Recovery (I)

 I definitely further qualify this "Recovery" entry with the "I" as I am unsure how many recovery entries there will be. After reading up a lot on the ankle fracture recovery process and hearing first hand from Sha Sha's friend Buddy, I know it will be a slow process. But I'm hoping that at least I will see progress during the recovery, no matter how slow it is.

Initial recovery from the surgery was certainly physically painful once the nerve block wore off, but I wasn't really that miserable necessarily. In fact, I'd even say I was relieved and quite optimistic. Really getting over the hump of surgery and knowing the worst part was over was great. I had a nice dinner with my Mom post surgery and basically spent the evening relaxed with friends checking in on me. That night I was in absolutely no pain. Nor any ill effects from the anesthesia. I did take one of each of the pain pills to make sure I could tolerate the medicines, but really I was fine. Even the next day was fine as well. I in fact still had the catheters from the nerve blocks inside my leg and was receiving numbing medication on the hour. I was resting, and again relieved to have the worst part over and be officially on the mend.

Life was fine. Until suddenly the nerve block had completely worn off. Then YIKES. Wednesday night. The pain caught me off guard. I think mainly it was caused by the large amount of swelling my leg had undergone. I wanted to rip off the splint. I started to take the oxycodone, something I had hoped to avoid. But I needed it. It felt like it barely helped at all. I tried to increase the numbing medication given by the nerve block pump, but that seemed to not work at all. I did NOT sleep that night. I told myself it was acute pain, but if I needed to, I could tough it out for the 2-3 days post surgery that the swelling was the worst. 

Then I thought better of it in the morning and called the clinic. Glad I did. They told me there was no problem in doubling the dose of the oxycodone. They immediately put in a prescription refill to the pharmacy and told me to contact them if I still had pain. I took the double dose, and it helped immensly. Not in the same manner as the nerve block, but more of a general pain relief. Also, very helpfully, the nurse mentioned that in addition to elevating my leg I should ice UNDER the knee. Brilliant, why hadn't I thought of this? I also spoke with the anesthesiologist about the nerve block, but still was unable to get the extra dose working. While I hated taking more pain medication, I was really glad I did. I needed it. I had another episode of pain that Friday night when I woke up from sleep after having unintentionally gotten into a very bad and painful position with my leg. Again, very glad I had the pain medication. And to be honest the knowledge of icing under your knee to relieve pain and swelling in lower extremities.

After those two initial pain episodes, the swelling GREATLY subsided. And thus followed the pain. I was able to stop taking the pain killers all together and go to a simple regimen of 2 tylenol. This was also a huge step in the progress to healing. Worst is over, and pain is 100% manageable? SUHWEET. I'm good right? Just a waiting process now. The weekend ended just fine, and I approached what would be my first full week back at work. I was optimistic.

The first week "back" was horrible.

The pain itself was very very manageable and nearly gone even save for some mild soreness and occasional bone aching. But the REALITY and the MAGNITUDE of the whole situation had finally begun to settle in. Up until this point times were trying and there was pain, but there was always sort of a clear "next step". Call for help to get rescued, make your way home, figure out surgery logistics, etc. These tasks I think are necessary in helping our spirits pass through a traumatic situation. Something objective to do to improve your situation. But once these are finished, your mind no longer has something to keep it very grounded and if you're not careful you can be swept off to a dark place.

So I was able to get back to work and be productive during the week. I was able to have all necessary food and supplies delivered to me. By all logistical means I was set. The problem was, my sort of "coping" and "happiness" mechanisms had completely gone by the wayside for the time being. 

I began running competitively when I joined Capital Crew at age 14. Since that fall, I have averaged running between 2 and 3 times a week. Sometimes more as when I was training for an event, sometimes less when I was not taking a very strict schedule for my running, nevertheless I found myself more often than not getting in 3 runs a week. Running has always been a bit of a love and hate relationship for me. I certainly don't have type I fun while running, but I LOVE the relief and focus I feel after a good run. It keeps me happy.

Furthermore, I have been able to cope during our shelter in place orders by driving out to a spot with good wifi and working from my truck for a few hours until my laptop battery wears out. This helps me feel like I'm out of my place, get a change of scenery, and set up a few walls between my personal and working life.

I cannot weight-bear on my right foot for the time being, and as such I cannot drive. Also ambulating is somewhat difficult in crutches, so I'm not able to crutch a long distance. I end up spending my recovering days generally enitrely in my place. This is HARD.

