Bicycle Accident Story and Analysis

Posted on December 6, 2011

At the end of October in 2011 I was in a moderately serious bike accident. I wrote this shortly after. It is a little goryish in some places, so consider yourself warned.

I guess I have about five reasons why I am writing this up:

  1. I want to acknowledge again all the wonderful people who helped me get through this
  2. I want others to be able to learn from some of the mistakes I made that contributed to the accident
  3. I observed some things about the structure of the medical system that seemed decidedly suboptimal, and I like prompting public discussion about things I think could be improved
  4. I have told various people various piecemeal bits of the story, this puts most of it all in one place for anyone who wants to know more
  5. It is an unfortunately important part of my life right now, and I just felt like it needed written up.

Ok so here goes, approximately chronological order, but with things I later thought about in each situation later interspersed in.

The accident occurred when I was biking to a Halloween party at around nine o’clock on saturday the 29th. We had the first snow of the season that night, but I am used to biking in the snow so I didn’t think much of it. I was on my new (new used, but you get the idea) road bike which unfortunately prompts me to keep my head down more. I also had not gotten a headlight on the bike yet mostly out of lasyness, but also because most of the areas I bike are well lit and I had gotten away without one just fine so far. This all lead to a situation where I was biking down Roseland (a street which I have biked many times in daylight, but I hadn’t realized it was not well lit). I looked up as I rounded the corner and didn’t see anything, put my head down again to keep snow out of my eyes. My mind wandered for probably a few 10s of seconds, and next thing I knew I was looking up at a car probably somewhere 2-4 meters in front of me. Wet brakes and wet ground led to poor braking, and my front wheel hit the bumper with far too much speed. I came over the handlebars and put my face through the rear windshield of the car. My helmet protected my eyes, but I broke my nose slightly and cut up sort of the front left side of my face pretty badly.

I want to say it right now: bike safety is important. I had kind of cut corners a lot of places and been getting away with it, but collusion of several factors and the odds caught up with me. Learn from my mistake so you don’t have to make it.

Luckily I didn’t loose consciousness (I shudder to think what might have happened if I had, down a slightly dark, not that heavily traveled side street, in the cold snow …). I called 911 from my cell phone and was chagrined to be asked where I was. I had though that they had been able to read GPS locations from phones for years now, but the 911 operator was sure I needed to tell them where I was. This turned out to be rather difficult because I didn’t know the name of the street I was on, so I was left trying to pull up google maps on my phone while dripping blood onto it and headed into shock. Not thinking clearly, I gave them an intersection and started staggering towards where I thought it was. I turned out I had given them the wrong location, but luckily a passerby called 911 as well and gave the correct address. The point here is that grabbing my position from GPS would have been very useful here, I am not sure why it didn’t work.

I took wilderness first aid recentlyish, so it was interesting in one of those strange ways to be on the other side of the situation and understand a little bit about why they were doing what they were doing and why. With my cut mouth, I was not able to talk well enough to assure them I didn’t have a spinal cord injury (and truth be told from the mechanics of the accident, I probably wouldn’t have ruled it out even if I had been fully able to describe it), and couldn’t reassure them that I didn’t have any injuries on the rest of my body. This meant they had to cut off my clothing to check for injuries and install a cardiac monitor. They underestimated how cold I would get without my clothes. I would have thought they should be used to people getting cold easily after injuries (since as I learned in my wilderness first aid, your body’s ability to maintain homeostasis is severely impaired in case of injuries), but I guess that is not something you worry about as much in urban medicine where you are very quickly going to be getting the patient to a warm hospital, but it felt weird and slightly worrying to me with first aid knowledge for a wilderness context.

