The Narrative

Here's how it was reported locally:
Date: Sat Jun  7 13:01:55 PDT 2003
Subject: report

some of you may know that on may 21, while riding with chad,
through no fault of chad's i had a serious accident.  coming
downhill i hit a pothole and fell from the bike.  kindly
passersby stopped to help me out.  one of them put our bikes
on the bike rack on top of his car and drove us to the stanford
medical center.  i remember apologizing profusely for getting
blood all over his car.  i had broken three ribs in five places,
smashed the clavicle, and split the scapula from bottom to top,
just short of the socket.  the shoulder joint is fine but there
was lots of damage around it.  of course i had my helmet on
and if this accident was any indication i suggest you follow my
example. the helmet was destroyed but i had only minor bruising
on my head and no concussion, not even a headache.

road rash too, but never mind that.

x-rays showed that there was a pneumothorax, air outside the
lung, caused by a broken rib puncturing the lung.  they decided
to keep me in overnight to make sure the lung would not collapse,
and it didn't. the next day there was another worrying sign but
it turned out to be a false alarm and i was sent home after two
nights in the hospital. there is still some fluid, probably
blood, under the lung above the diaphragm, but that will
eventually be resorbed and is no cause for worry.

last monday i had a followup with orthopedics and we learned
that, although things looked fine right after the accident, the
clavicle pieces had separated and were no longer lined up; my
shoulder had dropped and started to move inwards. surgery was
called for if i was to have full motion in my shoulder joint.
so on thursday morning i returned to the hospital to have a
plate installed under the clavicle to hold and support it while
the bone knits together.  a full recovery is expected.

i am home again now, my body is the right shape again (although
not the right color; the bruising is spectacular).  i expect to
return to work next week, although maybe not as early as monday.

slight change of topic. some of you may know that chris baldwin
just won the national time trial championship in pennsylvania.
i don't know chris, but i am good friends with his dad; we've
shared a number of adventures over the years.  when i returned
from the hospital yesterday, a parcel was waiting for me.  jim
baldwin, chris's dad, had sent me his son's team jersey (i think
it's from last year) with a note hoping the gift will encourage
me to get back on the bike.  it will.

see you all soon.  let's go riding when i'm fully recovered.


May 21, 2003: The day of the accident: broken bones

These X-rays were taken soon after arrival at the hospital. The first one shows a broken clavicle - but there are better views later - and that little metal thing is an electrode.

Here you can see the gap in the right clavicle (left side of the image). It broke into four pieces: two big pieces and a couple of shards in the middle.

The gap is very clear here. Look for broken ribs on the same side. There are five breaks in three ribs, and they're really broken.

This one is the best view of the broken shoulder blade (scapula). The crack is quite clear to the right of the shoulder socket, an area called the glenoid neck, and snakes all the way down to the bottom of the scapula. Click on the picture to see the higher-resolution image if you want to trace the fracture. I read somewhere that a large fraction of people with broken scapulae die in the accident; the bone is so strong and deep that a trauma sufficient to break it is often lethal. I was wearing my bicycle helmet; had my head hit the pavement unprotected I would have likely died.

Another general view.

May 22, 2003: The day after accident: a punctured lung

After the accident it was soon realized I had a punctured lung. In these images the trained eye should be able to see how the bottom of my right lung is lifted up by the blood pooled above the diaphragm.

May 27, 2003: The following week: a floating shoulder

These pictures are from the visit to the orthopaedist (Dr. Bellino), who - luckily for me - is a specialist in repairing badly broken collarbones. I had a floating shoulder, a shoulder supported by only broken bones. As a result, in the few days since the accident, gravity had pulled my shoulder down a couple of inches. Compare the appearance of the clavicle in these images with the ones immediately after the accident; you'll see that the pieces have separated and the outside has slumped. I'm not certain, but I think one of the shards of clavicle is clearly visible in these pictures, a sort of splinter an inch or so under the break.

This picture gives the feeling the clavicle is broken. Dr. Bellino suggested surgically reassembling the clavicle and holding it together with a stainless steel plate and some screws. I readily assented - I looked very unwell with my drooping shoulder and the broken clavicle piece jutting frighteningly close to the surface of my chest.

October 23, 2003: Five months later: an implant

This paired image shows the implant in place. In the lower image, notice the active growth (whitish areas) where the bone is healing around the glenoid neck, at the socket of the shoulder joint. You can also see some pretty spectacular kinks in the ribs near the sternum. I'm told that if I lose about 40 pounds (fat chance, ha ha), you'll be able to see the screw heads under the skin.

April 12, 2004: A year later: Healing well

Compare the state of the glenoid neck to its appearance in the prior image. You can see the progress in the healing bone.


I'm pretty much all better. My chest has some cool bumps (I also permanently dislocated two ribs from my sternum, but we didn't realize that until the swelling went down, and by then they'd set in place and didn't hurt anyway) and my arm has about 90% of its original range of motion and strength. It took about eight months for my ribs to stop hurting, especially getting in and out of bed. But by the time of these last X-rays there was no pain, and I'd already been happily riding for months.

Here's to modern medicine.