first attempt at stairs this morning.  Henceforth I'll use ice on the left foot/ankle after PT sessions or walking on my own until it begins to behave as well as the right foot/ankle.

This morning, after warming up on the peddle machine and demonstrating satisfactory pace and balance walking around the room for a couple laps, we headed outside to a half flight of stairs near the PT entryway and I began to make my way carefully up and down.  "Bad foot first on the way down, and good foot first on they way up," is the rule.  All went well with my PT person close at hand and ready to catch me if I got wobbly.  No sweat!  Afterward, we agreed that we should work on this several more times before she'll give me the green light to try this on my own out in the world.

Earlier this week she had given me permission to try driving, so this afternoon I met the AAA person at our house to jumpstart my car, and once it had warmed up thoroughly I drove around quiet Ballard streets to reintroduce basic driving skills, and then I drove along Ballard arterials and beyond through the nearby neighborhoods.  After an hour of anti-climatic tooling around I returned home, nonplused that getting to drive after five months of convalescence wasn't more euphoric.  It was like nothing had happened between now and the end of June.  I suppose that's a good thing?  

The good news is that with an ability to navigate stairs and operate an automobile, I am very much closer to heading back home, very likely before year end. 

This morning I asked my PT person what it would take use a bicycle and after a pause she suggested I work on balance and endurance by increasing the speed and distance I can walk before trying a bicycle.  OK, so those are my next goals, . . . speed & distance while walking and then commuting to work via bicycle, both awesome ways to build up conditioning and muscle mass.

Oh, . . . first I'll need to figure out a way to put socks on by myself!  Thus far I haven't regained enough flexibility to reach down with both hands to the tips of my toes to pull on socks.  I'll figure out something though! 

Steppin' it up

So that first walking experience wasn't a fluke, and there were no after-shocks or repercussions as far as pain or soreness afterward.  Since then I have returned to PT several times and have walked further & "faster" each time.

On my next visit I made a circuit around the PT room with a walker, leading with one foot and stepping up to, but not ahead of, the lead-off foot with the following foot.  The visit after that I made it three times around the PT room with the walker, still stepping "up to but not through." 

This morning---after totally dominating standing up out of the wheelchair, . . . why was that so challenging last week (?!)---I began taking honest to goodness full-on steps with the trailing foot moving ahead of the planted lead-off foot.  Did that several times with the walker and then graduated to two trekking poles for several laps and finished with a couple more laps using a single trekking pole, . . . which was kind of frightening with my balance still not where it needs to be.  Was glad to have my PT's hand on a gate belt strapped around my torso just in case I started to topple.  At the end of the session I was sweating and my legs were quaking from the effort.

In my minds eye, I see myself climbing the big glaciated mountains & volcanoes of the Pacific Northwest, . . . Rainier, Baker, Adams, Hood, Olympus, Glacier, Shuksan, Little T, etc, . . . and so there's an interesting little disconnect between that mental image and being tuckered after several very slow laps around a PT room carrying zero weight on my back and with no elevation gain and wearing comfy slippers rather than heavy mountaineering boots!  None-the-less, I savor every incremental improvement and revel in every new "personal best."  This is getting fun!

And it is so easy to celebrate as there is a Mighty O donut shop just across the street from my PT place, so I stop off there and pick up a dozen for the crew at The Mountaineers before catching a Metro bus to work.  Yah, . . . it's all for them, . . . what an altruist! 

I walked

Yesterday at physical therapy I stood up out of my wheelchair for the first time since the accident. I stretched my hands high above my head, looked up at the ceiling and gave a bellow of joy. It felt so good to be standing straight up, arching my back and flexing all my muscles.

Next I began gently swaying back and forth weighting each foot,  and then I began to shuffle gently and carefully sideways keeping balance with my hands on the edge of a table. After one circuit of sideways shuffling I turned and began walking straightforward with one hand for balance.  No pain. Okay well maybe just a little.

When I arrived at physical therapy yesterday morning I didn't really know what to expect. I had received a prescription from the foot surgeons to begin load bearing and it said something about load-bearing "to tolerance" and I wasn't exactly sure what that meant.  I thought maybe we would just apply gentle pressure initially while remaining seated in the wheelchair. Turns out "to tolerance" means "go for it!"

Achieving this milestone was totally unanticipated, as I wasn't expecting to start load bearing for another two months and I figured that I wouldn't be standing for another two months after that.  I'm completely off the map as far as where I'm going and what's next---which is not a bad thing and I'm not complaining---but I am just a little discombobulated is all in a very good sort of way.

Somebody pinch me!

It's amazing how quickly the days are passing, but this most recent Thursday marked another six weeks since the last visit with the Orthopedic Trauma teams who worked on my feet. Anticipating this visit I've been cautious and careful about transfers to and from the wheelchair--- trying especially hard not to load bear on my feet and cause swelling--- and I've taken extra precautions while under way in the wheelchair to ensure I don't run into things--- my feet always protruding in front as tender, ineffectual, and unintending battering rams!

