Home Sweet Home
After eight long weeks, we are officially back at home. It almost seems like a time warp. A lot has happened during that time and, believe it or not, this is considered ahead of schedule.
I’m happy to be back at home and feeling a sense of normalcy, but I acknowledge that recovery is not yet complete. You will see that this is going to be a rather lengthy description of what I’ve been through from the day of the accident, including a lot of the recovery steps, but I would like to first start by expressing my gratitude.
I want to express a sincere Thank You! to so many people:
Boris Tsenov who was first on scene. We rode together for a bit through the Red Rock loop, and he was behind me on the way towards Blue Diamond when I unexpectedly exited the road. We met again in person on May 19th.
Kristin and Damir, the couple that stopped their car to help and dropped off flowers at the hospital.
All the first responders, including but not limited to, the EMT and helicopter crew who worked together and successfully got me to UMC hospital so quickly.
All of the medical personnel at UMC and Craig, including all of the Doctors, Nurses, Techs, PT’s, OT’s and SLP’s.
Family – this really goes without saying but you all have been truly amazing! When I was a young kid, I remember being told we had a small family, but that definitely isn’t true now. This now includes my wife and her family, my sister/Mike/Naya, my mom and stepmom, my dad and stepmom, my stepbrothers and their wives and kids, aunts, uncles from all over the country. Many of you spent countless hours at the hospital including flying across the country to help me and my wife both physically and emotionally. Some of you even got to see how fantastic Englewood, Colorado could be in April.
Friends – I didn’t have access to my phone for a few days so I’m sorry if it took me awhile to get back to you, but I really appreciate all of your messages and support when I was able to get back in touch. When I reached the outpatient status one of you even made a trip to see me which was a great change of pace from staring at the walls in a hospital, but we’ll have to visit Denver again when we can partake in all the city has to offer. Also, a huge thank you for all the food including my new favorite donut shop.
Technologent – my employer for the last seven years. I consider many of you also my friends, but as an employer, you have been incredible in supporting me and collaborating with my wife and medical team.
I am sorry to have put all of you through this situation, but I hope you know how much I appreciate it knowing you were there for me.
It has been truly amazing to see and hear from so many friends, neighbors, and coworkers across the country. Las Vegas is known as being a transient town with no community, but I have always disagreed and you all really proved it. I don’t recommend going through this endeavor to find out for yourself but take it from me there are so many great people wishing you nothing but health and happiness.
I have made this joke to several people but if this is what lucky looks like you don’t want to be lucky. But the truth is compared to where I was 12 days after the accident, I’m lucky to be on the path I am. I also realize how lucky I am that I didn’t break anything more serious on my body and just how lucky I was to have some amazing people stabilize me and call for medical help on the scene. When I was moved to Craig’s inpatient care and I saw the other patients, I definitely considered myself one of the lucky ones. It was amazing to see and hear their progress while I was there getting the same access to the amazing staff treating them.
I’ll jump to the end a little bit and tell you that I think the hardest part about returning to normal life is that, while I may look like nothing happened, I am constantly aware that there’s still hidden healing going on.
How did we get here?
What we don't know?
Everyone keeps telling me I’m recovering so quickly because I was in such great shape, but no one can tell me what happened on the day of the accident. That great unknown has so far been the hardest part of this journey for me. The accident occurred on March 12th on what was just a scheduled training ride in preparation for the Oceanside 70.3 on April 1st. Riding a bike was my favorite outdoor activity of the three disciplines. I checked my Garmin data for the year 2022 and I rode almost 4,000 miles over 141 activities with a majority of those activities including a pass of the accident site. Why is this relevant? Good question. No one can make sense of why I crashed in that spot on March 12th and decided to lead with my head and not brace for impact. On that day my Garmin data doesn’t show anything unexpected. My heart rate, speed and power output were all within normal limits compared to previous rides and matched the expected output for the prescribed training ride (picture below). After four weeks in Colorado, Jess and I were able to make a weekend getaway from Craig Hospital and I did a quick inspection of the bike. It doesn’t appear to have had a mechanical issue and just a few cosmetic defects. Seven weeks later, the tires still had air in them, and the bike rolled freely and without any noticeable wobble from the wheels.
