Feb 17, 2016
bugler

Dark and Hazy Days In Hospital

Continued from A Typical Alice Springs Morning Ride

It took about 15min before the reassuring sight of red and blue flashing lights appeared at the top of the overpass. My ability to endure pain was sorely tested when I realised it was the police. By this stage the pain in my hip was made worse by violent shivering from the cold and shock. The police were surprised to find only two cyclists. When Rod was requesting an ambulance, the 000 operator didn’t ask if the driver had stopped. Understandably, the police assumed the driver would be at the accident. The police most likely went past the truck as they were driving north and the truck was heading south on the same highway.

A diagram drawn in hospital explaining how to get hit by a truck

Another 5min elapsed before the ambulance finally arrived. By this point my reserves of pain tolerance and patience were nearing their end. I wanted to be warm and I wanted the ache in my hip gone. Neither happened quickly. The paramedics were more concerned with other injuries. I was sitting and they began asking questions to ascertain if I had a spinal injury. It didn’t help when I said I had numb hands and feet. I stood up to demonstrate I was OK. There was a pool of blood where I had been sitting. I had been trying to reassure people I was fine. That blood undermined my argument. I had been also trying to say I was lucid. My inability to recognise I was bleeding didn’t help this argument either.

Two fire trucks arrived on the scene and I was starting to get upset. I was shivering violently. I badly wanted to be in the ambulance with a blanket and some pain relief. I had created a minor traffic jam as the population of the vicinity swelled. One of the policemen began directing traffic. Mrs Bugler arrived shortly after I was loaded into the ambulance. We had a quick discussion with those around me. The blood pooling on the sheets of the stretcher was not reassuring to Mrs Bugler.

By the time we left the scene it was well after 7am. The police went to our house with my bike and other belongings. The fire engines had realised they weren’t much use and headed back to the station. Mrs Bugler set off for the hospital. The ambulance staff struggled to get an IV into my violently shaking limbs. They had also cut away some lycra and subsequently struggled to slow the flow of blood. Evidently lycra has excellent properties for slowing bleeding. Eventually we got on our way with me bleeding and in pain. I can only imagine how Rod must have felt as I was carted away with my entourage of emergency services. The ride back on the highway must have been a touch lonely and frightening.

Tegaderm holding my leg together and blood in

 

From the very first moment, I didn’t grasp the danger I was in. I was the only one. When I got to Alice Springs Hospital Emergency, I was only worried about getting more blankets so I could warm up. For 3 hours a single nurse put pressure on my wound to stem the flow. Each time she took her hand away, there was someone who would say something such as “oh no, it’s still going”. A variety of doctors – residents, registrars, consultants, surgeons, orthopaedic, emergency – asked me questions I felt were irrelevant. It was gradually made clear that the pain in my hip could likely be distracting from something much more sinister. Internal abdominal bleeding, a head injury or a spinal injury were very real possibilities.

I had been in hospital for around 4 hours before I felt something approximating comfortable. My limbs had gradually thawed thanks to heated blankets and the copious amounts of morphine turned the pain to a dull stiffness. The emergency consultant had given me an ultrasound to ascertain if I had internal bleeding. She also gave me an examination to discover the possibility of a spinal injury. Both gave her confidence. Nevertheless, successive general and orthopaedic surgeons requested x-rays. I was wheeled out of the resuscitation area of emergency by a clerk who called himself the “Cheeky Kiwi”.

An photocopy of my x-ray with gauze in situ

My x-rays delivered a classic scenario of good and bad news. First the bad. The truck had smashed the top corner of my femur, a part called the greater trochanter. This had likely torn a number of muscle attachments off too. The fragments of my femur were floating throughout my general hip area and there was concern some of these fragments may have been gravel from the road. The open wound and shattered bone made concerns for infection with long-term consequences very real. And the good? Despite some initial concerns about a hairline fracture of my pelvis, I was given the all-clear for other injuries. No fractured skull. No spinal injury. A lucky Bugler.

Upon my return to ED, I was admitted under General Surgery but my surgery was to be done by the orthopaedic team. I was booked in for exploratory surgery that afternoon. This was to clean out the wound and to discover the extent of the damage.

A drawing of the anchors re-attaching my gluteals

The six days I spent in hospital following my initial surgery tend to blur together. A combination of drugs no doubt contributed to this. The effects of the surgery also made me feel much worse than the initial accident. A few key moments stand out.

Mini-Bugler fell sick adding to the extraordinary stress on a pregnant Mrs Bugler and each time they visited I felt a flood of emotions, love and guilt primary among them. I was greatly relieved that Mum and Dad decided to drop everything and fly up.

I was scheduled in for further surgery two days following the accident. My surgical team explained that this was to repair the damage to my greater trochanter, and to re-affix and repair my gluteus maximus, gluteus medius and gluteus minimus. The day of fasting waiting for the surgery was extraordinary. I kept getting bumped to later and later in the day. By 9pm my patience was wearing thin and I was hungry. After I was wheeled into the surgical suite, I spoke to my surgeon and questioned his ability to perform the surgery expertly at the end of a 15 hour day. Apparently his team was chuckling as they overheard the exchange in an adjoining room.

An exchange with a surgical nurse was particularly memorable. She recalled me from my surgery two days prior. She said something along the lines of “I remember you, I could fit my fist through the hole in your bum” and proceeded to motion with her clenched fist. I asked how the damage to my femur was done. She explained using her fist that the blunt edge of the truck had punched through my sufficiently hefty bum cheek and slammed into my femur, shattering the corner of it. This rather vivid image made it quite clear that I was in a bit more trouble than I had initially thought.

Centralian Advocate understating my injuries

My surgery went as planned and over the next few days we discussed my health with a myriad of doctors and nurses. I was grateful to have a doctor as a wife to help interpret what was being discussed. Not for the first time I felt concerned for the many other patients without the resources available to me. A discussion of my blood was particularly enlightening. My initial blood test indicated a haemoglobin of 144g/L and an haematocrit of 0.43, both comfortably in the reference range despite an hour of bleeding. During my second surgery, these had dropped below 50g/L and 0.20 respectively, about a third. I was given two blood transfusions of packed red blood cells which restored my blood to 103g/L and 0.31 – still significantly below the reference range.

By this point, I absolutely understood that I was not in good shape and that the rehabilitation was going to take a long while.

2 Comments

  • Wow Liam, you sure made a good job of it. Praying for a healthy recovery time for you and that you are able to get back on a bike one day.

    • Thanks Kelly, don’t worry my recovery has gone very well. I’ll post again soon about the last few months. Hope all is well with you!

Leave a comment