I feel very fotunate I was treated by Dr. Chou and the Stanford medical team. I also feel very fortunate I only broke one bone in my ankle: the medial malleolus. Finally, I am very fortunate the post surgery x ray showed good alignment and that my ankle mortise was never lost. Nevertheless, I am certainly not going to be running for many months. I may also have to face the painful fact that I will not be running after many months, too. If it will ever be such a regular part of my routine again. I don't know what the prognosis is yet, but I will know more at my follow up visit. This has been REALLY hard for me to process and the source of a lot of frustration.

But, I believe in ending this entry with a positive note. I am in the process of learning how to cope. So far I have found that a few things help me greatly. Reminding myself the situation is TEMPORARY. That I will heal. Keeping a countdown of days until the next milestone: in this case my follow up visit. Treating myself with little things like a light to make reading easier when I don't want to get up. Trying more positive acts when I feel the worst like exercising upper body only and writing postcards encouraging people to vote. But there is one great area of help in coping that is undeniably necessary.

People.

It's tough to be dependent on people to help you out, but it is great if you have people in your life that do help you out. From my family and Dr. Ford checking in on me to my friends being there to talk, give me rides, and hang out distanced, there is hope for pulling through even the toughest times.

Surgery

 The first two entries of the "ankle saga" are reasonably... action packed? and I might even risk boasting, entertaining? If not entertaining, I'm certainly happy to go back and add some extra details like how I was armed with an AK-47 and given classified information upon my helicopter rescue. This might get a bit weirder and drawn out. Sorry in advance!

I'm pretty sure I was on an adrenaline high through the events occuring between my fall and return home. I tried not too think about the craziness of getting hoisted into a helicopter or going in my first ambulance ride or the fact that I had shattered my medial malleolus. I tried to just focus on getting home safely and then immediately to contact my family to let them know I was okay and my primary care physician to figure out the next steps. Returning to safety was important. And then, after all that, I realized I was very VERY tired.

And the next few days were tough, but not unbearable. Reality was starting to settle in. Fortunately, I had a lot of support from my group of friends. And my primary care physician, Dr. Ford. My friend Cheryl came over the next day to check on me and brought me copius amounts of alcohol. Dr. Ford set me up with the orthopedic surgeon referal. My friend Annie bought lunch delivered to me. I was in reasonable spirits. My coworkers checked in on me and we made plans to offload any work I would need to, although I ended up not needing to. I did my best to focus on handling all work I needed to, setting up temporarily disabled person logistics for getting food and supplies, and preparing for the Friday appointment with Dr. Oji. Other than that, I slept, a LOT.

On Friday I ubered myself over to Dr. Oji's clinic. I basically had done my homework and expected to hear that I would need surgery. I also expected my surgery to be the "open reduction internal fixation" surgery, that is, adding a plate and screws to ensure the ankle bones heal properly. A quick aside: I may have not mentioned this much yet, but at every clinic and hospital I visited Covid precautions were HEAVILY followed. 

I had more X-rays taken, and consulted with Dr. Oji. Sure enough, he concluded I was in need of the surgery to avoid any malunion healings or arthritis down the road. I was not shocked, but accepting, though mildly nervous. I was told I would be contacted by Dr. Loretta Chou, and took an uber back home. Another quick aside: the AQI these days was somewhere near 200 due to even newer forest fires. Dr. Chou contacted me and we set up the surgery for the next Tuesday. I was relieved that the plan was in place, though naturally a bit apprehensive.

The weekend was actually fine, more or less uneventful. I picked up my post surgery prescriptions, did some socially distanced game watching at a friend's, and did my best to make surgery day plans. My mom offered to come give me a ride home from surgery, but we of course had to handle the necessary preparations given the danger of Covid to her. And this was stressful. Ultimately when Sunday night rolled around, the nerves crept in and I found myself very anxious. My plans for Monday and Tuesday were not yet set. I did not sleep much Sunday night at all.

On Monday I got up per usual to begin work, but then had to leave a Zoom meeting early to handle a call from the hospital. The hospital told me I had to schedule an immediate Covid test by THREE PM that afternoon in order to have my surgery the next day. WHUTTT!!!! As I would find out later, they had left me voicemails but my OLD phone did not pick them up. One I reactivated after I had lost my new phone. I panicked. I had no ride to get a Covid test. Furthermore, drive through Covid tests were not happening that day again due to the horrible air quality. 2020 to the max. THANKFULLY, my friend Walter came to the rescue, switched up a few meetings, and gave me an emergency ride to the Covid test site. 