I go to these appointments with a certain amount of trepidation, not knowing whether I've unintentionally done something to my feet, hands or back that has compromised progress or even permanently limited the potential for full recovery.  Have I been using them too much while bending, twisting, and lifting in all the little ways you really can't avoid when making your way in the world in a powered wheelchair? It's a compromise after all between forgoing daily explorations in the world to ensure the maximum potential for recovery and throwing caution to the wind while just getting on with life.  Hopefully the path I've chosen is well-balanced between mindfulness not to push the boundaries too far while getting out there and contributing.

So with fingers and toes crossed for good luck I made my way once again to Harborview in the unusually wet and blustery Seattle fall weather---lifting my feet high while fording street-side rain gutters, the wheels of my chair making wakes as they rolled through the puddles standing in the sidewalk dips & valleys, the poncho that covers me and most of the chair drenched and dripping whenever I come in from the elements.

The doctors wanted an extensive set of films, so the x-ray techs had me transfer from the chair to the exam table and we went through the motions of me striking multiple poses with both feet.  Pleased with their results they sent me away to an exam room to await the doctors' verdict on the healing process and next steps.  Once the doctors arrived we started slow, looking through the prior series of films and then looking at those taken just now, pointing out where various bone shards ended up after the fall, where they were resettled after surgery, and the extent to which they had regrown.  (As an aside, it amazes me that bones actually know which way to grow and they don't just end up growing in a puddle down there.)

The doctors recited what they had told me after the surgeries and upon each of the prior visits: this was the most trauma they had attempted to repair for over a decade (and these are trauma center docs!), the uncertainty of the outcome, the likelihood of early-onset arthritis, the necessity to be extremely careful as convalescence progressed, the possibility of additional surgeries. . . Yada yada yada.  Then they started talking about needing to wear the removable protective boots---that have been a constant part of my life since removing the casts a month after surgery--- only when I practice load bearing on my feet.  What?!  Huh?!! No more boots? Load bearing??

They described how I should begin limited load bearing by transferring to a non-powered wheelchair at work so that I can push myself around the office with my feet. They wrote prescriptions for the new wheelchair and a walker and for the physical therapists to begin working with me on a program of gradually increasing load bearing over the course of the next six to eight weeks with the intent of achieving 100% lead bearing within that time frame. Was I dreaming? Somebody pinch me!

I asked them to repeat themselves. It was like I was in an alternate reality. I wasn't expecting to be able to begin load bearing for another two months and now they were telling me that I could get going anytime.  I wanted to get out of there as soon as I could before they changed their minds or discovered that they had made a mistake. Everyone was smiling, the doctors, the nurses, Marijane and me. It was apparent the hospital staff were proud of what they had achieved and it felt a little like some sort of graduation ceremony.  Pretty heady stuff. I was going to walk again and two months sooner than I thought.

It occurred to me to ask why they hadn't given an inkling of this possibility at our last visit but then it became clear that there's really no saying what would (and will) happen from visit to visit and they didn't want to raise any false expectations along the way.  With all this very excellent news the doctors did also manage to slip in the possibility that at some point they might (probably would) need to go in and remove one of the large threaded screws (especially after it shears from repeated cross-load pressure with each step) and/or add another plate to stabilize (fuse) my left ankle.  Details, details, . . . In a matter of several  short weeks I am going to be a walking man!

Outside the hospital, under the cover of a large glass awning, Marijane and I hugged for a long time and we thanked each other for having worked so hard to get to this point.  She waited with me at the bus stop, we waved farewell multiple times as the bus pulled away, and I thanked my lucky stars (and all eminences of good will) for our love & friendship, for this life, and for this day.  Once at Magnuson Park I blew through the leaves billowing from the trees and raced them scutting along the ground as I wheeled my way back to work at the Mountaineers, . . . .

Tools of the trade

Some of you are probably curious how I get certain things accomplished, so I thought it would be helpful to share certain tools of the trade and the skills you acquire when you're living in a wheelchair.

First of all there's the wheelchair itself. Mine is a Permobile M300 and it is quite a thing to behold (a cobalt blue body with black trim).  Important features include the high-tech seat with dozens of separate but interconnected pressurized air cells that gradually shift air back and forth as you lean this way and that, which makes for incredibly comfortable seating (of critical importance when you're in the chair 16 hours per day).  Three electric motors control the chair's angle of repose, and you can adjust the leg support and the back rest from a sitting position to nearly horizontal; haven't done it yet but it would be easy to take a nap in this thing. A separate motor drives the wheels, and the battery holds enough juice for up to 10 miles.  You can adjust the sensitivity of the joystick direction & speed controller to move with more dexterity in tight quarters and otherwise to power up when you're out on the street.

Eventually you've got to get out of the chair---like when its bed time---and how does that work? Well there's this thing called a transition board.  You tuck one end underneath you and you set the other end on the thing you want to transition to,  and then you do this miraculous skootching motion, where you defy gravity for a fraction of a second while you slide/hop your butt along the board without placing any weight on your feet or hands.  Takes practice to keep both ends of the board in place and to keep your balance on the way.

