Near Death

I have few recollections of what occurred at the time of the crash, and recall little of the days immediately following it. What follows then is the best I can do describing my crash of April 14th, 2024, and ongoing recovery, which is still not 100% complete, and may never be. You can read the updates after the crash here.

Note: I would have preferred to write this much earlier than I did, but I could only type well enough as of August 6th (when I published the first part of this), barely, to do so. If nothing else, the writing and the thinking were both excellent therapy.

The Crash

I went out for a bit of a joyride on the afternoon of Sunday, April 14th. I usually head out for an hour or two and do 30-60km on these types of rides. Beyond that it was a pretty unremarkable day – clear and cool for spring in Vancouver.

Just past Boundary Road, I was heading east on Rumble Street in southwest Burnaby, crossing Joffre, when a car turned left across my path, slamming into me at what seemed like it must have been 40-50 km/hr. In my reading of the surgery notes from hospital, they estimated the car was going about 50km/hr from the force of the impact. Regardless, it was fast enough to throw me into the windshield of the car, and up over the roof of the vehicle, according to the police report. I landed on the pavement about 10-15 feet behind it. I remember the other vehicle coming to a stop diagonally, sort of pointing away from me.

The only thing I can recall from the impact is the driver exclaiming repeatedly that he never saw me – on an absolutely clear day with excellent visibility. And before anyone assumes anything, I was wearing a white helmet, and dressed in a very visible bright red cycling jersey. Apparently I never fully lost consciousness, but absolutely everything from that moment until days later in Royal Columbian Hospital is a blur. I know I was conscious at times, but I wouldn’t really say I was “awake” until several days after the crash.

Somehow, I managed to provide my wife’s cell number to a bystander, who called, and followed that up with a text message when she couldn’t reach my wife. In a strange turn of events, the bystander also provided contact info for the driver. Thinking he was a witness, my wife sent him a text asking what he saw, to which he responded that he was actually the driver who hit me. Given BC’s no-fault driver insurance, this hardly matters, as he’ll likely suffer not so much as a reprimand for his careless driving.

I spent three weeks in Royal Columbian Hospital, before being transferred for another five, to GF Strong, a rehab hospital that specializes in Spinal Cord and Traumatic Brain Injuries (more on that shortly). In total I was in hospital for eight weeks.

My wife visited me every day for the whole eight weeks, and the kids as much as their schedules would allow. What I’m about to describe in The Injuries section below gave them all a good scare, and in some ways, particularly the first days were probably as hard, if not worse, for them than they were for me. I wasn’t exactly cognizant of much going on.

The Injuries

Note: This section has obviously had significant contributions from my wife, since I have zero recollection of anything from surgery, ICU or the first week in hospital.

You’ll have to bear with me through this section. My injury list was serious and extensive. I’m also going to try to describe things below in roughly the order they happened.

Stop the Bleeding

When I arrived at Royal Columbian Emergency I had a lot of internal and external bleeding. The most obvious injuries were a massive gash just below my left elbow and additional gashes at my outer left knee and on my outer left thigh. I have scars from all of them, but the real souvenir is about five inches long, extending down my left forearm from my elbow. However, it was all the internal damage that would dominate everything that followed, for months after the crash.

Non-responsive

Once they finished stitching up my wounds, apparently I had become non-responsive. This was when they suspected I’d had one or more strokes, the most likely cause of which was that the force of the crash had damaged my right Carotid Artery. Neurology became involved at this point and, while not even my wife knew at the time, they must have done some imaging, as these pictures were referred to during an ophthalmology follow-up I had on August 2, 2024.

Catheter Embolism

Next, they did something called a catheter embolism. In spite of its scary sounding name, Google says it’s a “minimally invasive” procedure to stop bleeding.

Carotid Artery Stent

After the embolism, the neurologist’s recommendation was to put a stent in my right Carotid artery (which was apparently in much worse shape than my left). The reasoning was two-fold. Not only would it ensure enough blood and oxygen would get to my brain and make additional strokes less likely, but the chances of blood clots would be reduced. They were openly wondering whether my brain would get enough oxygen to prevent me suffering permanent damage. I guess it did, though my wife has probably always suspected my brain is a little oxygen-deficient. At one point in those first days they were planning to stent the other Carotid, but at the time, felt I wasn’t stable enough.

It’s also probably worth noting here that the risk of another stroke back then was not insignificant. Normal platelet levels are somewhere around 400-450. Mine were in the thousands in Royal Columbian.

Bowels, Spleen and Diaphragm

Which came first, the bowels or the spleen? Actually, I’m only half kidding. I returned to general surgery with my bowels in my chest cavity and my spleen an unsalvageable mess. Yes, you read that right – in my chest cavity. The force of the accident had jammed my bowels up into a place they weren’t supposed to be, and my spleen was too badly damaged to be saved. The surgeons originally thought they may have to take out sections of my bowels, too, but apparently found them to be in one piece, more or less.