What do we know?
So how did we get here? That’s the question everyone wants to know, especially me. Unfortunately, we likely will never know what happened that day. As mentioned above, what I do know is that on Sunday March 12th I had a prescribed 3 hour ride in preparation for the Oceanside race on April 1st. It was a beautiful, sunny mid 60-degree day so I took my triathlon bike for a ride outside. I rode from my house to the Red Rock National Park and even took a few selfies, which is a normal occurrence and shows no signs of despair. I chatted with Boris as we both made our way through the park before turning right towards the town of Blue Diamond.
Like I said in the previous section, the Garmin data shows my heart rate, power, cadence, speed all looking to be within “normal” ranges for this ride. However, just past the Spring Mountain Ranch State Park and the entrance to the old Bonnie Springs, I made an abrupt exit from the road and stopped myself with my head. There doesn’t appear to be any signs I slowed down or braced for impact, so whatever happened was definitely a surprise to me. Boris saw the crash and immediately stopped to check on me. He was able to flag down a passing car for additional assistance and they all stayed with me until I was removed from the scene. The EMT’s that arrived on the scene assessed the situation and arranged for me to be transported via air ambulance to UMC, the Level 1 Trauma Center here in Las Vegas.
I have been filling in a lot of this information from what people have told me because I don’t even remember walking the dog that morning before going on a bike ride, so I’ll include the notes on my file from UMC about my admission process.
The patient is a male who was involved in a bicycle accident. He was biking at Red Rock when he crashed off the road. He was wearing a helmet. He was combative and GCS 10 at the scene per EMS. On presentation to Trauma Room, he was GCS Eye Response 1, Verbal Response 1, Motor Response 5 so was subsequently intubated. He was transferred to the CT scanner where he was initially hypotensive.
What is a GCS score? Well according to the National Institutes of Health “The Glasgow Coma Scale (GCS) is used to objectively describe the extent of impaired consciousness in all types of acute medical and trauma patients. The scale assesses patients according to three aspects of responsiveness: eye-opening, motor, and verbal responses.”
So now that I was intubated what did the initial imaging show?
1. Multiple left rib fractures, some of which are displaced
2. Moderate left pneumothorax (collapsed lung)
3. Small left upper lobe lung laceration adjacent to the left fifth and sixth rib fractures.
4. Small left hemothorax (blood between chest and lungs)
5. Consolidation in the left greater than right lower lung lobes, likely combination of compression atelectasis and aspiration.
6. Small right temporal subdural hematoma.
7. Multiple bilateral peripheral hemorrhagic contusions are seen.
8. Left temporal bone fracture with partial opacification of the left temporal
This is where I think the story is going to get a bit long and technical. I will include more content as described by my medical team as well as the updates my wife kept throughout the process. If you don’t want to read all of the medical details, please scroll down and finish with some more of my thoughts and experiences through this process. However, I do think this is a great time to give you a short version of the story and if you want to read the details they’ll be down below in a somewhat chronological order.
As a result of my accident, I had several non-surgical bone fractures on my left side, including ribs, scapula, clavicle, and temporal bone in my head, as well as a tympanic membrane rupture. As a result of the rib fracture, I had a collapsed lung that required a chest tube to be inserted for drainage. However, the bigger concern to the staff was the presence of several brain bleeds which is why they kept me intubated and sedated. I spent most of the first six days sedated, and a total of twelve days in the Trauma ICU before being transferred to a private room within the hospital. From what I’ve read and have been told, there was a lot of positive progress but there were also several incidents that were a lot less flattering.
