Incarceration

When I was a kid I was obsessed with prison movies. My favorites were Escape from Alcatraz, The Big House, My Six Convicts and eventually The Great Escape and Cool Hand Luke. The kind of horrible things we now know to regularly occur in prisons were not depicted. Just a bunch a guys, perhaps a bit flawed, but with some attractive redeeming assets, cooped up in a stickin' prison with the passion to get out, whatever the cost. Maybe I was drawn to the reverse morality. The criminals were the good guys and the warden was the bad guy.


Identifying in any way with the bad guy was radical in the 1950's and 1960's cinema. For me, the real interest was identifying with their non acceptance of incarceration with the desire to break out. This was no easy task. While generally despicable characters, the warden and staff were no fools, always scrutinizing  my heroes


While other more mature junior high types were occasionally thinking about what they wanted to do for the rest of their lives, I had it down to being a professional athlete and if that didn't work out, I leaned toward incarceration with a mission to escape. The schemes were infinite. Sawing, scrapping, and squeezing through narrow vents as well as the bold run to fence at night after the search lights whizzed by. All looked to be quite fun. For me, tunneling was "the bomb." Luckily we did not have "Prisoner" on Career Day. Likely I would have spent all my time with these good fellows and further embarrassed the family.


I have never been that attracted to specific criminal enterprises and even less so now. The chance of me doing something to precipitate an arrest seems slim. But here I am, essentially incarcerated. I rarely leave the house and pretty much stay in 3 rooms. This qualifies as "house arrest" and it is time to plot an escape.


The Warden, previously known as the wife, cannot be easily fooled. As wardens go, she's not too shabby and even brings me coffee on occasion. Others times, when I become a bit too demanding, she'll leave me in solitary confinement. My cellmates, two cats a dog, are worthless. I have made multiple attempts to engage them in an escape plan, but they just look at me like I am some kind of a nut case. Maybe with their identification collars they feel the escape will be short lived and they will then suffer some of the retribution they oft see delivered in my direction. Other times I think they like it here. Jack, the Maine Coon Cat, may be a stool pigeon; in the movies, every prison had one. He runs to the door like a dog every time the Warden returns from one of her missions. Just out of my earshot, I can see him pouring out the info he has gathered in her absence.


The Warden has not yet put a collar on me, so if I am able to get out, I'm home free and won't be looking back. Hitchhiking should be easy with the walker but the prison pajamas may be a deterrent. Luckily my trusty iPhone has not been confiscated and I can talk to or text  my friends on a regular basis. The warden is old school and technology is not her strong hand. My friends have been bringing by a few beers but I can never seem to find them. I am suspicious the Warden may be consuming the brew, but so far I see no signs of beer belly. Her moods are erratic but she is not too wobbly. Sometimes, when she thinks I am asleep, I hear her on the phone ranting to to her friends what a curse these recent duties have been for her  The other day she left an application on her computer, essentially putting in for a transfer. I was not able to fully understand the application but I was able to get some information before she saw me on her computer. I will further investigate on my hidden iPhone when I'm next placed in solitary. It appears the company she is working through is called "eHarmony." If anyone reading this knows more about this organization, send me a text.


On another topic I have been told some of my recent entries have been too morose. Sorry if I have been bumming everybody out. All is well. The pain is minimal and serves as a convenient reminder not to make the type of move that would jeopardize good bone fusions. I've lately received some nice cards from people with relatives in Purgatory letting me know their deceased family members have been released on an accelerated basis.

Kindness

                   If I fall from grace with God
                   Where no doctor can relieve me 
                   If I'm buried neath' the sod
                   But the angels won't receive me
       
                   Let me go, boys
                   Let me go, boys
                   Let me go down in the mud
                   Where the rivers all run dry  
                                                         The Pogues  1988
                                 
                                       
As the dust settles and I look ahead to some type of normalcy, I have had plenty of down time to ruminate over how and why I am here. I doubt I will gain more insight into the cause of the accident, and frankly don't much now care. That was my best shot at the Ride from coast to coast. I crashed and burned, and it will be difficult to have another opportunity. Woody Allen once said comedy is tragedy plus time. Dark comedies are my favorite genre. Maybe I'll be laughing about it soon. I will ride again with new cycling goals I'll dream up and take seriously. Currently, though, I haven't a clue.


