I had no idea the spleen was such a fragile organ until I flipped over the handlebars of a bicycle in Vancouver, B.C. last week and found out the hard way.
I watch a lot of Grey’s Anatomy (it’s totally lame, I know, but still) and I guess that has always made me thankful I wasn’t born with a horrible disease or acquired a deadly cancer in my prime or any number of awful things. I’ve only been to an emergency room once, when I was at a Mardi Gras parade as a kid and I scratched my eye on a palm frond. I’ve never broken a bone. The only surgery I’ve ever had was for wisdom teeth. The most painful procedure I’d undergone before that was having a few baby teeth pulled. It’s not that I take my health for granted or go through life recklessly. I think I have a healthy fear of pain, suffering, and hospitals, and do my very best to stay away from all of that while still managing to live a full and happy life.
But I guess at some point the luck runs out. One of those daily mistakes you make that are no big deal turn out to be serious. That car that barely missed you in the crosswalk. That tree branch that fell two feet to your left. That flash flood that drowned someone in that canyon just hours after you finished your hike. There seem to be daily near-misses. It’s got to catch up with you eventually, right?
Catch up with me it did, and big time. Last week, on Tuesday afternoon, Sam and I rented bikes from a shop near Stanley Park in Vancouver. The guy working there seemed like he knew what he was doing but was maybe a little on the awkward side. And so he didn’t fit my helmet very well at all, possibly because he felt weird about having his hands near my face. Sam helped me when we left the store, which was good because she’s an expert at these things. Then we lumbered off on our comfort bikes for a self-guided tour of the city.
First we biked the perimeter of Stanley Park, Vancouver’s big urban green space. The morning was clear and cool. We rode slowly, stopping to take pictures of the harbor and the mountains and the impressive expanse of the Lion’s Gate Bridge. We huffed up the arch of the Burrard Bridge to Kitsilano Beach, a popular hang out on warmer weekend days. Our route threaded through Kits’ quiet, leafy neighborhood, the streets ablaze with fall colors. We turned around near UBC, hoping to make our way to the trendy shopping area in Kits for some lunch.
Things went well until 8th Ave. I switched bikes with Sam because hers had the basket full of our stuff and the heavy U-lock attached to the rack in the back. Those bikes were heavy enough without all that stuff, and she was working even harder on the hills. The new bike was a bit awkward, probably because I’m not used to riding something that isn”t a lightweight road bike, the kind that yield to your control. We biked next to a playfield full of kids, just above what looked like a moderate hill–easily handled, especially since I’d been biking on Seattle’s monstrous slopes for the past nine months. I placed a hand over the basket because the momentum from the hill made it seem like the contents could easily bounce out. That meant I was braking with only one hand, something you really shouldn’t do. I knew better. I’ve biked enough to understand that you can’t do this with any measure of safety. But I was being careful, and the hill wasn’t that steep, and I wasn’t braking hard.
The hill got steeper. I’m not entirely sure the braking is what made me crash, but it’s my best guess from a moment that is blurry and then black. I must have instinctively pulled hard on the rear brake in a panic as the bike sped downhill, and my forward momentum flung me, flipping me over the handle bars. Sam says I landed with a hard smack on the street, but I don’t remember that.
I woke up after about thirty seconds, seeing stars. The stuff in the basket scattered when I fell, and I remember seeing Sam’s green jacket on the ground. A woman walking near by called 911. The paramedics came a few minutes later and checked me over, but I felt pretty ok–despite moderate pain in my left arm and fuzzy vision. Sam showed me a crack in the front of the helmet I was wearing, the helmet that, had she not properly adjusted, would not have helped me at all. I may have cracked my head instead.
I resisted going to the ER until I stood up and felt faint. When I got to the hospital, there was a head CT, but my brain and neck and spine were fine. Then there were x-rays of my elbow, wrist and shoulder, but I broke nothing. I sat in the waiting room of the ER watching TV with Sam, talking about where we’d go for dinner as I waited for an ultrasound of my abdomen. The doctor treating me had already written up the discharge form to save time.
But my spleen was bleeding. A CT showed a serious laceration, likely very close to complete rupture, and I needed to be admitted for observation.
I changed into a gown, received a blood pressure cuff, sticky chest and abdomen monitors, an IV in each arm (one for posterity), a catheter, a pulse thing on my finger, and spent the night in the ER. Just in case, you know, my spleen decided to explode. I didn’t feel much pain until a doctor instructed me to lie flat so she could do an examination. An intense pain gripped my left side and shot up into my shoulder, where the nerves end. It hurt to breathe. It hurt to move. The morphine shots helped, but they made me throw up three times in the middle of the night in my bed between two crack addicts in the ER. Each hour the blood pressure cuff squeezed my IV-ed, bruised arm and every little while a nurse would check my vitals or a tiny Asian woman would come by to take a blood sample so the lab could measure my hemoglobin, whatever that means. And then I’d drift off into a morphine-addled haze until the entire process began again.
