Doc Ernie's Blog : Doc Ernie's Blog : Ernie Franz M.D. : Spinal Cord Injury, Disability, and Rehabilitation

I was battered by a modern day cannon, that being an automobile traveling about 50 mph. Despite my diligence to role model fitness and a healthy lifestyle my life would forever change in that instant. I was completing a bicycle training ride that beautiful Monday afternoon in our peaceful community when struck unawares from behind. I had been in excellent physical condition, periodically bicycle racing and always commuting by bike; it had been 18 months since I had driven a car to work. Though I recall every detail of that day, I can only remember up till 5 seconds before the unsuspected hit. The medics later told me I was adamantly declining paralysis and intubation before Airlift arrived; although apparently enough Versed was given that I do not recall (fortunately) any of that. I was in no condition to refuse as will soon be apparent.

  Only many months later, when presenting my own trauma case to ED physicians and medics, did I learn from the treating medic that there had been no time to obtain my vital signs, and yet they were thankful I was well conditioned so that bilateral lower extremity IV’s could easily be established. Throughout my practice and earlier ED residency at Michigan State University under the guidance of such as John Wiegenstein, Earl Reisdorff and Mary Hughes, I can remember only a handful of patients with a laundry list of injuries such that I sustained. Eight rib fractures, small hemo-pneumothorax, a liver laceration that took 3-4 units of blood (managed conservatively), bilateral open angulated humeral fractures with bilateral severe radial nerve contusions (both nerves were “skeletonized” in the words of my surgeon, meaning stripped bare), fractures of C7, T4, left scapula, right tibia. Left A/C separation, diffuse road rash; and last to be discovered six days post injury was a C3-4 central cord injury (therefore no steroids due to the delay in diagnosis) which has resulted in my being classified as an ASIA D (best prognosis) incomplete quadriparetic. Due to God’s graciousness and one good Bell helmet my brain seems to have remained intact. I was hospitalized for nearly four months.

The 19 year old driver that struck me the day our family’s lives changed had an alcohol level of 0.19. He had been home drinking, skipping work, mourning the injuries sustained by several of his friends from an accident the night before, a tragedy which resulted in one death and injuries to seven teens. “Stressed” he decided to randomly drive around the island we live on when our paths shortly thereafter met.

He spent 4 months in jail, and has since been arrested for intoxication and as a minor in possession.  I had hoped, as I told him face to face on the day of his sentencing, that “he could make something beautiful come out of his life" after what he had done to me, but I obviously have my doubts. Alcohol, as we well know and experience in our practice, is a most powerful drug and its control over our lives is not easily escaped, the apparent lessons not learned. Ten months after inflicting my career altering injuries, the older brother of my assailant, attempting to escape the police in a high speed chase whilst intoxicated, drove his car off a 56 foot cliff in end-over-end fashion. Amazingly he sustained only minor injuries.

It took this incident for me to finally learn the true value and treasure that are particularly my wife and family, then friends, community and church. Those first 45 nights in the hospital were accompanied by someone from that circle of support. Someone who fed me, turned me, wiped my tears, blew my nose, shaved me, flossed and brushed my teeth, called for nurses and more. My early goal as a physician-patient was to not be a jerk; to treat staff kindly and respectfully, and allow them to do their job as they had been trained to do. I had only slight finger flexion and toe movement those first 6 weeks. It was a challenge just to be tilted upright or be lifted into a wheelchair for short periods of time as postural hypotension was significant. Periodically deep anger and frustration would hit hard. Yet overall, for some unexplained reason I felt a peace that God truly would take care of me and our family; that things would be okay. Gwen and I have been married 23 years, and have 3 children: Evan – 16, Daniel – 14, and Heidi – 11. We had made it through medical school, residency, raising a family, and six very difficult years as an ED Director; surely we could make it though this.

