Fall Risk

(a professional’s guide to recreational disaster.)

By A.T. Cross

“The hero is always in love. The villain is always alone, or with some bitch in black vinyl.”

–Kelly.

Aftermarket Parts

“¡Dulce Madre de perla!” I hissed, white-knuckle-gripping the handrails of the wheelchair. I willed my left leg into submission, huffing and puffing because the paramedic bumped my left toe against the car door frame as she helped me lift it out of the car. “¡Tu pinche changa fea!” I clutched my thigh with both hands, far enough away from my busted knee that I couldn’t accidentally brush the sensitive area. “I’m sorry. I’m so sorry,” I said. “It’s not your fault.” I rushed through triple breathes like a first-time mother whose water just broke.

“Do you want me to put the put the footrest down?” She reached for the little aluminum flap that stood at attention beside my afflicted left foot. “Yes.” As she attempted to fold it down, it sort of popped into action, nearly hitting the foot. “NO!” The muscle twitched involuntarily launching me into “Fuck, shit, fuck. Damnit.” I clutched my thigh harder, pressing it down slightly, without allowing the foot to be jostled.

The slightest ripple in the tiled floors sent me into stuccato stream of obscenities, yelling and growling, but punctuated with hyperventilated apologies. The paramedic cringed behind me. “I’m so sorry,” she said. My hands hovered over my thigh willing it to stability. “It’s okay. It’s not your fault.” She hit the gap between the elevator and the waiting room lobby. “Fuck yer whole fucking family and bugger yer little brother up the ass twice you insensitive twatgobbler!” I screamed, clutching at my thigh and rolling a brilliant Tourette’s syndrome entrance into a nearly empty Emergency Room check-in desk. I gave the nice lady behind the counter my name, number, date of birth, and social security, as well as a veritable thesaurus of colorful invective when the paramedic accidentally bumped the wheelchair handle with her hip. Teresa held my hand and whispered gently in my ear: “It’s okay, Baby. It’s okay,” repeating the phrase like a mantra until my breathing slowed again.

The ER doctor remembered a head wound from a year before, the distinctive scar arching down my forehead, above my right eye. It’s probably not a good sign when the ER Doctor remembers another critical mishap from the previous year. At least she spoke familiarly enough and kept her voice very calm throughout the interview. She traced the scar with her rubber gloved fingertips to check out her work and change the subject for just a few moments. Once they got me calmed down it was decided amongst the group that touching anything near my left knee was a very bad idea. Teresa had me breathing slowly, occasionally whispering quietly in my ear: “Baby, it’s okay;” a slow breath rippling against my temples as soothing as a quiet sea.

The ER doctor finished filling out her initial forms, glancing through them and returning to the interview page. “So, what happened this time?” she asked, glancing up from her page.

“Nothing.” I shook my head. “I don’t know. I was smoking, I turned, or twisted a little, and when I turned to go, something popped in my knee.”

“I see.” She wrote this dutifully on her sheet. “And what had you been doing before that?” she asked.

Teresa petted my sweaty forehead and continued the question at a gentle whisper: “Sweetie, had you been drinking?”

“I was working on my motorcycle,” I said.

The doctor listed this. “and had you been drinking?”

I nodded. “Oh, yeah. I was pretty drunk.”

Apparently, she remembered more about me than just the headwound.

They didn’t have to lift me for the X rays, but they did have to take me down a long, linoleum-tiled hallway and we hit a few speedbumps along the way. Each time the wheelchair bounced, even slightly, it was the start of another round of cussing and screaming. It’s damn hard to tell a Labtech to just keep going when every bump comes with a new litany of insults against her every family member. We came in through the X-ray room door a rolling lexicon of colorful language. Two unsuspecting techs stood wide-eyed beside a big box that hung suspended from the ceiling by an articulated arm. They gently laid a lead blanket over my crotch and adjusted the X-ray camera in front of my leg. The lab techs ducked behind the wall. They snapped a few photos, adjusted the camera, snapped a few more. The emergency room paramedic came back, and we cussed our way back down the hall, hitting every possible crack and bump along the way. To anyone watching, I’m sure it looked like I was being treated for a terminal Tourette’s syndrome attack. Hell, at least I was bilingual about it.

