Sunday, 6 March 2016

Recovery and Dealing with Injury

Not everyone has been through the kind of injury that keeps you off the bike for several weeks, and the first time it happens it can be a real shock to find that there is a lot more than just the physical aspects to deal with.

This time, the third time of emergency surgery and plaster cast, I am finding the whole thing much easier and have felt mostly level headed, in fact regularly quite content and happy with this little life curve-ball. Experience is important, as is mental strength gained from knowing that injury can happen at any time but that it is possible to get through it with mindfulness and acceptance. Don't get me wrong, it's not all anodised happiness, in fact, sometimes it feels like a right royal PITA, but that's life, and every experience, even the bad ones, teach us something worthwhile.

Backtracking a week, around the time I hit that tree, I knew instantly my arm was broken. It took the full concentrated 20 mph impact of me + bike into a really small diameter, but very hard, trunk. Crack.

The guys were good, checking me over, but I was keen to get moving and get off the hill. With a break you have a magic pain-reduced window of approximately 40 minutes where then adrenaline is high, and the oedema has yet to manifest significantly. They were right though, making sure there was no head injury, before letting me walk. The first blessing to be counted was wearing my full face helmet, very nearly left in the car that morning in favour of a standard enduro/xc lid like the guys.

Two working legs. Easy to take for granted, but I have never been so grateful for them. The mental contingency plan began to take shape before I was even back at the van. Hospital, possible op, initial healing which will also give the rest of me a good recovery period, then time in cast limiting any riding and allow full focus on improving running technique....the more I thought about it, the happier I was. I'd have time to catch up with route planning, bike selling, blogging, reading, photography. The fact I'd be off the bike for a while just didn't seem to matter at all.

We settled on Gloucester Hospital and the guys loaded everything in the van. Yet another blessing, we were in Steve's van and not mine, and insurance wasn't an issue. I have had to drive myself a number of times in the past when injured, with a broken thumb, a separated shoulder and even, stupidly, whilst severely concussed. Not this time. This time I was lucky enough to be there with Steve who stayed calm and was nothing but brilliant through the entire event.

One of the hardest things to deal with when injured is letting people down. Breaking the bad news to the boss was done later, but at that point, there was a far more pressing issue. Telling Mum, who is, quite frankly, the most risk adverse person I know. It was a relief when my visiting brother answered the phone and I garbled we couldn't make dinner as my arm was in two pieces, and could he break the news gently to Mum please that I was perfectly OK, other than the broken arm which is a VERY MINOR thing. "No", he said, "it's too late, you are on speakerphone at the dinner table". Doh!

Gloucester hospital were brilliant. Steve dropped me off, and whilst he went on a 'giant van parking space' hunt,  A&E reception bumped me up the list and straight into preliminary assessment. It helped that my arm was bending where it shouldn't and bones were crunching. From that moment on I received nothing but five star care. Drugs, kindness and help with clothing from the triage nurse. Highly perfected distraction techniques and skill from the radiographer, who obtained x-rays without moving the bones too much. Not an easy job when there was a broken arm, potential finger dislocation and elbow damage to check. The A&E staff, after ooohhing and ahhhing over the X-ray did everything they could to get me a space on a ward and an assessment by the orthopedic consultant.  I wasn't surprised that surgery was required, but I was very relieved there was no faffing or stalling about it. I consider myself lucky that all three of my big accidents have resulted in surgical repair, after seeing so many friends on the 'wait and see' healing path: collar bones that never heal properly, long term wrist mobility issues and so many lost months of riding.

Times like this you really find out who cares for you, and I couldn't believe it when I was wheeled out of X ray to see my brother, niece and nephew waiting with Steve. They had popped in with a baguette and vegan marg and to check I was OK on their way to town. I rarely get to see my family and it really meant a lot that they took the time to come. Vikki put a picture on Facebook, and before I knew it, there were so many 'get well soon' wishes from friends and family, offers of help and general kindness.

The day ward coped admirably with me being dumped on them, and found me a bed by the evening. There was no sign of vegan food of course, the poor young lass nothing but apologetic for something that is a major system failure and not in any way her fault. I'll leave comment regarding the nutritional debarcle of NHS catering for another time, but thankfully Steve had left me with a carton of soya milk before he had to leave for home. Horses still need feeding even if your girlfriend is injured, but he had done more than enough by that point, bless him. In typical perfect boyfriend fashion he was worried about leaving, but I was calm as Hindu Cows and keen that he got home and got his work done before midnight.

After Steve left I was in an empty room, no TV, rapidly depleting phone battery and closed hospital shop. The wonderful nurses asked around and found me a magazine, but no phone charger, and I was getting hungry after the offerings of two slices of dry toast and jam. I couldn't believe it when my niece turned back up, with massive supplies of vegan food, a phone charger, clothes to sleep in with sleeves baggy enough to get over my arm, a magazine and a puzzle book. What an amazing lady, I will never forget her kindness.

A rough night was spent; codeine infused doziness interspersed with clanking bones. I asked for an extra pillow to support the arm, but there was none. The night nurse wasn't keen to help and rushed a '1 pillow, 1 person' retort and that was that. It was the only time where I felt like I was getting the rough end of the understaffed-over stretched NHS. The rest of the staff were rushed off their feet, under immense pressure, but were never once rude or unhelpful. It wasn't a major issue in the end as the ward was so hot I ruffled up the bedding in a big ball to support the arm, and it got me through til morning. We forget how incredibly lucky we are in the UK to even have the NHS. It's bowing and buckling under pressure and we still expect perfection from it. Time wasters are a massive part of the problem. Whilst in A&E one of the nurses asked if I had come in an ambulance. "Don't be daft" I said, "it's just a broken arm"! "We've had someone phone 999 for a broken toe before". Seriously, if you can hobble to a taxi or a lift, there is no excuse ever to phone for a precious ambulance. A broken arm is not a 999 emergency. Sometimes I wish I was in charge......but does a clumsy mountainbiker who has put significant stress on the system through a number of crashes have any right to pass judgement?

