Anthony Versus SUV, Part 2

From the last post, we left off with Anthony being scheduled for surgery the following day.

So on July 20, 2010, the day after I talked to the nurse, we arrive at 7 AM and sat in the waiting room for about an hour and a half before they finally took him back to prep him for surgery and I'm booted out. I head home to wait it out then head back later in the afternoon where I sat with him for about 45 minutes before I had to head across the street to my usual doctor's appointment (remember, currently 6 months pregnant). I tell the doctor what's happening with Anthony and that my blood pressure is probably high and sure enough, it was significantly higher than my usual readings. The doc agreed to wait until my next appointment before subjecting me to all sorts of tests.

I head back to Anthony and tried to feed him some food but after having a tube down his throat everything felt dry and rough. I stay with him late into the night until visitors were being booted out. Poor guy barely slept, due to the pain and discomfort but also because there was a hysterical female patient a few beds down. She started being loud even while I was there and was apparently on the phone most of the night. In short, she was wailing and cursing about her boyfriend not showing up to visit her in the hospital and not even bringing anything like flowers or chocolate to console her. She kept ranting about how he doesn't care, blah blah blah. Seriously, if she was that active (walking around, yelling into her phone, crying excessively) they should have released her from their care.

The day after the surgery I get back to the hospital as early as they would allow visitors. Anthony is, of course, awake courtesy of the squawking woman, who was still yapping away with the same complaints as I walked past her bed but this time it was to what looks like one of the nurses. Poor lady.

We waited around until Anthony could be visited by the various medical teams and cleared by them. The Anaesthesia and Pain Management team came by first and after some discussions, cleared him after some pain medication explanations. The hospital still has the 3 day pain medication limit so we were advised to go see a General Practitioner for more medication. I understand the limit is to prevent people from going to the hospital for drugs but really, after such an invasive surgery you think they would have made an exception.

After a couple more hours the Physiotherapist (or as we know them as Physical Therapists) came by, attempted to show Anthony some movements to do at home to prevent the muscle from stiffening but of course there wasn't much Anthony could do at the time but grimace in pain with every movement. He said he'd have a physio script mailed to us. (We've noticed anything medically related has been done by snail mail here, very annoying.)

A couple more hours and Anthony was wheeled off for x-rays. I followed along and when we got to the x-ray department and Anthony was wheeled thru some doors, I thought to follow but was quickly bombarded by various people stopping me from following. I'm guessing the bulging belly on me had something to do with such a reaction.

We get back to Anthony's bed and after another hour or so the Orthopaedic Surgeon that performed Anthony's surgery came for his required review. He said the surgery went well and he was pleased with the results. He then produced a print out of the x-ray.




You can see the collarbone (clavicle) is now flush with the acromion (the bone to the left of the plate) because it's being held down by a titanium plate and 4 screws. There's also the metal hook that goes from the plate and hooks into the rotator cuff. The pieces floating above the plate are the 18 metal stitches holding the incision close.

  

Here's a drawing from Wikipedia that shows what the AC Joint (dislocated on Anthony) should look like with the collarbone flush with the acromion.

The surgeon clears Anthony to go home and goes on his way. The nurse comes after a bit with the medication script and says he can leave when he's ready. We ask when the bandage can come off and she says to wait for the follow up appointment with the Orthopaedic Outpatient Clinic (located in the hospital) and what they referred to as the Fracture Clinic (lovely name). As usual, we're to wait for the letter that will come by snail mail with the follow up appointment, which should be in about 2 weeks.

So that was it. No paperwork, no offer of a wheelchair to take him out, no instructions whatsoever. Anthony was feeling woozy so he rests a little then we get him dressed and we walk down to the parking garage. Yup, just got up and walked out.

A few days before the 2 week follow up appointment, we opted to take the bandage off ourselves. It was looking pretty rank and wasn't smelling so swell either. So we got to see the stitches for the first time.


18 metal stitches, about 12 days after the surgery.

Frankenstein anyone?

At the 2 week follow up appointment an Orthopaedic Surgeon pops out the metal stitches with this little plastic contraption. We were expecting something really painful but Anthony said he only felt a few painful pinches. Just like all the other medical professionals we have met during this whole process, the doctor doesn't ask much question and doesn't provide much information. It was up to us to ask all the questions like "is such and such pain normal?" "how much can he lift?" "is the incision healing well?" "what's the next step?" If we hadn't asked any questions, I don't think the doctor would have spoken more than 10 words to us.

