Tuesday, August 30, 2016

My Long/Short Life As A Bicyclist/Patient

On my birthday last April, it was another sunny spring day in Seattle. I was turning 62, feeling 22, and anxious to ride my electric bike, the EZ Sprint. I'd been riding 10 miles to work and back almost every day for the past year. The ride took me through some congested areas downtown, but put me on a wondrous trail along the Puget Sound. When I rode, I felt on top of the world.

I purchased the electric bike in June of 2015, and it was a beast. It was really heavy, checking in at almost 60 pounds. But it was very comfortable with its upright styling. Its weight added to its stability and added to my sense of invincibility.

I loved riding bikes as a kid, starting when I won a contest at the Rexall Drugs Store in Silverton, Oregon in the early '60s. The contest required kids like me to call friends, relatives, and parents' friends and ask them to vote for me when they went to the store. Whoever got the most votes won a really cool bike, and I was preceded by my brother who won a few years earlier. I felt pressure to repeat his quest, and it was not fun work. My parents sat me down at a table with a corded phone and a long list of people to call. Silverton was small, population 3,000, so we worked through the phone book. "Hi, this is Jimmy Anderson, and I would like to ask you to vote for me in the bicycle contest when you go to Rexall Drugs." Over and over.

But I won, got a really cool bike, and my love affair with bicycles was further stoked. In the small town, we'd ride around in packs, stopping at Hoyt's for candy, pop, and weird tubular things floating in big clear jars filled with vinegar, then head back out. We'd stop and chat with friends, all of us standing astraddle over our bicycles, laughing and telling fifth-grader stories.

I didn't ride much after sixth grade, when we moved from Silverton to a much more urban Eugene, where riding seemed dangerous, and destinations were much further away. I did ride occasionally, and once I rode to a baseball game, proud to be in my little league uniform, only to have some older fellows throw their Slurpee on me as they drove past. Thanks guys.

From then in 1969, it took me until 2008 to resume bicycling, when worked as a physician assistant (PA) at Seattle Children's Hospital. They had a program providing free, high-end bikes and gear to employees who would ride regularly to work. I jumped at the chance, and I rode about 8 miles each way on a non-electric, commuter-style bike. It was light and moved through the air like silk.

In 2013, I moved to a downtown Seattle clinic, where I still work. The commute was about 10 miles each way, and with a new Manhattan Green 3-speed, I would bike to the bus and then ride from there to work. I rode about 6 miles per day, and it was a good setup.

I'd been fascinated by electric bikes, and wanted to find a way to ride all the way without using the bus. My knees are rotten to the core with osteoarthritis, and this seemed like a great way to keep me on a bike.

I looked around, but it didn't take long to find the electric bike I wanted in my neighborhood. It was electric, had 7 speeds, and was a pedal-assist type, meaning that when you pedaled it would provide assistance.

At full speed, I would hit around 20 mph, pedaling hard while the electric motor goosed the bike. I could make it from home to work in about 35 minutes, along some of the most beautiful bike trails in the world. Some of the trails were tight and tough going, but once I hit the bike trail, it was all blue sky, blue water, mountain views, and the smell of sea salt.

I previously had 2 weird wrecks on the non-electric bike. The first was in a parking lot at the legendary Uwajimaya Asian Supermarket in Seattle. The parking lot had a raising and lowering gate, where people would drive up, put in their money, and the gate would open, allowing them to proceed. I was on my bike behind a car, and the gate went up, the car went through, and I followed the car. I felt a flash of light and pain, and was on the ground with a bloody nose. The gate had come down and had hit me in the face, causing a minor injury, and leaving me to feel like a total fool.

A few months later, I had another single-vehicle accident. I was riding on the street, and when I moved from the driveway onto a sidewalk, I got caught on the prominent lip of the driveway and went flying. Again, I was not injured, and was thrown onto the parking strip instead of onto the busy street. I hit my head very hard, but I was wearing a full-coverage snow helmet, which held up very well. I was okay, but shaken.

Several months later I purchased the electric bike. I liked most things about it, but it had weird brakes. The right hand brake was for the rear wheels, and while being touted as hydraulic (whatever that means), it was very sluggish and even a strong squeeze would elicit very little braking. I complained several times to the shop, and they repeatedly said "that's just how it is."

