My Left Leg: Revisited

This is a story from my original 2nd year of medical school. It is the story of my experiences being hit by a drunk driver, being a patient, and life on the receiving/opposite side of "The White Coat".

“My Left Leg: Life on the Opposite Side of the White Coat”

Saturday 15 September 2007…what a Saturday that turned out to be…I woke up before dawn to get ready for a Maine Osteopathic Association Executive Board meeting in Augusta, Maine. I had to be up in Augusta quite early. I’m used to sleeping in, which means 8:30 AM if I’m lucky, on a Saturday morning. Not today. I was up and out the door, laptop under my arm and coffee in hand for the 90-minute trek north. It was pouring rain, dark, and dreary the whole drive. I remember thinking to myself “what a perfect day for a board meeting.” In the back of my mind was the annual UNECOM Anatomical Gift Memorial service scheduled for that evening. Little did I know something would happen that afternoon that would alter the course of my day, my 2nd year at UNECOM and subsequently my career for that matter.

The meeting was uneventful. I gave my student report, listened to reports from each committee member, and enjoyed a very scrumptious lobster roll lunch courtesy of the MOA before I was released for the day. By the time I had made it back to Biddeford the sunlight had broken through the clouds paving the way for my desire to go for a nice and relaxing bike ride before I had to be ready for the memorial service. I grabbed my iPod, my helmet, changed into a pair of comfortable sweatpants, a sweatshirt, hopped on my mountain bike and I left my house heading west towards the quiet rural roads away from reality.

After being out and about for 30-minutes or so I felt it was time to head back to get ready for my evening. As I was back on Main Street in Biddeford just 2-blocks from my apartment, near the Biddeford High School, my path was about to be crossed by an SUV operated by drunk driver. I remember seeing a big white object in my peripheral vision as I was cruising along. In my mind I was calculating the velocity of the object. I could tell it was slowing down, or at least it appeared to be based on my frame of reference. I assumed the SUV to be slowing to a stop to allow me to continue on my path unimpeded as I had the right of way since the individual driving was making a left hand turn off of Main Street onto a side street. Well, that was not the case.

CRUNCH! In a split second I was airborne. Not a euphoric sense of weightlessness mind you, but a shock to the system, “What the Hades is happening to me?!” flight through the air. I can recall just prior to collision making eye contact with the driver of the SUV and thinking to myself “This is only a dream, I will wake up any second.” As I was flying through the air similar thoughts went through my mind, “I’ll wake up any second…oh that is interesting, my left foot is flying up towards my head.” Knees are not meant to bend that way! I knew instantly that my left leg was severely injured. SLAM! I hit the pavement quite hard. Approximately 10-feet away from where I physically left my bike and the SUV. As soon as I hit the ground I was still in denial that this was actually happening. Man, my side hurt…

Ever have a nasty rug burn? That initial sense of irritation that subsides as the burning, searing pain increases in intensity rather exponentially. Well, lets just say I was very happy I had made the decision to wear sweatpants because I could feel this intense burning sensation starting to ramp up on my left leg and knee as my pain receptors unleashed their chemicals into my system. If I had seen the blood and jagged pieces of my tibia jutting out of what was originally my left leg I definitely would have passed out. Instead, I lay there on my side with my left leg supported on my right leg. As I placed my left leg on top of the right leg it collapsed under its own weight. Essentially my lower leg was only attached to my upper leg by the muscles, tendons, and ligaments left intact. The boney structures between the proximal and distal tibia/fibula had been obliterated. I have never experienced pain or disorientation of this caliber ever in my life. “I’ll wake up any second...right?”

Some strangers started to gather as I lay there writhing in pain. Some local children playing on their bikes had stopped to gawk at me. An elderly man from across the street tried to shoo them away because they were obviously not helping the situation. The inebriated driver who struck me had pulled over just up the street from the scene. He foolishly asked me if I was okay and if it would be a good idea to call for help. Seriously!? I mean COME ON now of course I’m not “okay” and yes call for help. In what seemed like a blink of an eye a Biddeford Police Officer was on the scene. The only thing I remember from my conversation with him was asking him if he could retrieve my wallet and mobile phone from my apartment just two blocks away as I tried to pass him my house keys. He declined saying it would be best if I held on to my keys and to lay still until the ambulance arrived.