So you've transitioned into bed and drifted off to sleep, but eventually you're awakened with the need for a bathroom break.  Are you going to set up a transition and roll to the bathroom? No way!  Enter the portable urinal, an oblong plastic bottle with a wide mouth and a handle for easy manipulation. I don't know how this works for women but for men it's a fairly straightforward deal; just position the urinal and take care of business.  Of course it's very important to have a secure place to set the urinal after use and you never want to fall asleep without first moving the urinal back to its secure position. Messes ensue otherwise (or so I'm told)!  This portable urinal trick works throughout the day to avoid having to transition to a toilet.

Eventually though you'll need to transition to a toilet which isn't a big deal as long as you have another transition board ready at hand. One thing to consider though is the amount of time it takes to set up and execute a transition so you've got to be extremely aware of your body's internal time clock and anticipate the need because you really can't afford to be 20 seconds late.  Everyone has their own means of getting things moving but I have found a couple cups of coffee and a couple of prunes first thing in the morning insure that I've taken care of business before it's time to leave for work, which is actually kind of critical for me because I commute via Metro bus for over an hour and I would be totally SOL if urgency struck while commuting.

Rolling the tape back several weeks---right after the surgeries---while still bed ridden and with arm casts up to your shoulders, your only strategy is to endear yourself to the assistants who bring the bedpans and clean you up afterwards.  But once the casts are off and you or able to transition to a toilet all by yourself you are not necessarily completely in the clear. If your wrists are still fixed in place with plates & rods for example, then there are certain places that you just can't reach unaided.  Enter the bathroom buddy device. This little guy is worth its weight in gold!  It is a curved plastic handle with a paper grabber on one end and it totally solves the inflexible wrist problem.  Just don't drop it while in use, as it's not so easy to retrieve and kind of messy even in the best case.

No doubt you're going to unintentionally drop things (hopefully not in a toilet) so you need a means of retrieving them. The Grabber is a two foot long hollow aluminum pole with a handle and trigger on one end and a little grabbing device on the other end. You will get really good at using the grabber (just don't drop it)!

 Hmmm, so what other tools are there? I use a 20 liter summit pack (Zero Point by Montbell) to carry odds and ends while motoring around in the wheelchair.  Inside the pack resides a waterproof poncho and a puffy jacket with enough room remaining to carry food for the day.  I use Seattle Metro to get just about everywhere beyond a five minute roll; if I lived in a town without public transit mobility would become expensive very quickly.  Oh, . . . and I use voice recognition on a tablet or phone to create blog posts like this or any other longish email, text, or other virtual message.  Typing? Not.

Back Augmentation

After a recent visit with the back doctors, I am struck by the marked contrast between how great I feel on the outside and how thrashed I look on the inside!

After nearly three months of convalescence, last week was the first follow-on visit with the back doctors since surgery.  We compared "after the fall" x-ray film with film they took on the day of this recent visit.  The before surgery film showed a lower-down vertebra completely exploded and a higher-up vertebra pretty-well cracked.  The doctors explained that had the upper vertebra experienced damage similar to the lower one it would have been game over for my spinal cord.   Toward the base of the spinal column our spinal cords divide into several smaller nerve bundles that continue down to the lower extremities, and the exploded vertebra they replaced was below this critical junction.  Yet again, a very lucky dude.

The x-rays from the recent visit showed significant scaffolding they had installed on either side of my backbone like a ladder but with screws attached and extending into either side of each of four vertebra.  I'll save you the doctors' blow-by-blow of the surgery, but given that this blog is all about being a "cautionary tale" (please skip the rest of this paragraph if you're sensitive to graphic surgery descriptions) I will leave your imagination with the doctors being far from gentle with me while peeling back muscle and scouring bone prior to drilling screw placements to prevent infection.  

Because it hasn't felt like there's much of anything new back there, I was expecting to see not much more than a series of screws holding the vertebral together. Surprise! I wasn't aware they had installed that much hardware and that it will remain in place for the duration.

The doctors were pleased with what they saw and indicated I should gradually test the boundaries of BLT (bending, lifting, and twisting) restrictions established at the outset of the first three months after surgery.  Initially while still bed-ridden I was cautioned countless times to treat my legs & torso like a solid log and roll en-masse from one side of the bed to the other for position shifts to avoid pressure sores, linen changes, sponge baths, and other vital functions.  After gaining the freedom of my power wheel chair I was allowed to sit up throughout the day and carefully reach out with the slightest bit of back twist & bend.

Eventually, and within the limits of the range of motion resulting from the hardware, I should be able to do just about everything I was doing before the fall.  It's not that I might yank something loose by trying to do too much, but rather it will probably be a little bit more difficult to reach down and tie my shoes. The doctors suggested looking into shoes with Velcro straps, . . . but you still have to get down there to strap them, and I haven't seen Mountaineering boots with Velcro straps in any case.

Other good news is that I shouldn't be overly concerned about the numbness I feel in my lower left side where they went in to replace that one lower vertebra.  They explained that in moving a lot of stuff around during surgery the nerves in the area tend to shut down but that eventually they would likely settle down and start reporting feeling again.  OK, so I'll suspend disbelief on this aspect of recovery until the next visit with them three months hence.

