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Cuyahoga Valley National Park/Akron General Hospital, Stowe, Ohio
This morning Joan is much better. She’s pretty immobilized with her right arm in a sling. And I will be headed out here shortly to fill a prescription for Tylenol with Codeine to ease the pain in her shoulder and back. She will really be fine, although the doctor said it may take as long as six weeks before the ligaments in her shoulder are fully healed back up. So during that time she has to minimize the motion in her arm. And since it is her right arm, she won’t be doing much of anything for awhile.
Joan dislocated her shoulder yesterday. We were bicycling, actually at the tail end of our planned trip. She had slowed down and was trying to come to a stop so she could read the sign about ‘Lock 29’. Unfortunately, she couldn’t unclip her shoes from the pedal on the bicycle, lost her balance and fell into the wooden fence that was protecting the surrounding vegetation. She did hit her head on the fence as she went down, but was wearing her helmet, so her head is just fine. Her shoulder, though, absorbed the brunt of the force and the arm was wrenched out of its socket. By the time I got to her, she was flat on her back with her arm laid out to the side in a rather strange looking position.
She was fully conscious, though, and she knew immediately what she had done. We both decided to let her lay there without moving the arm and wait for medical help. I tried to make her head more comfortable and got rid of the bicycle, which also suffered some damage. I phoned 911 and rather desperately tried to describe where we were. Best I could do was near Lock 29 on the towpath near the parking lot for the Peninsula train station. First person to arrive was a park ranger and he pretty much took charge of the situation clearing the area and asking all kinds of questions to determine the severity. Next came the fire chief, an older, genial man who joked a bit to lighten things up and said his men were on the way. After about five minutes the ambulance arrived and three medics got out - two stayed with the truck while the other came up and took care of Joan. So we had five emergency personnel all there to help Joan out. I have to say I was very impressed with the response and the professionalism and humanism of all of them. It was comforting to turn over control of the situation to them.
The professionals managed to get Joan standing while holding her arm very carefully, and they escorted her to the ambulance. With the help of the park ranger, I gathered up the bicycles and our gear. I stowed the gear in the car (yes, the accident happened within view of our car.) and, because I didn’t want to take the time to mount the bicycles back up on the car, the ranger had no problem with me locking them to a tree near the parking lot. (I have to go retrieve them today, and figure out how I’m going to put them on top of the car without Joan’s help.). Meanwhile, the ambulance personnel happily waited until I finished everything so I could follow them to the hospital. The fire chief explained where they were going to take her and how to get there if I got separated.
By this time, pain was starting to set in Joan’s shoulder and she was beginning to grimace. At the hospital she was starting to hurt so bad that her back tightened up into a curve and she couldn’t lay down. And she sat like that for about an hour while the docs and nurses tried to assess just what the damage was. They don’t like to administer pain meds early in the process because that can hinder the correct diagnosis. Finally, though, they gave her a first dose of fentanyl which had a small effect. The X-ray finally returned and, sure enough, she had a badly dislocated shoulder. After everything was over, the doc showed me the picture and the arm bone was way up near her neck, not in the proper socket.
Doctors don’t like to see their patients in pain, but they also take measures in incremental steps starting with the least invasive and moving on up to surgery as the final option. In this case, the doctor tried manipulation of the arm to get it back to where it should be. But the pain was so intense that I’ve never seen Joan scream that loudly. Finally, after Joan repeatedly begged that he stop, he went to a second step. He brought out a very big syringe with an even bigger needle and proceeded to inject lidocaine into the shoulder area. Needless to say, this didn’t go over very well with her either. After waiting for the lidocaine to take effect, he tried to pull the arm back into position, but, even with the lidocaine in there, Joan screamed insisting her pain levels were way over a ten.
The problem was that Joan’s reaction to the pain was so intense that she was involuntarily tightening all the muscles in her torso and arms. But doing that makes it even more difficult to pull the ligaments out to snap the bone back in place. So the next step was called ‘sedation’ - the idea is to basically put her under so she can’t tighten her muscles. He ordered a dose of ‘ketamine’ - a drug I’ve heard of, but, fortunately, have no experience with. They also began preparations for some kind of procedure involving two people with sheets wrapped around their waists. I think they were planning on literally yanking Joan’s arm outward so it would pop back in.