I seem compelled to come up with some spiritual  meaning from the experience. Always having an opinion but actually knowing little about the science of  Psychology, I suspect the quest for inner meaning is a standard reaction in any tragedy, which to some extent, mitigates the broken heart. "Tragedy " is a stretch. No one was killed, but not finishing the Ride when everything was going so well, with so much fun, compounded by the significant injury, was more than just a mere setback.

As a practicing Neurologist I am, in a way, a paid/professional observer. I look at someone walk and I may decide he/she has Parkinson's disease. I look at another person's hand and may decide the person is putting too much pressure on their ulnar nerve at the base of their hand. Someone passes out while I am watching, I can usually distinguish a seizure from a cardiac rhythm problem. After years of discipline, when a friend of mine comes in for "stiff back" I am able to ignore my prejudice of not wanting him to have a significant problem, and perhaps make a diagnosis that neither he nor I want him to have. When I was a little league umpire, circa age 17, all close calls at first base seem to go the way I wanted them to go. If a particular coach was obnoxious, his player genuinely looked  "out"  on every close play. At that point I was not a real professional, of course, subsequently succumbing  to my own prejudices. A professional observer does not make you a good or bad person nor does it qualify for additional merits. It's just a fact. I am confidant Neurologists are better observers than the general public.


As a passive and fully conscious recipient of emergency and hospital treatment as well as transport, it was easy to monitor all of the care I received after The Fall. From each observation I noted a very consistent theme. Most people were genuinely kind and more importantly, relished the opportunity to deliver on their inner virtue, to a total stranger, who was obviously in need. I am no Pollyanna. I am aware when I am not liked, not felt to be humorous, and not understood when I am trying to explain a medical issue to an unsophisticated or distracted patient, family member or student. The number of people involved in my care constituted a statistically significant sampling. This included people on the highway pass, ambulance staff, clerical workers at the Wyoming Hospital, the professional staff, housekeeping, other visitors, transporters to the plane and many workers and passengers on the plane and on the ground. These were men and women, white and of color, gay and straight, old and young. I'm not even including the ER people here in Macon. They were great but they knew me. Almost everyone I encountered after my crash was kind.


Professionally, I am on the eve of new direction. Next month, for the first time, I will be teaching medical students in their 3rd year rotation. Previously I have been teaching Neuroscience and other topics for the first two years in the classroom and  4th year electives to students who can be somewhat preoccupied by graduation or their impending Residency training program. Unless the medical students have done some missionary work, the third year rotation will be their first true exposure to meaningful 'hands on' medical care. Many permanent impressions are planted at this time. I remember these initial encounters in my own medical training as if they occurred last week instead of forty plus years ago. I was frequently awestruck a by the actions of the attendings, interns and residents. I recall not only the specific medical issues but how my superiors dealt with the patients and families. Often they were delivering some very bad news. Sometimes I was impressed and other times horrified, the latter, more often from a lack of kindness than some type of medical error. 

Before The Fall I had planned to exclusively deal with clinical skills. I am on a mission to rectify the recent pervasive attitude that young doctors share:
      "I really do not need to be an expert on taking a history or doing the physical exam. It is all about ordering tests and Googling the best treatment". 


There is some truth about the value of blood tests, xrays, CAT and MRI scans of course, but these students have been receiving the wrong message about the importance of taking a careful history and doing a revealing examination, very, very, wrong. Clinical medicine is primarily taking a detailed history then: touching, pulling, pushing, and probing. I intended to teach them well.


It is as if some force has been tapping me on the shoulder to notice something I was going to miss. The first tap came sprawled out on the highway, bloodied, stopping traffic in both directions. More taps with every wrong move :
                         " Hey dude, you used up your grace. Here is your next hand of cards. Play them well and don't leave anything out." 


There are many layers with this new task. It not just history taking and examinations skills. Kindness is in there. There may be other dimensions perhaps not yet considered. The persistent discomfort might be a reminder to keep an open mind. I think I get it.

Dog Days in Purgatory

Licking my wounds on the front porch

The expression dog days originated in ancient Greece and carried into Roman times. It was derived from Sirius, the brightest star in the constellation Canis Major, (Large Dog) which, in ancient times, rose with the sun during the late summer months and was thus blamed for the long hot days. Given the widespread negative perception of this star, other evils became associated with it throughout the centuries. In 1813, Brady's Clavis Calendria labeled dog days as the time when dogs went mad and man suffered various physical and mental illnesses. Dog days are here as expected in the deep south, but have also landed in all their historical infamy, at my house and appear intent on settling in for the next three months.