Potential bad news is that because I'll be bending/twisting with only a subset of vertebra those that remain in action will get much more wear and tear then they would have otherwise, and there's a chance---even a likelihood---that within a decade or so they will be done and will need to be fused as well.  The doctors said that everyone is different and there's really no single protocol for long-term recovery from this type of surgery, so I'll just move forward with the assumption that my body will adapt and build muscle to support the weakened areas and everything will be just fine. 

Harborview redux - shower time!

Beginning to settle into a quasi routine. Returning each evening to an apartment at the Ballard Landmark with spectacular views of both the Olympics and the Cascades has been very welcoming, but with only a bed for furniture I was motivated to visit Ikea to select a table and chairs, bedside tables and lamps. Taking the two hour Metro trip down to Ikea was quite an adventure I can tell you, and I probably shouldn't have had that second cup of coffee before heading out.

This week a group of friends came over for pizza and beer and afterwards assembled the furniture. It was a very fun evening filled with laughter and gentle ribbing about furniture assembly skills. Now the apartment looks a little more civilized and I have more flat spaces to lay things out on at the end of the day. Thanks guys!

Also this week Marijane and I went back to Harborview for another round of X-rays and evaluations. It felt marvelous having the casts removed from my arms and leg, but kind of gnarly looking.  We've come to make very good acquaintance with the cast team and they give us a hard time.  Coincidentally a patient and spouse who had seen Marijane and me on a previous appointment were there again, and they indicated I was looking very much better, . . . less like a train wreck anyway.  

After reviewing the x-rays the hand/wrist/forearm doctor decided I no longer need casts, so now I am in removable braces and can wash my hands and forearms properly. Likewise the foot/ankle/shin doctor decided I didn't need to be in a full-on cast so now I have matching removable boots.  In theory, I can take them off to thoroughly wash my legs, . . . if I could only reach the velcro bindings. (Note to self: it is OK to ask for this kind of help.)

So today was the really big day. It had been almost nine weeks since I had last taken a shower; by mid-morning I had taken the plunge and it was fantastic, like all the national holidays rolled up into one!   This first time needed to be on a weekend morning so that I had plenty of sleep and was fresh and able to think through all of the logistics associated with this first attempt. Also, Marijane nèeded to be on hand with plenty of time just in case something didn't work out and I needed an extra hand. 

Thankfully the logistics came together, catastrophe was avoided, and for the first time in nine weeks I feel wonderfully clean.  And without putting too fine a point on it, I just want to allude to how much doesn't naturally exfoliate when it's been trapped in casts for nine weeks or so. Pretty ripe.

Next visits to Harborview are at the end of the month for a first follow-up visit with the back doctors (one replaced vertebra and four fused as you may recall) and an additional follow-up with the hand doctors so that they can remove plates which will require surgery and more anesthesia. Oh joy!  With the plates out, however, I anticipate being able to start light physical therapy on my wrists and forearms by mid October. It will be interesting to learn what the back doctors have to say. From my point of view it feels pretty good and I just hope I haven't been doing too much and screwing it all up.

The heels, ankles, and shins will need quite a bit of additional convalescence time. We compared x-rays just after the surgeries to the most recent set and although we could see the wispy beginnings of new bone growth it was very apparent that there's quite a bit more that needs to regenerate before I can begin physical therapy.

All in all it was an excellent follow up visit to Harborview with lots of good news and the great joy of knowing that showers, many showers, are in my near future.

Slow motion

The first week on the job with the Mountaineers is complete and it has been an eye-opener. This may seem commonsensical but most everything takes longer to accomplish when you're sporting four casts and in a wheelchair. Not everything mind you; ironically, I motor along faster than most people walk so getting back and forth to bus stops happens in the blink of an eye.

Just about everything else requires strategy. From getting out of bed (and into the wheelchair) to getting out of the door, every step requires careful & methodical pre-planning. Sponging down (forget showering, and bathing is just a dream)? Brushing teeth and flossing? Shaving? Getting dressed? Preparing a lunch? We're talking two hours just to get to the breakfast table!

What you try to avoid above all else is dropping things. Picking things up after you drop them is a huge time sink. You use a long grabber device to pick things up and some things can be really slippery (like your cell phone) or very difficult to capture (like a credit card). The worst thing to drop of course is the grabber itself!  You're not totally SOL when this happens but retrieving it takes another big chunk of time, . . . You have to situate the wheelchair just so and then fully recline so you can barely reach down to retrieve the grabber. Oi!

At work you can no longer take for granted the simple things like preparing a cup of coffee or grabbing a snack out of the refrigerator. It's all about methodical process and careful planning to avoid catastrophes like dropping your coffee cup from a couple of feet off the ground or knocking over an open container of milk. Maneuvering around an office can be challenging as well. There are file cabinets and rolling chairs where you might not expect them so quite often you take detours to get to your planned destination.  It's all good, it just takes time.

Once home, just about every minute is spoken for in getting ready for the next day and preparing for bed.  All in all I have yet to arrive at work when I want to or get to bed on time.  I am getting better each day but man has this been a learning process.

The Mountaineers

They say never mix work with pleasure but I just couldn't resist.