As the EMT’s arrived I was letting a few color words out as I tried to breath through the pain. This was going to be my first ever ambulance ride as a patient, lucky me! As the EMT’s carefully cleared my cervical spine and boarded me, I was hoisted up via the gurney and wheeled onto the rig. The pain was at such a level that my head was swimming. I was having a hard time remembering my address, my mobile number, and what day it was. I was getting frustrated with all of the questions. The EMT’s were very professional and respected my dignity. I was very impressed. Once they pushed morphine, my first ever experience with it mind you, I was feeling a little better. The pain was a 10/10 but I didn’t care thanks to the morphine. I was able to sift through the pain-induced fog to ask the EMT sitting with me if he could do me a favor.

Thankfully I was friends/classmates with a local EMT and her Firefighter boyfriend. The EMT treating me knew both of them and was able to inform them of my location, what happened to me (I gave him permission to share this, HIPAA be damned!) and that I need someone to go to my apartment, get my wallet and mobile phone and oh, most importantly, call my wife, who happened to be visiting her grandmother in Buffalo, NY, and let her know what was going on. The ambulance ride was quite bumpy and almost surreal. To me it felt like we were in the ambulance for not even 5-minutes before they unloaded me at Maine Medical Center’s Emergency Department. Here is where the fun begins…

As I was wheeled into the trauma bay I remember seeing a blurry ocean of white and blue. I think blue…maybe green scrubs and of course the white from the white coats. I was bombarded with questions, poking hands, cold hard sensations of scissors shredding my clothes away from my tattered body. IV’s being placed. Monitors attached. Not the perspective I was planning on gaining during my years of medical school. “What is your pain now?” I was close to saying 20/10. I’ll never forget meeting my Orthopaedic surgeon. He was the only one who came in not wearing white. He introduced himself as Dr. Camuso and that he would be taking care of my leg. Apparently he explained a lot more to me but I was so out of it from the pain, morphine, and the reality of the situation I only recall meeting him and asking him about the severity of the damage to my leg. I also apparently had a conversation with Dr. Dan Kloda, a radiology resident who came down to meet me once the word was spread that I was a 2nd year medical student at UNE, his alma mater. I do remember being wheeled off to the magical CT room. I remember the technician explaining to me that the contrast die they were injecting would make me feel like I was peeing my pants. Odd sensation…it really does feel like one has wet themselves.

Of all the poking, prodding, cutting away of clothing, I have to say I have a greater appreciation of how scary and otherworldly it is to be a trauma victim or rather a patient in general. Pain can turn someone completely calm and collected into an expletive-spewing belligerent creature. I was somewhere in between I think. I know I was not belligerent, but expletive-spewing…maybe just a bit. It wasn’t directed at the white coats though, just at the pain I was experiencing. At some point I was sedated so the doctors could reset my leg and place it in a brace until surgery. I am very thankful I was not conscious for the reduction of the fracture and the slew of imaging studies that followed.

Once I regained consciousness again I was in my own little trauma room complete with a view of a very friendly nurse waiting for me to pee. I was informed that if I could not pee on my own she would have to insert something that would pee for me. Every man’s worst nightmare…a catheter! NO! I was determined to go on my own. I could tell my bladder was about ready to burst. Nothing was happening though. Curse you Morphine! The nurse, in a very professional and caring way took control and placed the catheter. Instantaneous relief! I think the fear of being on the receiving end of a catheter was more painful than the actual process. She was experienced though…I couldn’t help but think to myself “I’ll have to do this at some point, I just hope I can do it as painlessly and smoothly as this nurse.”

The sensation of helplessness had begun to set in. I needed all sorts of tubes going in and out of me to keep the fluids flowing. I couldn’t move my left leg at all without suffering severe pain. I needed help to situate myself in bed. Morphine helped numb me enough to sleep between each time my nurse checked on me through the night. Clouded mind, 10/10 pain, sleep deprived and yet still expected to answer questions like “How’re you feeling?” How the heck do you think I feel!? I thought it but never said it. I’m not that kind of patient. Morning arrived quickly.

The hospital hallways were eerily quiet at 6:30 in the morning on a Sunday. I remember the painful transfer from my bed to a gurney. I was wheeled down to what amounts to a holding bay for patients. Pre-op if you will. I met my anesthesiologist and was explained what to expect. What? You mean there is a risk I’ll never wake up? Or my leg might not heal from the surgery?!…I guess I’ll sign that form for you. There is nothing like a session of Informed Consent to start one’s day. All joking aside, I felt very confident in my surgeon and his team. I remember the cold feel of the operating room and the table as I was transferred from the gurney. The OR techs were very friendly and respectful as I succumbed to anesthesia.

