A New Ten

Tad took this one literally moments after the accident. The pain hadn't even reached its peak yet.

Tad took this one literally moments after the accident. The pain hadn’t even reached its peak yet.

“How is your pain, on a scale from one to ten?”

I was lying on my left side, with my cheek in the dirt, because it was the only position I could be in that was remotely tolerable. Tony Coven was my first responder, and it was Tony asking the question. Tony was the answer to a prayer tossed into the 911 dispatch system. He’s a trustee of the Westminster Pinnacle Trail Association, and my wreck was on the trails, a stones-throw from the pinnacle hut. Tony has been a First Responder and EMT for as long as I can remember. When Tad called 911 I made him ask for Tony, even though I knew that he was several layers of dispatch away from anybody who would know Tony or the Pinnacle, or anything about my situation. But it was going to be a trick to get me out to the road, and Tony was the one guy who I had absolutely confidence had spent hours envisioning this very scenario.

Nearly an hour had passed since my accident. Tad was with me when it happened. After he made the 911 call I asked him to ride back down to the trailhead to direct the first responders, and make sure they sent some drugs. We had tried and failed to find a more comfortable position for me. At one point I had harbored the idea that I might save everybody a bit of work by scrabbling up to the lean-to, about 150 feet up the trail, where it would be easier to stabilize me and prepare me for extraction. That was a laugh. I’ve read the books and heard the stories of people hauling themselves out of the wilderness, broken beyond belief, and feeling the pain anew with each repetition of whatever horrible locomotive sequence was working for them. My college ski coach, Terry Aldrich, had a story like that of his own – a story of hauling himself off the Long Trail with a broken leg.

IMG_3570I’ve always sort of assumed that I’m a tough guy, and that maybe I just hadn’t had the opportunity to prove it. I guess I’m wrong about that. There was a good chunk of time, up there near the pinnacle, where I would have taken the easy out. I’m not saying this to alarm anybody – I’m not remotely suicidal. But if somebody had put a gun by my head and quietly walked away, I think I would have done it. It turns out I’m kind of a pansy when it comes to pain.

In the midst of this intense and painful alone time something legitimately funny happened. Something crawled up my shorts and bit my balls. It felt like a bee sting. It hurt, just as much as a bee sting on the balls would ever hurt, and the absurdity of the situation actually made me laugh. Tad was off directing first responders, but I texted him. I still had bike gloves on, and I had to lick the pointer finger of my right hand to get the phone to type. It took a couple of minutes, but I figured Tad deserved the laugh. He took a screen shot of the exchange for posterity.

Tony Coven is the guy in the cap that says "42". Try asking for him next time you need to call 911.

Tony Coven is the guy in the cap that says “42”. Try asking for him next time you need to call 911.

I’m fortunate that I haven’t often been tested by severe pain. My standard answer to the “what’s the worst pain you’ve felt” question has been “childbirth”. It’s a joke; get it? I was only watching childbirth; the pain was all Amy’s, but it was still the hardest thing I’ve had to do. That answer usually scores me some points with females in the medical profession.

“How is your pain, on a scale from one to ten?” asked Tony.

“It’s a new ten.” I’ve got a new ten.

 

IMG_5374That was Friday the 15th. Today is my birthday, and tomorrow, two weeks after the accident, I’m headed back into Dartmouth Hitchock for reconstructive surgery on a pretty well shattered Tibia and Tibial Plateau. It turns out that the break is a legitimate one. It’s eerily similar to the break that ended Amy’s career as a professional triathlete fifteen years ago, when she was hit by a truck on a training ride. The Tibial Plateau is a tough break because it’s the load-bearing surface of the knee joint, and the articular cartilage that covers it does not regenerate on its own. Scar tissue in the knee joint is inevitable, and the prognosis is a pretty strong guarantee of arthritic complications sooner or later. Probably sooner.

I learned a lot about the subjective nature of pain from Amy’s accident. Compared to my recent experience, her situation in the weeks after her accident was downright medieval. She was sent home from the hospital on the same day as her accident, after having a trauma-induced seizure in the orthopedic waiting room of the Springfield hospital. She was supplied with Percocet and Vicodin, which weren’t even close to enough horsepower to suppress her pain. A few days after her accident she became convinced that she had an undiagnosed broken ankle. Her ankle was in so much pain that she was unable to tolerate even light touch on her toes. So we bundled her off to the hospital for more X-rays. The trip was over an hour on bumpy Vermont roads, and every crack in the pavement sent a new discrete shard of pain through her leg. We had to stop multiple times along the way so that she could catch her breath. Six hours later we were back home. The X-rays were clear; no break, but she had a bad hematoma and the doctors told her that it was critical that she start to mobilize her ankle, or she risked serious complications. Six hours later we were back home, and I was pushing against her foot with a high percentage of my body weight in order to increase her mobility. It was the same ankle, but her understanding of the trauma fundamentally changed her experience of the pain.

