Monday, January 4, 2010

What It's Like To Get Pipebombed

Well, I'm going to break with my rule of not actually mentioning anything about having a pipe thrown at you, but in celebration of the 6 month anniversary, I really wanted to write it up.

So, without further ado, here's what happened on my Fourth of July 2009, and the six months since:

So, it's the Fourth of July, 2009, about ten-ish or so at night. Being that we live in a condo, and our homeowner's association has prohibited fireworks being let off in our complex, we decided to take a walk around the neighborhood in order to better see the fireworks everyone else was letting off.

We walked straight out the front gate, got about maybe 50 feet down the street, and a dark car with it's headlights on pulled out onto the street, about a block ahead of us a man with a white shirt was walking in the same direction as us, nothing noteworthy about either of those. However, upon passing us, something was tossed out of the passenger window and bounced off my chest, upon the ground in front of me now rested a cylinder with a lit fuse sticking out of one end, someone threw a firework at us!

"Oh my god! Run!" my wife yells. Which we both do, it landed between us so we went in opposite directions.

*BOOM*

Or, at least, I imagine there was a boom, at this point I can't remember hearing one, I do remember feeling the shockwave, and then everything was kind of quiet, then my wife was screaming, I turned around to see her on the ground, holding her foot, I ran over to her, we'd managed to get about 30 feet apart or so, by the time I reached her, I realized that I was hopping on one foot, and my pant leg felt wet. Looking down revealed that my jeans below the knee on my left leg were completely red. I pulled out my cell phone and dialed 911 as I went down on my knees, the strength just sort of went out of me, I noticed the man in the white shirt had come running to see what had happened, and as the operator answered, I gave him my phone because I couldn't talk, I collapsed further to the ground, and looking at my legs thought, "I need to get my pants off and see the damage, maybe make a tourniquet." and then I was out.


At this point are my wife's recollections, after I passed out, she asked the man in the white shirt to call our parents, which he did, in the mean time, she was yelling at me trying to wake me up, at which point I apparently regained conciousness, said "I'm thirsty" and then passed out again with a single snore. While she was staunching the bleeding in her own foot, she looked on helplessly as I lay in a spreading pool of my own blood, she yelled at the gathering gawkers, begging someone to put pressure on my wound and stop the bleeding, but they all just watched.

Here is the phone call as my mother recounted it:

My older sister had driven from Vancouver, WA to Puyallup, WA (still about an hour away from my location in Everett), they were lighting off fireworks when her cellphone rang, obviously my name came up, but when she answered, no one was speaking to her, we suspect that the man with the phone had stopped to do something else, maybe talk to a police officer, and put the phone on speaker.

Silence

"Is he dead?"
"That's a lot of blood"
"What happened?"

Mom, screaming: "What's going on? Someone talk to me!"

Finally someone got on the phone back to my wife who told my mom what had happened, and eventually, where I was being taken.

My next recollection was being awoken by either an officer, or a paramedic, who asked if I was okay, and in any pain, "I'm just thirsty" (Protip: If someone's started to lose blood and they say this, it's a bad sign) I was just certain that if someone got me a bottle of gatorade I'd be able to get up and walk to the hospital under my own power, no problem.

They got me loaded into the ambulance, cut my jeans off, and then cut my shirt off, on account of I told them it bounced off my chest, but I liked that shirt, this shirt, actually, I know, blown up while wearing a shirt with a grenade on it, what are the odds? After that it was an interesting ride to the hospital, the paramedics kept talking to me, and I kept talking back, but no one laughed at my jokes, and when I asked for a souvenir, none was offered.

Arriving at the hospital was little incident, they ran me in through the emergency entrance, asked me to say my name, date of birth, adress, and social, oddly I couldn't remember my social, but everything else was easy, I totally would have gotten a C, maybe a B. They took me into a room where they could X-ray me, and took the stretcher out from under me, as they tipped me up, just about 90 degrees, I said "Don't let me fall", "Don't worry, we won't". Come on! What's a guy gotta do to get a laugh out of these people? They took an X-ray of my leg, and then it was off to pre-op. From the point of being loaded into the ambulance, and getting my X-ray done, I was asked no less than three times: "We're likely going to have to give you a blood transfusion, do you consent to that?" Which always had the response of "Hell yes! You do everything possible to keep my ass alive!" At least that's what I said in my head, what actually came out was usually "....oh, yeah, that's okay".

