Femur, Interrupted

So, here's what happened. On Friday evening (Feb. 1) I was in a group lesson on James. My recollection is that he was a little squirrelly about steering as we cantered right, maybe because he didn't like the puddles. Anyway, I didn't see what, if anything, set him to bucking. I don't think I had much of a chance: he launched me pretty effectively, and I came down on my left side, basically landing on my thigh. Right away I knew I wasn't going to just get up. The muscles in my left leg simply weren't working. It was pretty clear that the rest of me was okay (my head never even came close to the ground, my right leg seemed to be fine, and my left arm wasn't involved in breaking my fall). The thing is that any attempt to move my left leg at all resulted in excruciating pain. But I could wiggle my left angle and move my left toes, so I was still thinking this was just a really bad injury to the muscles. Big thank-yous to Carrie, Dee Dee, Carol, and everyone else who helped with keeping me comfortable and helping to get the paramedics out to me. The paramedics put me onto a board to move me, and there was some pain involved. Once we got into their truck, they started to cut off most of my clothing and gave me something for pain. I recall explaining very clearly that they did not have to cut off my boot, they just had to make sure the zipper was all the way down. They engaged in a discussion about whether I was a candidate for a field traction device known as a "Sager". It wasn't until this point that I realized they were quite certain the leg was broken. Anyway, they said the Sager could reduce the damage done by the bone ends and would also help reduce the pain, and I told them to go for it, so they went ahead and hooked it up. Then we headed off to the Stanford ER.

A Scale of 1 to 10

Before we even headed for the ER I had to start answering the question that would be the question of the week: how is your pain on a scale of 1 to 10, where 1 is none at all and 10 is the worst pain ... wait! Is it the worst pain you've ever had? The worst pain you can imagine? The worst pain you can imagine staying conscious through? If you find out for sure, let me know. I learned eventually that my answer had to be adjusted to meet expectations, so I didn't really answer based on my 1 to 10, I answered based on "this hurts pretty bad and I could use something for the pain," which seemed to be 3-4, or "this really hurts and I need something for the pain now," which seemed to be more like 4-5. Knowing that clinical studies of pain medication also use this kind of unscaled self-reported pain as data doesn't do anything for my faith in pain medication research. Somewhere along the line here, one of the paramedics was running down a summary of my status, and he said that I came off a horse and wasn't wearing a helmet. I got very indignant (at least, that's the way I remember it), saying, "Of course I was wearing a helmet. We took it off before you got here! Do I look like an idiot?" Okay, I can't swear that I actually said that last part, but I was thinking it.

Wet Behind The Ears

At the ER, the doctor looked awfully young. He looked at radiographs (yes, I will post them when I get copies) and said I had a spiral fracture of the femur. He explained that they needed to apply traction to my leg, so he'd be drilling a hole through my tibia just below the knee and putting a pin through it. Apparently this is better than doing it from the outside (with an ankle cuff?). After a nice big shot of lidocaine, he proceeded to drill a hole through my leg, which was interesting because it was like being at the dentist and feeling him drilling into your teeth. There wasn't any pain, but I could clearly feel that he was drilling through my bone. I didn't get to see any of this part, which is just as well. But I felt them attach the weights to me. I would be in that position until 8:00 am the next morning, when they actually performed surgery. (The thing I remember about that night is that I would drift off to sleep and wake up whenever my leg muscles decided to spasm. Not the best night's sleep ever.) Speaking of young doctors, the ones I interacted with during prep for surgery definitely were wet behind the ears. One thing I noticed is that having previously told them I'd never had any major medical problems, when I told them I had spent my fair share of time in hospital rooms, they looked confused. Clearly, they were too young to be dealing with parents' health problems yet. One of the joys of being at a university hospital: When I told the doctor that my major anxiety was not about the surgery itself but about general anesthesia, he assured me that things are much better than they used to be. In fact, he said, if a young healthy adult like me were to die, it would be so unusual that they would write a paper about it. Good to know my death would be publishable. So I went into surgery around 8:00 am Saturday and the next time I was aware of a clock it was 1:00 pm in the recovery area. The doctor said the surgery went well, and before long I was ensconced in the (private!) room that would be mine for the next five days, along with a PCA (patient-controlled administration) drug system giving me hydromorphone ("Dilaudid"). My primary task was to push the green button when I wanted more drugs and periodically wiggle my toes, flex my ankles, and confirm that I could feel when my toes, instep, and sole were touched. (And when I say "before long" that is almost before Michelle even knew that I was out of surgery.)

