Collision cost

September 24, 2016 § 39 Comments

Cyclists get hit by cagers every day. They aren’t “accidents.” They are collisions, and they happen for specific reasons. In the case I’m going to tell you about, the collision happened because a drunk guy decided to drive. He smashed into a group of cyclists, changing at least one life forever.

It wasn’t an accident.

The point of this story is three-fold. First, it’s an explicit command for you to check your auto liability insurance and make sure that you have at least $500,000 in uninsured/underinsured motorist coverage. If your carrier won’t let you insure to that amount, change carriers.

Second, it’s a commentary on the trajectory of injury. We see Facebook posts of friends in the hospital, or gory aftermath photos, or black-and-white images of pins and bolts drilled into bone, and then we move on to the next item. It’s difficult to comprehend that after we’ve glanced at the photo, the person is still living with the injury, suffering from it, and in some cases is going to be dealing with it the rest of their life.

But what these injuries often entail is impossible to understand or even empathize with because we don’t really know what the procedures involved are. The trajectory of injury is grisly, gruesome, painful, and life-altering.

Third, this is the story of how one person deals with having her entire life upended as a result of one drunk driver. It’s not an easy story or a saccharine one, and it doesn’t have a happy ending because there is no “ending.” There’s just a story about being in the wrong place at the wrong time, and moving forward with what you’ve got left.

When Deb Banks was hit on January 30, 2015, at about 3:10 PM, she didn’t feel anything. This is almost always the case in serious car-bike collisions. The victim might feel a bump or a light tap, sometimes nothing at all until she regains consciousness in a ditch, in an emergency room, or days later in a hospital room recovering from surgery.

On the day she was hit, Deb’s initial injuries included a gashed right arm requiring fifteen stitches, a cracked pelvis, and severe road rash that left permanent skid marks on her backside. The big one, though, was a pilon compound fracture of her right tibula and fibula.

The pilon fracture required an external fixator to stabilize the leg and calm the initial trauma before reconstructive surgery. A pilon fracture is one in which the lower ankle, just above the joint, is shattered. Think of a force pushing up through your ankle joint into the lower shin, so the explosive nature is up and out. That’s what a pilon fracture is, and hers was made worse by it also being compound, meaning bones sticking out from the skin.

The problem with these fractures, aside from the obvious pain and the fact that this is a key load-bearing point of the human body, is that they are really tough to heal due to low circulation, lots of broken bone, and the requirement of lots of time to heal. Most people that get these injuries are contractors who fall off a ladder, people in car crashes, or extreme snowboarders and skiers. They are said to be the worst fracture you can have and one of the hardest to heal.

The word “pilon” is derived from the French word pilon (pestle), an instrument used for crushing and pounding and usually used with a mortar. The pilon fracture is often described as an “explosive injuries” and subsequently, as noted in Orthopaedia Main, they have are also described as “explosion fractures.”

Pilon fractures have the worst outcome of all ankle fractures. They’re incredibly significant injuries, and if you look at surveys that try to measure overall function, pilons on average are more detrimental to the patient’s level of function than heart attacks.

On February 13, 2015, Deb had reconstructive surgery. Her doctor spent eight hours in surgery, taking out the external fixator and then adding two long plates and tacking them into place with twenty screws. One rod was twelve inches long, the other was five inches, and it took fifty stitches to hold it all together.

She then went into non-weight bearing mode for three months, after which she began physical therapy to begin working on walking.

Once Deb was able to get on a trainer, she did, and by May she was outside hobbling around in a black boot and riding around town on her mixte. By June she was on the back of a tandem and by August she rode 200km, the “easiest” length for a randonneur. She kept working on this, getting stronger and walking, although still limping, and her long-planned cycling trip to South America was a go.

Deb’s plan was to go to South America and ride from Santiago down the Carretera Austral to the southernmost part of Chile. She was to depart in early November; it was her comeback ride and a much deserved vacation.

Deb left for Chile and rode the Carretera Austral. During the first week, she was walking down a low sloping walkway and her left ankle twisted and instead of trying to use her right one, which was the injured ankle, to hold herself up, she dropped to the ground. The long plate had broken, also breaking more screws.

She was in incredible pain. She had walking hiking sticks and used them as crutches for a week. She started slowly to ride again and the trip, while fantastic, turned out to be a trip that included some cycling, versus a cycling trip.

On December 27, eleven months after being hit, Deb had her third surgery. It took seven hours, out with the old hardware, and in with new versions of the same plan, only this time they added a graft from her right hip that brought new scars and numbness, which she still has, and some stem cells to stimulate growth.