It was all wait and see. I spent one night in the ER and moved to a bed in surgery (you know, just in case) on Wednesday evening. I was on bed rest and hydrated and fed only by IV fluids. On Thursday, I was weaned onto solids, but had to stop eating again at midnight for a CT on Friday. I waited all day for that damn CT, which the resident said was clear. I was free to go, but needed to stay in Vancouver until Tuesday, when I’d have a final scan to be sure nothing was going to rupture and kill me. The nurse removed my IV and catheter and told me I had to pee before I could leave, to make sure everything still worked down there. I immediately expelled 150 ml of urine, because, if nothing else, I am a champion pee-er. I checked into a suite in a hotel across the street from the hospital. I bought eggs and cheese and bread so I could cook a decent breakfast. And then the phone rang.
The surgical resident assigned to my case had bad news. A radiology resident had read the scan wrong, and the attending caught some AVMs, or pseudo-aneurysms, in my spleen. I needed to come back to the hospital, because any one of those could go at any moment and I could bleed again.
So I walked back to the hospital at 11 that night. I changed into a gown, got back into bed, got re-cathetered, got stuck again with an IV, donated yet another blood sample to yet another tiny Asian woman, put my legs back into these cuffs that squeeze you periodically to avoid blood clots, and waited.
On Saturday I had an angiogram. The interventional radiologist threaded a wire or something through the artery in my groin up to my spleen, where he sealed off some blood vessels with tiny metal coils while I laid absolutely, deathly still. The drugs that made me high wore off about halfway through this two-hour ordeal and I stared at the ceiling tiles hoping I wouldn’t feel any pain. Instead I felt a scraping under my ribs and a strange pressure as he pulled the wire out of my abdomen and leg. He pressed two fingers on the insertion for 15 minutes so my artery wouldn’t erupt like a geyser. There’s a pressure point there or something so I felt weak, overheated and pukey. The nurse put cold rags on my face and neck, but I didn’t feel better until I was back up in my bed in surgery. There, I stayed absolutely still for the next 10 hours or so, because moving my leg or flexing my abdominal muscles could cause that cute little geyser problem.
Turns out that the process of sealing off the damaged blood vessels effectively killed about a third of my spleen, so I also got some vaccinations. I also had a whole lot more morphine. The body, in all its mystery, absorbs the blood and dead spleen parts and eventually the remaining spleen takes up the workload. And apparently your spleen filters your blood and helps fight infections, something I probably knew in 9th grade but haven’t heard mentioned in about 10 years, so this whole ordeal was quite educational. I had one final CT on Sunday before bumming around the hospital with my parents, who’d flown up from New Orleans on Saturday to do the supportive things parents do in situations like this. I was finally discharged, for real, on Sunday evening. On Monday we drove back to Seattle so I could collect my stuff, and yesterday we flew home. I can still feel a slight stitch in my side and my arm still hurts (my shoulder from the shots, my elbow and wrist from the fall), but I feel rested. And lucky.
I became abruptly aware of my fragility when I waited on a stretcher outside radiology for my angiogram on Saturday. Could I die if something went wrong? I’ve never been the type of reckless person who throws her body around in a display of idiotic invincibility, but I’ve also never felt so vulnerable, so utterly unable to control my own fate. There was this palpable disconnect between the me I felt and the me the CT scans showed and the nurses treated. The narrator in my head, the thinker of my thoughts, was not at all the same being as the organs and the blood and the bones inside of me. The very parts that kept me functioning didn’t feel my own and were in the control of a stranger.
I’d crossed the line I’d always feared, the one separating the lucky from the unlucky, the line between never having been hurt and having survived a painful and humiliating ordeal. Mostly though, I’m thankful for the troupe of nurses on twelve-hour shifts who smiled when I needed it, delivered warm blankets, emptied my pee bag, didn’t say anything when I reeked of four days of body odor, and wiped my butt when I was on bed rest. I’m thankful for Sam, who slept in the hospital for three nights even though visitor’s hours ended, scratched my nose, held a phone to my ear when I couldn’t bend my arms, fed me ice chips, called my parents, and knows how to properly fit and wear a bike helmet. Thankful that my parents’ jobs allowed them to drop everything and fly across the continent to me when I needed them.
My time in Seattle ended abruptly and in a heap of disorganization. I planned to have about 4 days after the Vancouver trip to pack, relax, bike around town, visit with friends, and put some measure of closure on the past year of my life in the Pacific Northwest. Instead I hastily packed and rushed to board a plane at 6:15 a.m. yesterday and hardly said good-bye to anyone. Now I’m reeling a bit from the shock of being back in the steamy South without a wink of transition.
I did learn a few unexpected tidbits during my Canadian hospital adventure. First, if you can swing it, wax your arms before you enter the hospital. That way when you remove all the bits of tape from your skin at the end of it, you won’t have to rip out your arm hair in the process. Also, Canadians are possibly the gentlest, most apologetic people I’ve ever met. “Sorry, the stethoscope is cold.” “I’m so sorry, I need to poke you with a four inch needle.” And hospitals, from a patient’s perspective at least, are unfortunately nothing like Grey’s Anatomy. But the nurses do gossip.
For more information on the crucial business of fitting a bicycle helmet, check out this page.