The left-grip front brake was more aggressive, but this made me nervous with worries of having the bike flip upon sudden braking, with the front being grabbier then the rear. The front brake also needed repeated adjustment, and the bike shop recommended replacing it with a "hydraulic" brake. I went for it, and it felt better, but I was still worried about the front brake being so much stronger than the rear.

As I rode home on my birthday on April 15, 2016, I rode where I always do, along Royal Brougham Avenue near Safeco Field, where the Mariners play. It's a busy street, but the ride had just started. I was moving at a maximum clip, at around 20 mph. There was a pothole in my path that I had hit several times. Usually I bounced through it, and each time I asked myself why I didn't remember to avoid it.

But that day, I braked hard when I hit the pothole. Suddenly, I felt the front wheel stick, and the rear wheel shot into the air. I felt myself float into the sky, and I launched over the handlebars as it flipped, rear wheel over front. I was flying in slow motion, and couldn't identify the orientation of my body. The flight lasted forever, and as I neared the ground I could see the heavy bike flying through the air over me. Please, I thought, don't let this beast land on me.

I hit the ground hard, landing on my right side, with my right arm chicken-winged under my chest. I didn't skid, and instead came straight down as though I had been dropped from a perch 10 feet high. My head didn't hit the ground, my face struck nothing, and the only thing I felt was a twinge in my right chest.

There was heavy traffic on the 4-lane street, with a bus on my left and cars behind me. I missed them all, and they missed me. I stood up quickly, stooping over with my hands on my knees, to assess my status. My right chest felt a little weird, but I otherwise felt okay. I could walk, I could move everything, I wasn't bleeding, my arms and legs were okay, and I could breathe deeply with no problem. I stood up straight, moved my arms around over my head, and things seemed okay.

Nobody stopped to check on me, even with my bike laying in the street, with me stooped over it. I picked up the bike, which was totally unscathed. With a strong sympathetic reaction in place, I got back on and rode it home, telling myself that I was okay. It was hard to focus, but I made it home. It was surreal ride indeed. I felt tearful.

Being the PA that I am, I assessed myself when I got home. Forgetting the old saying that "the medical provider who treats himself has a fool for a patient," I figured that I know how that abdominal trauma can lead to liver other organ laceration. But I felt okay, with none of the symptoms. Of course, later reading would indicate that these symptoms can be delayed, and I should have gone to an emergency department (ED), but like many of our patients, I didn't want to deal with all of that, the scans, the questions, the paperwork, and I was pretty sure I was okay. I thought that if I felt something later, I would go in.

My experience reminded me of what my patients often do, and of their distrust of the medical system. I wondered why I have that same distrust, which led me to not seek care. Still, I felt confident in my self-assessment, although I have very little training in emergency medicine. But I felt okay, and if that changed, I wasn't far from a local ED. Famous last words.

I was sore for a week, and I missed a day of work when I throbbed from head to toe. But luckily I ended up with no serious injury. I only had pain on my right chest and bruising that resolved quickly. This is far from what happens with many in the Over-The-Handlebar Club, who often have head, face, neck, back, fractures, or other orthopedic/organ injuries. Additionally, many are hit by nearby vehicles, or are thrown into traffic. That was the last time I rode a bicycle. I'd been so lucky on 3 different occasions, but the last experience featured a 62-year-old man being launched high into the air, only to land on pavement with little damage. After that my wife and I both came to the conclusion that this must end.

I fully understand that we take great risks just by leaving our homes, driving to the grocery store, or walking across the street. But I still wonder why I have such suspicion of the medical system--a system that I am so very much a part of as PA--that I would defer seeking care after being launched over the handlebars of a seventy pound machine at 20 mph.

I still have some post-traumatic issues with the event. I now drive to work daily, trading a fresh-air ride along the sea-scented Puget Sound for a gas-fume-filled car commute to and from work each day. Sometimes I look down from the viaduct where I drive each day and see the water that I used to ride next to, and I try to figure out how this all happened. I thought about why my tire stuck in the pot-hole, why I was not hurt worse, and why I did not seek the care that I should have. These are the same emotions that our patients work through as they are injured or sickened, and there is something strangely gratifying about experiencing the same bizarre processes that face our patients every day.

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