However, new lows were reached in late September 2004 after a C3-4 fusion was done to prevent further potential damage to my bruised spinal cord. The 4-5 days post operatively were enough to make me wish I had died when struck by the “cannon”. I was unable to eat or drink, still bedridden with trace movement in arms and legs, sore throat and hoarse voice post-intubation, painful to cough or use the incentive spirometer due to ongoing rib pain, IVF’s to keep me hydrated, yet devoid of energy – I was, in the words of my wife, an injured athlete bonking big time. It was then that I was verbal about my wishes to die so that my family could just collect the life insurance money and get on with their lives. Yet no relief came. I ran a post-op fever for days, alternating sheet drenching sweats with shaking chills; all the while unable to cover or uncover myself with bedding due to my paralysis. My throat soreness worsened, and a soothing ice cube soon became my enemy as I choked upon it, only to find relief in clearing it as I felt it slide down my right mainstem bronchus and slowly melt into my right lower lobe. My cough worsened slightly over the next few days as I cleared occasional thick brown sputum. No energy, I became convinced I was dying. The once patient doctor became quite difficult; attempting to order my own chest x-ray, soft tissue neck film, cultures and antibiotics – but the nurses and residents would not follow my directives. Just when I thought I had suffered all I could imagine, I broke out in hives. My floppy arms could in no way get even close to scratching this big itch. Suspected was my one of my few remaining comforts, IV Dilaudid, so it was discontinued. Subsequent trials with IV Morphine and Demerol were also abandoned as the urticaria persisted. Benadryl and Vistaril provided some relief, but markedly worsened the throat dryness and further prevented swallowing of liquids or solids. Only later was it discovered I had become allergic to the rinseless bed bath and shampoo solution.

 
Had it not been for the love and hope of my wife Gwen, or the encouragement and prayers of dear family and friends, many of whom stayed by me continually during this dark time, I truly may have failed. Gradually, quite slowly, I began to get a little better. Repulsed by Ensure and various soy based concoctions, perhaps TPN would be the answer, yet I got stronger sip after sip of fluid or juice. The anticipated pneumonia never developed, no retropharyngeal abscess, no sepsis; the fevers and hives eventually resolved, my mouth improved, and my energy began to return as I ingested calories. Within a week I would be transferred to a rehab facility, down to 136 lbs. from 163 in the course of 5 weeks. After four supportive weeks there, it was back to Harborview for 6 more weeks of intensive rehab before coming home.

While the homecoming was good, it was quite stressful. I was sobbing uncontrollably prior to leaving the hospital December 14th as I began to realize the burden which would fall upon my wife and the loss of 24/7 care. Fully dependent, wheelchair bound, my wife became my primary care giver. Just before I left for home one of my Rehab physicians predicted that I could not conceive of what I would be able to accomplish 2 and ½ months following my discharge. The words remained with me, but at the time felt like hollow encouragement. Giving new meaning to the phrase, adding insult to injury, I was soon to discover that the day before the homecoming my wife was served papers naming me in a wrongful death lawsuit (one that was subsequently dismissed; however the impact upon my wife was beyond overwhelming). Such was the mood and setting for my return home.

Given my prior contacts in healthcare and cycling I had been in email touch with a creative energetic physical therapist who held the perspective that my time at Harborview was a vacation; it was now time to get serious about the real work of rehab. With his encouragement and the ongoing prayers of so many, I have learned that there are no boundaries or limitations as to what this quad doc may be able to do. The first major goal was to focus on gaining independence in and out of the house so as to remove some of the burden from my wife. With PT, OT and rehab supervision 5 days per week for 3-4 hours per day that goal was to be accomplished in 6 months.

Simultaneously my PT and I began to work on conditioning and strength with the goal of completing an organized 33 mile bicycle ride at the end of February on a recumbent tandem. The Chilly Hilly, with 2500 feet of climbing, was to draw nearly 5000 riders in 2005. That almost did not happen, as on our first training ride together we went down twice to the asphalt; both times at such low speed while climbing hills that we came to no physical harm. Yet at this early point in my recovery I could not rollover, stand or walk without significant assistance. On the second spill, while lying prone on the street, an alarmed motorist remarked that I appeared to be seriously injured. I assured her those injuries were from a much earlier bicycle accident and that I would be fine. At that point another motorist informed us that on his scanner he had heard the medics dispatched to the scene. My response was to have my PT get me upright with my gait belt, and holding onto mailboxes, this time pointing downhill, we got on the tandem and rode away from the scene to avoid the medics. Little did I know by then we were being followed by the chief of police in an unmarked car as we rode into my PT’s open garage. Though the officer later told me he was baffled by the sudden closure of the garage door, he figured we must not be hurt and the medics were called off. Persistence however paid off as we were able to complete the Chilly Hilly ride with the support and encouragement of many friends, some of whom helped push us up and over the steepest gradients. Only after finishing the ride did I recall the prophetic words my rehab doc had spoken when I left the hospital. It had been 2 and ½ months to the day since my discharge that we completed the ride!