Earlier this week I had my first visit with the Ortho Trauma specialist. In addition to the injury directed exam, he was able to review my post injury pre-op X-rays and the post-op studies including all the blood clot stuff done in the ER, which coincidentally covered the same area of interest. After the appropriate greetings and salutations he reared backed and figuratively kicked me the stomach with a force of a Civil War canon. Relatively speaking "The Fall,* as I am now labeling it, was a stubbed toe. The resulting "vertically unstable" pelvic fracture is much more substantial, I learned, and requires three months of  no weight bearing on the right leg BEFORE I can even start rehab. THREE MONTHS. I have subsequently received several thoughtful condolences, all with the consistent message that three months won't be that long. Still stunned and staggering from the abdominal canon shot, I have inwardly countered, "30 minutes doesn't sound that long either, unless someone is holding your freakin head under water, then it's a lifetime."

The fractures do not hurt much unless I move wrong or put weight on the sacrum, both of which are difficult to avoid. But occasionally there is zero discomfort and I consider that the baseline. When the pain comes, its a problem, and this reality has me turned upside down philosophically and professionally. Though not a pain doctor, I do frequently see people in pain, and depending on the location, character, duration, etc, their subjective pain and my objective neurological exam direct me to the source and treatment of the problem. Pain as a diagnostic clue can therefore be of assistance to a clinician, and eventually to the patient, but that same pain is at the initial expense and detriment of the particular patient with respect to their individual comfort and overall well-being.    

Once you are a patient and "see it from the other side," one would think a doc would metamorphose to a kinder/gentler practitioner. My current personal experience, however, is having the opposite effect. While I don't feel humans have evolved to better handle exotic painful diseases, perhaps we have improved when it comes to managing injury. Think how common it must have been for primitive man to break a bone when hunting large animals with stone-age weapons, or fall out of a tree while foraging. Amorous disputes were unlikely settled by 'paper vs rock vs scissors.' Evenings in the cave after a hard day at the office must have looked like the locker room after a hockey game, or the local French ER during the fast, crowded, crashing stages of the Tour de France. I doubt anyone received Dilaudid . Folks back then had little choice other than deal with the pain and alter their activities accordingly.

Perhaps to alleviate the anxiety associated with the discomfort, I have convinced myself that I will get better faster and more thoroughly if I, in harmony with my primitive ancestors, just deal with it rather than take any pain meds. I'm on day four of my inner caveman. This new philosophy blends well with my early religious beliefs. Raised in a traditional and enthusiastic Catholic home with 12 years of formal Catholic education, I summarily dismissed much of the Church's teachings before I was 10 years old. I apologize if I have offended anyone, and will only likely make it worse defending each of my positions but I feel compelled to mention one. Not only did I think the infallibility of the Pope was ludicrous, once exposed the absurdities of their individual actions throughout my favorite time in history, the middle ages, (where some might say I belong) I think the current Pope should be tried at the Hague for Crimes Against Humanity. Charges based on his roll in the systemic Church supported child molestation epidemic while a Cardinal, as well as his current positions on birth control and HIV prevention in third world countries, are all qualifying crimes in my book.

The one teaching I absolutely did love as a child, and more so as a an adult, especially since I learned the Church has dumped their belief on the issue, is that of  Purgatory. Rarely a day passed without my mother telling one us four kids, while we were whining over some pain or seemingly serious injustice, "offer it up for the poor souls in Purgatory." The only statement I heard more often was " I'm going to kill you if you don't stop doing that." For you non Catholics, a quick lesson. We were taught that when you die, you went to either heaven or hell depending on a few easy to follow guidelines that any semi-competent mid-level bureaucrat could grasp. No need for St. Peter or God to get involved. If your case did not fall into one of these two choices, you roasted in Purgatory for awhile to atone for your minor sins and then on to heaven. Living people could cut your sentence by donating their suffering on earth for the deceased in purgatory.


The most attractive angle of this concept was that it made sufferings a relative zero sum game.  Pure zero sum delegates a winner and a loser, no in betweens - your loss is someone else's gain, like betting through Vegas on the Superbowl. Relative zero sum is more common, like the stock market, with money being split between the investor and the broker, though theoretically you and the broker could keep winning mutually. Zero sum in economics, mildly interesting. Zero sum for suffering, I LOVE IT. I loved it as kid, love it more now, and anticipate loving it even more in the future.


