Ride Tales (Interrupted)

[doc47]

In West Africa I usually avoid riding at night. There are too many surprises: potholes the size of a Manhattan borough, dogs sleeping in the road, fallen trees, cows, and the worst are donkeys. Their gray coats reflect nothing and they are virtually invisible in the dark.
I broke my rule on January 11. I was in an urban area, traveling on a brand-new road, with few livestock and no potholes. 9 PM, it's dark, divided highway, no traffic on my side, no street lights, I'm cruising at about 40, and WHAM! something hits me hard in the left leg, just below the knee. the impact was tremendous. I thought I glimpsed some black letters on an orange background.* I'm bellowing in pain and shock. I don't go down but guide the bike over to the shoulder and stop, right foot down. My left leg is just hanging. I can't take the bike out of gear. I'm afraid to try to do anything with that leg. I'm not sure whether it occurred to me to turn the ignition off, so I keep both hands on the bars with the clutch in. I'm yelling for help but there are few people around. It seems like a long time but probably only a minute or two and there are Gambians around me. They lift me off the bike gently. Someone puts the sidestand down and cuts the ignition.
A Spanish nurse shows up with her Gambian boyfriend. She calls , but no, there aren't any ambulances and no hospitals nearby. I'm lifted into the back seat of a cab. Africmed Clinic, where I worked when they first started up is not too far away, so we go there. I'm extracted from the cab onto a gurney and taken to x-ray. The tech remembers me. "You helped train me, doctah!" But there is no orthopedist here, so I will take my films and go to another clinic.
The films show the two bones, tibia and fibula, are shattered in pieces just below the knee. Not good.
I'm taken to what serves as the Emergency Dept. for the main hospital. This facility is four miles from the hospital and has been "temporary" for more than two years while the Accident and Emergency at the main hospital is remodeled. Interestingly, the contractor is the brother of the Minister of Health. I'm certain that had nothing to do with him getting the contract.
The triage room, where one enters, is perhaps 20 X 25 feet. There are eight rows of four patients each. Each patient has at least one family member attending him/her. Various people who work there move around the room, or cluster at the desk, front-and-center opposite the entrance door. Few are identified by costume.
All the beds are full. Some of the patients must be in pain but one doesn't hear a peep out of any of them. Africans have learned that pain is a big part of life that one endures.
I'm put on a stretcher, a few inches above the floor. I wait. I wait. I wait. After several hours a nurse comes to see me. After another hour I'm taken to another room where two orderlies hold my broken leg in the air horizontally while a nurse applies a posterior splint to immobilize the leg. The pain is unbearable. I am a baby. I scream a lot. But once the splint is on the pain decreases.
I'm returned to the triage room. Eventually, a Cuban orthopedist comes out to talk with me.
Oh hell! Let's cut to the chase. I choose to have the only other orthopod in The Gambia, Dr. Kebba Marenah, do the surgery. He has a good rep. I am discharged around mid-day and taken to the Westfield Clinic.
Marenah comes to see me in the evening. He examines and questions me and says the leg has to have an ORIF (Open Reduction and Internal Fixation), in other words a metal plate to reconnect and stabilize the two pieces of bone, BUT the leg is too swollen. Come back in two weeks.
I spend two weeks at home in bed with my leg above the level of my heart on pillows. Fatou, who is not quite yet my wife, takes excellent care of me.
In a week we return to the clinic for a dressing change. By a week later, the operative incision is deeply infected, oozing pus, and the sutures have all rotted. The thing has come apart. I call Marenah. It takes him three days to see me. That night I'm taken to surgery to wash out the wound and debride (cut out) the bad tissue. I'm left with a gaping hole inside of which you can see the broken ends of the tibia as well as some of the titanium plate he had installed.
Long story short, folks? I laid in that clinic for three weeks on the wrong antibiotic. Eventually, Marenah said I should return to the US. There's bone missing. The periosteum – the covering of the bone that fosters regrowth is missing at the fracture and the gap between the bones is the size of a tennis ball. Grafting is necessary and it would be better done there in the US than in The Gambia.

So I went to my Gambian brother's house and mostly lay in bed. The good part was that during this time, Fatou and I were married. It's a big deal for the women. Not so much for me but I enjoyed the small part I played and am happy to be hitched to this fine, happy, loving, responsible woman who has stood (and slept on the floor in the hospital) by me since this thing happened..

