This essay is adapted from an entry in Dr. Fosmire’s blog, DOctah Dad.
It’s funny how life-altering events often wrap themselves in days that begin like any other. On a beautiful September Saturday in Biddeford, Maine, I went out for a relaxing bike ride. Just two blocks from my apartment, I saw a large white object lurking in my peripheral vision. It was an SUV that was slowing to a stop, or so I thought. Crunch. In a split second, I was airborne. As I flew through the air, I thought, “I’ll wake up any second, this is only a dream.”
I hit the ground quite hard and was in a state of denial as I began to feel an intense burning sensation starting to ramp up in my left leg. My leg collapsed under its own weight as I placed it on top of my right leg. The sensation was brutal and gruesome.
This is the story of my broken leg, hospitalization and lengthy recovery. It happened in 2007 during my second year at the University of New England College of Osteopathic Medicine in Biddeford. The experience provided me with a valuable window into the world of the patient and changed my outlook on medicine.
Specifically, I learned that emotional trauma often accompanies physical trauma, but that physicians usually aren’t trained to recognize and treat it in their patients. Also, I developed a greater understanding of the frustration and helplessness patients with limited mobility can feel.
Following the car-bike collision on that Saturday, I lay on the pavement in pain. The car’s driver, who I learned was drunk, pulled over and asked me if I was OK. Shortly after, the police and an ambulance showed up. I tried to breathe through the pain while the EMTs carefully wheeled me onto the rig. The pain was at such a level that my head was swimming, but morphine helped to alleviate it.
As I was wheeled into the trauma bay I remember seeing a blurry ocean of white and blue. I was bombarded with questions and probing hands as I felt the cold, hard sensation of trauma shears exposing my tattered naked body for all to see. IV lines were placed. Monitors attached. “What is your pain now?” medics asked me. “What is your name and date of birth?”
The effects of pain
Pain can turn an otherwise calm and collected person into a frightened, angry mess. In my case, I also passed out. When I came to, I was in my own trauma room where my nurse was waiting for me to wake up and urinate. I felt the pressure, but I just couldn’t go. She said the two words men fear the most: “Foley catheter.” Wait, no, please not that! But the nurse placed the catheter with the utmost degree of professionalism and empathy. I felt instantaneous relief.
I had a clouded mind, 10/10 pain and complete exhaustion, and yet I was still expected to answer questions such as ‘How are you feeling?
I had officially become a human pincushion, or perhaps a mega-highway for IV fluids: They entered my hand and left via my catheter with a few stops along the way as my patient-controlled analgesia brought in numbing meds that made me oblivious to the whole ordeal.
The sensation of helplessness set in quickly. I couldn’t move my left leg at all without causing severe pain. I needed help to move around in bed. I had a clouded mind, 10/10 pain and complete exhaustion, and yet I was still expected to answer questions such as “How are you feeling?” from nurses and physicians. How the heck do you think I feel?
Eventually I was wheeled down to pre-op. The last thing I remember prior to surgery was the cold feel of the operating room and rubbery gas mask being placed over my face. Many hours later when I woke up, my wife and a few of our friends were at my bedside. I managed to mumble something nonsensical before drifting back into sleep.
I stayed in the hospital for a week, but it seemed like an eternity. My leg hurt, I couldn’t pee on my own, I had no appetite, I was bedridden and I was completely dependent upon everyone around me. And with my sheet-white complexion, I looked like the ghost of my former self. I later learned that I developed acute blood loss anemia, for which I was transfused two units of blood. I felt depressed and didn’t want people to see me this way.
When I was discharged, I had a bulky bionic-looking brace on my leg, crutches for getting around my house and a wheelchair for getting around town. I also had the knowledge that I couldn’t walk on my own for the foreseeable future. My hopes of returning to school were starting to fade. My then-pregnant wife, Senta, who is an occupational therapist, would become my personal care assistant. The line between home and work for her would be blurred for quite some time.
As I navigated my home and neighborhood, I developed a new understanding of how wonderful curb cutouts, automatic doors and elevators can be when one is reliant upon a wheelchair and the kindness of others to get places. Unfortunately, I also found that “kindness of others” was not as abundant as I had originally thought or expected from the community.