Getting me onto the examination table took an immense and loud string of cussing, yelling, convulsing, and the sort of noises that a patient never wants to hear coming from the adjoining room. Each time that the nurse touched me anywhere near my knee, my knee jerked up to my chest, causing a series of convulsions, each spasm deepening the agony of the one before. All that anyone could do was watch me writhe in agony and cuss profusely. Teresa ran her fingernails through my hair, gently shushing. She uncrumpled me and smoothed me flat across the examination table, attempting to make my pain legible to the examination staff. Meanwhile, the nurse had her removing my jewelry, gently stripping away my armor so that they could roll my wriggling-ass mass of pain and expletives down the hall for a CT scan. Teresa gently peeled me of all the totemic objects which protected me from the outside world, stripping me down to a body free of memory or identity, all the while petting my forehead, soothing me. She placed my jewelry into a small plastic bag with a biohazard logo on the side. Again, they rolled me down the hall towards another machine, each tiny jostling bump amplifying the constant throbbing pain. For the CT scan, they had to scoot me onto a flat plastic board and slide me across to another table. They had me fold my arms across my chest, as if I were a corpse, and rocked me gently to get the plastic stretcher under me. More screaming ensued. Eventually they let me just scootch across from the rolling examination table to the CT scan table, cussing, spitting and screaming at them the entire time.

By the time they got me back to the emergency examination room I was practically hyperventilating, Teresa gave me her hand to hold and I tried to crush it. The nurse prepared an IV, cleaning the inside of my forearm with an alcohol swab, tying off my bicep with a stretch of rubber ribbon and prepared a needle. The doctor remembered my fear of needles and reminded me to look away. In less than a minute there was a small plastic terminal inserted into my arm, a length of clear tube and a small clear plastic port taped down to my arm. The nurse peeled back a foil seal from a tiny blue bottle cap type object and twisted it on the end of the port to sanitize the port. She peeled back the plastic wrapper from a syringe and showed it to me. “There’s no needle.” She inserted it into the port and depressed the plunger slightly. “This is a saline wash, to flush the port and ensure that it is working properly. You may taste something salty or metallic as soon as it hits your bloodstream.” She depressed the plunger further, and she was right. I did taste something. She withdrew the saline wash and pulled another plastic wrapped syringe from the tray beside her. “This should help the pain.” She unwrapped the syringe, showed me the needleless tip and inserted it into the port. As she depressed the plunger, I could feel the effects almost instantly; the torsion in my body unwound slightly, tense limbs melting slightly, a warmth spreading throughout as I sank several atmospheres and melted into the exam table.

When the doctor came back in, she described what they would have to do. Due to the swelling in my leg, they were concerned about something called “compartment syndrome”. The possibility that my leg would continue swelling without release, and the possibility of another, different surgery which involved peeling back calf muscle in order to drain the fluid from my leg. If this didn’t happen, amputation was a very real threat and the possibility of death increased as well due to some sort of blood poisoning. The doctor continued in graphic detail, describing the break in the bone, the necessary surgeries, and the risk of amputation and death if left untreated. All of the explanation seemed entirely unnecessary. I wasn’t exactly in a good spot to jump up off the exam table and hobble my ass towards an exit to think it over for a few days. This wasn’t an elective surgery; I wasn’t there to have a mole removed. I continued to nod and agree to everything.

I answered every question honestly. There was no point in lying about my drinking habit or how many cigarettes I smoked each day. I was trapped in a hospital, immobilized, and about to go through some heavy withdrawals. There would be no ducking out for a quick smoke or sneaking an airplane banger of whiskey to alleviate the detox twitches in the morning. Everything I tried to hide was about to be laid bare under the glaring white light of an articulated halogen ceiling lamp and a cold stainless-steel examination slab. Stripped of my jewelry, leather armor, chemical dependencies, blue jeans and t-shirt, they laid a thin cotton smock over my chest and crotch, snapping the sleeves over my shoulders and tying it behind my neck.

