Grateful to be alive, part 2

17 months ago I was hit by a car while riding a bicycle.

(Part 1 is here)

It was a reminder how my community, friends, and family can come together when I need them most. Medics arrived within minutes and sped through traffic to the ER. Eight highly-skilled, highly-paid people who didn’t know me from Adam stayed at work after midnight to transfuse blood into me as fast as I was bleeding it out, while they expertly sewed up my lesions, one by one. As the trauma specialists gave me a 20% chance of living through the night, there was an orthopedist and a plastic surgeon in consultation, planning how to repair my left leg, just in case I made it. They stuck with me over the following months, with a lot of hardware in my legs, then a skin graft and muscle transplant, and finally a bone graft into my left calf. Against all odds, I have a left leg that works well enough to walk long distances and climb over rocks with only a hint of a limp.

Both lower legs were shattered within an inch of the knee joint. Somehow, they re-attached the bone in a way that saved my knees.

Love and Premonitions

My beloved family doc who has worked with me 20 years on anti-aging medicine was bugging me by email to get vaxxed. I wrote back to her that the adverse events from the mRNA vaccines were through the roof. She wrote to me that risks of bicycling were much higher. I responded, “I’m well aware that bicycling is the most dangerous thing I do.” That was just two days before my Date with Destiny.

Even spookier: Enid and I had been in a long-distance relationship on-and-off for 10 years, but in 2019 she left me behind, and I didn’t see her for nearly two years. Our issue was that she wanted to be loved passionately, exclusively, jealously. I couldn’t give her that. (I believe that jealousy is a perversion of love, and have worked over many years to delegitimize jealousy in myself.) She contacted me one day in June, and told me about a man she was dating who was disabled from a car accident; she was reluctant to invest time getting to know him. I encouraged her to give him a chance — not the message she wanted to hear from me. “You never know,” I added, “I could be disabled tomorrow.”

As it turned out, I got to spend two glorious days with Enid in July, and I fell in love with her, just as passionately as she had wished, complete with jealousy for her new man. Fortunately, I had time to tell her so before I was disabled, because it would have seemed self-serving to tell her I loved her from a hospital bed.

Enid spent time with me, stayed with me, nursed me off and on during the months of my recovery. The best thing to come from my Life-Changing Event was that Enid has come back into my life, with more trust and appreciation in our relationship than we had in the past.

Others who showed up in my time of greatest need. 

When I emerged from eight hours of surgery that first night, Alice, my ex-wife, was in the recovery room waiting for me. She had called all over town to find the hospital where I had been taken, and she talked to doctors and administrators about my treatment. She had introduced herself as my wife, not mentioning that we had been divorced 20 years. Over the ensuing weeks, Alice saw that I got the best care, arranged for food and visitors to come in, and (later) set up my home with a hospital bed on the first floor and a guest room for round-the-clock personal care attendants so I could come home. She signed consent forms for me when I was being stubborn and unreasonable.

I awoke from that first long surgery with a tube down my throat, unable to talk, and with three limbs immobilized. I was writing angry messages upside down on a yellow pad with a felt-tip pen, demanding that the doctors remove the breathing tube. They refused, saying I had to go back into surgery in a few hours.

I had known Meryl Nass for a year as friend and colleague as we were both writing about the COVID deception. If you’re not aware of Meryl’s work, she is a doctor and outspoken critic of COVID policy. I woke her in the middle of the night. She flew down from Maine to be with me in Philadelphia, to talk to doctors and assure herself and me that I was getting appropriate care. This was crucial, as it turned out. I had grown so suspicious of medicine and capitalism that it was hard for me to trust the doctors who had saved my life. But I knew Meryl to be as skeptical as I am, and far more knowledgeable. When she told me that I was being treated well and appropriately, I was able to relax and trust. She may have been the only person in the world from whom I could have received this message, and she turned my attitude around. 

Friends from my past and present life came through for me. People came to my hospital room from nearby and from across the country. Alice and my daughters were shopping and visiting and tending the things I couldn’t take care of myself. My housekeeper showed up frequently with flowers and fruit and prayers. A DC-area physical therapist with deep knowledge and healing hands was instrumental in my recovery. A new acquaintance pushed my wheelchair around Washington DC on January 23, and became a trusted friend thereafter. Many friends and acquaintances prayed for me, and I appreciated it immensely, though I don’t have a religious framework for this myself.