In my wheelchair, I was sometimes treated like a substandard citizen. Oblivious individuals nearly trampled over me while others ignored me or looked down upon me. Some businesses and parts of my school weren’t wheelchair accessible, so I had a hard time navigating my environment. My wife received looks of pity or horror from people around town as she helped wheel me around.
Independence, freedom and the ability to come and go as you please are very powerful. Losing that independence made me feel like a major hindrance upon my loved ones. I was angry with the drunk driver who did this to me. I hated my leg and myself. My life mirrored the damages my left leg sustained—it had become fractured too, and I was scared.
In providing comprehensive care to my patients, I try to address their physical and emotional trauma.
Emotional trauma 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 asked about my leg or about my physical pain. Senta asked on occasion because she could tell I was having a hard time emotionally. I couldn’t sleep, I was reliving the accident, and I was afraid to leave my house. Was I going through the stages of grieving?
I wish someone had asked me about my emotional trauma shortly after my accident. In addition to anger, I also had a lot of fear—of losing my Air Force scholarship, of not being able to pay my medical bills, of never again being able to walk or run. The best option, I realized, was to seek help for my emotional trauma on my own. I discovered that my university offered free counseling, and I didn’t hesitate to set up an appointment. It was one of the best decisions I made during the whole rehabilitation process.
I was homebound and out of medical school for the four months that I was unable to walk. Then I started intense physical therapy. After six challenging months, I could walk again on my own with minimal assistance from a cane. These days—six years after the accident—I am still healing after many counseling sessions, four surgeries and tons of physical therapy. But I no longer use an assistive device to get around. However, sometimes I miss my wheelchair because I could really get cruising in it!
I have discovered aspects of myself as a husband, a father, a son, and now a physician that I never would have learned had this not happened to me. I no longer hate the man who hit me. I forgave him long ago.
As I reflect on my experiences from the opposite side of the white coat, I have a new appreciation for the saying “What doesn’t kill you makes you stronger.” I know how scary and otherworldly it is to lie helpless and in pain on a stretcher while people stare down at you, asking annoying questions ad nauseam when all you want are pain meds and sleep. And although it was temporary, I also know personally how it feels to be looked down on by society as an individual with a disability.
These insights translated into revelations when it came to patient care. I’ve learned that respect, eye contact, human touch and getting down to eye level are all of paramount importance. Patients also need to be included in discussions about their treatment options whenever possible. I am aware that pain can change a person both physically and emotionally. In providing comprehensive care to my patients, I try to address their physical and emotional trauma.
I know what it is like to learn to walk again, and how much of a struggle it is to reintegrate into society after a traumatic event leaves physical and emotional scars. My patients have benefited from my experiences. I’ve advocated for patients who were helpless or afraid to speak up, such as the gravely ill and those who felt ignored by the system and didn’t speak up for fear of being labeled a troublemaker. I’ve also helped patients take ownership of their own care, something I had to do on my own.
On Tuesday, August 15, 1995, at around 4:00pm I had a head-on collision with a van in Seattle, WA. The van was making a left turn across our two lanes of traffic, and apparently couldn't get all the way onto the side street. It stopped in my (right) lane, and I had less than a second to stomp on the brakes of my Ford Aspire (AKA "Expire") rental before crashing into it. A combination of seatbelts and air bags "saved my bacon" (in the words of the emergency guys). I did, however, suffer a complete compound fracture of the right tibia and fibula (both bones of my lower leg). Apparently, all my weight came to bear on that leg, which was locked against the brake pedal.
Emergency crews got there quickly and whisked me away to Harborview Medical Center, an outstanding trauma and orthopædic hospital. After giving me pain medication and cutting off my clothes, they took lots of X-rays and prepped me for surgery. In this picture you can see where the seat belt tore the skin on my upper-left chest, and where my forehead met the air bag.
During a 2.5 hour procedure, a titanium nail was inserted into my weight-bearing tibia. Five screws were used to secure it in place. The surgery was performed by Dr. Jens Chapman, then of the University of Washington's Orthopædics Department. Three days later, the open wound above my ankle was again cleaned and finally sewn closed. My fibula was left unaffixed, and the doctors promised me it would align and heal itself in due time. The nail is intended to be permanent, and would only be removed if it caused trouble later. After some rehabilitation exercises that taught me how to use crutches, I was released after six days, on Monday, August 21.