So what does all this really have to do with pain?  Like most things in my life, it comes back to bicycling, and more specifically, the type of bicycling I most enjoy- hunkered down on the bars, big gear going, mailboxes and telephones poles flying by like strobe-lights type bicycling. Yes, "hammering" for selected believers. When riding this hard an inner voice shouts, "This hurts, this hurts." Trying to simply ignore or tolerate the voice is the wrong manuever- you've got to embrace it. If you press on through, the words evolve subtly yet significantly: "Yes this hurts all right, it hurts so good!" 

 *Likely to be eventually called "The Fall From Grace" if you are wondering which way this blog is going. 

The Longest Day

Sunday, July 8, 2012, was for me, the Longest Day EVER. And it probably ranks up there for Charlotte as well who spent the night in my room trying to sleep on a typically uncomfortable hospital room cot. The plan was to get up at 4:30 AM, pack, and head to airport at 5:30 AM for the 8:00 AM flight. Incredibly this was the only nonstop fight to Atlanta for an entire week. A reasonable couple would have packed the night before, but we had to put the Nespresso machine and the milk frother in the suitcase AFTER we had our morning fixes. No way I was going into German bunkers under heavy fire without two double espressos.  Odds were, I was not going to make it, and therefore no reason to die miserable. Also, it was "drinks on room 130" for the night crew in the hospital, who were all ending their shifts close to the time we were departing. The more espressos we dealt out, the more room in the suitcase. Predictably, not having a freaking thing to do all day for the last several days I had developed some pretty impressive skills in dishing out the coffee at high speed.

Early morning arrived and I was wheeled to the front of the hospital as the cab was rolling to a stop. This was first time in my entire life that I had not been outside for this long - from the moment I was admitted to leaving in the taxi totaled five days! The only previous time approaching this level of incarceration was 40 continuous hours, every forth day, back in New York circa 1976-77 as an Internal Medicine intern.

To say I was overwhelmed at leaving the hospital would be an understatement. I could not have been dropped in a more desirable spot on the entire planet. It was just below 60 degrees with the sun beginning to rise. There was a dry, light breeze that pleasurably stroked the bit of normal skin and soothed the still tender road rash, which in the natural light of early morning, I observed to cover much more of my body than I had initially noted. The birds were looking for food, friends, mates or whatever, with a subtle and peaceful concert. I was looking out at this mythical Great Plain extending to the horizon in the direction I was facing. To my left were the Grand Titans, as spectacular as the Dolomite's, with similar naked rock tops, looking as dangerous as they were beautiful. Yeah, they're dangerous alright, as that butterfly like feeling woofed through my belly, reminding me of what I had experienced five days prior and creating a sudden sensation of panic that mixed with the beauty of the sight. To my right were light green and sparsely forested mountains, not as high as the Tetons, but also appeared to jump up from the well demarcated Plain. It was as if some massive giant had come across these strikingly different topos, arranged them in the most attractive way possible while chuckling how unbelievable this was going to appear to his fellow giants.

The sights, however, did not compare with the most impacting sensation which was the smell. Not to bore you with technical Neuro shit that I can go on and on about, but the olfactory cortex is contiguous and lavishly interconnected to the limbic system that controls mood and behavior. You smell, you feel. Relaxed and unprepared for any approaching physical event, the intense pine tree smell almost knocked me out of the flimsy wheel chair. The sights, the sounds, the sensations and the smell that I simultaneously inhaled, after almost six days of sensory deprivation, unless you count pain, was the most surprising positive jolt of  post pubescent pleasure I had yet encountered.

I sat in the front seat for the 25 minute drive to the airport. I twisted my head to see all I could of this foreign terrain like a dog on his first car ride. My jaw dropped and I was likely panting; I don't think I barked but probably would have had I seen any wildlife. The Plain hosts 20,000 elk, in addition to bear, moose, deer, mountain lions, wolves, foxes and porcupines. It is the Serengeti of North America.

Upon arriving at the airport there wasn't as much difficulty getting out of the car as we anticipated and we were provided a wheel chair and ample assistance. We did not find a News Stand which struck us odd -  was this place post modern where everyone reads online or perhaps pre universal literacy. The next problem seemed to answer the question as there was no ramp to our awaiting Boeing 757. The last time I recall seeing this in the USA was when the Beatles arrived at Idlewild in 1964.  With multiple screws holding my bones in place I could manage one or two steps, but no way two flights of stairs. Even more troubling, no one with any decision making authority knew what do. Remembering we were in the land of Evil Knievel, I feared someone might suggest a catapult, which I would have liked seen deployed, perhaps, but on someone else.  Finally two guys who did not look quite up for the task were commanded to carry me up the stairs. It was a tense and rocky ride with the thought of being dropped and reliving my recent log roll, present on every step.