Joining the Mountaineers staff as director of operations is a dream job for me. I love what the Mountaineers stands for and how it goes about moving forward towards achieving its mission and vision. In my mind the Mountaineers organization is one of a kind in the world, and I am consistently amazed by the volunteer ethos continually exhibited by the 500+ people who pay it forward year-in year-out without a second thought.

I have come to know their motivation. We share a love for exploring beautiful natural places and we gain great pleasure from enabling others to safely venture into these realms to establish their own connection. This is a rare and beautiful gift freely given to over ten thousand members which replicates endlessly throughout the outdoor community. There are countless instances where Mountaineers meet others in need and offer their assistance without regard to the impact on there own adventure.

Then there is everything the Mountaineers does to support conservation of our beautiful natural places as well as outreach to youth who might not otherwise have access to these special places.  I feel so fortunate to be part if an organization with these lofty goals!

Getting ready to return to work

Yesterday Marijane, Marie and I hopped aboard Metro and did a dry run of my commute from the Landmark to my new workplace.  We took the 40 bus from Leary Way to downtown Fremont and then transferred to the 75 which took us to our final destination. The trip took about an hour (about 30 minutes in a car).  Marijane and Marie visited the final destination last weekend to evaluate possible wheelchair roadblocks and we ended up finding a safe way from the bus stop to the front door of my new workplace.

I have become adept at maneuvering my motorized wheelchair into the wheelchair accessible space at the front of the Metro buses such that I am able to raise my feet and lower my back and head to keep my feet as close to the level of my heart as possible which is what the doctors want. However to the other folks on the bus it looks like I'm totally chilling out.

Thankfully the dress code at this new workplace is pretty casual and that's good because for the next 6 months it's going to be pullover shirts and shorts for this young man!

New digs!

I've been making so much convalescence progress that our insurance provider decided it was time for me to migrate from a skilled nursing center to an assisted living community.  It makes perfect sense to me as I no longer have need of 24 hour nurse care, people doling out medications, or meals delivered to my bed.

Ideally I would head for home at this point, but because I'll be in this motorized wheelchair for the next 6 to 8 months, and because our home is so very wheelchair unfriendly it makes sense for me to remain in an ADA approved facility for the duration. It could be as simple as an apartment built for wheelchair-bound folk, however, because I am unable to load bear on hands or feet (just elbows and knees at this point) family members are concerned that if I deck then there would be nobody around to pick me up. Hence we've looked at several assisted living communities and have settled on the Ballard Landmark on Leary Way.

Miraculously, we were able to move from Anderson House to Ballard Landmark in a single day with the help of sister Laura and brother-in-law Bill. They packed up everything in my room, moved it out to their rental car,  transported it from Shoreline to Ballard, and then moved everything back into the Landmark.  I'll remain in a temporary guest suite for several days while the Landmark crew prepares my apartment; they want to replace carpet and paint the walls.  Simultaneously I'll coordinate delivery of a few pieces of IKEA furniture and a rented powered hospital bed, and then I'll be all set. 

The Landmark Community are very curious about me and I'll be making a bunch of new friends in the course of the next several months. By the way, it is a great place for visiting. The public spaces are very comfortable and well-appointed and it would be fun to entertain guests here.

First bus to Ballard

So, you've had a climbing gym accident, you've successfully made it through numerous surgeries, you've been bedridden for the last six weeks, but now you have just got a fancy new wheelchair and have demonstrated abilities to get around including on and off of buses.

You're free! Where would you go? What would you do?

I headed for home, and home for me is Ballard. More specifically my first and most pressing desire was too get to my barber, have a haircut and a thorough hair washing, and then have her shave the six-week beard off my face!  Heaven!!

Backing up just a bit. Laura and Bill arrived at Anderson House and sat with me for breakfast before we headed for the 348 bus stop. We took the 348 to Northgate Transit Center and caught the 40 to Ballard.  No muss no fuss. Disembarking at the main bus stop in Ballard was a very special moment: rolling along Market Street in perfect sunshine, seeing all the familiar places, feeling the energy of the neighborhood, knowing I was finally home.

In addition to the barber mission we also had an appointment to visit and tour Ballard Landmark on Leary Way. The Landmark is a senior assisted living community but in special cases they allow slightly less than senior individuals (like me!) to become residents. The tour left us very enthusiastic about my joining the community. You've got to see this place: many amenities and very well-appointed community spaces.  The one bedroom apartment we visited on the 5th floor has southwesterly views of both the ship canal and the Olympic range.  Ironically the Landmark is directly across the ship canal from Vertical World Climbing Gym.

Later in the afternoon we toured up and down Ballard Avenue stopping in various places. Sangrias at Matadors. Oysters at Acme bar.  Whiskeys at Macleod's.  Marijane and Marie joined us for dinner at Bastille. After a leisurely and entertaining meal I took Metro back to Anderson House and made it in time to watch the last 10 minutes of the Seahawks game.

What a fantastic first day of freedom!

Epiphany - summit fever

Family members noticed I was getting increasingly grouchy and impatient on the first and second days of my liberation by wheelchair. The evening of the second day after motoring around the neighborhood we sat out on the back porch of the facility and regardless of what we talked about I sensed in myself immense unease and it impacted how I interacted with loved ones.  They were right---and that was frustrating too---I had obviously lost my sense of being in the present and joyful in the now.  I wrote the previous blog entry just before bedtime with unease frothing over within me.