At MGH (Mass General Hospital for non Bostonians), I got a slightly hazy view of (probably a minor version) the zoo that descends on a trauma patient. I had probably ten people around me checking just about everything about me, and fortunately bringing me warm blankets. Mouth injuries have an extra complication for medical care, because I had a hard time answering their questions with my mouth cut open, so I thought they might have been overreacting because they might have thought I had more mental trauma than I thought I did. After I saw the pictures though, I don’t blame them at all for treating it like it was something serious, the worst cut didn’t really hurt yet, so I didn’t realize how bad it was, and while I didn’t have a bad concussion I probably had at least a minor one.

I am surprised I had to ask them for a piece of paper to write down my dad’s number so they could call him, I would have thought they would have dealt with situations like that before, but I guess whichever random nurse was asking for that maybe hadn’t. The nurse who called my dad to tell him about the accident was apparently quite excellent, somehow she managed to tell him that his son had been in an accident and was at the hospital awaiting having is face sewn back together without being any more alarming than necessary. My dad (as I guess parents do) dropped everything and came down to spend the night with me at the hospital. Thanks again Dad, I have already told you how much it helped having you there, but I can’t say it enough times.

They gave me IV pain meds, and a fair chunk of saline. I had lost a fair bit of blood, but apparently not enough to need a transfusion. The pain, pain meds, and the lack of sleep meant the rest of the night was a little fuzzy, but I remember getting a head CT so they could check for skull/spine injuries. I remember thinking about radon transforms as I was in the machine and hoping that eventually I might build an imaging tool that would help some poor shmuck in a similar situation N years down the road.

Eventually they brought in an oral and maxiofacial surgery resident to actually stitch me up. I guess it was actually two residents, but I think of Dr. Haas as “my surgeon” because he was the one who talked to me most and who I have had follow up with, even though I think they said the other guy was more senior and may have done more of the difficult stitches. Somebody was explaining what and why they were doing as they were stitching me up in any case. It was kind of neat and I tried to pay attention, but by that point I was very tired, the Novocaine kept sort of wearing off, and so I didn’t actually follow much of what they said. I am not sure if it was stunned nerves or my having a decent pain tolerance, but I am pretty sure I let the novocaine wear off pretty thouroughly several times as they were stitching me up. I think it was about 5 hours of surgery (from probably 11pm-4am or so) and an estimated 150 stitches in 4 layers (inside of mouth in the place where the cut went all the way through my cheek, muscle layer, and dermal and epidermal), I am impressed that those doctors were able to stay focused for that long and at that hour of the night to do as good of a job as they did. I am not embarrassed to say I broke down crying after they finished stitching me up, I am just glad I managed to hold off until then.

Unfortunately as I was about to be discharged, another more serious trauma case came in, and most of the staff got called away. My discharge was handled by who I later learned was a third year medical student. He did a good job answering all the questions I or my dad thought to ask, but by the end of a night with very little sleep and 5 hours of surgery, for some reason I wasn’t all that thorough. Here I think it would have been useful if they had had some standardized information that the med student could have checked boxes on a computer form and had it print out information partially customized to my injury.

The next problem was due to our country’s lovely overzealous war on drugs. They gave me a prescription for oxycodone for the pain, but the hospital could not give me any pills because their pharmacy was not open (for some reason 5 am on a Sunday is not peak time or something). More unfortunately, because oxycodone is a narcotic, I had to be present with a photo ID to pick it up. This probably comes as no great surprise to anyone, but going on a scavenger hunt for narcotics does not make an optimal chaser to a night of pain, surgery, and very little sleep. Finding a pharmacy that was open was fun enough, but when we got there we discovered that my prescription was for 50mg pills which that pharmacy didn’t stock (they claimed they were not made any more or something). Again because of the narcotic issue, they couldn’t just give me twice as many 25mg pills, so we had to go find another pharmacy. At least then I got to go home and sleep.

By Monday I a piece of my lower front cheek was swelling up and poking out in a slightly concerning manner. My dad was also slightly suspicious he saw some windshield glass in it, so it was back to the hospital. Unfortunately at this point I no longer counted as an emergency, so I got to wait, and wait, and wait some more.