In pre-op I finally found someone to laugh with me and make me feel a little better in the form of the nurses, by the time I was in pre-op, I probably had four or five people hovering over me, and here is where I finally started to get a little scared. "Um, could someone hold my hand please?" At which point a lovely nurse on either side of me did just that. A little later, I started to really need to pee. "That's okay, as soon as the anesthesiologist takes care of you, we'll be able to put a catheter in." "Oh, okay, well, if I pee this bed, it's totally not my fault then, agreed?"

A little later, my mom, sister and brother in law were able to see me, I can't recall if this was before or after the procedure, later still I was finally wheeled into a hospital room.

My wife's time in the emergency was definitely more stressful, we were taken to the hospital in separate ambulances, and she never took my last name, so she kept having to point out that we were related, and that she needed to know what was going on with me. She had stopped bleeding, so they didn't treat her with much urgency, at some point she spotted my family, and sent a nurse to get them and bring them over to her, then her parents showed up as well. When they finally got to her, they had her twist her ankle every which way while they tried to x-ray it, and then upon seeing that she'd taken a piece of shrapnel to the side of the heel, tried to dig it out with a pair of forceps and no anesthetic. After realizing the futility, and I can only assume, the stupidity of this strategy, they worked on getting a surgeon to remove it a little more artfully.

My mom says that once they'd got her in the OR and started to remove the shrapnel, the clots that were keeping her from bleeding out shook loose, and a blood covered nurse came out to let them know that everything was going to be okay.

Later, in my hospital room, I was instructed in the use of the patient controlled pain med delivery device, you push a button, and you get a dose of dilaudid, you can only get it so often, and no one else is supposed to be able to push the button for you. I have to wonder about the efficacy of this system, however, when every time the nurse walks in, they ask if you hit the button recently, and suggest that you try it in case you hadn't. They hooked me up with oxygen, and let me tell you, pure oxygen is simply wonderful, while you're on it, it gives you this calming, euphoric, high. Frequently during the first few days, I would hear an alarm, and then someone would come running into my room, or if someone was already there, they would say "You have to breathe now." So, apparently that was a problem, Dilaudid is a type of hydromorphone, a derivative of morphine, which like all opiates, has the unfortunate side effect of impeding your autonomic breathing process in high enough doses. I was on the fourth floor, my wife on the 8th, although she only had to stay two nights, as opposed to my 8 days. She would come down and see me in a wheelchair, and I'm told, by my mother, that my erratic heart rate would settle down as soon as she was in the room (Since this comes from my mom, I half suspect that this might be a romantic embellishment, but being as in need of a little romanticism as I am, I choose to believe it).

The morning of July 5th, a couple of nurses from the Wound Care Clinic come in, and bring with them two big needles of Dilaudid, after getting me freely out of Earth's gravity well with those, they proceeded to remove the blood stained wrap around my leg, once off, it reveals a whole log of packing along the entire front of my shin, then they start peeling that off. I start to realize that the bandage isn't on my leg, but rather in my leg. After my leg is free of all trappings, this is what I saw (warning, it's gross, seriously, if you don't want to see Bryce-leg hamburger, stay away). Naturally I said "get a camera!" so we have lots of pictures of my leg, which are all viewable on Photobucket, the link to the album I will provide shortly. They packed the open wound with what looks like black speaker foam, and then lifted up my leg and did the same with a much smaller, although no less deep, hole in my calf (the nurse said she could fit two fingers all the way up to her knuckles into it). The foam was then taped over with clear tape, and hooked up via tubes to a machine, which when turned on, immediately sucked all of the air out of the foam, and caused a not unpleasant relief of pressure.

Over time, I found out that the facts were these:

Two pieces of metal shrapnel were removed from an entry wound in the back of my calf, one was a V shaped hunk, approximately 6 centimeters long, the second was considerable smaller, maybe the size of a postage stamp, and likely broke off from the larger after entry. It tore apart the Tibial nerve, which is mostly a sensory nerve, allowing you to feel most of the bottom of your feet, as well as your toes, it also controls your ability to curl your toes down and make a "fist". It also obliterated the two arteries which supply blood to your legs and feet, unfortunately, while they can give you an artificial vein, there's no such thing as an artificial artery, so, you get two in each leg just in case something happens... oh crap! Luckily, I still had two good ones in my right leg, so the surgeon cut one out, and grafted it into my left. The ginormous incision in my leg, which is easily 12 inches long, was made to treat something called compartment syndrome. Think of each of your muscles as a compartment, the walls of the compartment are called a fascia, any time that significant trauma is inflicted on any muscle, it causes swelling, and the swelling pushes on the adjacent compartments, which can cause a chain reaction of really bad stuff. So, you cut open the leg, relieve the pressure, safeguard all the other compartments, problem solved. He also performed a fasciotomy, which is the removal of the compartment wall around the muscle that was damaged, think of it like peeling the skin of a sausage. The foam and vacuum contraption is called a wound vacuum, and it sucks all the excess fluids out of you, to keep swelling down, and also keeps a constant supply of fresh blood flowing to the wounded areas, this greatly speeds up the recovery time.