I cannot explain just how deeply emotional I felt that day. Of course it may have been the drugs, but I was so blessed with people to care for me and western healthcare. In the third world this kind of injury would be a huge issue. A right arm break, unable to feed myself or my children, no drugs, plaster and especially no surgical intervention. It would be life changing, if not fatal.  But I was fed, loved and cared for with no significant pain and knowing my only dependent, sophie-dog, was safe at the stables and undoubtedly not missing me an ounce.

The senior consultant came to visit and talked me through the injury and the operation. Two things can happen when you break a forearm, either both bones break or, like in my situation, one bone breaks and the strength from the intact bone forces the other out of the wrist joint. Thus the joint requires setting and the bone plating.  The surgical team also came to visit, as did a further consultant who I suspect will be dealing with my case directly. So many amazingly talented people involved in patching one person up, I felt like I could put all my trust in them to do it right.

Surgery was scheduled for 9:15 am Monday, and I enjoyed the jolly-trolly trip through the hospital with the amusing porters, and the 'going under' experience a lot. I remember the first general anesthetic I had, being petrified about the risks and how it would feel, but this time it was just great. There is something quite magical about the countdown to induced sleep.

Coming round was the usual mission, I understand.  I don't remember anything until 1:30 pm, but apparently I had them worried in the recovery room as the drugs may have been a bit too strong for little me. Usual post-op pain was numbed instantly by intravenous morphine and the afternoon was spent in a haze of lovely sleep waiting for Steve to come and collect me.  Unfortunately the sleep didn't help the wound swelling and that, along with my difficult recovery, and I suspect 'home-time' for the consultant, meant another night in. The evening went quickly with visits from Steve and my Niece, both thankfully bringing ridiculous quantities of vegan food to supplement the horrid-looking, but exceptionally tasty, hospital root veg curry. Luckily the morphine had worn off by then, as Vikki brought Mum along too and I could hold a compos mentis conversation and provide reassurance that I was on the road to recovery.

Attempting left handed sudoko at midnight with another dose of morphine coursing through my veins wasn't wholly unsucessful and I felt rather smug that my accomplished left-handed skills, developed last time in plaster, hadn't been lost. I slept on and off, but it was a very tough night for the elderly lady opposite who spent most of the time screaming and moaning in pain as a massive number of doctors and nurses tried to help. The room was empty when I woke in the morning.

Discharge always takes time, but beds are needed, so understandably, I was shifted into the discharge lounge as soon as possible after seeing the consultant on Tuesday morning. Interestingly, other than instruction to keep the arm elevated for three days and information on compartment syndrome, I was let go with no instruction regarding rest, healing, work or driving. I was given a huge bag of drugs though, codeine, liquid morphine and paracetamol, all of which remain unopened. Other than popping a few asprin for the journey home, I've not needed pain meds since. My digestion thanks me.

Getting home, that's when the challenge really starts. The kindest and 'escape from real life' of a hospital stay is over, and the importance of mental strength comes to the fore,

Firstly, work. I work for a small company and there is no redundancy in the system. Profitable staff, i.e. the technical ones who complete the work, support not just themselves, but the administration staff in the office. It is just not feasible for the company to carry unproductive people on the pay roll. It is also not fair, both on our small scale business, and bigger society, for me to sit around being supported by others when I am more than capable of doing something. Again, I was very lucky, if I had to get injured, it couldn't have happened at a better time. My normal national work profile has changed for the next few months and I'm staying in the county, working for a local public body. Wednesday and Thursday I was trying to report. Slowly, typing left handed, but still, getting work done, emailing clients and checking reports. It was hard, but important to keep sane. By Friday I was back on site. Work were brilliant, and made it clear I didn't have to get back on site until I was ready, but I was struggling with reporting. Using my left hand was mentally very tiring and I knew I would be more use surveying.  Despite my offers to get public transport to site, work provided a trained young labourer to collect me from home and do all my asbestos sampling until I am fixed. Friday I just had to use my eyes and brain whilst the young lad did the physical stuff. It was brilliant, we got loads done and I was happy to be contributing again..

It's still the early stages of healing, but I have tried to make the most of the induced rest, eating good nutritous food, watching films, reading books and making plans for long runs later in the healing process.  I've also managed to get out in the vibram five fingers, using the time to keep working with adapting to barefoot form and investigating local footpaths.

There is so much pleasure in exploration and it feels good to still find mini adventures so close to home. Today my legs took me on a 10 km tactile barefoot tour, feeling so many sensations: sun warmed tarmac, stony massages on my soles, plasticine mud between my toes and soft springy grass bouncing me uphill. Looking over to snow covered Hay Bluff, feeling the terrain beneath my feet, I felt so at peace and wanted for nothing, and to be nowhere else.

I know I should wrap this up as, even typing left-handed, this appears to be of essay proportions, so I'll summarise the things that are helping me get through injury and time off the bike.

1) acceptance of the situation and experience
2) looking at the positives, being grateful for the good
3) using the opportunity to do something different, learn new skills (like writing left handed!) and relish the new experiences the rehabilitation journey brings