Tuesday, June 21, 2011

Broken Hip

In a gathering shortly after the beginning of my second year of law school, several of my classmates shared how they had spent their summer vacations. One of my classmates explained that he had spent the summer training with the US Army, intending, as I recall, to embark upon graduation with a career as an officer. During a training exercise, however, he fell and broke his hip. This injury derailed his plans, as he was unable to complete the summer program. He concluded that the injury was the Lord's way of telling him he should not have an Army career. He now understood that he must look for something that would be more accommodating to the demands of his large family.

After the meeting, a close friend, who shall remain nameless, joked that, with most people a "still, small voice" would do. In the case of my classmate, who apparently was hearing impaired, the Lord found it necessary to issue the command: "Break his hip!"

That phrase may or may not have occurred to me when my father broke his hip last summer. Dad was, in his eyes (and maybe mine as well) indestructible until he was about my current age (62), at which time severe arteriosclerosis necessitated life-saving quintuple bypass surgery. After that, he never quite had the same spring in his step. As I recall, he retired from full-time insurance sales shortly after his surgery. Though Dad was always very busy and continued to serve a few clients for many years (and maybe still does), he became, for the first time in my eyes, an old man following his surgery. He still continued to pursue his interests -- golf, adding up long columns of numbers, yelling at the TV when watching sporting events, fulfilling church assignments, and spending time with family and friends on a scheduled basis, preferably with several days advance notice. But I no longer recall him bounding out of bed at 5:30AM, playing racket ball at the YMCA, jogging regularly, or needling his boys to excess as had been his practice while we were growing up.

About six years later he was diagnosed with prostate cancer. When diagnosed, the cancer had spread through his bones and was considered untreatable by surgery, chemo or radiation. The doctors had one remaining silver bullet that often gives prostate cancer patients a reprieve, but seldom a complete cure. Prostate cancer tumors feed on testosterone; if testosterone is eliminated from the system the cancer starves, at least temporarily. Dad opted for surgical treatment on his doctors' promise that, if successful, he might live another 3-5 years. As hoped, the tumors shrunk, and he soon Dad was cancer free. What Dad had no reasonable reason to expect, but what has happened, is that he has remained cancer free for 19 years and counting.

But, as with Hercules, the gods threw more labors in Dad's path. Somewhere around age 75 it became evident that Dad suffered from a balance disorder. His brain could no longer make the vast number of calculations required to process changes in ground surface and direct his feet where to go while maintaining balance. Dad learned to shuffle along on smooth surfaces, but uneven ground slowed him and, too often, grounded him. As fate would have it, Dad's primary contact with uneven ground came at one of his favorite places, the golf course. Now, even with a cart, a round of golf became a peril, the mere survival of which without injury was an achievement. One of Dad's first fractures occurred when he stubbornly refused to give up for lost a ball that he hit into a ravine. Unable to judge the surface, he lost his balance, fell and broke his arm. This was but one in a series of increasingly debilitating falls and fractures, from which we learned that Dad also suffered from severe osteoporosis. Besides breaking arms, elbows and wrists. Dad had a penchant for stress fractures to his foot. It seemed, after awhile, that there was seldom a time when he was without a cast or a bandage. Eventually he grudgingly accepted that he could not walk without a walker to aid him in maintaining his balance.

Early last summer Dad fell yet again, fracturing his shoulder. This was the most serious of the fractures he had suffered, not only because the cumulation of falls had drained him of a lot of strength, but because the shoulder fracture deprived him of an upper limb that was essential to supporting his body and maintaining any semblance of balance. As a family, we wondered if this signaled the end of life without constant nursing care. While deliberating how we might deal with that possibility, my brother Ron and his wife Karen volunteered to move in with Mom and Dad for long enough to nurse him back to health. (Mom wasn't exactly the picture of health either, having had two knee replacements and a recent early stage cancer diagnosis).

