Two days ago I was joyfully riding my bike along an easy waterfront trail through a forest, before dinner. I was going quite slowly, searching for little clearings with good views to which I could return to do some plein-air (outdoor) watercolour paintings of the lake. I was riding carefully, because there was a steep drop-off to my right, heading down to the shore.
When I saw that someone had smashed a glass vodka bottle right across the trail (apparently it’s a popular party spot for someone!), I swerved to avoid the broken glass. Unfortunately, my tire slid right across an exposed root and turned my bike so that it was facing directly downhill towards the lake – and still moving. Before I could even begin to brake, or put a foot a down, I hit a 4″ diameter branch – with my throat.
Because my bike hard started moving downhill at a fairly steep angle, the back wheel of my bike lifted, and I was thrown up and over the branch – pivoting around the branch on my throat and chin to land flat on my back. My bike landed partly on top of me, partly in the water. Before I even moved, or tried to get my bike off me, I used my old-fashioned military First Aid training to do an emergency evaluation on myself. Once I’d checked for the ABCs – airway, breathing, and circulation – I checked for any symptoms of a concussion.
With no memory of hitting my head and no apparent loss of consciousness, I felt no head pain, dizziness, spotty vision, or nausea. I’ve had concussions before, from other sports injuries, and didn’t feel that I had one this time. That was good news! Nor did I seem to have broken any bones, or even sprained anything.
By the way, it surprised every doctor I met at the hospital that I had no head injuries. Why? Because of my bike helmet. What I did have, though, was a really abraded neck and chin along with a constellation of bruises and scratches. And, as I’d later find out, two particularly nasty throat injuries. More on those in a moment.
Right after the accident I couldn’t talk or even swallow my saliva, so I couldn’t call for help. Again, it was very lucky that I hadn’t broken any bones, because I was able to pick up my bike, collect all the cycling lights and water bottles that had flown off of it, and bushwack it back up the ravine to the trail. There was a dead-end road just a few hundred feet away from the trail, so I pushed my bike over to the road and then checked the wheels, gears, brakes, and pedals.
I got back in the saddle and rode a few feet, to be sure that the bike was rideable, and then stopped to text a photo and a message to my husband. He was at the office that day, about a half-hour away. This is the photo I texted him, to ask him to leave work early. I was trying not to show how much pain I was in, probably not very successfully:
Bad fall
Back on bike 2 go home
Seem ok, but hit throat & can’t talk, swallow properly
U will have to call 811 4 me”
In our area, we dial 911 to reach an ambulance service. The 811 emergency services line (1) is to speak with a nurse, when you’re not sure whether you should go to a hospital or clinic for an illness or an injury. These days, with current global illnesses, I was really hoping to avoid a trip to the hospital!
By the time my husband got home, I’d had a quick lukewarm bath to clean the dirt out of my scrapes and scratches. I’d also used a mirror to check for any bleeding or injuries that I’d missed when I did my initial First Aid assessment on myself, while I was still lying on the ground under my bike. No new injuries, but I by then I was having more trouble swallowing, and still couldn’t talk.
We didn’t bother calling the 811 service, we just headed right to the hospital with our facemasks. We arrived in the Emergency Department at dinnertime, with even fewer hospital staff available than usual because of their meal breaks. Despite that, I was seen in pre-triage after less than an hour even though a couple of ambulances had arrived in the meantime (if I’d had any trouble breathing, was bleeding severely, or had signs of concussion or other time-sensitive injuries, I’d have been seen sooner).’
Still unable to speak, my husband had to explain what had happened and how I was feeling. I’d texted him the details, as we were sitting in the waiting area, so he was well-prepared! He also had to tell anyone examining me that they couldn’t touch my right hand or arm, because of my Complex Regional Pain Syndrome (CRPS).
The neuropathic pain from that rare disease is so intense that I’ll sometimes pass out or vomit from pain if someone bumps into or even touches that part of my body. I did NOT want either of those things to happen while I was in being evaluated for injuries from my cycling accident. The entire time I was in the hospital, I was more concerned that someone would ‘aggravate’ my CRPS than I was about my actual injuries. I’d been so lucky not to fall onto my CRPS-affected hand and arm, and didn’t want to undo that ‘good luck’ while being assessed or treated.
A little while after the pre-triage evaluation, we were called in for full triage. As soon as my husband explained that I’d hit my throat on that branch hard enough to flip my bike – and me – up and over the branch, and that I was now unable to swallow or speak, the triage team slapped a cervical collar onto me and started really rushing around.
The cervical collar was meant to prevent me from bending or turning my neck at all – to keep my airway open as wide as possible because my throat was obviously quite swollen. It caused quite a stir among the nurses and residents, because they’re taught that someone in a cervical collar has to be kept immobile and lying down, but I was sitting straight up on my gurney and even walking around (with my husband right beside he; he didn’t leave my side for even a moment!).
Any hospital team member who passed my gurney, parked right beside the nurses’ station, would stop and try to lower my bed. It was a good thing that my husband could explain that the doctors were allowing me to sit up, because otherwise I was choking on my own saliva – because I still couldn’t swallow – or talk!
