General, or spinal?

"So I wondering if you want general anesthesia or a spinal?"

It's the morning after my big break and the Korean anesthesiologist has come to call. I'll call him Dr. Lee. He's mostly hidden by his paper surgery hat, gown, glasses. If something goes wrong, I think, I'll never be able to pick him out of a line-up.

I consider his question. My mother had slept through childbirth five different times while blanketed by the bliss of general anesthesia. I'm thinking that sounds good, but hey, he's the expert.

"Which do you suggest?"

"General anesthesia good, very good, you fall asleep, wake up, all over. But sometimes side effects not so good. With spinal you feel nothing, you wake up. Either one good."

I'd had general anesthesia before for other procedures, and had never suffered side effects. I'd had a spinal for my C-section—an injection of opiates right into the spinal fluid. I remembered lying on my side, "curled into a ball" to the extent that a nine-month pregnancy allows, trying to heed the warning to lie still lest the doctor nick something he shouldn't with that needle, even while my entire mid-section was wracked with contractions.

Now my brain was addled with trauma, lack of sleep, no food or water, and pain meds. I simply wanted this show on the road, in the least dangerous way. "I'll have the general," I said.

"Hmm. You sure? Spinal really very good. Also it last beyond when you wake up, which help with pain."

"So you're recommending the spinal?"

"No, no, general very good also. You fall right asleep, no problem."

Dr. Lee would be no help at all. But sleep? That sounded like the antidote I'd needed all night. I craved it. I settled on the general anesthesia.

Take two. Later that afternoon, another guy in scrubs came in. He strode in, shook my hand, introduced himself. I'll call him Dan. He had a red beard and mustache and the kind of stocky build and fresh face that suggested he'd been bow-hunting in the woods earlier that day. Thanks to a scheduling change, he would be my anesthesiologist.

"We're going to be taking you down for surgery soon but I wanted to meet with you first. I understand you want general?"

"Yes." With my work life blown to Hades, my loved ones scattered, and my ankle lying in pieces, it felt so good to feel confident about something.

"No you don't," Dan said. "Believe me, you want a spinal."

"I do?"

"No doubt about it." Dan smiled. "We'll take you into the O.R. and give you a little juice to relax you. We'll have you sit on the edge of the bed, bent over, and you'll feel one little pinprick for the injection. Next thing you know, the surgery will be behind you. Added bonus: complete pain relief for another few hours. Sound good?"

I'm not sure if it was his targeted argument or the thought of Dan out there in those woods, bow in hand, but something gave me faith in his aim. I said, "Where do I sign?"

I was alone when they came to get me for surgery. My mother hadn't come—while she was able to get me the help I shouted for when I fell out on that rainy hill, her grief over my father's recent death and her memory issues had made the struggles of daily life enough for her to worry about. A neighbor was looking in on her. Dave had left Pennsylvania that morning and was on his way. On the ride to the operating suite, as ceiling tiles flew past, I took deep breaths and tried to relax, hoping I wouldn't flinch when the needle went in and inadvertently cause my own paralysis.

They parked my bed next to the operating table and I inched from one to the other. I remember seeing Dr. Luc Perrier, my straight-from-the-pages-of-a-romance-novel surgeon, tying on his mask. Dan said, "Here comes the feel good juice" and I recognized the heat going into my arm...

"Mrs. Craft? Mrs. Craft?" It sounded like someone was speaking to me through a long tube. "The operation is over. How are you feeling?"

All I could think was, How many operating nurses does it take to balance a patient on the edge of a table if she's completely passed out? Memories of half-carrying wasted friends home from college parties came to mind. Maybe I should have told them that when two aspirin are suggested I can sometimes get by with a half.

Oh well. It was over. And Dan was right about the added bonus: then, and for a few additional, blessed hours, I felt nothing but relief from all that had plagued me. I'd had a great nap. They brought me a tray of food that I was able to enjoy with no distraction from pain, and a full pitcher of water. Dave arrived from Pennsylvania and I was no longer alone.

On my left ankle I sported a new wrap made of felt-like material bound with Ace bandages. Hidden within, my new permanent hardware:

That night, my post-trauma flashbacks would recur. But there was a difference in my reaction to them: with respite from the pain, some heavy-duty stainless steel on the inside, and my husband by my side, I now had resources to help hold me together.