She was upbeat. For sure this was going to do the trick. Most people (over 90%) whose non-union doesn’t mend, end up getting the bones to union with this procedure. It was however the same drill: non weight bearing for three months, then the boot, etc.

She was smarter about this now. She had read a ton of medical articles on this, and at first Deb felt great. She had minimal to no pain and at the three-month marker she waltzed into her doctor’s office with crutches and walked out without the crutches or the boot. The surgeon gave her the go ahead to do PT and to ride, which she carefully began.

“Carefully” meant no clipping into or out of pedals, no standing on pedals, and spinning only. She put flat pedals on her bike and used power straps to keep her clogs on the pedals. “Yes!” she said to herself, “I ride my bike in my clogs! They are comfy, they support my foot and if I need to put my foot down fast, they absorb quite a bit of the impact. In fact, I think I may go to this plan forever!”

Forever, of course, is a real long time when you’ve only just gotten started. In early May, now fifteen months after getting hit by the young drunk who, in the interim, has been sentenced to prison and will spend nine years in jail, Deb has a standard appointment with her surgeon and she’s not feeling as good as she was. She felt like her leg was out of kilter, and it wasn’t holding her anywhere near as well as the two months prior. She told the doc and he took x-rays.

Essentially, if a non-union hasn’t shown signs of union after three months, then the likelihood of it getting to mend go dramatically down, and more than likely the end result will be another non-union. By now Deb was really getting tired of her expertise in orthopedics, more particularly, in her necessity of applying it.

She pushed for a CT scan because the x-rays weren’t conclusively showing whether or not the bones were healing, whereas there’s no arguing with the CT scan. Her doctor agreed, and the bad news hit home, hard. Non-union. Again. He was frustrated and she was beyond bummed.

In June she took every test they could think of to try and find out why the bones weren’t growing back together. Blood tests, CT scans, bone scans revealing the happy news that physiologically she had the bones of 29-year-old, but emotionally the bones of a teenager in full rebellion – “You can’t tell me when to heal!”

She had thyroid tests, a liver panel (Did you know that your liver makes enzymes for bone growth? Right! Why would you want to know that?), etc. She took tests all month long in the run-up to her informal Ph.D. in boneology, and in the end the good news-bad news was that there’s nothing about her chemistry that was preventing the mend.

The next step was going to be terrible. The surgeon put an Iliazov fixator in her hands, a contraption that oozes horror and pain, and asked her to read up on the device and to think about it, because the fixator was in her very immediate future.

Deb took a trip to Colorado to see friends; it’s an annual trip as she lived in Boulder for thirty years, after which she came home and on July 8 she went in for Rebuild No. 3, Surgery No. 5. It was with a lot of trepidation, because after the last surgery she had gotten an infection that required a full surgery on top of that to open the wound and make sure that the infection hadn’t gone to the bone. Such infections can end things permanently.

By now the nurses in the surgery pre-op area knew her by name. They’ve seen her three times, and if there’s anyone you don’t want to know you on a first-name basis, it’s a surgical team. Again, they pulled out all of the old hardware, in with another graft which this time was from a pig, plus stem cells from the left side of her pelvis, plus biomorphenegenetic proteins (bone doping), two days in the hospital completely laid out. It had now been close to two years since she began paying for the driver’s few moments of drunken oblivion, and she knew that her sentence had already been worse than his.

As I write this, her surgery was ten weeks ago, and there’s still no sign of healing. The surgeon’s timeline? The fixator stays until the bone heals, period. When it comes off she has a year of physical therapy. Dr. Google says that you can see signs of recovery for up to two and a half years after the last surgery. Add up all the months and she’s looking at five years of hell with an uncertain outcome.

His timeline? The fixator is on until it heals. Period. And then, when it’s off, finally, looking at a year of PT and getting stronger and riding and gaining strength. The research says that you can see signs of recovery for up to 2.5 years AFTER the LAST surgery. Add that she’s closing in on two years of surgical procedures, she’s expecting this to be close to a 5-year ordeal. Gabriel Ray’s 11 years won’t have this type of hardship attached to it. Too bad.

All of this, however, is nothing more than a physiological chronology, the prison equivalent of marking off days with tally marks on the wall. The real jail sentence has been the collateral life damage, and it’s something that every injured cyclist knows about intimately.

