The Accident & Injuries
I have few recollections of what occurred at the time of the accident, and recall little of the days immediately following it. What follows then is the best I can do describing my accident of April 14th, 2024, and lengthy recovery. I plan to return to this post from time to time to provide recovery updates, as that piece is still very much a work-in-progress.
Note: I would have preferred to write this some time ago, but I could only type well enough as of August 6th (when I first published this), barely, to do so. If nothing else, the typing and the thinking have both been excellent therapy.
The Accident
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, dressed in a very visible bright red cycling jersey. Apparently I never fully lost consciousness, but absolutely everything from that moment until after I came to 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, 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 suffer not so much as a reprimand for his careless driving.
My wife visited me at both hospitals every day 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.
I spent about 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 spent eight weeks in hospital.
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 going to try to not give into hyperbole, but it is probably worth trying to paint a bit of a picture for you, so apologies in advance for what will undoubtedly seem overly graphic to some. I’m also going to try to describe things 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 less obvious stuff that would come to dominate everything that followed for me.
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. 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.
Catheter Embolism
Once they stitched up my obvious external damage, they needed to do a procedure 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, but the chances of blood clots would be reduced. It was about this time when they openly wondered whether my brain would get enough oxygen to prevent me suffering permanent brain damage. I guess it did, though my wife has probably always suspected my brain is a little oxygen-deficient.
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 and 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 surgeon originally thought they may have to take out sections of my bowels, but apparently found them to be in one piece, more or less, and repairable.
My diaphragm was also in the wrong place and needed repair. The surgeon was hoping it could be “coaxed” back down to where it belonged, but ultimately it required manual 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.
The Effects
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. Somewhat miraculously, I suffered no lower body injuries, save for the gashes, but the strokes made my right hand uncoordinated and slow. This necessitated fairly extensive hand therapy. It could best be described as a near-useless appendage upon my release from hospital, but has thankfully shown remarkable improvement, to the point where I’m now drumming and typing again, just slower than I did them before the accident.
Memory and cognition is, and shall remain for some time, a work-in-progress. When first released from hospital, I constantly forgot where I put things and misremembered details of everything generally. I couldn’t really read or even parse the hands on a clock face very well, and I became confused easily. I’m happy to say this has improved significantly as well. I am, however, a long way from being fully recovered cognitively. The complex planning I used to do without so much as a thought is nowhere near ready for primetime, or even just a return to work. In fact, while UX design and user testing used to form the bulk of my job, as a Scrum Master with UX responsibilities, planning now constitutes the majority of my work.
Back when I was in the early days of Royal Columbian, my wife says I was limited to one-word responses and most often stared off into space, so I guess there’s been lots of improvement on the aggregate. I also 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. While this all probably sounds bad, in truth, to look at me you wouldn’t know I’ve had “polytrauma.” Dig in a bit more under the hood and my deficits quickly become more obvious. My speech therapy is delving into the cognitive domain. The therapist is working with me to improve executive functioning and things like complex and abstract planning – exactly what I need right now. As of this update, I’m five or six sessions in and very impressed with her approach.
As a result of losing my spleen, the other major impact on me is becoming immunocompromised. I have five new vaccines as a result, with two of them requiring two doses at least two months apart, then either being done completely or requiring boosters every 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 infections, I can proceed with my life fairly normally.
Reticent Right Hand
I can’t really separate the right hand functioning from the stroke, as they go hand-in-hand (pun intended). This can largely be thought of as a slow, steady climb to regaining as much function as I can. It’s going well, but seemingly like everything, progress is measured in weeks and months, and not days. I’d say the drumming is about 75% of where it was (as of October 11th) and the typing and writing, maybe 40%. The goal for me is to get to where I could return to work if I that ends up happening, though, obviously I can’t separate the cognitive skills from the motor skills like typing when it comes to work. Both would have to be far better than they are now for me to even entertain the notion. My speech/cognitive therapy is making a massive difference.
Visual fatigue, Light Sensitivity and Brain Fog
I lump all these together because they are completely inseparable in my mind. The biggest issue by far is the fog, which can most accurately be described as an exceedingly mild hangover, minus the headache. I’m also very sensitive to bright sunlight and the white glare of overcast days. Finally, I have generalized visual fatigue. It’s slowly and steadily improving, but monitor use (still, as of October 11th) has to be kept to about 90 minutes at a time. When combined with everything else it feels like I’m still a long way from working.
The other thing that the fog and fatigue also triggers are vestibular symptoms. Slow, steady improvement on that front is offset by the fact that returning to running is a VERY slow proposition. I’ve managed about 9k at a 5:30 pace so far, as of October 11th, and have been as fast as 5:06 on an 8k run. I tire very easily on efforts that barely broke me a sweat before the crash. But I’m determined, and the cycling is returning a bit faster than the running, which are both also measured in weeks and months as opposed to days. I’m doing both e.bike and trainer rides right now and managing 60-75 minute bike trainer sessions at fairly low power output.