Tomorrow: my hospital roommate's secret to happiness.

Awaiting surgery

I can fall asleep for only a few minutes at a time. Then I hit the mud, slide, hear my bones breaking...and wake up crying out. To try to outrun my repeat fate I have pressed my broken ankle into its stack of pillows, and it is now on fire with pain.

And heat.

The posterior leg splint (right) the orthopedic surgeon made for me in the ER—bent to suit my ankle and strapped onto my broken yet realigned bones with Ace bandages—is curing. It heats up to do so. Every single thing I know about first aid injury treatment says this heat is my enemy. Time's a-wasting; my foot is swelling out of control but no one seems terribly concerned about this. My foot structure (narrow heel, high arch, small bones) never handled well my active life; it turns easily and I have sprained each ankle at least eight times. Experience tells me that the immediate application of ice can be the difference between walking and not.

I ask for ice. My nurse says she'll check my orders. Ice isn't listed, so I can't have it. It amazes me that ice can't be administered unless it's prescribed by a doctor.

What the hell. Guess I'm not walking anywhere soon.

They give me pain meds every four hours but as the interior pressure builds they only take the edge off for three. The last hour is a killer.

It's the middle of the night. I'm in a double but do not yet have a roommate. A hundred cable channels and nothing to watch but zumba routines I won't be able to dance and exercise machines I won't be able to use. I try, again, to sleep. Almost there... I hit the mud. Slip and roll. My bones snap and crunch. I wake mid-stride, ankle searing.

I've been panting. Mouth so dry. No water—can I have ice chips?

"I'll have to check your doctor's orders." I know where that will go.

Although my thirst cannot be slaked I'm hooked to plenty of IV fluids and I can feel them pumping, pumping into my swelling foot—then redistributing to my bladder. I have to get off the bed and onto the commode about every half hour. Lifting my leg from its pile of pillows is so painful as the tissue fluids redistribute, but that's nothing compared to the sensation of the broken bones shifting, and the hot knives that thrust into my ankle once my leg is dangling off the edge of the bed. Thanks to the efficiency of movement conveyed by a previous life as a dancer, I can get from bed to commode in one graceful pirouette (one must take one's small victories).

As I perform this bravura feat my debonaire cavalier (okay, the nurse) holds the commode so it won't kick out from under me. "I'm sorry, you can't have the ice chips, you're scheduled for surgery."

I keep my eye on the prize—that more manageable post-surgery pain, which they promise like offering a horse a carrot, then yank away, time and again. They can't give me water because surgery will be later that morning. Then it won't be until early afternoon, I'm told, so sorry, you can't have breakfast. Looks like the surgery will be later this afternoon, so you can't have lunch. Good news! We've heard from your surgeon, he'll be over after his office hours, so your surgery will be this evening.

I was glad I'd taken the sandwich offered the night before in the ER; I hadn't eaten since noon that day. (Then again, the offered sandwich was ham. I was thirsty.) The night before, when they'd come to the ER to take me up to my room, I'd instinctively wanted to wrap the uneaten half and take it along like some hoarder in a nursing home but they took it away, saying there'd be more of the same up on my floor. No such luck.

Luckily, dawn brought the distraction of my anesthesiologist comedy team—and a roommate who held a small key to happiness. More on that tomorrow.

My Big Break, in pictures

Today I'm sharing a series of photos of my broken and dislocated ankle. I'm going to go out of order so you can appreciate the mal-alignment after the fracture. This first x-ray is of my ankle after the orthopedic surgeon pulled on my foot and crunched my bones back into approximate place:

Compare that to the next x-ray of my ankle when I arrived at the ER:

I know, ick. If you have a good eye, even in this "scan of a printout of an x-ray" you can see the way the bottom of my fibula (here, on the right) is snapped off to the side.