Early the next morning I contemplated the last sentence of the previous evening's blog post where I used the analogy of having a severe case of summit fever. I thought more about this and all of the sudden it became obvious: metaphorically I had been climbing for the last 6 weeks and in gaining use of the motorized wheelchair I found myself within striking distance of the next major encampment on the route, . . . perhaps with grand territorial views. There was no doubt I was indeed experiencing a form of summit fever.

And then it all came into proper perspective again and I laughed at myself; the frustration, unease, and impatience were all banished.  I understand summit fever and know what to do when it strikes. I have to be careful not to move forward if the route has become too dangerous or the weather too bad or some other condition is present that would put the climbing party at risk. I have to step back for a moment and reconsider whether all the conditions are within tolerable limits of risk and whether the climbing party's skills are up to the task.

Deep relaxing sigh.  I was ready for this next day regardless of what it would bring. And thankfully it brought the next step of the progression in mastering motorized wheelchair skills. My operational therapist surprised me by suggesting we use the Metro to practice bus entry and exit skills; I wouldn't have to wait 3 or 4 days to attempt this next progression.

Yehaw!

We (two operational therapists, my sister Laura and brother-in-law Bill) motored to the bus stop outside of Anderson House and boarded the 348 headed for the Northgate Transit Center.  Navigating the ramp up into the bus was easy but making turns to get the wheelchair positioned inside the bus was challenging, . . . but doable.  It was grand sitting up front in the wheelchair accessible spot with excellent views of the street ahead.

Rather than going all the way to the transit center we disembarked  as we arrived at Northgate Mall  so that we could make a more realistic transition from one bus to another . Maneuvering out of the bus was much easier than getting situated within the bus. Before I knew it we were back at Anderson house and my occupational therapist had given me two thumbs up for a successful journey.

Starting the next day I would be free to go wherever I wanted to on Metro!

Four wheelin' in the hood

Wow!  This new wheelchair is fantastic!! I spent the first afternoon practicing throughout the facility and the staff seemed as enthusiastic as I was about my new mobility. It took no time at all to gain skill in motoring down hallways, making turns, getting through doors, and deft maneuvering in small spaces. It was fun motoring up to  people who, previously, I had needed to call to my bedside for assistance.    After being bedridden for six weeks no doubt there was a certain amount of motivation to acquire these new skills.

On day two I got into the chair at 7 a.m. and relinquished mobility at 9 p.m. I ate all three meals in the dining room rather than lying in bed. I spent much of the day on the back patio visiting with my elder sister Laura and brother-in-law Bill who flew in  from Tampa the previous evening.  My occupational therapist wanted to observe me venturing out into the nearby neighborhood and so we motored out of the parking lot, turned onto a sidewalk, crossed the street at a designated crosswalk, and continued to a grocery store on the next corner. We went inside and I demonstrated skill in grocery shopping for a few items.

I am really looking forward to using the Metro System to get from Anderson House to just about anywhere that is wheelchair accessible in Seattle.  Before I can tool around on my own, however, my occupational therapist needs to accompany me on a trial run and that may not be until next Monday.   Until then I'm limited to visiting places in the local neighborhood. Hey, there's a 7-Eleven not so far away. Haven't had a Slurpee and a while!

Man, exhibiting patience from now until Monday will be an excellent test of my new-found perspective on remaining present in the now.  The closest climbing analogy I can think of is having a severe case of summit fever.  So close.

My new ride

Two weeks ago we began speaking with a wheelchair company representative about my needs going forward for the next six to eight months and we came up with the specifications for a fairly fancy motorized wheelchair.  The wheelchair company submitted a claim to our insurance and ordered fabrication of the wheelchair.

On Friday of last week we received pre-authorization from our insurance company to receive the wheelchair and simultaneously the wheelchair arrived at the wheelchair company facility close by.

This afternoon at 2:30 p.m. we have an appointment with the wheelchair company technician to be introduced to this fantastic new enabler of freedom and mobility.  We will be going on a series of practice outings for the remainder of the week, and if all goes as expected then from this afternoon onward I will be able to go just about anywhere that is wheelchair accessible in Seattle!  Yahoo!!

Of course I'll have to give my new mount a fitting name. I'll wait several days to allow us a chance to get to know one another and then will come up with something.

Looking forward to being a little saddle sore!

The now

Another unexpected gift I have received as a result of taking this unexpected journey is perceiving a unique and profound outlook or point of view. I have attempted to describe this to friends and family in terms of a "before the fall" perspective compared with an "after the fall" perspective.

Looking at my current situation through the lens of the before the fall perspective you might anticipate that I would be frustrated and impatient about being bedridden and then limited to a wheelchair for such a long period of time.  But something happened once I departed Harborview and found a more restful environment at Anderson House. I had time to reflect and count my blessings.

And that kind of multiplied on itself. I found myself being thankful to the point of overflowing just about every hour of every day. I became more 'present' and 'mindful' in 'the now.'  Not thinking about tomorrow or next week or next month eliminated any cause for frustration or impatience. In 'the now' there was just enough room for extreme thankfulness and appreciation for my good fortune.  One morning I woke up and experienced a literal tidal wave of thankfulness and appreciation; it was overwhelming.  I hesitate to use words like transformational but that's exactly how I felt.