IMG_5368My own newly calibrated pain scale has left me confused at times about the relative nature of pain. I spent a week in the hospital dealing with acute compartment syndrome and some aggressive fasciotomies and vac dressings to relieve and drain the soft tissue trauma that is common with this type of injury. I was asked for subjective pain assessments many times a day, as I went through different pain management strategies in preparation for discharge from the hospital. At times my honest assessment of the pain, as it related to my “new ten” was insufficient to justify the kind of narcotic dose that both the nurses and I knew was required to stay on top of the situation, and so I’ve been encouraged to inflate the values a bit. On balance, I feel that I’ve spent most of the last two weeks somewhere at or below 5 on the pain scale, while I’m certain that Amy spent the two weeks after her accident far, far higher on the pain scale than that. I have no idea how she survived that.

In isolation this accident can only been considered bad misfortune. But in the context of the summer that I’ve had, it’s necessary to ask some hard questions about my judgment. After all, that ride with Tad on the 15th was in spite of doctor’s orders to avoid any risk of re-injuring the broken Scaphoid that I had surgically repaired on May 6th. Yup, this is my second bike accident of the year to require surgery. And prior to the hand injury, there was a litany of relatively minor injuries that seemed to be occurring on a weekly basis. Tad can attest that I was riding cautiously and within myself when I broke my leg, and it’s true. But that doesn’t tell the whole story.

It’s a middle-age thing. I’m pretty young and pretty fit, but I’ve reached an age where the aging process is undeniable. The heavily seasonal nature of our work guarantees that I spend a lot of the year quite fatigued, and in terrible shape by my historic standards. I gain weight easily compared with ten years ago, and much of the time I have very real body image issues. I enjoy reclaiming some fitness every year, and especially love those times when I’m able to get enough running miles under my belt (and I’m able to get light enough), that running feels natural and free instead of like a plodding self-flagellation of poorly contained soft tissue. But the aches and pains associated with running make that elusive feeling of running fitness increasingly rare and fleeting.

I’ve always enjoyed mountain biking, but for most of my life I’ve approached it the way most Nordic skiers do; from a racing perspective. Until two years ago my idea of mountain biking was to take a fast and light XC race bike out on the trails, and try to go fast. I didn’t grow up riding BMX or motocross or doing any of the things that would give me any real athleticism or skill on two wheels. So my attempts to go fast were ugly. I had all the skill and grace on a bike that your average road biker has on cross country skis. Kind of embarrassing, really.

Then I started to think differently. It began with the realization that I don’t race. I work with racers, and I’ve always thought like a racer, but it’s been a long time since I’ve raced with any consistency or intent. The bottom line is that I don’t have the time or ability to extract representative performances from myself, and I’m not satisfied to race badly. So I don’t race. I’m generally fit enough to keep up with everybody I ride with, and so I decided to start working toward a totally different skill set. I bought a six-inch travel dual suspension bike based almost entirely on image, attitude, and glowing reviews from people who use the word “gnarly” regularly in their writing. I set about learning how to jump on a bike, how to manual through rough terrain, how to corner, how to take drops. I had some great advice from some phenomenal riding partners. My friend Todd Miller has been my MTB motivation for decades, and a great guy to ride with. Mike Wynn came to me as a customer when I first started grinding skis, and has become one of my very best friends over the past fifteen years. He’s got a motocross background, and the patience to teach me a huge amount on the bike. Roger Bird is another customer who has spent a lifetime involved in mountain biking. In one comment after one ride together he changed the way I think about cornering fundamentally.

Early spring riding.

Early spring riding.

I’m a forty-six (today!) year old guy learning skills that are best learned as a young teenager. But even though I’m late to the party, the learning curve has been astonishing, and the rate of improvement has been exciting. I’m not exaggerating to say that mountain biking has become the one thing in my life that turns back the clock and makes me feel younger. The best part of the whole thing has been that Amy and Gunnar share the passion. We’ve taken-up lift-serve riding at every opportunity, and genuinely enjoy spending time with each-other on bikes.

All of this is glowingly positive. The downside is that there are inherent risks. My decision to get a long-travel bike was easy to rationalize. I wasn’t confident on a steep-angle hard-tail bike pushing my skill acquisition into unknown territory. The bigger bike put bigger features within reach. But at the same time, the acceptable risk line got pushed further into the danger zone. I started to get fairly proficient, and pretty fast, but my speed got ahead of my experience and judgement. It would be a good thing if I had learned to fall back in my teens. Learning to fall in your forties is tough.