Here's an x-ray of how the dislocation looked from the side. Without dislocation, the tibia bone should center over that hump beneath it:

The next photos show you what this looked like in the flesh. Although the angle of the photos make it difficult to appreciate the way the foot is twisted down and to the outside, if you let your eye travel along the top line, you should be able to perceive an aberration. (Got to admit, I have to take a deep breath to look at these, even four weeks later):

To make me feel better—and because we know all such accidents happen in the most heroic and romantic fashion—let's review the effort on my part that resulted in this mishap. Hurricane Irene had knocked something from one of the tall trees by our camp, and it had fallen at such speed, it thrust right into the rain-sodden earth! I was talking to Dave on my cell, and couldn't see what it was through the raindrops stuck to the window screens. I had to go out into the wind-driven rain and investigate!

Turned out there wasn't as much of an emergency to report as I first perceived. The object that had fallen from the sky on August 28 was still skewered into the lawn on Labor Day weekend, when Dave and my sons were scheduled to arrive. Indeed it was still there there when we closed up camp on September 8, when Dave snapped this photo, and it was still there on September 19 when Dave returned to the lake to retrieve my car.

Who knows, it may be there still. What do you think it looks like? (If you missed Dave's answer, it's in the post that explains how I broke my ankle.) Here it is:

ER

I hit the Canton-Potsdam Hospital Emergency Room on a slow evening, I guess—or maybe that's just the kind of service you get when you arrive by ambulance. They wheeled me right into a room, transferred my backboard to a bed, and had me roll off it. Right away a nurse came in. She told me to get changed—I'd never so happy to don a hospital gown. I peeled off my cold, wet clothes, begged her to cut off my wet pants so I didn't have to jar my leg, and asked for a towel. I soon lay clothed in a dry gown and beneath heated blankets. For the first time in two hours, I stopped shivering. With these small improvements, my sense of the emergency felt behind me.

The nurse started an IV and did an EKG (I was thinking, isn't that for older people? It took me a moment to realize that I was just days from my 55th birthday.) They told me the on-call orthopedic surgeon was on his way over from Ogdensburg, a border town on the St. Lawrence River, and he should be here within the hour. I was told how lucky I was: he was the orthopedic surgeon for the Clarkson University ice hockey team. I was also told that if I'd gone to the emergency rooms of Gouverneur or Star Lake, I would have had to transfer to CPH for orthopedic specialty care anyway, so I silently offered up a quick thanks to the EMT who diverted me here, and begged forgiveness for objecting, however silently, to the disgusting cigarette smoke smell on his fingers as he tied on my oxygen mask.

My mother and neighbor Beth, who drove her, soon arrived with my purse. Beth is a real take-the-bull-by-the-horns type; she had already rifled through my wallet, given them my insurance info, and called Dave to tell him we were at the ER. She found my mom something to eat while they took me to x-ray. Thankfully, the tech was able to x-ray through the splint, positioning plates so that I didn't have to move.

When I got back to the ER the nurse pulled the splint from my foot; the doctor would soon arrive. As she put some dilaudid in my IV she explained that some of the pain was from the dislocation tugging at muscles and ligaments now held in an unnatural position. I recognized an opportunity—as gross as it was to look at my foot, I was a bio major with a graduate degree in health and physical education; I knew I'd one day want to study my foot in its current condition. I asked Beth to look in my purse for my cell phone to snap a photo. I hoped it was in there—my mother suffers from short term memory loss and she was quite stressed when I asked her to dry the rain from it and put it in my purse. I also hoped the phone would still work.

Beth pawed around in my purse and said, "Look at this." She pulled out my digital camera, which I never carry around in my purse. For once, dementia to the rescue—my mother had a hard time distinguishing my cell from my camera, so had brought both. Beth took several shots of my foot.

The doctor arrived and told me he'd already reviewed the x-rays. My ankle was fractured in three places (a trimalleolar fracture): the tibia, the fibula, and the talus, the ankle bone that these longer bones articulate with at the ankle. Later research put me right in the middle of the demographic for such fractures. According to the American Academy of Orthopaedic Surgeons:

During the past 30 to 40 years, doctors have noted an increase in the number and severity of broken ankles, due in part to an active, older population of "baby boomers."