The ketamine took effect very quickly - I was surprised. Within a minute or two, Joan’s eyes began vibrating back and forth, as if in REM sleep, but they were wide open. She reports absolutely no memories of the next ten minutes, except for dream-like scenes that could have been sequences from Blade Runner or Matrix movies. But after just a couple of minutes of Joan blinking out, the doctor and a PA moved in with these sheets. First, though, he said he wanted to try the simple manipulation he had tried before. He grabbed her arm and moved it up and outward. Bingo, the arm moved back in. He smiled and said it worked. I asked if he had heard it pop in, because I hadn’t heard anything. He said no, he didn’t need to, he could see the bones move right into place. So whatever that scary procedure was with the bed sheets, it wasn’t necessary. The ketamine, called a ‘dissociative sedative’, had basically separated her brain for her body long enough for the pain not to register. With no feeling of pain, all the muscles relaxed and the arm returned to its proper position. It was all over in about 5 seconds, after hours of excruciating pain.
She started to return to us - the lights were coming back on - and, at first, she didn’t even remember that she had been in an accident. After about fifteen minutes she was fully conscious and, thankfully, the pain had dropped from 10+ to a 1 - it was over. It took another couple of hours to fully rid herself of all the drugs and manage the discharge papers and all that.
We had entered the hospital around 5:30 and didn’t leave until after 10:00. Then there was an hours drive back to the trailer. The girls, even though being left alone several extra hours and getting dinner very late, were still excited to see us. We managed to get Joan into bed and she slept pretty well last night.
I’ve often speculated about what we would do in a medical emergency on one of our road trips. I wasn’t really excited about finding out, but we did anyway. It worked out OK. Medicare is accepted everywhere and you don’t even need to carry your card with you - all they need to look you up is your SSN. And, like the emergency personnel at the park, the emergency room staff at this hospital were fantastic - I never had a reason to question their plans and was very happy with the level of care they gave Joan. They were good people with a strong professional ethic.
So we managed the immediate crisis, but we now have some difficult decisions to make. In the short run is what do we do about our ongoing trip - do we cancel the rest of it and return home? That would involve abandoning a fair amount of investment of time and money, not to mention the excitement of our yearly trips. But with Joan’s right arm incapacitated, it is clear we won’t be doing any more bicycling on this trip. And it means that all of the hitching up, and a good chunk I of housekeeping now falls on me. So will it be worth it? We are still discussing that but will have to make at least a temporary decision today since we are scheduled to leave here tomorrow morning.
In the long-run there are also some difficult decisions. One we know of is that Joan has to get rid of those clip-in shoes and pedals. While they worked for us when we were doing cycling that required more power to the wheels, clearly they pose a problem now. We already threw the shoes away, so that decision has been made.
The other, somewhat sad, realization is that we just aren’t spring chickens anymore. The accident occurred at the end of a thirteen mile bike ride. Now in earlier days thirteen miles was nothing (we did the 410 mile Ride the Rockies twelve years ago). But with today’s body, thirteen miles takes its toll. Just as we limit our hikes now to about five miles, maybe we need to limit our bicycle rides to ten miles. Had Joan not been as tired as she was, maybe unclipping wouldn’t have been so difficult.
So we have things to talk about and decisions to make. I suspect we will be sharing some of that in future posts.
A future post also needs to talk about the Towpath trail at Cuyahoga Valley National Park and the Scenic railroad trip. We took the train North almost to Cleveland and then bicycled back yesterday. It really was a terrific ride - right up until the last 100 feet! I’ll try to talk about that some more tomorrow. Right now I need to make some tea for Joan!
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Missy
non-member comment
Joan, I am so sorry! I hope your pain level remains more towards one! Ketamine is a commonly used drug in my world, but it also is street named Special K. Date rape drug.