My diaphragm was also ruptured and needed repair. The surgeon was hoping it could be “coaxed” back into place, but ultimately it required surgical intervention.

Multiple Fractured Ribs

I have no idea how many exactly, but I broke several ribs and, honestly, they ended up the least of my concerns. During my recuperation, I really didn’t sneeze or cough much and aside from some slight stiffness I barely noticed them. If only everything could have been that easy. I was, of course, on heavy pain meds in the hospital, so that may have had something to do with it.

The Impacts

Strokes

By far the strokes (yes, I had more than one) have had the largest impact on my life. They have affected my cognitive skills, memory, reading, writing, typing, vision, and my right hand. Miraculously, I suffered no lower body injuries, save for the gashes, but the strokes made my right hand uncoordinated and slow. This necessitated a couple months of extensive hand therapy. It could best be described as a near-useless appendage upon my release from hospital, but has thankfully shown remarkable improvement over time.

Memory and cognition has also been a stroke-related work-in-progress, as the strokes also caused a traumatic brain injury. When first released from hospital, I constantly forgot where I put things and misremembered details of almost everything. I couldn’t read or even just parse the hands on a clock face very well, and I became confused easily. This has improved significantly as well. I am, however, not yet fully recovered cognitively, and may never be.

Back in the early days of Royal Columbian, my wife says I was limited to one-word responses and most often stared off into space. Even by the time I was transferred to GF Strong I still had problems with things like labelling, categorization and word finding, often stumbling for terms that came easily to me before the crash. I had a speech therapy assessment in two sessions, on July 12th and 19th, and began 13 sessions on September 3rd, 2024.

As a result of losing my spleen, the other major impact on me is that of becoming immunocompromised. I had five new vaccines as a result, with two of them requiring two doses at least two months apart, then either being finished completely or requiring boosters in five years. And, while we have always taken our COVID and flu vaccines enthusiastically, missing them now isn’t remotely an option. Thankfully, beyond that, and ensuring I do my best to avoid bacterial infections, I can proceed with my life fairly normally, whatever normally actually means now. I often find myself wondering what my risk of developing an infection in any given situation is, but this really isn’t a context where rigid percentages can be applied. At least most of the immune system functions previously provided by the spleen are then handled by other organs, notably the liver and kidneys, and the vaccines should protect me from most of the rest of the potentially fatal things.

Reticent Right Hand

I can’t really separate the right hand functioning from the strokes, as they go “hand-in-hand.” This has largely been a slow, steady climb to regaining as much function as I can. It’s gone very well, but like everything, progress has been measured in weeks and months, and not days. As of late 2024, most right hand functioning was becoming “passable,” but given the dependency of things like typing, printing and drumming on fine motor skills, still not 100%. Daily tasks and general right hand use, though, were largely indistinguishable from before the crash.

My wife says that in the very early days of my hospitalization, I had a lot of right and lower limb swelling, so I’m exceedingly thankful for my very normal appearance on that front.

Visual fatigue, Light Sensitivity and Brain Fog

I lump all these together because the boundaries of any of them blend seamlessly into each other. The biggest issue by far is the fog, which can most accurately be described as a very mild hangover, minus the headache. I’m also very sensitive to bright sunlight. And finally, for the longest time I had generalized visual fatigue, causing me to easily tire mentally. It’s all improved a lot since I left GF Strong, as I couldn’t tolerate more than 30-45 minutes of screen time at a stretch back then.

The other thing that the fog and light sensitivity triggers is vestibular symptoms. Returning to running has been a slow proposition. As of the end of 2024, I made substantial progress in both running and cycling, with the only ceiling detected being my effort, age, and natural ability.

The most noticeable difference day-to-day is that I need to do everything with far more intention and attention now. Whether it’s where I place my foot plant and watching for tripping / ankle-turning hazards when running, or slowing down and double / triple checking at corners when I’m riding, I take far more care with everything. And, frankly, being more intentional isn’t remotely a bad thing. I guess it’s simply a matter of living more presently than I did before the crash.

Tubes and (more) Scars

It’s probably worth mentioning at this point that I was also intubated for breathing, had a PICC line so the multiple needles I got were easier to handle, had chest and stomach tubes to drain blood, had a feeding tube to get calories into me (I dropped about 30 lbs at my skinniest point), and even had a catheter for, well, you know …

In addition to the scars I’ve already mentioned, I’ve got about a foot long beauty running the length of my abdomen, another that meets that one, perpendicular to it and a little 2″ one on my ribs, under my arm. Apparently diaphragm, bowel and splenectomy surgery is hard to do neatly. The thing about big cuts and organ removal is that they can cause some mild loss of sensation. There’s a good chance it will return, but a very small area in my left pectoral and under my arm has experienced this.