I was in first class (one way Frequent Flyer purchase), bulkhead seat. Charlotte was not able to be upgraded. The seat was very comfortable considering I was still sitting on my broken and pinned sacrum. We then stalled on the tarmac for two hours with a mechanical problem and the temperature was rising. I had to draw on Tennessee Williams and my male Blanch Dubois routine, faking a near fainting episode. I was thus a hero to my fellow first class passengers as this forced the airline to bring in some auxiliary power and more AC. When I told them how I always depended on the kindness of strangers, the staff wrinkled their foreheads in a way that revealed their true suspicions; this was not the first time they had seen this routine.

I understand there was a real threat of mutiny in steerage but I did not see anyone thrown off the plane onto the runway - at least not on my side. Charlotte came up regularly to check on me and hustle some free benefits. I donated two bags of chips to settle the huddled masses in her area as I feared an all out riot would have potentially added more sitting time. Recalling the Newstand situation, I was concerned no one would be calmly passing the time reading.

Any hope of making the whole flight without peeing was up in smoke. I had to conquer the bathroom. Toilet humor is sophomoric but I could fill a book with "funny things that happened to me in the john," and I have multiple ideas for short films at the Sundance Film Festival based on these experiences. For the sake of this blog's high standards I'll just say that the numero uno (#1) experience has always been a challenge for me on an airplane, and the idea of standing on one leg with a walker in the small moving bathroom seemed insurmountable. The nice Parisian flight attendant helped me to the bathroom and when we had difficulty closing the door because of the walker, my swollen ass, or both, she pulled a curtain and all went well. I think she sneaked a peak but that was OK with me.

The three hour flight was smooth and the seat was the best seat for my type of injury. I had little pain and was actually able to sleep. I was the last to get off the plane and I was taken to baggage claim in an airline wheelchair. Charlotte was tipping everyone big from my wallet and we had a small entourage by the time we picked up the suitcases. My trip to the ATM and the accounting while sprawled out on the highway were not in vain. Like clockwork, Jim picked us up at baggage claim in Charlotte's station wagon.

We then undertook what I initially thought would be a clear, fast, midday Sunday ride 70 miles south. Unfortunately a massive accident with two helicopters, five fire trucks and more ambulances brought us to a stop. My patience was thinning, my butt was hurting and my left leg was growing by the minute.

Eventually we made it home and I began the short walk to the front door. This time it took a bit longer and I did so, staring straight ahead, ignoring my 30+ years of hard-scape and landscaping efforts. Under normal circumstances this walk makes me happy every time I come home from work. But now the heart was no longer receptive to any comfort. I would try to lift my spirits this way on another day. Limping, tired, hurting and now somewhat panicked, I immediately called Chuck and John to survey the newest case of elephantitis in Middle Georgia. My swollen leg, groin to toes, was a potential serious problem. Either the swelling inside the pelvis from the fractures had blocked the lymphatic drainage (benign), or it had caused a blood clot in the deep veins. The latter, deep vein thrombophebitis, is inherently unstable. The clot can break off, travel to the lungs and cut you down like those Germans did on the real Longest Day.


I did eat two tomatoes sandwiches. My tomatoes, (the best) picked ripe and arranged on Italian County Bread from the Buckhead Bread Co, Hellman's mayo, salt and pepper. The best meal on six continents. If I was going to die, at least I would have this taste in me for eternity. Back in the car, it was off to the ER where I would likely need a series of tests to investigate the vein problem. Chuck and I, with our Southern approach are not that great about getting anything done in a hurry. John, on the other hand, spent a critical amount of his development in New York City and took over the choreography. Everything went fast: check in, wallet biopsis, vital signs, clearing out a room, finding a real doc, physical exam, IV, blood work, bring in an ultrasound tech, the actual ultrasound, bring in radiologist (friend), CAT tech, CAT test with dye, once labs back and OK, CAT read, back to ER and dismissed home with no clot--whew!  It was like a Daytona 500 pit-crew.