Upon arriving at the site, I was a little disturbed to discover that the line for the test was LONG and extending outside. I was in no condition to hobble around on crutches for half an hour! Fortunately, the nurses saw my condition and were kind enough to perform the test while I waited in Walter's van. They also realized I had a medical rush test due to next day surgery. Phew. 

Next task to kill was the pre-operation meeting, which was done over a Zoom like client due to Covid concerns. I was nervous for this meeting, but fortunately the nurse was very friendly and handled all my worries. And finally, one last medication pick up was needed. A ride was supplied by none other than Dr. Ford, who basically is the best hands down physician ever. Afterwards, I made contact with my Mom, who had arrived in her motel. And the ONE SINGLE SILVER LINING OF 2020: my covid test had returned negative. So I could actually spend some time with my Mom for the first time since our distanced lunch, and the first real indoors time since Christmas 2019. After all that, my surgery plan was finally in place, and I slept well Monday Night.

I was nervous Tuesday morning, but I knew I was in good hands, that my friend Sha Sha's friend Buddy had had the same surgeon ten years ago, and that it was absolutely the right call to go through with it for the future of my ankle. So Matt, cowboy up time. Showed up at the outpatient surgery center, performed the necessary paperwork, had my vitals taken, and found myself chilling in the hospital bed. Somewhat lonely because no family was allowed in the clinic due to Covid. I mean, I kept both my parents company for their major surgeries and visited my brother and his wife after their first baby was born. I thought surgeries and like a close family member are like peanut butter and jelly ?!?!? 

I believe I was nervous right up until the anesthesia team installed a nerve block on my lower right leg. They seemed like a kind of unusually sadistic bunch, almost taking pleasure in mentioning that ankle surgery is one of the most painful kinds there is, nevertheless they took good care of me. I made an off hand comment asking if the block added a dose of epinepherine, similar to the dentists' common mix of lidocaine and epinepherine during dental work, and mildly impressed one anesthesiologist. I got to mention my side project work (www.organicchemmaster.com) and my heavy interest in synthetic pathways of organic molecules. The other anesthesiologist FLOORED me however, when we broached the subject of running and I learned he had qualified for the Boston Marathon. I congratulated him on breaking 3 hours only to find out his qualifying time was actually 2:37. WOW. 

And, after they ran a few stimulus tests on my lower leg, I was convinced the block was fine. I'd been given a bit of anesthesia at the time too, so I was more relaxed. At some point I dozed off, woke up with a splint around my leg, and I was very relieved the worst part was over. I spent the evening having dinner with my Mom, and felt absolutely no pain. Furthermore since I did not require heavy general anesthesia due to the nerve block, neither did I have any lingering nausea. I relaxed. The worst was over, and for now I was on the mend.

Ankle Rescue

Again, figuring that shouting for help was my best bet as mountain weather can very suddenly take a turn for the worse, I shouted "HELP" for approximately 15 minutes or so. I was fortunate I have a rather booming voice and there were plenty of natural canyons in Desolation Wilderness to provide echo and reverberation effects. I imagined a hiker/camper would at first hear my shouts and not take them too seriously, or rather see the situation as a curiosity, but ultimately with enough repetition would realize I was in a serious situation. This is kind of the way human nature is when presented with a new situation I find. So the repetition was certainly important. I even threw in a few "911" and "SOS" yells in there. Then. I heard a few responses along the lines of "Hello" and "Where are you". To which I replied "California!". No I didn't. But I was encouraged.

A few more minutes of shouting back and forth eventually had me hearing, in the distance, "We have called 911". A few more minutes and I finally saw hope: three hikers about 1000ft elevation below me. They had not yet seen me, so I shouted that I was at about 9000ft elevation and signaled with my head lamp towards them. This helped them see me. We made eye contact, albeit from about a quarter mile apart. FINALLY, I was able to breathe a sigh of relief. 

I at first thought the three hikers might be paramedics, but I soon realized they were instead just some pretty awesome late teenage dudes. I say this because I heard some moderate swearing at each others' expense about what to do and not a lot of sound technical advice ;) But they had hearts of gold and assured me they would stay near until I was rescued. They then assured me a helicopter was on the way and only an hour and a half away. Again, more sighs of relief. Followed by some mild qualms of where said helicopter might actually land near me; it was quite rocky. Well, I imagined even in my situation I could crawl eventually to a helicopter.

