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Outside Magazine September 2001

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A World of Hurt
Injury, pain, the psychology of recovery, and getting back on the trail

By Mark Jenkins


	Mount Olympus: No fragile mortals allowed.

THE SOUND RESEMBLED that of a large limb being broken off a tree. One second I was pounding down the trail on my bike, enveloped in the myth of my own immortality, artfully dodging rocks and sagebrush, and the next I was sprawled out on my back in the dirt. It happened so fast I don't remember going over the handlebars, or flying through the air like a man shot from a cannon, or even tucking before impact. (Forensic evidence would later reveal that I hit a deep, cleverly concealed gopher hole at approximately 35 miles per hour, came off the bicycle headfirst, and rammed my right shoulder into a boulder.) All I remember is that sound.

When I sat up my right arm didn't bother to come with me, and I knew I'd ruined my evening. I lifted the arm like a chunk of firewood, set it in my lap, and inspected the top of the shoulder. Sticking out was a new protuberance somewhat larger than a doorknob, over which the skin stretched taut. Cradling my right arm in my left, I stood up. I was out in the rolling prairie. I didn't feel my finest. I remember looking up into the blue late-afternoon sky as if an airplane, or perhaps the gods, might have witnessed my little accident and would consider coming to my rescue. But the firmament remained inscrutable. I abandoned my bike and set off cross-country. I could walk only so far before I had to sit down for several minutes to keep from passing out. Sweat was seeping out my pores, soaking my clothes, burning my eyes, and dripping into the dirt; I was racked with spasms of shivering. Peripheral vision disappeared, and the sky turned black and closed down around me.

At some point I reached a house on the edge of town and rang the doorbell. By now the muscles in my neck and back had convulsed and distended. I must have looked like Quasimodo, for the woman who opened the screen door took one look at me, turned pale, and declared, "We have to take you to the emergency room." She got me into her pickup, ran every stop sign to the hospital, moved me past the receptionist into a room, took my phone number, and left to call my wife.

I sat on a white bed. The walls of the room were white. The fluorescent lights were white, the floor tiles white. A nurse in white started asking me questions, and I answered, although I could barely hear my voice. He said the doctor would be in any moment. "Thank you," I said. "I'm going to pass out now."

When I came to, struggling up out of swirling confusion and nausea, there were several people moving swiftly around me. I had no idea who they were or what was going on. Someone was shoving a needle into my arm, someone else was cutting off my clothes, and a man had his face right up in mine, examining my eyes.

"Where am I?" I demanded.

"The hospital," he said.

"Why am I here?"

"You basically tore your arm off your shoulder."

THE NEXT MORNING, Dr. Michael Wasser, master bone carpenter and shoulder specialist at Gem City Bone and Joint, the local orthopedic clinic, studied the X rays excitedly. "A-C separations are usually graded one through three," he said. "You have a five."

I opened my well-thumbed copy of Atlas of Human Anatomy, an intimately detailed medical textbook. I bought it a decade ago and take it to doctor's appointments after every wreck. Pointing to various illustrated body parts, Wasser explained how I had torn my clavicle (C) from my acromion (A), shredding the trapezoid and conoid ligaments and ripping apart the fascia between the deltoid and the trapezius muscles. To put it back together would require sawing off the ends of the acromion and clavicle, drilling holes, slicing the vestigial coracoacromial ligament, and using the ligament like a hose clamp to reattach the joint.

"Procedure's called a Weaver-Dunn," said Wasser, manipulating my arm and shoulder into surprising positions while I jumped. "Looks like you also tore your labrum. I'll nail it back on. There's other damage as well, but we won't find it until we're in there."

Translation: total shoulder reconstruction. An orthopedic surgeon's wet dream.

Wasser grinned. "Want me to repair that torn joint capsule while I'm at it?"

I smirked. "Might as well."

Wasser knew me as a steady customer. Eighteen months earlier I had dislocated my shoulder doing a contortionist move on a 5.11 off-width crack climb. Although I had managed to pop it back in while hanging from the rope, I'd also torn my joint capsule. The MRI revealed damage to the rotator cuff and the labrum, but I'd chosen several rounds of rehab over surgery. "Up to you," Wasser had said at the time. "You'll be back in here soon enough anyway."

And here I was, nothing if not punctual.

The next morning I was being prepped for surgery by a nurse as friendly as she was frank. She deftly slipped in the IV, read the lengthy preoperative diagnosis, and pooched her lovely lips.

"They have a lot of work to do," she said. "I don't want you to misunderstand: You're going to be in a lot of pain for a long time. Have you ever been hurt before?"

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