Up at 4:30 AM, three wheelchairs, two cars, one airplane, three stretchers, 3,000 miles, two amazing tomato sandwiches, and in bed by 11:00 PM. For me, The Longest Day .

Hospital Jackson Hole

OK with my Sweetie (lap top, Nespresso and sound system too)

Well I had my first taste of real Surgery with General Anesthesia and the rest of the works yesterday. Recalling my grandmother died in her 30's from anesthesia with a routine minor procedure, my dad, while still working, died from a heart cath complications this millennium, and my good friend and long time partner, Mike, died recently from elective heart surgery, I was more nervous in the preop on deck circle than I was on the Teton Pass, when it was inevitable I was crashing at high speed on a busy road. Is that the definition of an ridiculous control freak? Yes, and blend that with a near Psychotic Paranoid. 

OK, I'll put all the cards on the table. In addition to the above Psych diagnosis I have bestowed upon myself, as well as the previously mentioned PreTraumatic Stress Disorder, I also have the mundane seasonal affective disorder (SAD). Right now I am most concerned with this diagnosis. I am not convinced the major factor in SAD is the decrease in light one experiences each winter. I have often said "sunshine is like family, maybe overrated." Based on no data, (which always screws up a progressive free thinker) I am convinced SAD is due to diminished outdoor physical activity, a consequence of the shorter days. Right now I am staring down the barrel of that gun. Staying sane over next month is going to be way harder than riding across the US of A. The Ride was going well and I felt I was getting stronger each day. Inactivity is a malignant threat. If I don't come up with a solution, I might need to utter my favorite line, in my all time favorite movie Moonstruck. When Nicholas Cage meets Cher for the first time, distraught to learn his brother is going to marry her, something that can never happen to him because of his hand wound,  he screams " Chrissey, get me the big knife"


I love it when everything is on the line and I need to come up with a plan. I am the only geek that likes to go the ER in middle of the night. I enjoy the drive in when I have heard the story and don't have clue of what I am going to do when I get there. I always think of something, and usually feel confident about it, even the next day. Usually, that is, if I am carrying an overall positive attitude. Bad attitude translates to no confidence, to doubt, to fear, to terror, to the big knife, Chrissey. Right now I don't know my next step. I'll come up with something.


The surgery went well. The right hemipelvis was detached. The bones were line up and bolted together. All done from the back side with minimum incisions. No blood loss and it only took an hour and 1/2

Worst pain of the week . Self portrait taken while foley
catheter was being removed. Bite holes were in the cloth

No Garmen data. Hey you nice people on face book, thanks for the comments but I can't reply for some reason. Send me an email if you know my address and I'll figure out how to reply on face book when I get home. Plan is to fly out on Sunday AM. I am up and walking with a walker, no significant pain since above photo which clearly defined what pain could be!

Grander Finale at the Grand Tetons

The faux bandages

Well, I hadn't planned to make this post but here we go. To quote from one my favorite books of all time  "It was the best of times and it was the worst of times."  We started out of Idaho Falls on another crisp day with arm warmers and a sleeveless high tech undershirt (for warmth) beneath my favorite outfit. This is a very loud pink, black and white kit I bought in Civita Castallana, Italy when I was accompanying Charlotte on one of her painting trips. 

Idaho Falls in the center of town

The ride started with rolling hills alternating with flats and would ultimately cover 95 miles with two climbs, the second one, much more difficult than the first, and over the Grand Teton's Pass. The Pass dramatically came into view well before the climb. Even before we could see the Tetons, the the farms and the National Park were the most attractive landscapes we had encountered on the trip. Idaho has had record draught and everything is supposedly uncharacteristically brown. We have been following the Snake River to is origin and perhaps local  residents in this area are more aggressive with irrigation, given the verdant landscapes. When we hit the Park, the evergreen trees were large, plentiful and healthy. I told my riding mates Ainslee and  Big Charley, I felt we were looking at the most attractive area we would see on the entire trip. Like I said, "It was the best of times".


The first five miles of the second climb was close to the end of the ride and was only a 2-3 % grade. The scenery mitigated the slight discomfort of going up. The last three miles were at a 10 % grade and very difficult. Despite even better scenery, everything went to shit with a full two miles remaining. I felt I had good legs, but I was extraordinarily short of breath and very lightheaded. I had to get off the bike with the summit in sight.