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 30lbs 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.
I think I actually count five scars on my torso …
I guess the photo above isn’t as bad as it could be, anyway.
August Update
ICBC’s “Enhanced” Care
For the most part, this is ICBC’s euphemism for paying for therapy. They also have wage top-up to 90% of salaries to $113k and in some cases (like mine) make a lump sum permanent impairment payment, but mostly it means payment for community-based therapy. My experience with this has been both good and not so good, but as I’m still in the middle of therapies, I’ll probably wait to comment until I’m closer to the end of them. What I will comment on now is something that happened while I was still convalescing in GF Strong.
At some point not long before your discharge date, a family meeting occurs, and it includes all therapists you’ve seen while in rehab, any affected family members, the attending physician(s) and, nominally, third parties like ICBC. Attending on their behalf was a support and recovery specialist and his manager. The ICBC line is that they want to ensure your support in the transition back home, all the way through your eventual return to work. In this specialist’s case it seemed more like they wanted to ensure maximum mis/disinformation.
Of course, for all attendees’ benefit we were assured by him and his manager that ICBC’s financial support of necessary therapies would only begin when I was discharged (a point the attending physician made his manager repeat for all to hear). This is important because ICBC only pre-approves 12 weeks of therapy. Later, by email, he then insisted that he and his manager had misspoke, and the 12 weeks began from the date of the accident. This would have rendered their financial support nearly useless, as I ended up in hospital for eight weeks. Had I been limited to a mere four weeks of therapy, my progress would have been nearly nonexistent, as it would have ended on roughly August 14th.
As an aside, one thing I’ve found very odd in dealing with ICBC for therapy payment is their over-reliance on family doctors. In fact, our original specialist wanted all assessments and treatment plans to come from our GP, as opposed to the therapists who actually do the assessments and provide the therapies. In many cases a GP won’t know anything about your therapy, and will have to reach out to the therapists for updates. In short it just creates another barrier to things happening quickly. More important still, a GP has no expertise in acquired brain injury rehabilitation.
Turns out, the specialist was spouting complete BS. My case was thankfully handed off to a senior support and recovery specialist, who has placed no such limitations on my therapies, and also seems to actually defer to the expertise of, well, the experts. The OT we hired (who’s excellent, BTW) thought he was inexperienced because ICBC usually approves therapy as needed for much longer than 12 weeks. While this has thankfully been the case, even just allowing someone to state incorrect information like this is very damaging and introduces completely unnecessary stress for people already frazzled and typically in a very vulnerable place. In my case, I’ve just had the aforementioned speech/language therapy approved and additional vestibular physiotherapy well beyond the pre-approved 12 weeks has also just been approved. I expect my speech/cognitive therapist will be requesting additional therapy well beyond the end of the year, when my current block runs out.
ICBC Bike Claim
After opening a claim within a couple days of my crash, my wife was simply ignored by the assigned adjuster. She periodically added information and occasionally asked for some sort of update as to progress. The adjuster couldn’t be bothered with so much as just an acknowledgment, let alone an update. We heard absolutely nothing for about 17 weeks, until roughly August 9th. I had escalated the lack of communication through social media first, then ICBC’s Fair Practices Office. After that I finally received an email from the adjuster’s manager. In it, she never apologized for his ignoring us for over four months, nor explained why, but did promise to get back to me the following week (about with an update on my claim.
It’s no big surprise that the ICBC manager never followed up, but as I did have her email address, expected to be bugging her regularly. I still maintain that five months is far too long to take to settle a claim for a written-off bike and a pair of carbon wheels.
More ICBC Nonsense
In a development that should come as a surprise to absolutely no one, there were still more delays from ICBC. Immediately after the adjuster’s manager said they’d get back to me, they then went on vacation for two weeks. Not only that, but at virtually the same time as I got their out-of-office auto-reply when I followed up with them, the Fair Practices Office, with whom I had escalated my claim a week or so prior to August 9th, responded to me. In particular, as I had suggested there was no deterrent for people who drive carelessly, they assured me (with absolutely no supporting evidence) that “fault still matters” and more laughable still, that the system still has “the same incentives” to drive safely. Never mind that no-fault insurance literally removes those incentives by banning customers from suing for injuries and damage, no matter how bad they may be. Wrongful death? Careless driving causing death? Manslaughter? Lifelong, permanent and/or severe injuries? Brain damage? Never fear, as the system includes the same incentives it’s always had, minus, of course, any ability to be compensated beyond the enhanced care model for one’s injuries in any way. And sorry, but in many cases, ICBC footing the bill for some therapy sessions and providing a lump sum impairment payment isn’t going to be nearly enough.