Percocet and Me

I think it must have been Sunday morning that I was switched from the IV pain drugs to Percocet (oxycodone and acetaminophen). Percocet did not like me. Thankfully, none of the pain drugs I used caused me nausea, which is all too common for the whole narcotic family in some people. But Percocet just made me feel crummy: I felt like I had a fever even though I didn't, it destroyed what appetite I had, and it made me wish I could just sleep through the next few hours instead of experiencing them. I put up with it because I didn't really understand that there were alternatives I could try, and it turns out that Lortab (hydrocodone and acetaminophen, aka Vicodin) likes me much better. Oh, well. I'll know next time.

Out Go The Lights (part 1)

On Sunday, the cheery team from occupational and physical therapy showed and assured me I'd be skipping down the halls (without putting any weight on my left leg, of course) in no time. I was dubious, but they said I'd have a lot movement back within a week. Following their directions, I skooched over to the side of the bed using my arms to propel me and lifting my butt off the bed. We got to the edge of the bed with my legs over the side and I was basically sitting up. All was good. I just needed to grab the walker with my left hand, brace my right hand against the bed, and push with my right hand and leg to get upright. It went really well. Then I fainted. I only lost consciousness for a few seconds. They assured me that fainting on the first time getting vertical like this wasn't out of the ordinary, but it did put a damper on the proceedings. My blood pressure was fine after I fainted, but my pulse rate had been on the high side ever since I came in to the hospital. Later that evening there was an incident where my pulse rate decided to go sky high for no particular reason. It hit 150, and they slapped an EKG on me, but my heart rhythm waveforms were apparently perfectly normal -- just really fast. They gave me metoprolol, a beta blocker that slows the heart rate (my Dad was on this for his congestive heart failure). They also gave me a unit of blood, because of the fainting and a low hematocrit test result.

Out Go The Lights (part 2)

On Monday we repeated this procedure with very similar results. They actually monitored my blood pressure during the process, and it was pretty good right up until I tried to stand up, and right after I sat down again. (I didn't actually lose consciousness this time, but it was close.) Later we successfully got me standing long enough to transfer into a chair, but it was not so great being upright in the chair: I felt dizzy a couple of times. That night I got two more units of blood, and I felt a lot better the next day. (My mother-in-law the nurse said I should feel able to leap over roof-tops after 3 units of blood.) I was able to make it all around the bed and as far as the door.

Where Do We Go From Here?

By now, Stanford was itching to get me out of there. They wanted to send me home with some in-home PT and good luck. Michelle was seriously freaked about the idea and by that time I was, too. The alternative was to discharge to a rehab center (a skilled nursing facility) where I could have 3 days to a week of more intensive therapy in an in-patient setting. We decided that was the most sensible choice, because at that point I couldn't even get in and out of bed without help.

I'm In Rehab, Where's Lindsay?

Stanford looked at places they've had good experience with and places that contract with my insurance, and recommended Los Altos Sub-Acute Rehab. Thursday (Feb. 7) I got sent off with a lick and a promise (well, not really, but I definitely got the sense that Stanford was less interested in me when we decided not to go straight home). So, the average age at a skilled nursing facility is typically going to be on the high side. Most people don't wind up in in-patient rehab unless they're very badly injured or elderly. I was extremely lucky, and got a single room because there were no male semi-private beds available when I arrived. (Lucky because my insurance wouldn't cover the difference.) The one drawback to the room is that it is right next to the nurses station. That means there's a lot of activity and a very obnoxious buzzing display panel that is supposed to ensure that patient call buttons are responded to quickly. (Something is wrong with this design, however, because staffing levels are naturally adjusted to avoid waste, which means no call is ever answered immediately, which means that the damn panel buzzes pretty much continually -- that is, it buzzes once every ten seconds, pretty much all the time except in the middle of the night). My PT (Pat) and OT (May) have been great. They say that my overall good health and strength will make things a lot easier, and that seems to be true. Still ... toe-touch weight bearing means basically standing on one leg when standing up (left leg is only good for balance), and that uses a lot more energy that one might imagine. And two arms are not as strong as one leg, so walking with the walker or crutches tires out my arms pretty fast. But I seem to be able to manage all the important stuff at this point.

Homeward Bound

So, they're springing me from this joint on Valentine's Day, and after that I'll be doing home-visit PT for a while, then eventually outpatient PT. I have a followup visit with the Stanford orthopædic surgeon in a week, and hopefully I'll find out then what to expect in terms of progress.