Teton Pass

After a brief recuperation I made it to the Pass. At the top I caught my breath within a reasonable amount of time. The main problem there was the lightheaded feeling. I decided to stay for awhile and I let some of the riders I had been with and in front of throughout the day, go ahead. I drank some water and ate a cookie and in 20 minutes, was significantly better, but not at 100% . I headed down cautiously with riders immediately in front of me pulling away. The plan was to take it very cautiously and not attempt to catch anyone. Everything went as planned for 2 to3 miles, then I hit a steep straightaway. Since there was no turn I just relaxed and did not pay any attention to my speed. I am now labeling this moment as a "brief mental lapse". I noted I was going over 50 MPH so I touched my brakes softly. Shorty thereafter, the bike started to shimmy. I came off the saddle to squeeze the top tube with both legs which is the recommended maneuver for this problem. I was not successful and it is possible I did not totally clear my butt from the saddle or may have not given this strategy  enough time.


At that point I had 3 choices: (1) Continue to fight it and risk sailing across the center lane at the obvious approaching right hand bend 300 meters ahead and into oncoming traffic: (2) Pull off to the soft shoulder and likely hit the guard rail which I figured would launch me over to the cliff and never to be found; (3) Voluntarily lay the bike down and start rolling . I took a quick look in my rear view mirror to see if anyone was behind me, which would preclude option (3). Option (2), over the cliff is a good way for an old cyclist to go, but I am not that old. I never looked ahead again to confirm the turn in the road or to see if there was oncoming traffic. There was no one behind me so I immediately put the bike down on the right and started rolling clockwise around a head to toe axis, if you were looking at my head from the road shoulder, the direction my head was pointing. 


They say these type episodes always proceed in slow motion but my impression was definitely the opposite. I was spinning as fast as a cartoon character drilling his way into the ground. The distance before stopping was much more than I could have possible anticipated. Gravity with a 10% drop was providing quite the additional vector to the 50 plus MPH forward movement. I had plenty of time to think, and I was sure nothing too bad was going happen. I was confidant I owned that part of the road and there were no obstacles to hit or hit me. I knew I would eventually stop in plain site and given all the movement with all the colors I was wearing, this would have to attract the attention of an approaching vehicle, even one driven by an mountain watching geezer or a txting teenager.


The next vehicle stopped and someone called 911. My wallet came out my pocket and it was stuffed with twenty dollar bills (having been to the ATM for the second time in my life in Boise). The money was EVERYWHERE.  To diffuse the intense situation, (and do do greatly apologize for freaking everyone out) I announced that I knew how much money I had in there and I would count it in the ER).


I went to the ER and the medical details are boring. I gave them my medical insurance card and they handed it back saying it was a dental card. Before I handed them the correct card I told them that was all I had and couldn't they just say it was dental complication. After appropriate imaging I was told  I had a broken pelvis, not hip, and the pelvis was unstable. I do not have that much road rash because of little sliding, but I do have rather extensive mild to moderate bruising in a lot a places, from the bounces with the roll. Right now I am in the hospital with my wife Charlotte. I'm sitting in the chair and she is in the bed. I took 2 Tylenol yesterday morning an nothing for pain since. They ran a Diluadid drip for more than 24 hours which I needed then,but it was making me queasy and gave me a headache. Drug addict has been scratched from my Bucket List . As long as I'm still, I hurt a little in a lot of places. My brain must figure this is an error with the gain. No one, not even a fibromyalgia victim could hurt in this many places, so my brain has more or less shut down the painful input. If I make a wrong move I flash back to me in another life when I was a black woman delivering Wilt Chamberlain with a basketball in each hand


My friends from the Ride came by to see me the night they were here in Jackson Hole. They called to say they were coming and and the nurses helped me jerk their chain by letting me put on a total head and face bandage like the character in Catch 22 (Nurses come in chatting to each other and put the IV bottle where the bladder drainage bag was and vice versus) They came in and didn't say a word assuming I guess that I had total face road rash.


In the hospital I discovered an interesting fact that I want to report for the pathetic reason of assigning at least some blame beyond my control. My O2 saturation, normally 99% on room air at sea level was 83% here in the hospital at 6500 feet and the Pass is at 8431. The nurses say it is not unusual for us flatlanders to have a slight drop in their O2 saturation but not quite this much. I am speculating the extreme shortness of breath and  light headed feeling put me below my slightly above average ability to concentrate. I'll run it by the Pulmonary guys back home 


Tomorrow I will have surgery by a real nice Ortho guy who primarily rides a titanium Merlin. I'll have 2 fixation screws and supposedly will be able get around with out the flashbacks and fly home on Sunday to start the rest of my life. Further blog decisions to made then.