Suddenly Settled?
I was afraid I’d been a little too snarky in an email exchange I had with the Fair Practices Office, but lo and behold on August 22nd I received a call from the adjuster. Again, no explanation for ghosting us and no apology, but (drum roll please) a settlement offer. I was to receive nearly $7300, which is almost what I paid for the bike and wheels, minus the tax. I signed the the acceptance letter immediately and received a cheque in the mail September 10th, a mere four days from the five month anniversary of the crash, and an apology from the manager for taking so long (but still nothing from the adjuster).
No more hand Therapy
This change had been coming for a while, as I was plateauing with the therapy while the hand continued to progress slowly. Really, if you’re doing all the assigned exercises and still seeing improvement, there isn’t a lot more the therapist can do. Beyond working a little on the continuing stiffness/osteoarthritis I’m developing, using the hand continually for nearly everything (as I do) is really the best therapy. I thank my lucky stars I’m a drummer because I’m convinced that nothing is better hand therapy. I continue to see improved function, fine and gross motor skills, with typing and printing also continuing to see slow, steady improvement. As always, my goal remains to get as close to where I was before the crash as possible.
Running and Cycling
There’s a litany of data supporting the benefits of cardiovascular exercise on recovering from an acquired/traumatic brain injury. People recover faster and show more improvement in their cognitive functioning overall. It’s very slow, but my vestibular symptoms also seem to be lessening just a little bit. I still experience the brain “fog” but the dizziness and balance issues I experience are a tiny bit less intense than when I came home from GF Strong.
I’ve also decided to do my best to do either a run, e-bike or trainer ride most days. I’m obviously not training for anything now, but I figure the only way I can reduce my vestibular symptoms as fast as possible is to continually desensitize myself by triggering them. It’s what all vestibular physio is based on, and running is a particularly big trigger. I usually have to stop occasionally while running, so working toward longer periods of continuous running is also a goal. As I said I can do a few km without stopping much, at roughly a 5:30/km pace. This weekend (October 13th) I hope to finally crack the 10k mark, now that my pace is getting a bit better.
As I said, my trainer rides are currently clocking in around 60-75 minutes, max. I’m not worried about power output or distance at all, just moderate intervals. It always slips my mind just how far I’ve come in the nearly six months since the crash, and that I need to be patient. When I first came home from GF Strong I had to pause and rest just going up the stairs and now I’m doing decent rides and runs. So, with both, I’m focusing on increasing duration very incrementally for some time, and only then very gradually increasing the intensity.
Long-term Disability
By far the best news in September was that my LTD claim was approved when we had our Manulife phone interview. In general, the entire Manulife LTD application process was pretty painless. I’m not sure at this point whether there’s a return to work in my future or not, but the focus is always to get back to a place where I could return to my job. That’s also been my approach with therapy since day 1. Regardless of what ends up happening, I want to get as close to my old self as possible. Right now, I’m still dealing with significant cognitive deficits in things like complex planning, reading retention and recall, and memory, and while a little less directly related to work, some of my remaining vestibular triggers, light sensitivity and visual fatigue would absolutely kill my ability to work more than about 90 minutes at a stretch. It’s not as bad as when I was first released from hospital, but I still get very frustrated trying to do some things that came easily to me before the crash, and my attention to detail and recall is, frankly, still shitty. My typing speed is also a fraction of what it was in the “before times” and far more mistake-prone. One thing I have already decided is that, given my immunocompromised status, any return to work will be 100% remote or it’s not happening. My employer has accommodated other immunocompromised people so I don’t think this should be a showstopper.
Fitness – August 2024
If nothing else, I’m not going to regress in my recovery because I didn’t put in the effort. The list below also doesn’t include my therapies or homework, which probably averages about an an hour a day now. When I first began my hand and vestibular physiotherapy, it was common for me to spend three to five hours a day.
- Run: 33km
- Walk: 50km
- Cycling (trainer & e-bike): 178km
- Weights: 4.5 hrs
- Yoga: 4.5 hrs
- Drums: 9 hrs
September Update
Victoria
For the first time since my crash, we got back to Victoria from September 17-20. It wasn’t quite the same without craft beer or whisky, but it was still very enjoyable. Sadly, Connie was nursing a calf/outer knee strain, so we couldn’t do the walking we typically love to do while there. I did have my fastest short run, at the time, since the crash while there (4.5k @ 5:15/km) so that’s something I guess. I’ve since done 8k @ 5:06/km.