Not long after Ron and Karen moved in, while shuffling along with his walker in his kitchen, Dad apparently blacked out momentarily and fell. This time he broke the big one, his hip. Hip fractures often signal the end with elderly patients, and it surely appeared that Dad would be no exception. I recall gathering in his hospital room a few days after the fall. Dad is always impeccably groomed, and on this day he was anything but. He seemed so frail that even raising an arm taxed the limits of his strength. He seemed uncharacteristically downcast, and I wondered if his seemingly inexhaustible will to live was finally spent. Within a few days, however, he had set his goals for reaching physical milestones, had regained his color and immaculate appearance, and was focused on one thing, home. This time my sister Katie and husband Steve volunteered to move in with my parents. This arrangement provided the economic relief Steve and Katie needed while offering my parents the nursing care my parents required. Remarkably, after a few weeks stay in the rehab ward, Dad, once again, achieved his goal. He returned home.

Since that return, his forays outside his home are few and well monitored. He still attends church and the occasional family function. Mostly, he sits in his recliner with book or remote control in had. His involvement in sports now is limited to the morning paper and yelling at the TV, but the constant variety and drama of athletic competition still gives Dad a reason to get up in the morning. As for Mom, she accepts her caretaker role, and seems anxious only when separated from Dad for more than a very few hours.

I have observed Dad accept his condition with minimal complaint. My visits are too few, but when I see him he always seems in good spirits and appreciative of the small amount of time I spend with him. I have wondered if I could endure his labors anywhere near as well.

And then it happened. I have been working out for months, lost 30 pounds, recently completed the Salt Lake Century bicycle tour with son-in-law Blake, and am possibly the strongest I have ever been. On June 10, while at a Boot Camp session under direction of a trainer, on a day focused on core exercises, I choose first to work on a balance board, my least favorite core exercise. As I shifted my weight on the board, I overcompensated, the board flew out from under me, and I landed hard on my right hip. I couldn't move my right leg at all, and knew immediately I had hurt myself badly. The trainer told me afterward to me he heard a pop, though I remember hearing nothing.

The Farmington fire department paramedics arrived first. One of them broke a needle trying to start an IV in my left arm. They couldn't move me and called for help. The Davis County paramedics showed up next, large no nonsense guys who had undoubtedly seen far worse injuries than mine. The largest of them, who probably goes about 6'4", 275 lbs, grabbed my right arm and without fanfare jammed a needle in one of my forearm veins. Despite my whimpering, the Farmington and Davis County guys circled me, counted to three, and lifted me onto a gurney. I directed them to take me to Lakeview Hospital, which has the virtues of being the closest hospital to my home, and have a wonderful orthopedics staff and my brother-in-law Rand Kerr as CEO.

I arrived moderately sedated with morphine, enough that I was slipping in and out of a dream state, what Tauni in her more direct way called hallucinating. I had a few years earlier visited the orthopedist on call, Josh Hickman, for diagnosis regarding my sore hips. He told me I had moderately advanced osteoarthritis in both hips and would be a candidate for hip replacement once the discomfort got bad enough that I couldn't stand it anymore. I had learned the Dr. Hickman is an outstanding surgeon and was thrilled to learn that he would be providing my care.

Before seeing Dr. Hickman, however, I needed an x-ray. After all the attention I received that morning, it seemed odd when I was wheeled into an x-ray room with but one technician. I told him I hoped he didn't plan to move me off the gurney. He assured me that was unnecessary. He took the first x-ray with me laying on my side in the fetal position I had occupied all morning. The second x-ray, he told me, required that I roll onto my back. Though his tone indicated he would not mess with me, I told him that would not be possible. He told me that unless I rolled to my back, he could not take the x-ray. He told me to roll my shoulders back and the hip would follow. I rolled my shoulders but could not find the strength to roll my hip. He finally told me he was going to pull up on my sheet and flip me to my back. My brain was too addled to evaluate whether this was a good idea. Before I could process it I felt the sheet lifting and I flopped to my back. The pain of the maneuver, surprisingly, was less than I expected. I felt much more comfortable on my back than in the fetal position.

The only surprise from the hip x-ray was that my hip was merely fractured, not dislocated. Actually, from the x ray it appeared there were several fractures at the femoral neck, where the main femur bone joins the femoral head that fits into the pelvic socket. Dr. Hickman finally arrived around 1:30 or 2:00, bursting with energy and enthusiasm. He announced that my injury was just "bad luck." He said the location of the break precluded a hip replacement, but that he could repair the fracture with a rod that would run the length of the upper femur and pin that would attach the femoral head. As is always a wonder with surgery, there seemed to be no passage of time between the visit of Dr. Hickman and the anesthesiologist and my revival in the recovery room following surgery. I recovered a reasonable semblance of consciousness quickly, and soon found myself in my room surrounded by family. I have no memory of that evening, other than that I remained sufficiently drugged that my comments coming in and out of dreams, visions or hallucinations kept everyone wildly amused.