No telling whether I'll be able to maintain this sense of presence and mindfulness, but having had the chance to experience it and having the prospect of being able to hang on to it gives me cause for great joy. Here is yet another example of tremendous good fortune.

When I first experienced it and coined the phrase 'being in the now' I thought it was something brand new, but then coincidentally I was reading a book called 10% Happier about the documented physical and mental benefits associated with meditation. The author of that book went into quite a bit of detail about how to meditate and he discussed being in the now.  Who'da thunk it.

Silver Linings

Wow, so many things to be thankful for!

Marijane and the girls basically took six weeks of their lives and put them on hold while helping me through the thickest part of it.  It is impossible to imagine having to have done all that on my own. Marijane has worked ceaselessly on my behalf with doctors, nurses, hospital administrators, nursing home administrators, insurance administrators, wheelchair experts, physical therapy experts, the list goes on and on. No way could I have done any of that. When I was in full-arm casts and the meals arrived she even fed me. And while Marijane has been supporting me, Marie and Rachel have been supporting Marijane by picking up responsibilities at the house.

Then by all my lucky stars I've gotten out of this with the all of the important things intact.  My spinal cord, brain, and nervous system as well as all internal organs were unharmed.  I am one lucky dude!  Yes there's a lot of mechanical stuff to put back together, but I'm in the hands of Harborview medical teams and those folks have put people back together a gazillion times.

And it has been fantastic to receive all the love, kindness, and support from family and friends. Sisters and brothers are flying in to visit. Friends are dropping by and I have company just about every day. Mom and Dad expect a call every evening and we chat for about a half an hour; it's amazing how much new stuff I am learning about their lives.

Just before the fall I was in final conversations with a wonderful organization about a terrific job and it is amazing that they have been patient with me during this ordeal.  In the last week we have progressed to a full understanding of roles and responsibilities and timing for me joining the organization. As a matter of fact the CEO announced to the board of directors at a recent meeting that I would be coming on board very soon. Tom Vogl and I have discussed my joining the Mountaineers staff as director of operations and I can't wait to get started!

Anderson House

After two weeks at Harborview I transferred to Anderson House in Shoreline and have settled in very comfortably here.  Ah Anderson House.  Peace and quiet reigns.   It is definitely a place to convalesce and I’ve been making marked improvement every day.  The people are kind and responsive, the food is homemade and tasty, and it is close enough to home in Ballard so that it is convenient for Marijane to visit. 

My bed is situated close to a large window that overlooks the facility’s backyard and I can see a green corridor with trees, bushes, and rockery.  The very kind maintenance person has hung a bird feeder and a hummingbird feeder just outside of my window to increase the activity out there.

Over my bed a two-tiered triangular shaped clothesline arrangement has been installed (originally inspired by Caycee) and dozens of pictures brought here by friends and attached with small clothes pins hang from this impromptu display system.  I have further personalized the room by draping Tibetan prayer flags along the nearest leg of the overhead triangle and hanging pictures from home on the walls.

My days at Anderson House are fairly well regimented with several sessions of in bed workout for arms, legs, and core (as well as special focus on hand strength and range of motion), blocks of time with physical therapy and occupational therapy, practice getting out of bed and into a wheelchair, plus time for three square meals (this convalescence stuff takes a lot of energy!), catching up on email, making phone calls and visiting with friends. The days have flown by.

We have made two return visits to Harborview as well. The first visit focused on my hands and very thankfully the doctors allowed me to move away from full arm casts. With three-quarter casts I am able to feed myself, brush teeth, comb hair and otherwise greatly increase self-reliance.

The second visit focused on my feet, and the doctors replaced splints with more permanent protection. My right leg has a full-on cast and my left leg is in a removable boot. Apparently there's enough damage in the right leg that they want continued complete immobility, but they have instructed physical therapy to remove the boot from my left leg once a day and begin very gentle manipulation of the ankle joint; no more than 10 degrees or so in any direction. Coming out of the boot feels fantastic and the gentle manipulation was initially a little freaky but represents no significant increase in discomfort.

The next scheduled visit to Harborview is in the first week of September, two weeks hence, and who knows what they'll decide at that point.  Very likely it will all depend on what the x-rays reveal. Fingers crossed that everything is mending as the doctors anticipate.

Harborview

As it turned out four separate teams of Harborview doctors got to work on me right away: a separate team for each foot, a team for the wrists and forearms, and another team for the backbone.  Subsequently the teams got together and awarded me the dubious honor of having presented the greatest amount of repairable injuries in a single incident short of amputation (in the last 12 months). I think they thought of me as kind of an interesting jigsaw puzzle.

I was in ICU for the first week and for the first round of surgeries where the teams put things back more or less in the right location.  I tuned out when they started talking about bone degloving and things that should be in my shins ending up in my heels. The second week at Harborview I was out of ICU and going through the second round of surgeries where the teams were installing rods and plates and screws and all kinds of neat stuff making final structural placements as accurately as possible.