On balance, I’m unapologetic, and plan to return to my risky ways as soon as I can. A sober assessment of the case-by-case realities paints a less than totally bleak picture. My higher-speed and higher-risk mishaps have generally resulted in more minor scrapes and bruises. The big stuff has come when I’ve been backed-off and a little bit checked-out mentally. It’s an important lesson; when you’re doing something inherently risky, backing-off is fine, but you need to stay focused.

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First Steps

If my high-risk lifestyle has come in response to a bit of an aging crisis, then the frequent visits to the hospital have yielded an unexpected side benefit. I spend most of my life surrounded by incredibly fit and skilled athletes. My wife trains as much as most of the skiers we work with. My twelve year old son is starting to run faster than a comfortable pace for me. Our houseguests are national champions and world cup racers. It’s easy to start feeling old and fat and useless. But in a hospital environment I’m basically a super-hero. I set-off the alarms on the bedside monitors because my HR drops down into the 30s. The doctors are surprised and pleased with how quickly I heal and mend. I don’t smoke, drink, or take recreational drugs, as I get to smugly report two to three times a day in that environment as I get passed from one care team to another. My self assessment of being overweight is laughable in the context of the general population of a hospital setting. Twice this summer I’ve been told that I’m the healthiest patient they’ve seen in months. Perhaps I’m not actually doing all that badly! We can call that another “new ten”. I may be aging, and I may be anxious because of it. But in the context of the general population I’m extremely fit, and I’ve got a lot of really fun years ahead of me.

When I broke my hand at the end of April I was bitter. It was a disappointment and almost an insult. I was anxious to enjoy my limited down-time because work always returns, and the fun gets put way on the back burner. The broken hand felt like something I should be able to work around, but it was just enough to really ensure that I couldn’t go out and have fun biking, which is all I wanted to do. So I was bitter, and I was a bad person to be around. I knew that I was being hard on Amy and Gunnar, but I couldn’t help it. I was angry.

I'm feeling awfully lucky to have a wife who knows EXACTLY what I'm dealing with.

I’m feeling awfully lucky to have a wife who knows EXACTLY what I’m dealing with.

I think Amy was really concerned that the broken leg would put me over the edge. Curiously, I think it’s slowed me down a bit and given me pause to consider how lucky I am. Maybe it’s the fact that I’ve been on a constant stream of narcotics for the past two weeks, but I feel remarkably sanguine about the whole situation. It’s possible that I really needed a major correction to my attitude and brain chemistry. Right now I’m doing fine, and I’m hopeful that my current state of mind holds through what will be a long and challenging rehab.

Work will be a challenge. I won’t be fully weight-bearing on my leg until 12 weeks post surgery (at least, that’s the estimate I’ve heard so far). That puts me at the end of October before I even start to fully load my right leg. We’ve got a new shop helper this year – we’ll put out an announcement and introduction soon – and we’re bringing him on-board right away – a month earlier than we have in the past. Once surgery is over we’ll schedule our follow-up ski selection trips around my projected mobility. Meanwhile, the skis we selected in May are here, and we’ve got plenty of work in the shop to get started with.

Grinding will be the biggest issue. Amy is an extremely well qualified grinder operator, and our new guy will come up to speed quickly. Producing final structure is something that I have generally reserved for myself in the past because it takes some confidence; that’s the step where you don’t want to bobble and screw-up. But the real art involved with producing good grinds is in setting up the machine to get the right cut on the stone. While I may not be able to physically feed the skis through the machine, I’ll be able to handle the machine set-up, and ensure that the work meets the standard that we’ve established.

Because I’ll be quite limited in terms of what I can do physically, I expect to be spending more time working directly with customers, and very hopefully, more time working on marketing and informational material. We’ve got exciting products and projects going in the wax category, and lots to communicate about skis and grinds as well. My hope is that all of the time I’ll be spending sitting on my butt will yield some good material to support our customers at an even higher level than before.

Crutches to make an injury worthwhile. I'm genuinely excited about these!

Crutches to make an injury worthwhile. I’m genuinely excited about these!

Based on Amy’s Tibial Plateau experience from 15 years ago, I have every expectation that I’ll be on skis this winter. Her accident occurred at the start of September, and she was able to do quite a lot of double-poling on skis that winter. Maybe this will be a good opportunity for me to experiment with the double-poling phenomenon that has generated so much discussion, not to mention new ski models! At any rate, by the time the snow flies I’ll be hobbling around with enough facility to enjoy the winter. In the meantime, Todd Miller has corralled donations from a whole bunch of friends and scored me a set of the most bad-assed carbon-fiber crutches you can imagine. 220 grams each, and stiff as well! Right now I can only scratch the surface of the fun I can have on these, but a few days after surgery I’ll be tearing-up the crutch circuit, and probably throwing down some new tricks as well…

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