“Due to your extensive alcoholism, we will be monitoring you for the effects of alcohol withdrawal. As you may know, alcohol is one of the most dangerous chemical dependencies to quit cold turkey as it can actually result in death, unlike most of the others. Heroin and opioid withdrawals may make you wish that you were dead, but alcohol withdrawals can kill you.”

I nodded. “I’m familiar with the process. I’ll let you know if anything starts to happen.”

This wouldn’t be the first time that I’d ever had to dry out. I’d done it before, as recently as a few months ago. The first few days generally sucked. First the sweating, then the itchy twitchies, the insomnia and the brain on loop, dredging up all of the anxieties which became the excuse to drink in the first place. Drying out meant dealing with a subset of psychological issues that dated all the way back to my childhood. As if the mind flattening pain of a shattered knee were not enough to deal with, I would have plenty of time entirely immobilized so that I could confront the lifelong effects of childhood post-traumatic stress disorder and a genetic predisposition to chemical dependency.

The surgeon glanced up at me, over the top of his clipboard. “And you’re a smoker?”

I nodded. “Yup.” And I could really use a smoke. Even without the screaming and cussing at every crack in the sidewalk, there was no way that anyone was going to roll my ass out to a curb so that I could smoke a cigarette.

“I’d like you to consider this an opportunity to quit smoking, as well. Tobacco use increases the amount of time that it will take to allow your bones to heal by two to three times. We can, of course help with your withdrawals if necessary, although, as a rule we are generally opposed to prescribing nicotine patches to patients as we are here to help you get healthy.” 

“This just gets better and better.”

“If you think that there’s going to be a problem with this, you can have someone bring them to you—”

I shook my head. “I smoke the cigarettes without all the additives, and I generally smoke less than half a pack a day, and less when I’m not drinking. I don’t envision this causing a helluva lot of problems. It’s just going to suck, that’s all.”

He nodded.

“But hell, I’ve got a few days holed up here. That should get me through the worst of it, and I don’t imagine I’ll be too eager to do three flights of stairs on crutches every time I want a cigarette, so I’ll have plenty of time to get through a few more weeks without smoking as soon as I get home.”

He nodded again.

The nurse who prepared me for my first surgery continued to describe the procedure in a level of detail which I felt excessive. I wasn’t about to change my mind. The next few months would suck; the surgeries, the recovery, and the ongoing rehabilitation process, but as far as I could tell, there were no other options.

Teresa held my hand through the discussion, feeling my grip tighten as each wave of pain washed over me. We weren’t married yet, but I needed her there beside me, to be the second set of eyes and ears, to know what was happening. She could make no legal decisions for me, and she didn’t need to. There were no decisions to be made. Despite the threat of death and dismemberment, there were no other options. There is no bravery in a single option scenario.  

“You’ll be unable to walk on it until the swelling reduces and we are able to remove the external fixator and complete the surgery. You will be confined to your bed for the duration of your stay here. With any luck, the swelling will reduce quickly, and we might be able to get you in for your next surgery before the end of the week.”

They explained anesthesia, we discussed allergies, I signed a few pieces of paper. The surgeon came in to explain the risks again, and after I signed a few more pieces of paper, he signed my leg in purple magic marker. He beckoned to the anesthesiologist who had hovered just outside the door as I agreed to the possibility that I wouldn’t wake up from this. The anesthesiologist rolled in a small steel tray on a cart, no bigger than a sheet of notebook paper, which held a variety of syringes, all hermetically sealed in tiny plastic wrappers. Teresa collected her things, and what had been stripped of me, my identity, in a big blue plastic hospital bag. If anyone was being brave in that room, it was her, watching me, all stripped down as they prepared to render me entirely helpless. As the anesthesiologist cleaned the port with the tiny blue cap and inserted the first syringe, she bent over the slab, smoothing back my hair with a look of beatific empathy. “I’ll be here when you wake,” she said, kissing me goodnight as I sank slowly into the dreamless darkness.