My sweetheart was fantastic, really. The whole time I was in that gurney, except when he had to wait outside the nuclear medicine area during my scans, he was massaging and rubbing my back and shoulders. I’d mentioned – writing notes into my phone – that I could feel bruises forming, and that I was starting to get stiff from the impact of the fall.
The hospital kept me overnight for “airway observation”, basically keeping me awake to ensure that my airway didn’t swell closed while I was sleeping. I had two CT (computed tomography) scans, a regular one of my head and then a second one with contrast of my neck.
That second CT scan, with contrast, showed my two throat injuries – and both are considered to be rare. What are they? A fractured trachea – my windpipe – along with hemorrhaged vocal cords. Once we had the CT results and the doctors decided there shouldn’t be any need for immediate surgery, they sent my sweetheart home. By then it was well after midnight, so at least he didn’t have any traffic to deal with on his way home!
But I wasn’t alone. I still had my little CRPS rare disease and chronic pain awareness buddy/bunny Max with me, from our bike ride. Max fits perfectly into the pocket of my cycling shirt, and comes with me on all my rides to help raise awareness of CRPS. I’d typed a little description of CRPS – and of Max – into my phone, so could show anyone who asked about him. Max never misses an opportunity to raise awareness of this rare disease, especially when we’re with healthcare professionals!
The next day an ear-nose-throat (ENT) surgeon assessed me, using fiberoptic laryngoscopy (nasolaryngoscopy) to look inside my throat. It was no fun when she pushed that camera-tube down my nostril and into my throat, but it meant that they’d soon be letting me out of the hospital.
She prescribed a bunch of medications, to hopefully help these two throat injuries heal quickly enough that I won’t need either of two potential surgeries to repair them. And I promised to “rest at home, avoid any exercise or physical exertion – even cooking or housecleaning”. No worries on those last two, but I already miss my regular exercise. And yes, my bike!
What else? I’m limited to a diet of soft foods and liquids, not too hot and not too cold. Kind of like the story of Goldilocks and the Three Bears! I also have to completely avoid coughing, try not to sneeze, and not blow my nose. Any of these, apparently, could worsen the herniated vocal cords. Who knew?
The ENT surgeon did give me an exemption to her ‘stay-home and rest’ admonishment, permission to go to an old friend’s funeral on Saturday as long as I promised to wear a ‘good’ mask. She’d noticed that I’d been wearing my own KN95 mask the entire time I’d been in the hospital, so asked me about it. I told her that my field was bioethics, and that I’d worked in research ethics and as part of a university-hospital public health team; the doctors I know from the latter were all recommending that people continue to wear good-quality masks indoors, so that’s what I’m doing.
I’ve been on a ventilator three times so far, when I’ve stopped breathing during severe asthma attacks, and I have no desire to ever be on a vent’ again. If that means wearing a mask when I go indoors, apart from at home, I’m more than willing to accept that minor inconvenience as a trade-off for avoiding any more time with a machine breathing for me!
So even though our mask mandates have been lifted, I still wear my KN95 mask – much better protection than a regular medical mask (2) – anytime I’m in a public place. After that, the surgeon she said I could go to the funeral as long as I wear a KN95 mask.
The surgeon’s final instruction was to avoid keeping my neck tilted or bent, so I can’t even do any watercolour painting or sketching with all this new-found free time. I’ve cancelled all my plans until the end of next week, as I don’t know when my voice will come back.
My follow-up consultation with the ENT surgeon is next Tuesday, with another fiberoptic laryngoscopy down my nose and into my throat (ick!), and I’m hoping for confirmation that I’ll be able to avoid both surgeries. And that my injuries seem to be healing okay, that my voice will eventually come back. Then once my throat heals and I’m able to talk again, I’ve been referred to a neurologist to double-check the results of the CT scans.
I mentioned my old friend’s funeral earlier. That was a reminder that this accident could have been so very much worse. I’m still here, still mobile, still breathing on my own. If it hadn’t been for that good-quality bike helmet, the doctors said I probably wouldn’t be here to write this. So please wear a helmet when you ride your bike, because you just never know!
As always, thanks so much for stopping by. Feel free to reach out or comment over on Instagram or Twitter. There’s no Comments section here on the blog anymore, because it became too much for me to handle when I was diagnosed with a CRPS-related mild cognitive impairment back at the end of 2018. I had to disable this feature, but I do still love to hear from you!
References
(1) CBC News, Montreal. Quebec urges people to stop calling 811 for COVID-19 concerns. CBC/Radio-Canada; website. 12 Mar 2020, updated 13 Mar 2020. Accessed 11 Jun 2022. Online:
https://www.cbc.ca/news/canada/montreal/811-quebec-covid-19-1.5495689
(2) Mayo Clinic Staff. How well do face masks protect against COVID-19? Mayo Foundation for Medical Education and Research (MFMER); website. 11 Jun 2022. Accessed 11 Jun 2022. Online:
https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-mask/art-20485449