Some 5 minutes later, to my surprise, a helicopter flew by. I aided them by signaling again with my headlamp and waving my arms. They shouted at me through a loud speaker to waive my arms if I was injured, so I did. They then assured me they would return shortly to help. And they did, some 10 minutes later. The three dudes were STILL waiting. If I ever get their info I would really want to reward them with at least some GCs or something. Again, another sigh of relief when the helicopter returned.

And then the helicopter flew towards me. I thought, "For sure it won't land all the way up here!" And to my surprise, a young woman dropped out of the helicopter attached to a cable. Then it hit me, "OHHHHHHH. I'm getting pulled up into the helicopter." Wow. Yikes. The woman, named Rita, aided me in putting on a harness and took my day pack after asking if I needed anything from it first, to which I replied, "no". I should have said "yes, my wallet". She explained I couldn't wear the pack while being hoisted up. She then instructed me to grab on to the handles of the harness and pull myself in a ball. WHEEE!

Don't think Matt. Don't think. Just do it. I used to be frightened of even 1 hour domestic flights. Getting pulled up into a helicopter was brand new territory. But the hoist was pretty seamless. I made it to the top and then got dumped in the cabin as the helicopter tilted the other direction. Greg and Kevin I believe were the pilots. Greg offered me water. I was scared crapless that I would fall out of the helicopter so I hung on to every last bit of scaffolding in the cabin I could find (even well after the door closed.) Greg explained we would fly to South Tahoe airport where I would then be transferred by ambulance to the hospital. Cool. I mean I was not in pain and pretty stoked to be out of danger, so yeah. 

Kinda chilled at the airport for a while as the ambulance had not yet arrived and there was another trauma that needed a medi evac. Triage wise, a painless broken ankle is nothing. So, was pretty fine with that time. Chatted with Greg and Kevin, thanked them, watched the chopper get refueled, and eventually was escorted to the ambulance gurney. Took a nice uneventful ride to the hospital. Chatted it up with the EMT who happened to also be a scorpio. She offered a bag of ice for my ankle and I figured I didn't need it. I told her my pain level was probably a 1. We arrived at the ER and I was put in an exam room. The transfer to the hospital bed was PAINFUL due to my sore back.

I was checked on by nurses and eventually the ER Doctor. After a negative exam of all other parts of my body, he decided the only serious concern was my ankle and ordered an X-ray. The result was a fracture (a comminuted medial malleolas fracture to be precise). Part of me went oh shit broken ankles suck and part of me was relieved I didn't cause all this fuss for a simple sprain. He told me I would be released, set me up with a walking boot and crutches, and said that I should consult an orthopedic surgeon as soon as I returned home. Okay, NOT BAD! But wait, I don't have a wallet, don't have a phone, and have no food/water/extra layers because they were in my pack. Yeah. I'm stranded.

Fortunately, the lovely Barton hospital staff came to my rescue and set me up with a care package of blankets, food, water, and a free taxi voucher back to my truck. The plan was to sleep in my truck for the night, get my day pack from the ranger in the morning, and then drive home. Kinda worried about this? Driving on my broken foot? But, the plan was in place. I called my Mom with the idea of reassuring my family I was okay. This instead led to a panic, but I assuaged their worries the next day. I made it to the taxi, slept, and somewhat gingerly drove back on the broken foot. I was safe again at home.

Ankle Injury

To be honest, as I write this post, I'm not even sure if/when I will feel like publishing it. It's pretty painfully fresh in my mind and I'm still processing what has happened. And, at the same time, I do want to share the experience to sort of help me process it. So, this blog (as opposed to maybe a lighter facebook post) seems appropriate. Plus I'm only worried about thoroughly embarrassing myself in front of my devoted reader base of one. So maybe this post will show up soon, maybe later, maybe it will be taken down and reposted, I don't know! 

So here it goes. 

September 4: Excited. Had been toying around with exactly which mountain/peak I would climb or which trail I would hike for the past few days. Since Shelter In Place had begun in March, I had not set foot outside of the Bay Area. The most adventurous I had been was hiking in Mission Peak prior to the Wildfires and having a socially distanced picnic/walk with my Mom in Martinez. But now we were kicking off Labor Day weekend. The Bay Area air quality was horrible as were the nearby surrounding areas. I was absolutely DYING to go on SOME kind of a road trip to some place new and have an adventure. Pyramid Peak had been on the list as a goal for a while, especially since I was looking more for class 2/3 scrambles; mountains that would add an element of challenge to your normal hike by requiring some climbing moves with your hands. I first set on Pyramid Peak as a goal with a friend, but then after discussing with my Dad decided to switch to a bit more moderate of a climb for Mt. Price. The trip was a bit touch and go for a while as my friend and I were unsure of the AQI in nearby Strawberry (our closest reference), nevertheless I did fully prepare to get up early Saturday morning and drive out. 