Weights
Early in the month I decided I didn’t really like going to the weight room to do my strength workouts with me missing my spleen and all, and given my need to keep building strength, I asked my OT if it would be possible to get some weights for home. Much to my surprise, it was approved by ICBC and I feel much more comfortable not exposing myself to the viral stew at the gym. This will be particularly beneficial with flu season coming soon and COVID already seeing significant community spread.
New bike choices
As I said in last month’s update, I finally got my bike money from ICBC in August and I’ve just begun shopping for a replacement steed since mid-September. I’m taking my time, not only because I hope to snag an end-of-season bargain on a 2024 model, but also because I want to be sure I won’t switch to more transport and city biking. If I don’t feel I need a road machine any longer it’ll reduce my cost by half or more. I think I’ll ultimately still want to do group road rides, but it’s best to be sure and not regret my purchase immediately after making it.
Lump-sum, tax-free
My ICBC person apparently discussed it with me, but my brain being what it is, I completely forgot. However, my injuries qualified me for a permanent impairment payment. While it really doesn’t come close to making up for an acquired brain injury, the lengthy recovery and rehab, or losing a spleen, to name just three, the money will at least help a bit, particularly when we buy another place. They have a very complex formula that factors everything into the calculation. There’s something for the broken ribs, the strokes, the brain injury, the right carotid artery dissection, the ruptured diaphragm, the splenectomy – everything. I don’t know how you accurately price being immunocompromised or a brain injury you may never fully recover from, but ICBC seems to have found a formula. They also do a final review once you’re recovered medically to about the fullest extent possible according to your doctor and therapists, to see if any further compensation is warranted.
Still more ICBC cruft
While my ICBC recovery specialist has generally been very good, she did a very odd thing last week. In addition to my receiving LTD, part of ICBC’s enhanced care model is to provide an additional income replacement top-up to 90% of my income, to a maximum of $113k per year. She asked if I would see if I qualify for federal EI sickness benefits. EI sickness benefits are basically the equivalent of short-term disability benefits, only pay a maximum of $668 a week, and only last 26 weeks.
Long story short, I’ve just submitted my EI application, which will almost surely be denied, but now I also have to wait for my final paycheque and vacation payout so that my ROE can be generated, so that my EI claim can be processed. It will be mid-November at the earliest before that’s all done and.
Given that she reminded me that ICBC is secondary income replacement, I’d guess it’s about trying to reduce ICBC’s payout. So, now I wait …
Fitness – September 2024
This month, I tried to get a little more regimented with my fitness and saw pretty significant increases in time/distance across the board. While I’m not beating myself up for missing workouts, I also need to do my best to stick to a schedule and it paid off in September. I set modest time or distance goals for all major activity types a week ago to see how well I could do in the coming weeks and months.
Running continues to be the most challenging to return to, and still a significant vestibular symptom trigger. I continue to see improvement in my strength, coordination and general right hand functioning. Typing and writing are still slow, but improving. Drumming is surprisingly improving the most, buit closer to nearing a plateau, I think. I walked a lot in Victoria, so that’s more a blip than actual progress, but walking a lot is thankfully not an issue. Cycling on the trainer is seeing glimpses of power returning, but progress is also very slow.
- Running: 55 km
- Walking: 92 km
- Cycling (trainer & e-bike): 233 km
- Weights: 6.75 hrs
- Yoga: 6.2 hrs
- Drums: 19 hrs
Notes
- I haven’t mentioned it so far, but one thing I have struggled with since the crash is keeping up my weight. I used to hold steady at about 165, which was probably ten pounds heavier than I’d have liked. Now I usually weigh 148-150. In a perfect world I’d weigh around 155. I’ve taken to smaller, more frequent meals because my appetite has been smaller since my hospital stay, with all the abdominal and chest related surgeries, and eating denser, more high calorie foods often comes with additional salt, sugar, cholesterol or a combination of them. Hopefully I’ll gain that final 5-7 pounds at some point.
- I also have slightly elevated BP now, but really have been dealing with it for a few years, but the medication I’m taking for it (Amlodipine) seems to cause constipation. I tried a few things without much success and finally gave in to Metamucil in the past week, and that seems to have done the trick. I’m very regular now and much happier. We already eat a pretty high fibre diet, so I figured I didn’t need it, but I’m glad I tried it. Unlike polyethylene glycol, I can use it daily, with the added benefits of potentially helping to regulate blood sugar, blood pressure and LDL cholesterol. Man, does all this stuff make me sound old now.
- In addition to the new vaccines resulting from my immunocompromised status, I have to take infections more seriously in a general sense. So, in addition to masking when in confined spaces, things like live hockey games, concerts and places where people pack tightly like sardines are no longer a good option for me. I guess being a bit of an introvert is finally paying off, whether I like it or not.