The kind staff at one hospital donated a commercial grade treadmill so that I could learn to walk again. My PT’s have dissected and reconnected the various aspects of my gait cycle, such that over a year I have transitioned from wheelchair to walker to cane and now often walk without such devices or orthotics. I am also happy to report that with a climbing harness & ropes over the treadmill I am able to run at over 4 mph for brief periods. Ten months post-injury I was found to be capable of driving without adaptive equipment necessary. Nearly one year after the trauma I was able to ride a bicycle on my own. Shortly thereafter was able to complete my goal of finishing the ride home on the one year anniversary of my injury, cycling past the spot of injury to our home with over 20 close friends. It was a celebration of life, and of a miraculous recovery inspired by the encouragement of family & friends, the creativity of several physical therapists, and allowed by God. I continue in PT, now 21 months later, to fine tune my gait, improve my posture, strengthen still atrophied muscles and push left hand function via neurologic retraining and recently with piano lessons (my brilliant wife’s idea). I have been so left brain oriented for all these years; it is finally time to work the right brain with a deep appreciation for art, music and creativity. I am now learning to understand my emotions and those of my wife. Though inspired by successes, I have to say this life is not easy. I remain with typical C5 sensory loss from the clavicles and everything due south; scarcely feeling my legs I realize each step is truly a gift, a miracle. Although I am no longer wearing Attends and have gotten used to once daily self caths, elimination functions have obviously improved, but are not likely to return to normal. Bilateral radial nerve damage has improved to a degree; however my non-dominant left hand strength, sensation and function are particularly poor. I have come to a newfound appreciation of the complex coordination in our bodies we take for granted, and to understand the ability to heal/recover with amazement.

To this point rehab has been my full time occupation. Gratefully, I have two disability policies, which will allow our family to keep afloat for a few more years. Yet my desires to serve others are as strong as ever; so that what initially appeared as a destroyed career, now I see with new eyes as an opportunity to find even deeper satisfaction in other aspects of medicine outside the Emergency Department. I cannot see spending my remaining years in a dark room reading radiographs given what I have lived through. Although sitting behind a desk as an ED Director seems physically possible, my previous experience was stressful beyond comprehension, and culminated with a lawsuit from colleagues. About that time I backed my Audi through our closed garage door as my mind was in other places and devising new strategies. Thus I have ruled out ED Administration. So what do I fill my days with beyond the luxury of time I get to spend with my wife and three children? (A question the disability companies often ask.) I have had the opportunity to speak with many High School and Elementary students, police, medics, civic leaders and medical students. I was able to assist in teaching musculoskeletal gross anatomy to second year medical students this past winter, and will do so in future years. In the past two months I began shadowing a Sports Medicine physician who is willing to help teach me the trade. The plan then is to shadow various willing providers in Orthopedics, Rehab Medicine and Sports Medicine over the next 18 months to learn those skills. That much time will be required as I can only tolerate being on my feet up to 4 hours at a time a few days per week. Additionally I have offered my services to teach Emergency Medicine residents, and will volunteer to provide medical coverage for various athletic events such as the Hawaiian Ironman and future Paralympic events. In those settings the nurses and medics will be an extension of my hands. With my personal experience in overcoming loss, a change in intended life course, and learning to thrive despite disability I hope to inspire others to succeed where injury or hardship has struck. I understand what depression feels like, and how with the love of friends, establishing goals, and faith a person can survive. I am pleased to talk to students about driving and about the various dangers of alcohol that lurk for those who are captured by its deceptive message. As responsible adults we often choose to point a judgmental finger at illicit drug use, when simply one weekend shift in “the pit” will reveal the true danger to our society is the legal drug ethanol; of which use and abuse may result in brokenness, illness, trauma, failed relationships, domestic violence, and loss of vitality. We seek to fill the void in each of us with something, just often that something is other than what God intended.

In closing, I wish to somehow convey a deep heartfelt thanks to so many physicians, nurses and medical personnel who have truly pulled me through this trial. The visits, emails and phone calls have meant so very much in the course of my recovery, such that my wife continually reminds me that with so many people pulling for me, praying for me, and encouraging me – I can’t help but to get better. Thank you!

Ernest A. Franz, MD FACEP