We did learn that it's best that he leaves the plate & hook in for up to 6 months but not much longer than that otherwise the rotator cuff will sustain long term or permanent damage. So in up to 6 months, they'll redo the entire surgery, yup, slicing through the muscle and all. This is in hopes that it will have given the ligament time to have repair. We weren't ready to hear the doctor mention the chance that when the plate comes out the collarbone will pop right back out. He didn't really discuss what would happen if that occurred but I think we were too shocked to think straight at that point.

Anthony still hadn't received any physiotherapy information at that point so the doctor got us in to see their on staff physio when he was done with us. She wrote us a script to take to any physiotherapy and sent Anthony home with a few more at home exercises.

After another 6 weeks, Anthony went in for another set of x-rays and another follow up appointment with a different Ortho but at the same Fracture Clinic. Last time we waited two hours and this time we waited an hour and a half. I had to go out and feed more money into the parking meter. Unfortunately, this doctor was not nearly as nice as the previous one. He was cold and his remarks/answers almost bordered on being rude.

We asked him about Anthony's risk of doing any damages if he returned to cycling at this point and instead of answering the question the doctor immediately shot him down with "if you want me to tell you not to ride, I won't but if you fall you'll do worse damage. So if I were you I wouldn't ride." Okay, so we get that. It doesn't take a genius to know that any trauma to Anthony's shoulder especially with titanium plates in it will most likely do further damage. So we tried to ask him again as to whether the riding itself would inhibit the healing process, cause tears/damages, or just in general undo any of the healing. The doc still didn't get it and said "like I said, if you fall, you'll do worse damage." We gave up. The doctor was obviously trying to rush through the appointment and I don't think he cracked a single smile during the short 10 minute appointment. Waited an hour and a half (with a designated appointment time in hand) for a 10 minute appointment with a doctor that couldn't bother to listen to the patient. He's definitely due for a refresher Bedside Manner 101.

So here we are today. Anthony still has a lot of muscle soreness, limited range of motion, unable to bear much weight in his right arm, and still can't turn to sleep on his right side. We joke that to others he must look like an awful husband because his pregnant wife was having to do some of the lifting on large bulky items when we're out and about.

We're only in the middle of the whole story. Still waiting to have his second surgery then to redo all the physio and regain all the improvement he has already built up. Definitely a long road, lengthened even more by the fact that we'll be welcoming our first born within a matter of weeks or even days. However, in the end, Anthony is still with us and in one piece and on the mend, regardless of how long it will take him.

Until the next big development.....

- julie

Anthony Versus SUV, Part 1

After years of cycling, both recreational and competitively, and logging countless hours on the trail and on the road, one of the biggest fears of any bicyclist became a reality for Anthony. On his regular ~40 minute commute to work, an SUV turned directly into the path of Anthony resulting in an unavoidable collision. The ironic part of it all is that Melbourne, Australia, where the accident happened, has a great deal of invested infrastructure to support bicycling. Sure it can always be better but by comparison to the States that tout being bicycle friendly, Melbourne probably still has more dedicated bicycle lanes and cyclists in general on the road.

For the state of Victoria, in which Melbourne is located, statistics show that from 2001 (18,941) to 2006 (25,181), there was a 33% increase in commuter cyclists in which cycling is their only method of travel to work. Recreational riding has gone from 2001 (461,200) to 2009 (551,400) with a 20% increase. Victoria's roadway authority estimates that 12,000 bicycle commuters are equivalent of 10,000 cars, 86 trams, or 15 trains. Melbourne currently has what they call the Principal Bicycle Network which is Melbourne's major network of cycle routes, both actual and proposed. To date, 1,200 km (745.65 miles) have been completed out of the planned 2,300 km (1,429 miles). I don't believe that includes many of the existing parks.  I won't ramble off any more statistics but you get the gist that Melbourne has a lot of cyclists and it's a very common day to day sight to see cyclists everywhere.

Which is why I was stunned that an accident would happen to Anthony while we were here in Melbourne after his years of cycling in Austin, TX, side-by-side with many vehicle drivers that are less likely to be exposed to cyclists. In any case, on with the story.

