WA to MT Days 8 & 9 - Sandpoint Hospital
Here is the x-ray of my left ankle post surgery. I now have a plate holding my fibula together and 2 long screws holding my tibia together. I start here because it is the only injury photo I want to post. However, let's start from arriving at the hospital.
I arrived at the Sandpoint hospital after a 30-40 minute ambulance ride and probably 80 minutes after the crash. The body does some remarkable things with trauma. I was very surprised how little pain I felt despite a very bad break. While I was on the pavement post crash, I lay on my stomach and held my broken foot in the air to reduce immediate swelling. During that time, my pain was really only a 3 or perhaps 4 on a 1-10 scale. For the ambulance trip, Ruth gave me a Percocet which she has for her bad back. That kept the pain stable during the trip.
When I arrived in the ER, they got an IV into my arm and gave me Fentanyl. That was quite effective, although it still hurt as they moved my ankle slightly to get the necessary x-rays. After a short wait, an orthopedic surgeon arrived. Looking at my mangled ankle, he smiled at me and said, "Now what seems to be the problem?" I immediately responded with, "I had a bike crash and scraped my elbow. I am worried about infection. What should we do?" And with that intro, he explained that I had a clean break of the tibia and fibula with the foot significantly displaced. The first step was to get everything realigned. To do this, they would need to sedate me.
After filling out the necessary forms for the surgeon and anesthesiologist, they prepared to sedate me. Fentanyl has a very short half life which they wanted because they don't want significant cross interactions with the sedation medicine. Of course, by this time, my natural endorphins and adrenalin which had masked the pain had faded. Unfortunately, the fentanyl also faded slightly before the sedation started, When it faded, it faded fast, so I had about 3 minutes where the pain pegged the meter. But fortunately, it was only about 3 minutes.
Very shortly, I was sedated. I do not remember them realigning my bones which I am sure is a very good thing. Afterwards, the orthopedic surgeon showed me an x-ray of my ankle. While the breaks could be clearly seen in the x-ray, the tibia looked almost perfectly aligned. The two parts of the fibula were touching but slightly misaligned. My foot felt massively better.
My orthopedic surgeon explained that I would need two screws to hold my tibia together and a plate to hold my fibula together. He explained that it was actually fairly straight forward surgery. He then explained that I could be splinted, released, go home and have the surgery done in the Boston area if I liked. The plus of that is that my surgeon would also be the one providing the continuing care. The potential disadvantage is that if my ankle swelled too much, my surgeon would likely delay the surgery until the swelling was reduced. This could delay my healing by about 2 weeks. He also said that he was on duty the next day, July 4th, and he could do the surgery then. He said he had "done a million of these surgeries... well not a million, but quite a lot." He applied no pressure to go one way or the other. He took time to answer all of my questions in detail. Since my wife, Kate, had nearly identical surgery in 2019, I knew generally what to expect. After talking with Kate, and with Jesse (now doing much better and a doctor), and with Ruth (critical care nurse), I decided to go ahead with the surgery here. This would allow me to start healing faster and to travel home with a fully stabilized ankle.
I struggled to sleep that night even though the pain was generally well managed. I think the adrenalin from the day and anticipation for the surgery played a big role. However, at 8am the next morning, I was rolled down to the ER for surgery. The anesthesiologist put me under, and the next thing I knew it was almost noon. The surgeon had already called Kate, but he told me that the surgery had gone completely fine. I was groggy from the anesthesia throughout the afternoon, but my leg felt remarkably good. Undoubtedly, part of that was the nerve block drip they had going into my leg at the knee. I napped three times that afternoon and generally slept fairly well overnight.
This morning, I felt rather normal except for the splint on my leg and the nerve block drip attached to my knee with the bulb in a sling over my shoulder. After some getting some crutches, some prescriptions, and my discharge papers, I was ready to go. I do want to say that the hospital staff was uniformly amazing. Every single interaction was very positive. I feel extremely lucky to have landed in Sandpoint Hospital following my crash. I really can not imagine how my care could have been any better.
Doug had come to Sandpoint the evening following the crash and was staying in a nearby hotel. He visited me yesterday, and he has been helping me this afternoon and tonight. He has been a tremendous friend. This is a mirror of 3 years ago when his wife Trish spent time helping Kate out when she was recovering from her surgery and I was travelling.
Doug and I will be driven back to Seattle tomorrow by the tour guides. On Thursday night, I will take the Jet Blue red eye to Boston. Jet Blue's red eye first class (Mint) has lay flat beds which will be very helpful for me. To reduce swelling and minimize pain, I need to keep my leg up as much as possible.
For obvious reasons, this will likely be my last biking post for quite a while. I look forward to healing and getting back on the bike. While the accident sucks, the biking was beautiful and great fun.