As soon as the doctor found out I was a writer he said I must cast him in my next novel as the handsome doctor who swoops in to save my life. I smiled, but knew this wouldn't be possible: the details would strain believability. Because he was Canadian by birth he spoke with a French accent, his name was "Luc Perrier," he was fit and handsome (as you can see), and, like most orthopedic surgeons I've met in my life, quite full of himself. I try not to adhere to such stereotypes in my creative writing. He marched over to my foot, picked it up by my big toe, and suspended it—I prepared to scream, but this didn't hurt as much as I thought it would. My guess is gravity itself was beginning the process he would soon complete.

"We will add something to your IV now," he said, and I turned to watch the nurse insert a syringe into the port. "Can you feel it?"

"It feels all hot going in there," I said, looking at my arm, and with that he grasped hold of my dislocated foot and pulled. I heard and felt the crunching of the bones as they realigned, but whatever anesthetic he'd given me had done the trick—it didn't hurt, at least not any worse than it already did. I now understood the orthopedic surgeon stereotype: it certainly would take some mad hubris to do something like that and believe you were helping the situation.

Before I was wheeled off for a set of post-reduction x-rays, he told me he'd admit me tonight and perform surgery tomorrow. The need for this didn't surprise me. Beth, however, followed him from the room and demanded to see my x-rays, she told me later. She doesn't think people should be operated upon without some proof of the necessity.

But even to her untrained eye, she said, after seeing the x-rays, she knew he spoke the truth.

Tomorrow: a photo montage of my ankle, inside and out, and a special tribute to the cause of my accident.

My first ambulance ride

The sound and sight of the ambulance backing down our driveway finally drew the attention of some other neighbors. I recognized the voice of Ken, two doors over, as the EMT reached into my makeshift tent and strapped oxygen onto my face. He apologized that he now had to touch my foot, and strap it into a splint to immobilize it for the ride. I was so focused on the implied promise—that I would soon get out of this weather and get some help—that it only hurt a little more when he cinched the straps that kept my foot in its twisted position.

I rolled to one side and they slipped a backboard under me. Later, Ken would tell me he became one of the "pall bearers" that carried me up the hill and into the ambulance. I said over and over, "Be so careful. It's incredibly slippery." It's odd how safe you feel in the world until something like this happens—now, I could perfectly picture them all falling on the hill, dropping me, and sending my newly sledded body down the hill and into the lake.

But we made it to the gurney behind the ambulance without mishap and they set me, with the backboard, down on top of it. They asked what hospital I wanted to go to. I knew Gouverneur was the closest, but my aunt had had such a bad experience there a few years earlier she made me promise that if I had any emergency with my parents I would take them to Star Lake. So I said, "Star Lake."

The guy actually laughed, which isn't surprising—Star Lake, like most destinations any farther east into the Adirondack National Park, was kind of in the middle of nowhere. He said, "It's Gouverneur or Canton-Potsdam."

I said, "Take me anywhere where I can find a good orthopedic surgeon."

As they pulled the raincoat off of me and pushed the gurney into the ambulance he yelled to the driver (without hesitation, I noticed): "She's going to Canton-Potsdam."

Potsdam was an hour away, over many back roads with plenty of painful bumps. To make me comfortable for the ride (please note intended sarcasm), they left me on the backboard. They claimed I was strapped on but every time we went around a turn I reached over my head to hold on for fear I'd roll off.

Surprisingly, the man and woman in back with me kept me distracted for most of the ride. They checked me over for other injuries (none), kept asking me if I had chest pain or difficulty breathing (no). All I wanted at that point was to get warm, and they did crank up the heat and cover me with dry blankets, which made me feel a bit better. They were kind of surprised when from beneath my shirt I produced the damp rice sock that had been keeping me warm.

Then he told me he had to cut off my sneaker.

I was wearing my MBTs, the mother of all the new knock-off toning shoes. I was rarely without them: they'd greatly improved my feet in the past year and eliminated my need for the custom orthotics I'd previously never been able to go without. Since they're so expensive, and since my feet had never complained that the shoes had "broken down" the way other sneakers usually do, I had delayed replacing them as long as possible. I have no doubt that their complete lack of tread was the main reason I went down so fast—with no channels for the water in the lawn to seep into, I'd hydroplaned.

