May 6, 2011
Given the physical and psychological demands of sports competition, it is almost inevitable that at some point in a competitive athlete's career, he or she will will be faced with a serious injury -- serious enough to jettison any thoughts of competition or training until the injury is repaired or healed? This is particularly true of older competitors. Because I have recently gone through such an experience at the age of 69, I wanted to capture and share my thoughts about my recovery from the injury while they are still fresh in my memory.
This winter I decided to reacquaint myself with cross-country skiing. Several decades ago, I lived in Vermont and learned to cross-country ski (X-C ski)in, as Dylan Thomas recalled, "the muffled silence of the eternal snows..." For many years after leaving Vermont I lived where the snows were light and ephemeral, if there was snow at all. But this winter the eternal snows returned and, after a thirty-year hiatus, I took up X-C skiing again. On a sunny February afternoon I went skiing on a set of gentle, but icy trails. Not surprisingly, I fell several times. On one of these falls I bounced down on my right hip, raising a nice bruise. Not a big deal -- except that I was on Coumadin, an aggressive blood thinner. The result was that the internal bleeding around my right hip continued unabated long after the fall. In fact it took several days for the bleeding to be staunched. By that time I had a large hematoma and had hemorrhaged a significant amount of blood. After a week in the hospital and five blood transfusions, I returned home with a deep purple contusion on my right side that ran from my knee to my hip.
But this article is not about my medical history, fascinating at that may be. Rather, I want to describe my thoughts and feelings as I moved from incapacitating injury to a reasonable approximation of good health.
For the first few days in the hospital I had no thoughts of doing anything more physical than maintaining consciousness. Gradually, I did spend time puzzling out the tiny, limited movements I could manage in bed, all of which centered around bodily functions -- how to pee without pain, getting food down, finding a tolerable position(s) for sleeping. For someone who had been very active physically, this was a humbling experience. Unlike the relatively slow changes so typical of aging (graying of hair, hearing loss, wrinkles), suddenly I was helpless. I watched with envy as a nurse moved about the room carrying a tray or picking a soiled towel off the floor. I coveted the grace of the janitor as he glided down the hall swinging his mop from side to side. Pain medication dulled some of my frustrations. I couldn't help wondering if this state of incapacity was a vision of my future. In fact, many similarities between aging and the injury popped into my head during this period.
It's a matter of time. Isn't aging just becoming injured at a glacial pace (if we're lucky)? The cartilage in my knee disintegrates over several decades and, voila, in my dotage I am limping as surely as if I'd been whacked with a pipe wrench that morning. But today in the hospital, I am caught in the simultaneity of the two: aging and injury. As my body labors to repair itself, it continues to disintegrate slowly with age. As the melancholy philosopher, Jaques, in Shakespeare's As You Like It observes:
And so, from hour to hour, we ripe and ripe,
and then from hour to hour, we rot and rot;
and thereby hangs a tale.
Act II, vii
My ripening is taking place rather rapidly as the contusion on my hip has begun to stabilize, the internal bleeding halted. Necrotic cells are carried away and replaced with healthy tissue. A ripe me is a healthy me. At the same time my rotting continues, marked in part, by a decline in my immune system. It will take me longer to heal than it would have, if I were 40.
At the end of my week-long hospital stay I was, at last, mobile. When I returned home my focus became getting around without aid. Initially, "aid" consisted of a walker. I shuffled around the house pushing the walker until I could manage crutches. After two days on crutches, I graduated to a cane. Moving was painful, but a small price to pay for even limited independence. My days were marked with small triumphs -- eating dinner at the table, getting briefly outside the house, going to the bathroom on my own. Urinating into a toilet, rather than a bottle, was a great victory. Throughout these early weeks, my wife became my caregiver, infinitely patient, empathetic, and encouraging. And my moods, swinging from frustration to elation, to depression, surely tested her.
Injuries, especially traumatic injuries, call for a rapid adjustment in expectations. My plans for the winter to X-C ski, to swim more, to continue weight training and biking quickly flew out the window leaving my sports psyche empty and desolate. I attempted to fill the void with the small victories, such a bathing myself or tying my right shoe, but this only worked occasionally. For most of these days my mood was dark. These small, unexpected brightenings would pass through me like a comet slicing across the night sky.
I had seen a physical therapist in the hospital, but real physical therapy didn't begin until I returned home. After an evaluation by the physical therapist at her office, I was given a series of exercises to stretch and strengthen the muscles around my right hip and leg. Every day I dutifully pulled, pushed, squeezed, stretched, opened, closed, twisted, and turned. These exercises became my training regimen, at least that's how I thought of them. Like a training routine, my exercises -- the "Clam Shell", the "Figure 4", the "Squat Walk", and others -- demanded discipline and focus. Just as sometimes I trained too long without rest, I probably overdid the exercises on some days. The lump on my right hip was now beginning to shrink, ever so slowly, from the size of a small carry-on bag, to a catcher's mitt, to a woman's purse, to a pouch of pipe tobacco. The process of healing was something of a "Benjamin Button" experience, moving from weakness to strength, from frailty to growing physical confidence.
As I regained some strength my thoughts began to wander from the PT exercises to other kinds of physical activities more closely related to the sports I enjoy. I knew that running was out of the question at this point and the size of my contusion made it impossible to sit in my kayak But I could begin to swim. Tennis season was coming and I had a chance to go to the Nationals (More about that in a future posting). What about practicing some serves? Could I bike? Putting my other, uninjured muscles to work grew from a temptation to an obsession. I knew that pushing too quickly might re-injure my hip. But it was only my right hip and right let that were the problem. Right?
You should not be astonished to learn that within a few days I succumbed to the obsession and began some modest training, in addition to my PT exercises. I began to use a stationary bike (the weather was too wintry for cycling outside), lifting weights, and spending time on the elliptical. My physical therapist encouraged this, as long as my efforts were "moderate." The transition from PT exercises has taken several weeks. I still have a small bruise on my hip , about the size of an Oreo Cookie, but it doesn't affect my swimming, paddling, or cycling. My running is pain-free, but slower than ever.
Am I healed? I'll let Hippocrates have the last word:
"Healing is a matter of time, but it also a matter of opportunity"