Given my workload and related travel plans, the injury could hardly have come at a more inopportune time. My first post-op reaction was almost relief that I would have some reprieve from all the travel and work. I finally went to the office on Thursday, six days after the injury. One secretary told me I was "white," another that I looked "grey," and there seemed be staff consensus that I was foolish to be there. They collectively did their best to run me out of the office and back to bed. The lawyers' reactions were appropriately sympathetic, but none of them commented on my color or seemed dismayed at my presence. After all, that's what we do, show up too soon and work.

Lawyer work ethic aside, I mostly rested the next three days. I did take one short field trip. I rode with my son-in-law and most of his team up to Exchange 6 of the Ragnar Wasatch Back in Liberty, which my sister manages. Trying to walk with crutches across the uneven ground of Liberty Park was not pleasant, nor was sitting in a fold up chair watching healthy and energized runners walk by. It was a relief when my daughter Mari called for help. She needed to drop off her cousin Kelsey and get to Oakley stat. Kelsey's mother Joeen, who was helping Katie, handled the crisis perfectly. She told Mari to drop Kelsey off at a McDonald's in Ogden and that we would head down to pick her up immediately. Thus ended my one great weekend adventure. I spent the next two days reading and watching Rory McIlroy's thrilling victory at the US Open, occasionally scouring the Internet for the latest NBA draft rumors.

I had a mound of work at home, and began to dig at it in earnest Monday morning, putting in a full day. My home care physical therapist showed up in the afternoon and put me through a round of exercises. Tauni was very concerned about my level of pain meds, so I called Dr. Hickman's nurse, and with her guidance came up with a plan to wean myself off them. I believe that, where drugs are concerned, I have a very non-addictive personality. I am not highly reactive and have never had difficulty dropping them following prior surgeries. Nonetheless, Monday night, after skipping the usual dose of oxycontin, I had transformed from a combination of Dopey, Sleepy and Happy to just plain Grumpy. When Tauni made the not-unreasonable comment that if I needed drugs for pain I should take them but if I needed them for sleep I should not, I hollered "I don't know what I need," gathered my stuff and stomped off to try to sleep in Brandt's bed, feeling sorry for myself for the first time.

It proved to be a painful night, and I awoke discouraged, impatient for the remaining recovery time to end, particularly to be able to walk without aid of crutches. I thought about Dad and his multiple fractures, who spent a combined six weeks of hospitalization last summer for his fractured shoulder and hip, and even upon discharge couldn't shower, dress or use a toilet without assistance, who even now can only move slowly with aid of a walker, and spends most of his days seated in his recliner. I thought of all the selfless care he has received from my mother, my sisters and my brothers. Each of them has sacrificed time and personal comfort to see to his. I thought about pain, about those who must face it day after day, no end in sight. I wondered how they manage. Where so much of my joy has come from getting stronger, fitter and faster, I wondered how I could face a life where those things are no longer possible. I remembered laughing about the Lord's command to "break his hip." I don't imagine the Lord told anyone to break mine, but I recognize my need to learn from this very hard dose of reality.

It is one thing be sanguine about the training benefits of pain - just enough to know your body is getting fitter but not so much as to signal injury. It is quite another to be sanguine about the pain that follows injury or that comes with disease, pain that tells you something is terribly wrong after the wrong has occurred, that seems to have no purpose but to sap your will to live. There is nothing to be done with that pain, other than to learn to endure it, and hope that the pain ultimately sweetens, rather than embitters. I credit my parents for their patience and endurance. I can't but admire my once invincible Dad still setting goals, making plans, finding little things that bring him small doses of joy each day, small bursts of sunlight through the storm. I think of Oscar Wilde's line: "There is no Mystery so great as Misery.'"

Admittedly, my small misery ain't much in the scheme of things. I am thankful for the health and strength I have enjoyed. But I am in the third act of my life, and, as in many things, my parents by their examples, have shown me that, even though I will recover, that recovery will last only for a season, which I must cherish. When that season ends, I will look to them for the courage, faith and patience I will need to endure with grace. And meanwhile, I hope to return some of the graces given to me while I have been in pain.