Being the story of how I broke three ribs one fine summer day

I had my oral surgery on Tuesday morning for the installation of two titanium implants into my upper jawbone, including a small bone graft to give them more support.  In a few months they'll use these implants to anchor two new teeth to replace a couple I've lost.  I really wasn't too worried about it because I've visited Dental Hell many times and I'm sort of used to it.  Besides, the end result in this case is supposed to be excellent and well worth the physical and financial cost of getting there. 

I was getting out of my car at 8:30 AM in the oral surgeon's parking lot when I heard the breaking news about the crash of the Concorde in Paris.  "Oh God, this is already turning out to be a bad day", I couldn't help but thinking.  Not to equate my little inconveniences with the horrible deaths of all those poor people, but I've noticed in the past that my own worst days seem to align with major world disasters.  For example, May 18, 1980, the day Mt. St. Helens erupted, was one of the very worst days in my life (I won't go into details on that one). 

But the operation went quite smoothly.  It was a piece-of-cake really, and I was out of there by 11:00 feeling pretty good.  They had told me to take two days off and expect a lot of post-operative pain, but it didn't turn out that way.  By dinnertime I had taken a nap and was feeling fine, no pain at all, even though I was sporting about 25 stitches in my mouth.  The doctor called late in the afternoon to check on me and say how well things had gone from his perspective, and I told him that I was fine and that I hadn't even needed to take the pain-killers he’d prescribed for me.  I was looking forward to a vacation day Wednesday, to take it easy and maybe get some work done around the house. 

That's about when the good (?) part of my day ended.  I've been building a little deck around our new above-ground pool in the backyard and after dinner I went outside to putter around a bit.  My 10-year-old daughter was in the pool and I was on the deck alongside, working on a temporary ladder that extended from the deck to the ground (sort of like the ladder you'd see on a ship).  I noticed that the ladder wasn’t properly attached and I started trying to repair it so that she wouldn't have a dangerous situation when she got out of the pool.  Thinking that I had fixed it, I put a foot on it so I could descend and install some additional support to the bottom of the ladder. 

This was the "oops" part.  Descend I did.  The ladder spun out from under me so amazingly quickly that I was twisting like a high-diver when I hit the grass 4 feet below.  Even if I’d had time to try to protect myself, I was spinning so fast that I had no idea which way was down.  I landed on my left side with my left arm bent at my side.  Internally, I heard "cru-unch" as my elbow was driven through my rib cage. (It’s a good thing that I've been watering that area a lot lately, the ground was actually fairly soft).  I screamed out in alarm, "Diana!  Get Mom!  Tell her I broke some ribs and we need to go to the emergency room right this minute!"  (Forget 9-1-1, we live about 8 minutes from a good hospital and at that moment all I wanted was to be there ASAP).  Then I became aware that I couldn’t breathe. I hopped to my feet, violently trying to find an ameliorative position, now in total panic.  The feeling of not having any air inside the lungs is intensely terrifying, as anyone can imagine.  I lay down on a chaise lounge and started to black out.  As I was about to go completely bye-bye I started coming back, which was a tiny bit reassuring.  Although still in extreme distress, I allowed myself the optimism that I might not have punctured my lung and might actually survive to be a fool another day. 

Amy was on the fly by this point and we piled into the car, pulling out of the driveway at most 2 minutes after the accident.  I could hardly breathe yet and was still writhing around trying to find an optimal position.  About halfway to the hospital I started to breathe a little better, which greatly eased my fear and discomfort, if not my pain.  We got there at 7:30.  I was very pale, having difficulty breathing, and holding my chest, so they shot me right into triage without even signing-in.  The triage nurse was able to determine to a fair degree of certainty that the lung wasn't punctured, by listening to it and by measuring the O₂ in my blood with a pulse oxymeter. That's the amazing little gadget that clips onto the fingertip and shoots a light beam through it during and between heartbeats to allow the computer to compare the color of the blood and instantly calculate how much oxygen is in it.  By this point I was pinking-up again, and she informed me that I was starting to do too well to bypass the queue.  I was glad of that -- you don't really want them to have to expedite you at that place!  So we settled into the crowded waiting room for a couple of hours.  It only hurt when I moved or tried to breathe deeply (or talked, or laughed, or yawned - especially yawned).  Amy went home to check on the kids and put them to bed, and returned to the ER at around 10:30.  She brought me my book, my wallet, and a bottle of water.  I was still waiting to be seen so after a bit I asked her to go home and go to sleep, she was getting very tired and I figured that we would really need her to be in top shape the following day.  

At around midnight the attending physician came in and examined me.  He agreed with my theory and ordered the X-rays.  He jokingly asked me if I'd been skiing.  It seems skiers are the typical demographic for jamming an elbow through a rib cage.  (I bet they're wearing a lot more padding than a T-shirt when they do it).  He gave me a pretty big dose of codeine and I waited for the radiologist.  A little while later, after re-reading the same paragraph in King Lear about 40 times, I realized the drugs were starting to kick in (it usually only takes me about 20 times).  But the ribs still hurt just as much.  The radiologist came for me about 12:30,  but I couldn't move too well so we took quite a while to get to the X-ray lab.  The X-rays clearly showed two broken ribs, which later turned out to be three.  The doctor came back and wrote up my prescription and discharge instructions.  Then a respiratory physician came in to give me a machine to take with me to exercise my breathing.  I was told that although inhaling was the most painful thing I could possibly do, I needed to be sure to take enough pain killers to be able to take deep breaths, as measured by this device, or else the lung would be in danger of deteriorating.  Unused, the small air sacs would begin to collapse and fill with fluid.  The attending physician, the radiologist, the respiratory specialist, and no less than 3 nurses offered as to how very painful this particular injury was going to be for the next 6 weeks or so.  I thought that odd, they usually don't talk that way.

By a little past 2 A.M. I was in a taxi on my way home.  I asked him to take it slow on the bumps and turns.  He kindly drove very slowly (I only screamed out a few times) and I tipped him an extra few bucks.  I'm home in front of the computer now, not doing too badly except for a few moments ago when a small bout of hiccups led me to re-initiate my contemplation of life's great mysteries.

Sorry for the long-winded narrative, it's the Vicodin talking.  I can't complain - my mouth doesn't hurt a bit!
7/22/2000
 

Update - July 2001 - The ribs healed very well. For quite a while I could walk around more easily than sitting, and I could not lay down at all.  I returned to work after 2 weeks, able to function more-or-less, although there were still moments when my short, loud screams were uncontrollable, such as a cough, hiccup, sneeze, yawn,  etc.  After 3 weeks I hardly needed any more codeine.   After 4 weeks I could lay down in a bed, although getting up again was time-consuming (I slept sitting in a chair the first month).  And the pain was very nearly gone after 6 weeks, totally gone after about 6-7 months.  I managed to complete the deck, but it took several weeks longer than planned.  The dental implants are wonderful, about as strong as healthy natural teeth.
 

Update - January 2007 - I take back what I said about the dental implants, they have broken and are worthless now.  Great while they lasted, but they didn't live up to their promise of a permanent solution.  Apparently it's very rare to have them break, but that's what happened...  My guess is that they were imbalanced.  If I had gotten a couple of implants on the other side of the mouth also, it would have balanced the forces, and could have prevented the bending and twisting stresses that eventually caused the titanium to fatigue. 

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