Eventually, three different airplane flights over 29 hours took me to Seattle.I was impressed with how kind people were. One young woman offered me her seat so I would be more comfortable. My son, Ben, picked me up at Seatac airport with a huge hug..
The next day, I was admitted to Harborview Hospital, Orthopedic Trauma Service. Four surgeries were done. Three to clean everything out, and during the third, to place a rod through the marrow of the tibia and a fresh plate screwed in place to immobilize the bone ends.

Cultures were taken repeatedly and turned up an array of different bacterial tenants living rent-free, inside my leg. Some of them are nasty, resistant critters. I'm started on a regimen of two intravenous and one oral antibiotic. Heavy hitters!

For the fourth surgery, the plastic surgery team was enlisted. They took a piece of my left lateral gastroc (calf) muscle, cut it across about 6 “ from the knee, and, leaving the top end attached, rotated it to cover the gap in my leg bone to create an environment where new bone will fill the gap with grafting. They also inserted a spacer of antibiotic-infused cement in the gap.

I turned out to be allergic to the vancomycin, a heavy-hitter antibiotic, and after a serious, whole-body rash and other side-effects, they discontinued it, then replaced it with a different monster we hope will kill Enterobacter without killing me.

I did fine until we noticed my hemoglobin dropping and me becoming more anemic.

“We'll keep an eye on it and if your hemoglobin keeps dropping, we'll discontinue it,” they tell me.

Out of the hospital, mostly in a wheelchair, I've been staying with friends in Seattle. I was on two oral antibiotics and one by IV, which I have to self-administer three times a day. There's no pain. I'm trying to get my wife, Fatou, over here to help me.
The plan is for a total of twelve weeks of antibiotics to (hopefully) clear the infection. Then, the doc will dive back in and start grafting bone. How many surgeries will be necessary is anyone's guess.

But, my hemoglobin kept dropping. I felt like the clock in Dali's famous painting. The plan was if It hits 8 (I should be running 12-13,) they would stop it.

It hit 8. The medication was stopped. Now, we'll wait to see if my blood rebounds. If it doesn't, things will get very interesting, indeed!
Wish me luck, folks. Send good wishes. Send Payday bars. Send money. It has certainly been painful, boring at times, unforeseen certainly, expensive, yes (!) and I wouldn't wish it on anyone. (Well, with the elections approaching I might be able to think of some.)
It has turned my life upside-down. I want very badly to get back to Africa. The possible ramifications of a broken leg never occurred to me before.
What do you think, folks, should I keep riding or is it time to sell the machines?

[Twisties]

Too early to to say.  Also, only you can say.  Only you know what riding means to you.  Only you know how you feel.  Only you know the conditions you ride in.  

 

Over the years you've had many tales of adversity on the bikes....  None of us are getting any younger.  

 

 

[Hosstage]

I was sorry to read of your injuries and struggles. I hope things are getting better every day.

As far as riding again or not, it is a big part of my life, it brings me great joy. After your injury and struggles for recovery, I can understand the questions about getting back on. I'd like to think that I couldn't wait to get strong enough to get back to riding, it brings me great joy, and I would use that for motivation to work on rehab. I understand though, that I might start thinking the other way too, that the risk isn't worth the reward. I guess I don't know how I'd react in your situation. 

I have a feeling you're mad at yourself a little for breaking your own rule, causing this. I know I probably would be.

I hope you can recover well, and get back on the bike. The first few rides might be nerve wracking, or they might feel like getting back with an old friend. 

Some never recover that confidence, others modify their cast so they can get back on the bike sooner than they should (had a couple friends go this route!).

Good luck, keep us updated on your recovery, your riding decisions, your return to helping and treating people, wherever that might be.

[doc47]

I've been fully weight-bearing on the leg, but the calf is weak and my gait resembles Walter Brennan's as Grandpa Clampett.

The ortho surgeon has scrapped the original plan of repair as being too risky. I report to Harborview this Tuesday for a different bone grafting approach plus the addifion of another plate to accompany the rod and plate already in place.

Bone for grafting will be harvested from the interior of my left femur, then a rod inserted in the femur...probably to keep the one in the tibia company!

I am hoping I'll be able to rdturn to Africa in August.

[szurszewski]

@doc47 you must have had another post* with this story because I know I read it and posted in that thread just before you came to the US. 
 

I hope Tuesday goes well and healing progresses. If you feel up to it sometime after this surgery and before you return to Africa, I’d be happy to deliver a case of Payday bars to you in Seattle. 
 

 

*found it  for anyone who might be interested in a few more details (and some painful looking photos!):

 

 

[Dennis Andress]

I, for one, am always excited to see your progress posts. Please keep it up!

Dennis