Thankfully, I do not remember anything that happened during the long and arduous surgery. That is the beauty of modern anesthesia care. When I look at the Operation Notes I can’t help but think to that I am very thankful they were able to salvage my leg and I’m glad I was completely knocked out during the whole procedure. When I finally woke up I was greeted by my wife’s beautiful yet extremely upset looking face. She had taken an earlier flight back to Maine from Buffalo. My friends Marcey and Erin were also there. I felt like a rag doll that had been trampled by a herd of elephants. I was in no place to converse with anyone. I mumbled something nonsensical and passed out.

I spent a week in hospital. It seemed like an eternity at that time. Over the course of Post-op days 0-2, my hematocrit plummeted, my oxygen saturations were consistently low even on supplemental oxygen. I ended up requiring 2 blood transfusions. My leg hurt, I couldn’t pee on my own, had no appetite whatsoever, I was bedridden, and I was completely dependent upon everyone around me. I felt horrible. I’ll never forget how painful it was to have the drainage tube removed from the surgical site on my left leg. The Fellow working with my surgeon ensured me it would not hurt a bit. Liar! I do not think I’ll be able to lie to my patients about things I know to be painful. I’ll also be able to explain to a future patient that receiving a blood transfusion is quite surreal and slightly irritating. The blood is cold and enters your arm cold. I thought my left arm was going to fall off! Guess the nurse did not feel like tracking down a blood warmer for me...

I had officially become a human pincushion. Or more realistically, a mega highway for IV fluids to enter my hand and leave via my catheter with a few stops along the way as the Patient Controlled Analgesia (PCA) pumped in happy numbing meds so I was oblivious to the whole ordeal. Two blood transfusions and a chest CT later, I was finally starting to change colors from sheet white to pink and maintaining O2 sats in the 90’s. I was at the mercy of the lovely day nurses, the dietary folks, Physical Therapy, white coats of all shapes and sizes (except my surgeon, he never wore one, go figure), and the CNA’s. I was not a fan of Physical Therapy at first, I knew they meant well and I respected them because in a former life I was aspiring to be a Physical Therapist myself. At first I avoided having to get out of bed because I was in pain, depressed, and did not want people to see me this way. My pride, my independence, my spirit had been stripped from me.

I left the hospital on crutches unable to put weight on my leg, a big bionic looking brace on my left leg, and the prospect of having to go through another surgery once my leg was healthy enough to handle another surgical invasion. My hopes of returning to school, to my classes, and to my friends were starting to fade. My then-pregnant wife Senta, a full-time Occupational Therapist at an adult neurological rehabilitation, would become my personal care assistant. She would never have that disconnect from work to home for a long time. God bless her for being there for me. Senta truly went above and beyond anything that I could have ever expected from her. “Through sickness and in health” was truly put to the test. I was non-weight bearing for a while. I had crutches for around the house and a wheelchair for community ambulation. I truly understand how wonderful curb cutouts, automatic doors and elevators can be when one is reliant upon a wheelchair and the kindness of others to get around in the community. I have also learned that “kindness of others” is not as abundant as I had originally thought or expected from the members of my community.

I felt like a substandard citizen. This did not bode well for those who ignored me in my wheelchair. I came close to running over some people because of their lack of respect for my space or just blatantly ignoring me. It is sad that in this day an age society still looks down upon disability. I’ll never forget what one of my patients, who relied upon a wheelchair for mobility, said to me once back in Physical Therapy school: “I do not trust anyone that is not on four wheels or who is temporarily ‘able-bodied’.” I can completely understand and appreciate his sentiments now. My wife even experienced looks of pity or horror from people in the community as she helped wheel me around. Some people do not realize just how lucky they are to have the use of all four limbs and to be at eye-level with the world around them. Being at waist level is very challenging. It’s easy to be overlooked unless you are loud and crotchety to make your presence known.