Superficially, Deb can tell you that her new fixator friend is made up of external rings and three 4-inch pins that are drilled into her shin. It requires constant daily care. It hurts all the time. It gets infected. She can’t swim, can’t bike, can barely walk, sleeps with her leg on a foam pad, and can’t sleep under the covers. In other words, her life has completely changed as she’s been thrust into the alt-Universe of the catastrophically injured, i.e. those who carry massive disruptions to their daily life and emotional well-being along with the catastrophic physical injuries.

Business, a/k/a making a living, dinner, meetings, everything collides with the injured leg, they’re no longer compatible. “Can I do this? Laundry used to be easy.” Simple things take on the aura of an uncleaned Augean stable and it’s been like this for two years with no reprieve. Throw in the massive uncertainty with regard to what the future holds and the destabilization is intense.

And of course there is the spiral of declining visions of the possible. “I’ll be back on my bike doing a 500k rando,” has become “I just want to be able to walk.” And when well-meaning people see her pedaling her mixte and say “Thank God you can ride a bike again,” she silently knows that waking trumps riding a bike any day. If she can walk, riding will come as a result. But if the ankle never mends, life today becomes a template for the rest of life, which means dealing with a leg that is permanently disabled.

With this experience comes the other horseman of the apocalypse, depression. Life contracts as you do less, and what used to be natural optimism and a positive outlook becomes a full time job trying to maintain. She watched a TEDx piece about the power of positive thinking and tries to focus on how that process releases dopamine, helping productivity and creativity. But looming behind the depression is the constant, intense pain, and no matter how tough you think you are, you will eventually take pain meds in the evening just to get some relief and to give yourself a breather from the chasm of not being able to keep fighting, without end, a terrible and terribly painful battle.

One unexpected benefit to constantly struggling is empathy. Deb now “gets it” in a profound way. However big her challenges are, she understands and empathizes with people who are in even bigger pain, in even more dire straits with no hope, ever, of recovery.

And of course there are the parallel lives of the people who were also hit that day. She was the first hit of five. The other four are back to their daily activities, cycling all over the world and getting back to their normal lives. She’s the only one still injured, and although she can’t help but occasionally wonder “Why me?” she doesn’t think much about the driver, Gabriel Ray. He’s not on her radar and she doesn’t replay the collision, and perhaps that’s because there’s so little to replay. She felt a tap and woke up in a ditch. Far from dealing with the past, she deals with what’s in front of her, taking care of her leg, running her business, running her life, and getting healed.

It’s not intellectually stimulating and it’s mundane, but it takes all her energy and attention. With regard to the question “Where are you now?” it’s indeterminate, like her injury. Deb will find out where she is once she gets there, but for the moment the new her is more compassionate, and that’s nothing but a positive. When she was hit she was at the top of her cycling game, doing the hardest randonneur rides there were, knocking out four 1,200 km rides in a single year, in the best shape of her life and all at the age of 58.

When you feel like you’re invincible, large and in charge, except that in a few seconds you’re not. She was hit and now she struggles with laundry. Easy, right? One day 1,200 km on a bike. The next day, fighting to wash your socks. But at the same time, she realizes that when you’re on the mountaintop it’s hard to see what’s going on down in the valley. For her, she has a whole new place to learn from, and she’s learning something that in the past has always eluded her, patience. She’s determined and wants to climb the mountain again, but maybe this time she’ll appreciate the trek more than the destination. Maybe.

Little things along the way make life better, too. She has a trainer and is working with him to try and regain some fitness in this limited state. It takes Deb as long to get dressed as it does to do her fifteen-minute workout. One day a woman saw her in the gym and remarked how great it was that she hadn’t given up. It’s true, she realized, she hadn’t and she won’t, and in the process she’s gained compassion for others because now she’s fighting like hell for each bit of progress a minute at a time, unwilling to concede the field to the inertia of not being able to act, to the inertia of the passive tense.

In blots and jots it hits her this way: Just take the parts when you were feeling your worst and string it out for two straight years. That’s where she is and the intoxicating whisper is always at her shoulder: “Just give up,” it says. It’s there because you’re in pain and the pain meds don’t fix it. At the same time, she’s also planning her next 1,600 km ride, and she’s planning it for next June.

Whether it ever happens, the plan is there, and you never hit the target unless you aim for it. She wants to prove that she can come back, that she can do it again, and then maybe she’ll be done with it. It’s occurred to her that cycling for hundreds of miles may not be her thing anymore, but if she does bow out, she’s vowed to do it on her terms, not on the terms of Gabriel Ray. “He doesn’t get to decide how I choose to live my life. He doesn’t.”

[Deb is the owner of Rivet Cycle Works and has chronicled the first year of her recovery here, with photos and a much in-depth picture of her ongoing recovery.]



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