Quibbles

There are many things the doctors might have done better, but they did all the important things right, and today I am alive, pain-free, able to walk and even to hike and climb, more active than most 73-year-olds. Last spring, I left behind standard PT exercises and resumed a Tai ch’i practice for balance, yoga for flexibility, swimming and an elliptical trainer for endurance, push-ups and pull-ups for strength.

I have a fully-functional body, but it’s quirky. There are scars on my arms, legs, and belly. I have a crooked nose. Toes on both feet are so stiff that I can’t run, and pushups are awkward. There are titanium screws and plates in 3 of my 4 limbs. My left hand still doesn’t open or close all the way. My lower right leg was screwed back on at a 5 degree angle, pointing outward from the knee.  I have rods holding my pelvis together, one of which makes my erection cockeyed. I have a surgical hernia the size of a goose egg, for which I’m not eager to go back under the knife.  

I’m as crazy as ever, exploring the fringes of scientific knowledge skeptically and trying to figure out what is real. I have a newfound appreciation of life and mystery, and a confidence that I am doing the work for which I came to this planet.

Anesthesia

Before each of my eight surgeries, I had a brief tête-a-tête with the anesthesiologist. What I really wanted was a local anesthetic and they always told me this was out of the question, even when the surgeries were quick and relatively minor. Barring this, I told each anesthesiologist that I wanted a minimal dosage, no memory impairment, and I wanted to be awake and fully alert as soon as the procedure was ended. None of them took me seriously. 

It’s my belief — I don’t know if it is supported by evidence — that pain is part of the healing process, and that I recover more quickly and smoothly the more pain I am willing to experience. I consistently refused narcotics during 5 weeks of hospitalization, and took Tylenol sparingly during the worst moments.

My last surgery, three months into the ordeal, was a major operation involving a drill inserted through my right knee to harvest bone marrow from my femur. This was mixed into a matrix of cadaver bone and implanted in my left calf, where a piece of the tibia was missing. This time, I think the anesthesiologist took me at my word. 

Minutes out of the OR, I awoke in more pain than I’ve ever known in my life. I was also shivering uncontrollably. The recovery nurse was caring and innovative and expert at his job. Of course, he offered me morphine, and of course I refused. He gave me heat packs to help me warm up. 

Though the pain was intense, my recovery was super-fast. The only pain relief I asked for at the time was Tylenol, and by the time it wore off (6 hours) I didn’t need another dose. I slept through the night and an ambulance took me home on a stretcher the next morning. No regrets. 

Informed consent — an Editorial and a Proposal

Informed consent is the most difficult and the most essential aspect of medical care. Every patient has the right to play an active and determinative role in decisions about his care. The “informed” part is terribly difficult because medical decisions depend on judgment, experience, and a mountain of background explanation. Doctors are in demand. In today’s managed-care environment, no one is going to pay them to sit with the patient for hours explaining available options and answering questions. And many surgeons, though expert in their field and skilled with their hands, lack the requisite communications skills.

But informed consent is also essential because there is no more fundamental freedom than a person’s autonomy over her body. 

There were several points in my treatment where my will was overridden by busy doctors, but this is not a problem unique to me. In most environments today where Western Medicine is practiced, “informed consent” is honored in the breach. 

Here is my proposal: We need a new kind of medical professional, a medical communicator or patient advocate or ombudsman or mediator between patient and doctor. This is not an unknown role, but it is not available for most patients today, and there are few hospitals where this service is considered a standard of care.

This role requires a range of skills and aptitudes. A successful practitioner must have a broad knowledge of medicine and be able to learn new details on the fly. S/he must be able to communicate efficiently at the level of the doctor and also at the level of the patient, explaining all the factors involved in a medical decision and skillfully reading the patient’s intention when he may be too polite to be assertive or (at the other extreme) angry and self-destructive and likely to make decision that he will later regret. S/he will have to be assertive with the patient on occasion, and — more difficult — be assertive with the doctor who has clear ideas about what course of treatment is best, and may be used to having his way.

Most professionals are trained in a dogma that they believe whole-heartedly. But a patient communicator cannot be dogmatic. S/he must adapt to the patient’s belief system and help the patient to evaluate available options without imposing a framework of Western medicine any more than s/he would insist on traditional Chinese medicine or homeopathy or Ayurvedic thinking. This role requires an extraordinary person and an extraordinary training regimen.

Everyone facing serious medical decisions deserves an advocate like this, knowledgeable, caring, and willing to take all the time needed for understanding and finding agreement. Let’s see if we can make this a system-wide change in medical culture. In the meanwhile, it is an opportunity for entrepreneurs who provide this service for a fee.