How advanced is your technology?

The world doesn't need another corollary to Clarke's Third Law, to be sure. And yet …

Any insufficiently advanced technology is indistinguishable from a spell that backfires.

Impressions of Manila

Humid Hot Security

• cars are stopped approaching the hotel
• bags are inspected at the hotel and office building
• many bomb-sniffing dogs (black labs who look hot and tired)
• Airport security has X-ray screening at the entrance, then again at the gate area, and finally flights to the US have a third hand inspection and X-ray of shoes. Hand inspection includes flipping through the pages of a paperback to see if there's anything concealed there.

English everywhere McDonald's McRice burger Pedestrian underpasses

• escalators up-only

The Thrilla in Manila is the taxi ride to the airport during rush hour

Sigh

The Little Green Car

The smart key system on the Prius at first seemed like just a convenience: I wouldn't have to fumble in my pocket for the clicker. But it turns out that the system operates on a very emotional level. Here's what happens: I walk up to the car, and the transmitter in the door pings the transponder on the key. Satisfied with the key's identity, it arms the unlock system and lights the interior. When I grasp the door handle, the car unlocks (with two beeps) and I can open the door. There's no perceptible delay in unlocking the door. Here's what it feels like: I walk up to the car, and it recognizes me. (It literally lights up in recognition.) As I open the door, it yelps excitedly. It's been waiting for me, anticipating my entry, so it unlocked the door as soon as it knew I wanted to come in. I know that it's just a well-designed electro-mechanical system, but I can't deny the emotional reaction I have to it. It feels as though the car is pleased to see me, perhaps because it seems to behave a lot like a dog would. The Little Green Car likes me.

Quite the run-on sentence

Actual TV blurb:

A model child who became a killer: tonight only on Eleven @ 11:00, Scott Dyleski's mother on why she burned his belongings and what her son said after the murder and where to find the best bargains on bay area homes.

What could I possibly add?

Surprising Candor

I opened the paper this morning and read that Donald Rumsfeld says we need to "confront the rising threat of a new type of fascism." I didn't expect him to attack the administration like that.