Harborview is our trauma center for the Pacific Northwest and the doctors there put people back together again all the time and they're really good at it. Another thing they are really good at is understanding when the body begins giving back real sensation and knowing when to dial up the pain meds.  Yes, I did experience some pain, but far less than you might imagine. The nurses keep asking you what's your pain level and they make adjustments based on your response. Their goal is to back down the pain meds in a reasonable amount of time and get you ready to transition to a convalescence facility so they can make room for the next trauma patient.

Harborview is definitely a place to get fixed and not to convalesce. The four separate teams have an overarching goal of achieving the best outcome for their assigned limb and they don't have time to coordinate amongst themselves so you're constantly getting pulled out of bed for one thing or another. The net result is an optimal surgical outcome but customer service isn't the greatest.  Also the pace of the place is non-stop 24/7. The intercom is constantly blaring code red this and code blue that, or Dr. so-and-so hit your call button, or nurse X please go to room Y stat!   It's exhausting.

After two weeks at Harborview I was finished with surgeries, off of intravenous pain meds, and more or less stable and ready to transition to Anderson House in Shoreline, a full-on nursing / convalescence facility.

The fall

It's fast. And then you're on the ground. Moments later I was surrounded by people with medical skills watching over me and letting me know I wasn't alone. I didn't lose consciousness and afterwards people told me I was apologizing for the disturbance and inconvenience.  Sounds about right.

My nervous system did a pretty neat thing. Immediately, it gave me only a dial tone rather than pain. I knew I needed to stay still but had no idea how injured I might be. I was breathing through a bloody nose so knew I had hit my face at some point. The paramedics arrived in no time, bundled me onto a gurney, and wheeled me out to their ambulance. The ride to Harborview was quick and uneventful and I was thinking, 'hmmm maybe it's not so bad.'

Maybe not. The good news is my spinal cord was not impacted, I didn't injure my brain, and I have 100% access to my nervous system, so I am one lucky dude. The bad news I did pretty serious damage to both feet, ankles, and shins, backbone,  both wrists and forearms. I landed at sort of a 45 degree angle feet first, then butt, then hands and finally face, . . . as I must have been looking over my shoulder to see whether there was someone below me.

Once at Harborview I was able to make several phone calls to let people know I wouldn't be able to meet certain commitments later that day and that weekend. Marijane got the first call of course letting her know what had happened and where I was and that I was ok but not so ok.   Next I called an afternoon meeting appointment to let them know I probably wouldn't be able to make it. Finally I called a climbing friend to let them know the situation and the likelihood that I wouldn't be able to make our planned climb that weekend. I still didn't know how serious the injuries were and was probably in total denial.

The day of the fall

Climbing at Vertical World in Ballard on Tuesday and Thursday mornings as well as Sunday evenings was a part of my usual schedule. Many of us arrived on weekday mornings as soon as the gym opened and got our climbs in prior to the rest of the day unfolding. On this particular Thursday my usual climbing partner was on vacation and so I was using the auto belays.

I have used auto belays all the time and have a very methodical approach to clipping in and double-checking that I am clipped in before climbing.  I never boulder climb unclipped, so there is absolutely no circumstance where I would intentionally start heading up a climbing route without protection.  On this morning I had already finished one lap with all of the available auto belays and had one route left to go to complete my second full lap.

With everything else going on that day I was in a bit of a hurry, but was having to wait for someone else to finish with that one last route. When it came free I walked straight up and got going. Because this was my last route of the morning I didn't intend to get to the very top but to get most of the way up to the crux and then just auto belay back down.  As a result I would be letting go of the wall rather than triple checking the auto belay at the top of the route before heading back down.

It is still absolutely incomprehensible to me that I could have started climbing without clipping in but there's no other explanation. People who were there close by when I fell noticed immediately that the auto belay I should have been using was still clipped to the wall.

Hence, contributing factors to the fall include:
1. sleepiness from all nighters pulled earlier in the week
2. other important pressing items that needed to get taken care of later that day
3. Impatience at having to wait to get started on that last route of the day
4. the decision to climb only a portion of the route

When I imagine that moment when I let go of the wall and realized that I had no protection I still flinch in shear amazement.  For crying out loud, how could I have possibly allowed myself to become that distracted?!

The week before the fall

Naturally the week before the fall was a busy week: standard Ashby protocol. The prior weekend we had climbed Black Peak's North East Ridge and it was fantastic.

However taking the weekend to climb put me behind schedule on wrapping up a six month DIY project (+300 hour invested thus far) for my daughter's birthday that Tuesday. I basically pulled all-nighters Sunday night and Monday night to get done on time, and of course I made it. I was able to catch up on sleep to some extent on Tuesday and Wednesday night but I was still a little groggy on Thursday morning.

Also I needed to prepare for the coming weekend's climb of Tupshin, Devore and Flora. I needed to do more research on available beta and begin getting my gear together Thursday afternoon. One other pressing matter was a job interview scheduled for Thursday afternoon.

Hence, on Thursday morning there was a lot going on and I found myself in a bit of a hurry and a little distracted and probably a little mentally tired from the all-nighters.