This did give a couple of chances for people to be excellent, but I would still have rathered just get seen in a timely manner. The first I was able to see sympathy emails come in in real time on my android as friends and family poured out support for me.

The second was that two medical students who had been involved when I was in the emergency room on Saturday/Sunday recognized me waiting in an exam room and came by to check on me. The didn’t have anything they were supposed to do, they just recognized me and wanted to check that how I was doing. They answered some of my questions, made attempts to answer more of them, asked me a bit about my research, and generally helped me feel like a human being, and one who was cared about, not just ignored by the system. So if any medical students are still reading, don’t underestimate your ability to help improve a patient’s experience at the hospital. Especially once I had been waiting a long time, it was really nice to be acknowledged and remembered, even if it was by people with minimal ability to do much more.

Eventually a doctor came in, and almost immediately after we mentioned suspicion of a glass fragment in the wound had me scheduled for an X-ray and left. By that point the swelling had developed in a manner that we were far less suspicious of a glass fragment, and if he had talked to us for 5 minutes we could have agreed the chances of a foreign inclusion were negligible. But nope, defensive medicine kicks in. So I got to wait longer for an x-ray, that confirmed what we were pretty sure of by then, it had been a transitory feature in the swelling process that had slightly looked like an inclusion.

I guess the good thing at this point I had waited long enough that Dr. Haas came on shift and was able to explain a little more to me about what had happened to cause the concerning protrusion and reassure me that it was not a problem.

The next bit of people excellence was my mom insisting that she could clear her work schedule and drive down from Ithaca on Tuesday to take care of me for the rest of the week. In cases of serious injury, 25 almost 26 is definitely not too old to appreciate mommy being there to take care of you. She was tireless at figuring out how to get me food I could eat through my damaged mouth, putting as much nutrition and tastyness in it as possible, and keeping me as entertained and comfortable as was possible in the situation. By a week after the accident I was able to at least sort of fend for myself, and so she was able to go home, but between my dad covering the first few days and my mom covering the rest of the week, my parents did an amazing job of making an awful situation suck as little as possible.

At that point (actually overlapping a little with when my mom was there) my friends and labmates took over making sure I didn’t feel isolated while home-bound, I had visitors more nights than not I think for the next week while I was confined to home healing. You all know I appreciate it, but thanks again friends.

The surgeon who did my first followup was one of the few people who was not excellent. He got the surface stitches out fine, but getting more information out of him was like pulling teeth, and I still did not leave the office with a satisfactory understanding of many things. I could only ask about things I could think of, I would have wished that once it was apparent I wanted as much information as possible he would have volunteered things I didn’t know to ask.

Luckily, my second followup was with Dr. Haas who explained in good detail how he had put me back together, what I should expect from the healing process, and what I should do to aid it. He also gave me his email and was very prompt about responding when I emailed him about a few questions. Email is really a great medium for interacting with medical people, it doesn’t waste nearly as much of either of our time, and thus makes it possible to get reassurance about minor things that aren’t really worth an appointment.

The Harvard health clinic also did a great job supporting me, I was able to get in to see my primary care doctor quickly, and she was really good about following up and keeping me informed about day to day things about my recovery, and they assigned a patient care coordinator who helped chase down information and make sure my questions got answered.

All said and done, I have a bit of a nasty scar down the left side of my face that is unfortunately going to get uglier for another 2 months and then to will continue to develop and contract another 9 or so. The broken nose is pretty much healed. I still have some lingering difficulty sleeping well (unfortunately I used to sleep on the my left, now injured, side), and working back up to full speed on my research has been slower than I would like with the head trauma, but my adviser and everyone have been very understanding. Things are getting better week by week (if not monotonically day by day).

It really sucked, but as bike accidents go, it could have been a whole lot worse. I got a wake up call on bicycle safety and got reminded how much how many people care about me. Life goes on, and I take a little less for granted now.