As he snipped through the laces, I told him that this pair of shoes had cost me $245. He said, "Look at it this way, then—cutting this one off only cost you $122.50."

Every few minutes they asked what my pain level was, on a sale of one to ten, with ten being the worst pain I'd ever experienced. The first time I answered I looked at the woman: "I'd say it's a five, but that's only because I've had a child. If I were a man, I'd say a nine."

They finally started to orient me: we're past Canton, we're past the new Wal-Mart, this will hurt a bit because there's a bump here but the hospital's just ahead. They told me my mom and Beth, Ken's wife, were in the car behind the ambulance, and that they had my purse.

And I thought, this is just so ironic. I'd never heard of this hospital until earlier this summer, when a social worker whose family summers at the lake hired me to teach my "Healing Through Writing" workshop in the building across the parking lot. That had been at the beginning of August.

Now, at month's end, I was being wheeled into the hospital in desperate need of my own healing.

Awaiting help

On any other Sunday the lake would have been busy with waterskiers and kayakers and the shore would have been lined with parents watching young children splash in the shallows or fish from docks, but Hurricane Irene had chased them all inside. I lay on the sloping lakeside outside our camp, where decades before two of my sisters had done their great Sun-In vs. hydrogen peroxide experiment, and where more than once I had fallen asleep on a grass mat while drugged with sun-comfort only to later regret the hot pain of my reddened skin. But late in the afternoon on August 28, groundwater seeped through my shirt, hoodie and pants from below and rain pelted me from above and I held my calf so my disfigured ankle wouldn't touch the ground. My body temperature lowered, and I started to shiver.

I was shaking uncontrollably when my mother arrived, holding loosely over her head a long camo coat in dual shades of green from our resident rainwear supply.

"Charlie's coming," she said. My mother, 80, looked so little as she hovered above me. She had lost weight since my Dad's death this spring and weighed a mere 117 pounds—I knew because she'd recently recovered from a bad case of bronchitis and a double ear infection that required I take her to the health clinic in town. I had cared for her, helping her sort out the meds since she kept thinking she should take the antibiotic four times a day and the cough syrup only once, instead of vice versa. Now she said, "What can I do to help you?"

I was shaking so profoundly I had trouble getting her to understand my words. "Take my c-c-c-cell phone inside and d-d-dry it off. I'll need it." She took the phone and covered me with the raincoat she'd been wearing. "And be careful—it's so slick out here." I pulled the raincoat over my head—it covered most of me—to wait until help arrived.

After another minute or two I heard a man's voice. "Kathy, it's Charlie." I moved the raincoat aside so it shielded me from the rain, but allowed me to peek out. "I've called 9-1-1, but it will be a while till they can get here. What happened?" I gave him the shaky, Reader's Digest version. Pat, his wife, arrived too. Both stood over me in hooded raincoats. My mom arrived with an umbrella and several more jackets, which she used to cover my legs. Now, only the twisted foot remained uncovered.

"I wish I had a tarp or something, " Charlie said. He might not have had one, but we did—we had several on the shelves in the garage. I told him where to locate them. What I didn't factor in: like any 76-year-old Charlie needed light to see, we have no electricity in the garage, and the hurricane sky offered little light. He came back with our hot pink, fully inflated float. "This is all I could find," he said. "Here." He laid the lightweight float over the broken ankle.

Distracting me with chitchat was the best medicine available just then, and Pat and Charlie are masters of the form. Yet even they could find a limited number of things to talk about in such a situation. "I wish there was more I could do," my mother said during an awkward lull. My number one complaint at that point was the wet and the cold—my foot was screwed and I knew there was nothing to be done about that. It was then I remembered the rice socks.

I host writing retreats for women at the camp at the beginning and end of the summer season, when nights can be chilly in our unheated camp. So I keep tube socks filled with rice on top of the fridge—3 minutes in the microwave to heat them, slip them beneath the covers, and your bed will be toasty when you climb in. I asked my mother to heat me one. When she passed it under the raincoat to me a puddle of collected water spilled onto my face, but I took the sock and held it to my chest. When the heat dissipated some, I stuck it right beneath my shirt. I couldn't stop shivering—I assumed at this point that might be from shock—but I did draw some comfort from the heat source.