During a 2.5 hour procedure, I was lucky to have several friends living in Seattle, and Jed and Allison Lengyel put me up in their house for a few days after my release. On Wednesday, August 23 I flew home to Ithaca, and began re-establishing my lifestyle (or some fraction thereof). My Mom came to visit and help me around the house for a few days. My upper body was regularly sore from using the crutches and hoisting myself around.
I was not allowed to put weight on my right leg for six weeks, during which time I wore a removable, ski-boot style light cast. I began seeing Dr. Robert Hole, an orthopædic surgeon here in Ithaca. On September 29 he gave me permission to start putting weight on my right leg. Walking on the leg as much as possible was my prescribed physical therapy. At the point when I began using my right leg again, my right leg's muscles had atrophied (and my left leg's muscles had grown), yielding the following circumference disparities:
From the time I was allowed to walk, I made steady progress towards being 100% recovered. Many improvements happened slowly, and I can't say exactly when I was able to do certain things or when I didn't feel various types of pain. The following is a rough timeline of my recovery:
- 6 weeks - allowed to walk with crutches or cane
- 8 weeks - able to play six holes of golf, walking with cane
- 10 weeks - no longer using a cane
- 5 months - no longer limping, went cross country skiing
- 7 months - playing non-contact ice hockey
- 10 months - playing softball, racing for several home runs!
- 1 year - released by doctor, nearly 100% recovered and discomfort-free
These X-rays were taken at my final examination on August 15, 1996 (exactly one year after the accident!). Note the substantial bone growth on three sides of my tibia (though not as much on the front of my shin). You can also see where one of the upper screws was surgically removed to allow the bone to compress and mend more completely (this was done in November of 1995). I was cleared for any physical activity, including kicking things! I was quite pleased with the way the fibula aligned itself and healed. Quite a bit of bone grew over the head of the screw at the top of my tibia. If the rod were ever to be removed, they'd have to chisel this sucker out.
(Update in 2016) After more than twenty years, I am happy to say that my leg has not caused me any substantial problems since the break healed. There is a small patch of skin below the site of the compound fracture where I do not have any sensation, but I rarely notice it. When I ski for a day, I do have some discomfort where one of the remaining screws above my ankle presses on my skin when I lean into the ski boot. I try to relieve this by placing padding on my shin around the screw. Other than that, I have no problems and consider myself very fortunate.
Top Ten Questions About My Leg and Accident
- Is the rod going to be taken out?
Not unless it causes some problems later (such as an infection).
- Have you recovered 100%?
I am pleased to say that I have.
- Are you scared of driving now?
Sometimes when I pass a truck (or even if one drives by when I'm walking) I get a chill up my spine. I haven't flinched while driving, and pretty much drive the way I always did.
- Does your rod set off metal detectors at airports?
No. I've been through dozens of detectors since the accident, and nothing has registered.
- What happened to the marrow where the rod is?
I understand that the marrow in your large bones (like the tibia) is less dense than in smaller bones, and so it probably got compacted. Even if some was destroyed, I don't think it will affect my health.
- What happens if you break the leg the same way again?
The rod is actually breakable, so certain forces might be able to break both the rod and leg. My guess is that in a similar accident the bone would hold up and my ankle or knee would sustain more damage.
- Do you feel it in your leg when a storm is coming?
No. At first I couldn't tell because there was always a varying amount of pain in my ankle. Now that things have settled down, I'm sure that I don't notice the weather.
- Does your leg get really cold in the winter?
No. I've heard stories of people with plates on their bones whose skin turns blue when it's cold. I haven't felt anything, as the rod is deep within my leg.
- Is your leg Bionic now?
Yes. Yes, it is.
Remove the Rod?
Whether intramedullary rods should be removed or left in place is a subject of some debate in the medical community. Thomas Anthony, a visitor to this page, has compiled some information about studies and statistics related to nail removal, and kindly shared this information with me. Thank you Tom!
More Broken Leg Stories
You can read many more patient-supplied stories about broken legs at MyBrokenLeg.com.