It's the morning of Thursday, July 8, 2010, middle of winter here in Melbourne. Anthony goes about his usual morning prep to head out to work on his bicycle. He leaves around 7 AM with my usual send off and wishes for a good and safe ride. Being just a little over 6 months pregnant, I crawl back into bed. Just a little before 10 AM, I get a call on my cell, a number I don't recognize but I answer. A lady on the phone asks for me then says her name and all I remember catching was "....Melbourne Hospital.....Anthony....don't panic.....collision...." I remember her asking me if I was coming to the hospital and I had a moment of sanity where I actually asked, or more like confirmed, which hospital and where (it's next to the hospital where we will be delivering Baby Netkow) since I hadn't driven to the area on my own yet as Anthony has always gone to my doctor appointments with me (in a building across the street from the hospital). I also remember the nurse saying over and over again that Anthony was okay and that they're waiting for test results.

So I hung up with her and promptly started getting dressed. Of course little bubbles of panic and horrible thoughts kept creeping up. But I remember thinking, breakdown now but not in front of Anthony because he has already gone through enough and will need me together. Plus knowing Anthony, he'll be worried about me stressing out while pregnant. So I collected myself, called a co-worker of Anthony's since he obviously didn't make it into work so that she could pass on the info to his boss, collected a few things for Anthony like clothing since he would be in bicycle gear, prepped the dogs to be home for a while, locked up the house, popped into the GPS to the hospital, and started the 40 minute drive. In hindsight, I'm surprised I kept it together long enough to remember to do all of that instead of just blindly jumping into the car and going.

After a stressful drive to the hospital, finding parking in the overpriced hospital parking lot ($18 start, up to $30 for over 5 hrs) I made my way through the hospital maze to get to the Emergency & Trauma Services area. They slapped a visitor sticker on me and told me what number bed he was in then sent me on my way to find him through the 20+ beds.

And this was the sight I was greeted with:


Took this with my phone so it's pretty grainy. But you can imagine how I reacted upon seeing him like this.



Poor guy was really no comfortable in this narrow portable ER bed. You can see his left arm is pinched between the rail and not really supported by the bed.



Anthony was a little out of it otherwise he probably wouldn't have let me snap these pictures. You can see his cut jersey and windbreaker under him. He laid in this exact position for hours.

I think I stopped breathing for a bit and my heart went a little erratic at that moment. My eyes immediately watered and I fought hard to make sure they didn't go any further. Didn't need Anthony worried about me when he needed to focus on himself. He was awake when I got to his side, a little sluggish, but awake. To be honest, not having been told what to expect or what the series of events were, I was expecting the worse in appearance. I was preparing myself to see lacerations, road burns, generally a bloody mess. Fortunately that wasn't what I saw although I think seeing him in a c-collar was probably worse.

He kept asking me how I was and I kept asking him how he was. Apparently he seriously considered not having the nurse call me until much later. And of course I told him I would have been furious with him if he had withheld this from me.

I didn't want Anthony to think too hard about the accident so I didn't push for details, plus he was in a great deal of pain, and so initially I only got bits and pieces of what happened. In the end, I learned the full series of events. He was about 20 minutes into his ride, in an area called Yarraville, which is a section that he was already riding through even before we moved further out so it's a path that he'd been riding for a year already. He was going about 35 km/hr (~22 miles/hr) in the bicycle designated path on the road. A SUV/utility vehicle heading in the opposite direction turned directly into his path without warning (not even slowing down to turn) and with no time to stop. Anthony only had enough time to turn his head away before slamming into the door of the vehicle then dropping hard to the cold asphalt. Remember it's winter.

Fortunately the driver stopped and other witnesses stopped to render aid. Many used their own coats to cover him as now he was laying on the ground unable to move on his own. He recalls blacking out for a little bit and most of the event is a blur. Police and ambulance show up and since his collision is considered a trauma with possible neck or spine injury, they took him to the Royal Melbourne Hospital which has a trauma center. One of the witnesses worked nearby and gave the police his business card, which he passed on to Anthony, and was nice enough to take care of collecting the bicycle and helmet until we could retrieve it. When we later met up with him, he told us Anthony left a huge dent in the door that left it unable to be opened. If I recall correctly, I think he mentioned that the driver of the vehicle didn't see Anthony before making the turn.