Pat went into our camp and found paper and pencil and opened the window so I could shout up to her with Dave's phone number. She said she'd call him as soon as the ambulance left.

EMTs were in the firehouse in Hermon when Charlie's call came in, so they responded instead of the crew from nearby Edwards. I had shivered on the ground about a half hour when I heard the beeping of the ambulance backing up. Charlie went to greet them. He told me later that the EMT said, "Where is she? I told you not to move her." To which Charlie replied, "That's her—down there, under that heap of coats."

I've heard they're canceling All My Children so feel free to stop in here daily for your daily fix instead! Sorry, no sex scenes, but plenty of drama. More tomorrow...

The edges of the storm

Up in Northern New York State, where my mother and I were staying at the family summer home, we didn't expect much damage from Hurricane Irene. We were located at the storm's feathery edges, meteorologists said—although to my untrained eye it doesn't look like that in this satellite image. All day the wind pushed whitecaps towards us down the lake and blew a onslaught of water at us, making it difficult to see out through the rain-spotted window screens.

I called Dave back in PA and asked him how bad the flooding was near our home. As we spoke I went from window to window, trying to see if we had any tree damage to report. On the short hill between our camp and the lake, I noticed something skewered into the lawn. It was small, but sticking up straight. Curious. Like an on-the-spot reporter I carried my cell out into the storm so I could tell Dave what it was. I didn't bother with a coat—I'd only be out there a sec—but three strides later I was skidding on the water-sodden hill as fast as if it were wet ice.

It all happened so fast. Between heartbeats. I rolled over the inside of my left foot as I fell and heard a loud snap then more crunching sounds. Even before I saw my foot stuck in a goddawful, unnatural position I knew what had happened.

The cell call was still open, but the phone had slid several feet down the hill.

Powerless to help from Pennsylvania, my husband stayed on the line and heard me screaming, "Oh god I've broken my ankle! Mom! Mom, you've got to hear me! Mo-o-om!"

Inside, my mother did not hear this. She was enjoying the thrumming of the steady rainfall on our tin roof, a sound my whole family finds comforting, blissfully shielded from any intrusive noise by the double-paned windows we installed when we renovated the formerly screened-in porch.

I screamed for a few more minutes, my throat raw, my shirt and hoodie soaking up the groundwater that was the cause of the accident, new rain pelting me from above. I held my left calf so my foot wouldn't touch the ground—dear god, the sight of it, twisted that way—and somehow eased myself downhill a foot or two so I could kick the cell up toward my hand.

"I've broken my ankle and my mom can't hear me," I told Dave. "The phone's all wet. I've got to shut it. I'll call you back when I can." My mother finally peeked out to see what was taking me so long. "Get Charlie," I yelled, referring to my neighbor. I knew she couldn't help me. I was up there caring for her after my dad's memorial service this summer; losing him after almost 60 years of marriage had worsened her dementia. "I've broken my ankle."

As I waited for Charlie, an uncontrollable shivering began.

***

Well, I've done it. After three weeks I've finally committed the edges of my personal hurricane story to the page. I'll keep writing every day until I'm spent on the issue. I knew that writing about it would help me heal, But I've suffered post-traumatic stress symptoms that gave these images way too much power over me and until an hour ago, when I once again dissolved into tears about it with my sister on the phone, it turned my stomach to blog about it yet. But crying helps relieve pressure, as I hope writing about this will, so I thought I'd give it a go. More tomorrow.

But to end today's post I'd like to skip ahead to my return to the camp after my hospitalization. The storm is now over, Dave is with me, and I am on the couch with my leg propped up on pillows, doped up on pain meds. He is looking out at the lake, and says, "I see it. The thing that's skewered into the lawn. It's a pine cone."

The pine cone had blown from the top of a hemlock standing some sixty feet high above us, and the hurricane winds combined with gravity and the soaked earth created a situation in which the first 3/4 inches or so skewered into the ground and the rest of its length, some seven inches or so, stuck straight up.

Dave says, "You're right. That is weird. It looks like the lawn has an erection."

Granted, I've had to pay dearly for my curiosity. But I ask you: wouldn't you have wanted to check that out?