The real hospital scene. .Still able to drink good coffee Check
the Nespresso machine and Frother on my right

Hit below for link to ride and ignore max speed
http://connect.garmin.com/activity/195852543

P.S. I'm not that pissed, mostly happy to be alive                                                                                                                                          

Burley, Id to Pacatello, Id to Idaho Falls, Id

Well today was a relatively flat stage with a minimum of turns. I woke up this morning  refreshed from the short day yesterday and  thought I would opt for some speed. That meant not slowing and stopping for as many pictures, which I now realize is much more interesting than anything I might have to say. Sorry. The winds were light and variable. Like every day so far on this Northern Route, it was cool in the morning so I needed my light jacket. Given the temperatures back East, record highs in Baltimore where my daughter Sarah lives, 105 on the east deck of my house in Macon (according to my wife Charlotte), I felt somewhat guilty needing a jacket. But that was the plan all along. After two consecutive hotter than hell summers, I picked this Northern Route Ride to avoid another. The third, I surmised would do me in for good.

Readers of this blog have likely concluded by now that I am suffering from one or several psychiatric disorders. I'll now confess, that is the truth. The major problem is Pretraumatic Stress Disorder, a condition, previously not described until I coined it approximately six years ago. I ran it by a few shrinks in the Doctor's Lounge. Though they were unaware of the disorder, they were OK with the concept. The difference between PreTSD and a garden variety anxiety disorder is, with generalized anxiety, a person tends to dwell on many things unlikely to occur. In PreTSD the afflicted, blessed or cursed with keen insight , worries about something that always DOES occur. Given the cumulative torture of fearing its occurrence and the actual traumatic event, the patient is beaten down for the count. So I knew it was going to be hot again this summer and I knew three in a row would have caused DISABLING depression. Hide the guns, ropes, razor blades and tall buildings type depression. I saw it coming and I was able to side step it. Right now I am having FUN all day. Endorphins are at near toxic levels where I like them and I have so much serotonin on board, I can see it when I blow my nose.

So after a long warm up it was off to the races. I rode with a a few riders including Barry the "Hammerin' Hemophiliac". (permission granted by him to use this term), Aussie Ainsley, NYC Richard, and San Diego Mitch. Barry is a big guy from Texas who can motor in the flats. As previously mentioned he hopes to be the first person afflicted with this disorder to go across the USA. Much of the surface was Macadam, also called "tar and chips", but we Georgia Crackers call it "shake and bake". This slowed our actual speed a bit, but not our effort. We generally did not run a pace line, just tempo to above tempo riding while conversing a bit. I felt great all day, loved every minute and I am somewhat baffled that the cumulative miles do not seem to be taking a toll as I had previously (before the Ride) guessed would have occurred. I averaged almost 20 MPH with multiple slow downs for stops and getting lost once.

We were tempted to see what was down this road

Everyday when we arrive at the hotel we sign in order to preclude a search party going to look for us  We receive instructions on the "board". Lately I have been photographing the instructions since they are all very similar but not identical. I have had a few screw ups. Note: The leader of the tour, Mike Monk, broke his ankle fixing a flat on the truck

Click below for link to the ride
http://connect.garmin.com/activity/194510635

Today was relatively flat, typically cool and we had a tail wind for most of the way. Tomorrow will be one of the hardest days of the Ride, going into Jackson Hole with long a long steep climb at the end. Everyone is a bit nervous and therefore decided to take it easy today. There was very little separation between the riders so I was able to see everyone at the rest stop. With the quiet of the tailwind and the paucity of traffic it was easy to chat. I assumed this group would consist predominantly of young teachers on summer break. Instead there is an abundance of successful business people close my age who have retired early or have someone else tending the ship in their absence. As opposed to business people in the South the majority appear to be left leaning which surprised me. They are generally reluctant to discuss politics. In Macon we love to argue while riding but I guess you need to know someone well when you call them " a stupid idiot" five times during a long ride and expect them not to take it personally.

San Diego Mitch

One side of the road. Potatoes to mountains

Other side of the road. Hay to infinity

Trees in the fields are unusual

Boston Al takes a swim in the Snake River with 10 miles to go

Click below for link to the ride
http://connect.garmin.com/activity/194870486