Back at the hospital, Anthony is stuck in his c-collar for about 8 hours because they wouldn't let him out of it until the x-rays and whatever other scans he had came back. For whatever reason, it took forever. They had cut open his cycling jersey and wind breaker but he was still in the rest of his cycling gear. Between wearing spandex clothing and forced to lay still for 8 hours, he was feeling pretty miserable. On top of that, he usually doesn't eat breakfast until he got to work so he was starving and they wouldn't even let him drink water until the test results came back. Something about fear of choking.

I did the best I could to make him comfortable. I was constantly massaging his hands, legs, and feet. I eventually helped him change into more comfortable shorts that I had grabbed from home. Considering he was bruised from his right hip to his right shoulder, helping him change clothing with minimal movement was a challenge.

After being in the ER for about 6 hours, they moved him to the emergency room's short stay area. It was certainly a plus being that it was quieter and the bed was bigger. He was still stuck in the c-collar, but at least he was a bit more comfortable. Text messages and calls were coming in from friends and family but I think half of them were concerns for him and half were concerns for me. Our cell phone reception was shoddy in the hospital so we sent out updates as often as we could.

In pain, uncomfortable, hungry, and thirsty, we finally got a visit from a doctor. Apparently because of the risk of neck/spinal injury, they required 3-4 different levels of doctor to senior doctor and specialists reviews before the final ruling. Anthony was cleared of any neck or spinal injuries so the c-collar was able to come off. The bad news was that the big protrusion on his right collar area was due to the collar bone no longer attached to anything and was popped out of place. Or as they called it, a dislocated AC (acromioclavicular) joint.

They didn't show us the x-ray at the ER but at his first ortho appointment the doctor left the image on the computer and walked out so I quickly snapped a shot of it with the phone. You can see the dislocation that's causing the protrusion. The bone should be completely flush with each other in an undamaged x-ray.

After we received the news, the doctors had advised that he stay overnight for both observation and pain management but eventually reluctantly agreed that if he stayed a few more hours, ate, proved he could pee and walk on his own, then he could go home. Anthony being Anthony, wanted to get home. So after getting some food into him finally, and a few wobbly attempts at getting up without getting dizzy, and of course go tinkle, he was finally released. They sent him home with only 3 days of medication as by law that is the maximum allotment a hospital can dispense. We were told if he needed more to go to our General Practitioner. Fortunately he had an orthopaedic surgeon appointment on the third day.

So I drove us home with Anthony cursing every bump in the road. On the bright side, we learned he really craved peanut M&M's so eating a whole bag of it on the way home was his only consolation. I had bought a bag of it for him from the hospital gift shop, $5 for a bag of M&M's, outrageous.


This is what his collar/shoulder looked like when we got him home from the ER.

At the visit with the orthopaedic surgeon, we received mixed answers as to the next step. Initially the doctor said Anthony's ligament injury was at the cusp of needing surgery but could also forgo it, he just would have the protrusion for the rest of his life along with usual aches and pains. We stressed to him that Anthony is a very active individual and cycling is his primary mode of transportation to and from work plus he isn't just a recreational cyclists, he wants to be able to return to competing which he had just started to do in Australia only a few weeks ago. To top it off, we have a baby on the way so it was very important for him to return to fully functional and minimal issues down the line.

After some consideration the doctor left to discuss the situation with other doctors. After a while he came back and said that since his case bordered on needing surgery, he was going to present his case to the hospital's medical board the next day. Apparently the board is made up of 20 or so senior doctors in which they review medical cases that were out of the ordinary. In addition, he had Anthony take new x-rays at the end of the appointment to present to the board.

So two days later we get a call from the doctor and apparently the new x-rays show a 5th degree ligament tear, the most extreme case. The medical board unanimously agreed he required surgery. The doctor said we would get a call back with the surgery date and he expected it would be within just a week. A week passed and we hadn't heard anything so I called. Initially they had no record of him needing surgery but after some searching we got a call back and the nurse said, "oh yes, he has the highest level of urgency for surgery so we'll get him scheduled within 30 days." I think the voice of a hysterical pregnant woman had the nurse call me back to tell me he was scheduled for surgery the next day and to show up at 7 AM.

This has turned out to be a much longer post than I had expected so I'm going to stop here and pick up from the surgery in a separate post, with more lovely pictures to share.

- julie