I was also transfused a total 7 units of blood over the course of the week, 5 during surgery, one that I was conscious for, and another one that happened some other time. After the last transfusion, my red count was approximately 60% of optimal. Doing the math, based on my body weight, I had approximately 14 units of blood before the accident, 60% then puts me at around 8.5, so before transfusion, I was down to 1 or 2 units of blood. That's close. I wonder at this point how much of the blood in my veins originated with me? It's not a philosophical issue, I'm just curious, doing some research, it takes 4-6 weeks to regenerate the 3/4 of a unit that you give when you donate, at that same rate, it will take me a total of 7-11 months to regenerate the 5.5 pints I estimate I was still short.

The wound vac stayed in the greater incision for a week, until they closed it up, with nine crude sutures:

Reduced: 78% of original size [ 1024 x 768 ] - Click to view full image


Later on they had to give me fourteen staples at the top of the incision to close some gapping. The back of my leg required the vac for another few weeks.

Here's a few shots of the roadside the next day after the accident, as you can see there are still blood stains in the pavement, even after the fire department hosed it off.





I walked with a walker, then crutches, then one crutch, then, five months of physical therapy, and I'm able to walk with only a slight limp, the feeling still hasn't returned to my foot, and I get itches in places I can't feel, WTF? They think the majority of my sensation will return in 2-3 years. Thankfully my wife got off much easier. They never caught the bombers, so I suppose it's a good thing that I believe in karma.

Here's a few shots of the my scars mostly healed up, this pic still shows the back of my leg bandaged.




And... I guess that's really all I feel like writing tonight. Here's the rest of my pics, have fun.

P.S. Also of note, is that the scar tissue on my shin healed onto the underlying muscle, meaning that I can suck it in by flexing (see a video here). I've joked about getting a belly dancer tattooed on it. My wife and I are definitely going to have matching cartoon bombs tattooed on our afflicted ankles.

3 comments:

  1. Hi, I kind of stumbled across your blog in an attempt to find a picture of a cartoon hamburger and ended up fascinated by your story. I'm really sorry that happened to you, it sounds simply horrifying.

    On a side note, I too had a wound vac 3 years ago. Hope you're healing well!

    Destinee

    ReplyDelete
  2. I was injured in a plywood mill in Oregon and so many of the things you describe were exactly the same. Multiple compound fractures of the right arm, 10 days in Hotel Horsepistol, vac-bag thingy, button-drip drugs, and there was only one thing that you didnt' quite capture... the fact that time stands utterly still and a moment is a lifetime in a hospital.

    So glad to hear you have had such a good recovery.

    Good pictures of the leg. You look at it and say "that ain't right!" and then because you've got nothing better to do you say "But that's really cool."

    ReplyDelete
  3. Hey bloke!

    I have just found your blog whilst looking for a picture of a leg so I can illustrate my current injuries. I got run over by a lorry on Feb 17th - amazingly no broken bones but it 'degloved' my leg on the inside of the calf (ie: all the skin and tissue burned off by the leg being dragged along the road by the wheel). So I have a couple of grafts right now but basically nearly a month later it's a great big open wound, gradually getting better. Wrapped up under god knows how many dressings most of the time, of course.

    So I totally respect that you wrote it all up, and that it took 6 months to do it! I've got a lot of pain at the moment. I can 'kind of' walk around the house. I use crutches outdoors for short journeys and wheelchair for longer. The most difficult thing is the feeling so helpless and useless thing. But I know that will go.

    Total respect for posting the 'gruesome' photos. My leg looks a lot like something you'd see in a butcher's window right now. Unreal, isn't it. And the numbness! So weird.

    Anyway, so glad to hear you're well mended after such an insane attack. Take care of yourself!

    Cait.

    ReplyDelete