September 5: Wake up early to check AQI and weather forecast. We're looking at about 75 AQI in Strawberry and highs of low 90s. Not ideal.... but good enough. I'm stoked. Unfortunately, my friend decides she's out, but I've waited so long for an adventure I decide to go anyway! There is of course inherent risk in hiking/scrambling alone, but I'm confident that I'm prepared by having shared my itinerary with my Dad beforehand and that I have all 10 essentials in my pack. Get on the road at 8am, quick bite and coffee on my way up and I'm at the trailhead.

I hike from Wright's Lake Trail head out to Smith Lake on a very steady trail. Am a bit miffed I had to hike an extra half mile or so due to lack of parking spots, but meh. Excited to be out. Some minor bouldering along well marked cairns to make my way up to Smith lake, and then a quick lunch rest. Afterwards the "scrambling" portion of the climb began in earnest. I checked my map and decided I would continue up in an approximately NW fashion to gain the next ridge. There were a few ways to make it to Price, and I figured this way looked reasonable and would save me from having to traverse the perimeter of Smith Lake. The going was slow and many rests were taken, but I did gain the ridge. At that point I rechecked my map to decide where I would head next, which I figured was a NE direction along the ridge to a peak I imagined would be Price. 

As I approached the next peak, it became pretty obvious to me that the peak was not in fact Price at all, but just an intermediate peak. I decided at that point, that I would be satisfied gaining only that peak, as it offered beautiful views and it was getting somewhat late (about 4:30 pm.) I summited the intermediate peak, took a panaroma video and a few other shots with my brand new phone, and planned the trip back. I descended the peak and made for the same ridge I had ascended earlier. I began back on my path towards Smith Lake, trying to choose the safest way back. And then...

Without a warning I found myself falling. I don't know if my foot slipped, or I lost a handhold, or what. But I knew I was falling and shortly thereafter I hit something on my right side. I expected of course what I had hit to stop me from falling. That that would be it, a couple bruises, no more. Instead, I found myself falling even further. This feeling was freaky. My immediate panic was that if I had not stopped falling after the first thing I hit, why would the second one stop me. I mean you gain speed falling down. Fortunately, my fate was to stop falling after the second "leg" of the stumble. Luckily.

And there I was. I knew I had fallen and was likely hurt, but I did not know how severely. I told myself the best thing to do would be to take a few deep breaths, relax for a moment, and then try to assess myself and figure out a plan. So I did that. My back was sore, but not sharply painful. I had a few bumps and bruises on my face, hands and hip, but I did not seem to be profusely bleeding. Then I looked at my right ankle. The inner bone of the ankle looked crooked and out of place. I was not in severe pain, so my first thought was, "Oh this must be one of those situations where it's broken but doesn't hurt that much surprisingly." Probably because I had recently read "Touching The Void" describing Joe Simpson's catastrophic leg break and subsequent fall into a crevasse. 

My second thought, also stemming from the frightening recall of Joe Simpson's Peru mountain climbing accident was, "Someone with a broken leg/foot/ankle is as good as dead in the mountains". Fortunately, I convinced myself I was overthinking that as a balmy day with highs in the 90s in a snowless desolation wilderness with many hikers nearby would be far more survivable than a remote ice-laden mountain face in Peru.

I also took inventory of my gear. Apparently, in the fall, I had lost my map and 5 day old phone from my shorts pocket. Also my sunglasses were broken and my hat lost to the ages. But everything in my pack had been retained. It was now time to "cowboy" up. To figure out what I needed to do to get back to safety. Basically I figured, force yourself not to freak out now, there's plenty of time for that later (basically what I'm doing with the blog writing). 

My first thought was to see if my ankle was indeed broken and how weight-bearing it would be. I attempted to stand up and found I could put my weight on the right foot, but as soon as I twisted it slightly I felt excrutiating pain and fell back down. Broken. I then thought to use the first-aid technique of immobilization and took a spare fleece out of my pack to wrap tightly around my ankle. This did provide support and I was able to take a few more steps before experiencing the same excrutiating pain as before and ultimately falling back down. At this point I had to make a decision. If ABSOLUTELY necessary, I imagined I could crawl and drag myself back down the scrambling portion of the climb to a trail. However, this would GREATLY delay my return to safety and might injure my ankle further. So instead, I imagined that I would be within shouting range of other hikers/campers and began shouting for help.