One thing I’ve learned from my nursing home research is patient care is all about respect. Stand at the foot of my bed and talk to the nurse, medical students/interns/residents rounding with you and ask me stupid questions, regardless of how relevant they may be, without making eye contact with me, and I’m not going to respect you as a physician or as a human being. Sit down on the bed or in a chair next to me, shake my hand and make eye contact with me at my level as you begin a short conversation, I’m going to respect you and readily answer your relevant yet still annoying questions. I say annoying questions because honestly after about the fifth time someone asks you the same questions within what seems like an hour’s time, its painful.

Independence, freedom, and the ability to come and go as you please without help, guidance, and/or restrictions is very powerful. Lose that independence and you either feel like a fixture in a museum for everyone to stare at or you feel utterly useless, and a major hindrance upon those you hold dear. I felt like my world had collapsed around me and I could do nothing to stop it. I felt useless. I was angry. I snapped at my friends. I could not understand why I never woke up from this dream…er…nightmare. I felt as if I was a huge burden on my wife. Senta was 5-months pregnant, working full-time at work and at home. I hated the drunk driver who put me in this situation against my will. I also hated my leg and myself. My life mirrored the damages my left leg sustained. My life had become a complex, compound, comminuted fracture. Ultimately, I was scared.

Emotional trauma. It is not easily diagnosed and is often overlooked. Not once did my surgeon, my nurses, my friends or family ask me how I felt mentally and emotionally. Everyone would ask about my leg or about my physical pain. Senta asked on occasion because she could tell I was having a hard time emotionally. I had no clue what to do. Was I going through the stages of grieving? No one died right? Wrong, my independence, my well-being, my spirit died. I was going a million miles an hour and was hit by a brick wall in the shape of a white SUV with a inebriated idiot at the wheel.

I wish someone had asked me about my emotional trauma very early on. I was the patient not the student physician; I was not in the frame of mind to explain to others responsible for my care how I might care for someone in the same situation. Now, I was stuck in a sphere of fear. Fear of losing my Air Force Scholarship, fear of not getting enough money to cover my medical bills, fear I would never be able to walk, run, enjoy my daughter’s childhood without pain. I decided the best option was to seek help for my emotional trauma on my own. In my search for someone to help me out I discovered that my University’s Health Care Clinic offered a free counseling service to students. I did not hesitate to set up an appointment. It was possibly one of the best decisions I had made during this whole rehabilitation process.

Nevertheless, two surgeries, two metal plates, multiple screws and pins, and a bone graft later I’m still healing. At least I am no longer using an assistive device to ambulate. I am walking on my own; it’s not pretty at times but it sure beats using crutches! I do miss my wheelchair at times, I could really get cruising in that thing! Rehabilitation early on was quite rough. Learning to walk again is not easy. Toddlers make it look so easy! My knee will give out at random times, my balance is still a bit squirrelly, my left ankle is not as adept as it used to be. I’ve put on a lot of weight because of this situation. One thing I miss the most is running. I used to run a lot and loved running for a sense of clearing my mind. I was able to escape reality and get into a sphere of utter clarity.

The events that took place on 15 September 2007 changed my life forever. Cliché, yes, however very true considering my left leg is no longer the way it was prior to that day. I was not born with screws, bolts, plates, or a hole in my tibia. My mind is not the same either. I do not hate or wish ill things upon the man who hit me and caused this chain reaction of events. I forgive him. He is being punished for his poor judgment and has also made every effort to help make me a whole person again within his own sphere of influence.

I have discovered aspects of myself as a husband, a student physician, as a son, grandson, friend, relative and now a new father that I would have never learned if this had not happened. Some of these revelations are positive while others are negative, yet combined they have made me a stronger person. I am no longer a member of the UNECOM class of 2010 and I will always set off metal detectors when I travel. I am happy to be a member of my new class, the class of 2011. The extra time has been very beneficial in my emotional and physical rehabilitation. Also, I have had the opportunity to spend a great deal of quality time with my now 11-month old daughter, Crescentia Rose.

Lastly, I have been enlightened as to what it is like to truly be on the receiving end of healthcare, on the opposite side of the “White Coat”, and what it is like to be looked down upon by society as someone with a disability however temporary it was for me. Respect, eye contact, getting down to eye level is important, human touch, connecting emotionally, and including a patient in his/her treatment options is very important. Realizing that pain can change you regardless of its source whether it be physical, emotional/mental or a combination of the two should be and needs to be addressed when providing comprehensive care to ones patients. It’s the right thing to do.