Ashland

Although many of our friends and acquaintances are regular goers to the Oregon Shakespeare Festival in Ashland, this was our first visit to the festival. I expected to enjoy it, but it turned out to be even more fun than I thought it would be. I had a great time, which Michelle points out may not be clear from the dry report that follows. So, just so you know, every single event was absolutely delightful. Since we didn't want to drive for long stretches or take the extra time for a more leisurely trip with stops along the way, we flew. Our plane from SFO to Medford ("Rogue Valley International Airport") was one of those cute little Embrauer turbo-props. I confess I like them. In case you're wondering, Medford's international airport has three "gates" and a single waiting area that must seat a good seventy people. (A word of warning: once you pass through security, your dining option consists of a vending machine with potato chips and granola bars.) Having waited too late to get reservations at a hotel or bed and breakfast close to the festival, we stayed in a perfectly serviceable Holiday Inn Express. It was only fifteen or twenty minutes from the festival, and my fears about parking proved overblown. On-street parking in the morning wasn't difficult. In the afternoon, we didn't have trouble parking in the free city lot a couple blocks away. There's also a paid city lot near the festival that's quite reasonable. We got in Wednesday evening, rented our car and checked in at the hotel. Thursday morning we drove into town and found the festival with no difficulty. The Visitor Center was staffed with helpful people who told us about the free noon-time "park talks," so we went to see actor Chris DuVal do a short introduction and a lively question and answer talk. Chris plays a couple of comic roles in the productions, but he did seem to react (albeit mildly) to being characterized by one questioner as a "comic actor." He also planted the seed that we might want to see Cyrano de Bergerac, which was not part of our original plan (nor our collection of tickets, of course). Our first play was The Winter's Tale. I wasn't very familiar with it, but the production was very accessible. The stage was quite bare, befitting the wintry theme. There were excellent performances by William Langan (Leontes) and Mark Murphey (Antigonus), and outstanding ones by Josiah Phillips (Old Shepherd) and Greta Oglesby (Paulina). This play has the famous stage direction, "Exit pursued by a bear," but no bear appeared on-stage. There is an animal on-stage in The Two Gentlemen of Verona. We attended a preface talk Thursday evening before we saw it, which gave some insight into the way the theme was interpreted in the design. Crab was played by a local dog named Terwilliger. The program reveals that more than a dozen local canines auditioned for the part. Terwilliger got along famously with David Kelly (Launce), and there was some fun at intermission with chasing a ball. Eileen DeSandre (Speed) was hilarious, and Juan Rivera LeBron (Valentine) did a wonderful job. On Friday we went to a noon-time lecture on The Merry Wives, language, and "citizen comedy" by a guest lecturer from Winchester (I need to look up his name). (Update: it's Geoff Ridden) Friday afternoon we saw King John in the New Theatre, a very intimate performance space. King John is not one of the more frequently produced histories, so it isn't full of familiar lines. (It is the source of the mangled metaphor about gilding the lily, which is originally painting the lily, or gilding refined gold.) Robynn Rodrigues (Constance) delivered a stunning performance of Constance's monologue on grief and madness. I don't think I had ever heard this speech before, but it's richly human and her delivery was quite breathtaking. If I could nominate only one performance we saw for an award, this would be it. Friday evening was The Merry Wives of Windsor. The scenery and costumes were brightly colored cartoons, described by our backstage tour-guide as "Doctor Seuss on coffee." Jonathan Haugen really stood out in his performance as Master Ford. Both of the wives, Tyler Layton (Mistress Ford) and Shona Tucker (Mistress Page) were also excellent. Saturday morning we showed up bright and early at the box office in hopes of getting tickets to Cyrano de Bergerac, but the few tickets available went to the few people ahead of us in line. After that was our backstage tour. We were guided by stage manager Kimberly Jean Barry, who truly amazed us with the amount of work that goes on before, between, and during the productions that we don't see from the audience. She likened it to the tip of the iceberg 90% under water, and I was quite convinced. Saturday afternoon was The Importance of Being Earnest. I would have to say that while all of the performances were excellent, no one stood out above the others, with the possible exception of Dee Maaske (Miss Prism). At five o'clock we returned to the box office area hoping against hope that someone would be selling tickets for Cyrano or that the box office would have unclaimed seats. As luck would have it, at six o'clock, when unclaimed tickets were released, there were only two people in front of us, and we actually got the last two seats for that night's performance. Cyrano de Bergerac was wonderful. The lead was being played by the understudy, Richard Howard. This was only his second performance in the role, and it would have been a fantastic performance even without considering the circumstance. Our only complaint was directed at the playwright: maybe Cyrano didn't have to stretch out his death scene with quite so much dialogue. Sunday noon we heard Greta Oglesby talk, which was delightful. She was well into a career in accounting, of all things, before she discovered that performing was her true calling. We finished up Sunday afternoon with David Edgar's adaptation of Dr. Jekyll and Mr. Hyde. We were left with some questions about the playwright's intentions in some aspects of the plot, but the production was stunning. The set design was very creative (which we heard a bit about during the backstage tour), and James Newcombe (Jekyll/Hyde) did an amazing job of transformation (even if his accent was a little inconstant). Now the only problem is that we're sitting in the aforementioned waiting area, grounded by the weather (at least there's free Wi-Fi). But we're definitely looking forward to a return trip next year.

I am shocked—shocked!—to find that business is going on in here!

When I read Tim Bray's posting on "Open Source and Money," I was a little confused. When you're writing about something called "Open Source Business Conference," isn't it a little disingenuous to suggest that people attending need to brace themselves for the possibility that money might be a major topic of discussion? Tim's usually more sensible than this. I don't understand why he seemingly credits Ben Rockwood with some kind of insight. Of course, very little open-source software gets written for money—but why is he equating money with self-interest? Tim's list of reasons for writing open-source software?

• To solve a problem I was facing.
• To solve a problem I heard a lot of people complaining about.
• To win a point in a technical argument, by example.
• The code was interesting to write.

The only one of these that isn't obviously “self-interest” in some form or other is the second one, and let's be honest: Would the second reason stand alone, without the first and/or last? I suspect not. People's interests are not necessarily monetary, and a pure altruist is an awfully rare bird. Encouraging illusions about why people create open-source software doesn't help developers or business-people.

Our National Sick Pet

Mike Jensen of the Philadelphia Inquirer wrote: "In just a few days—having suffered his horrifying misstep at the Preakness Stakes on Saturday—Barbaro has gone from being a dominant 3-year-old racehorse to kind of our national sick pet." That seems to capture a lot of the sentiment. We love to root for the underdog—when he has a fighting chance. For many people, the routine destruction of injured horses has always seemed callous. One thing that's come out of Barbaro's story is a better explanation for why a broken leg really is a life-threatening injury to a horse; not just a career-ending one.