At this point, I’d like to inform you about the Rancho scale that measures a person’s levels of cognitive functioning. It is a ten-point scale, and I included levels 1-7 below as my experience appears to be textbook to portions of the scale. I mention all of this because I have zero recollection of anything that happened to me at this point. There were portions of my stay where I was a Level I patient that had no response and there were definitely several instances where I was a Level IV, very agitated at the situation, and didn’t understand why I couldn’t go home. I’d like to say it got a lot better from here, but it was a slow progress for everyone climbing that scale.
| Level I No Response: Appears to be in a deep sleep and does not outwardly respond to pain or stimulation of the senses. |
| Level II Generalized Response: Will sometimes respond to stimulation by becoming more or less physically active. The person's reaction may be the same to pain, noise, a visual stimulus, or any other stimulation encountered. He or she will continue to "sleep" much of the time. |
| Level III Localized Response: Is awake a greater amount of the time and reacts more to what is happening around him or her. For example, the person may begin to turn toward sounds such as a door closing or to look at objects. Also, the person may begin to recognize familiar faces. |
| Level IV Confused, Agitated: Behavior may appear bizarre and out of character at this stage. The individual may act aggressively and attempt to remove restraints, tubes, or crawl out of bed. Talking may be incoherent and not related to anything around them. The person has a hard time remembering current events and may only recall what happened prior to the accident. |
| Level V Confused, Inappropriate, Not Agitated: More alert and beginning to follow simple directions. Situations or activities that are unfamiliar or difficult may trigger restless behavior or outbursts, but this happens less frequently. Concentration improved, but redirection is still needed. Poor memory from moment to moment. |
| Level VI Confused, Appropriate: Now follows simple directions consistently. Beginning to show awareness of the injury and may become frustrated or annoyed when they can't do things they could before the injury. Confused and disoriented at times. Attends activities for up to 30 minutes. |
| Level VII Automatic, Appropriate: Appears appropriate and normal on the surface. Goes through daily routine automatically but may have little recollection of what has been happening day to day or week to week. Improving awareness. Lack of insight and judgment for safety. |
Timeline
March 12th, admitted to UMC Trauma ICU
March 16th, they tried to remove my intubation tube, however I did not respond correctly to commands, so I was immediately reintubated. An MRI was subsequently scheduled to learn why my lungs met the criteria for extubation, but my brain did not respond to necessary commands to safely breathe on my own.
March 18th, my wife and father received the results of the MRI and were told that it might be another 3-4 days before they attempted to extubate again.
This morning the doctor talked to me and Dr. Larry about David's progress and MRI results. Unfortunately, the MRI confirmed that he has what is known as "brain sheering" or DAI in his front and temporal lobes, which basically means that the fibers in his brain have been stretched and damaged. They likened it to picking apart a cotton ball and the cotton fibers becoming more fluffy, rather than compact. It will heal, but is going to take time. More time than any of us were prepared to think about. Again, the weeks to months spectrum.
One positive note in addition to his lungs being in great shape - he had his neck collar removed, so he is definitely more comfortable. At this point, the only injuries of concern are his brain. All else are in (relatively) good spots.
Well, this is where that Rancho scale comes in to play. Apparently, I heard this and didn’t like it so I self-extubated not long after, which is really not recommended. Thankfully, I did not have to be reintubated and I am extremely lucky that I do not have side effects from my (subconscious) decision. On March 19th, my wife documented this occurrence this way:
I'm not even sure how to say this, so instead I'm going to scream it... LATE YESTERDAY AFTERNOON, DAVID RIPPED OUT HIS OWN BREATHING TUBE AND IS NOW AWAKE, BREATHING ON HIS OWN, AND TALKING!!!!!
He is very confused, but asked for me by name and knew his name. They had a nurse stay with him in his room all night due to him being a bit agitated while trying to understand what is going on. This morning they've already lowered his oxygen, which is absolutely amazing. When I got there early this morning, he greeted me with a "wtf?" and then asked me if I had his phone so he could show his nurse "the app".
March 20th, not one of my finer moments 😀
Extremely agitated and calling nurse names. Yelling to help him get up and that he wants to leave. When asked where he was going, he said he needed to go for a 100 mile run. Was put in full restraints, including wrists, ankles, vest for his torso, and mittens on his hands.
It is funny in retrospect, but I feel bad about what I said. I have never had a desire to run 100 miles, so it was clear that my head wasn’t all there.
The craziest part of this testing is that I remember none of it actually occurring. One of the more interesting things Jess and I discussed was she said that I was able to read a clock on the wall, so it amazes me how things don’t correlate. Even though I appeared lucid and could seemingly hold a conversation, my brain was not saving much to memory. One of my only memories during this time is when I was told I looked like Abe Lincoln without a hat, and I told them I knew where I could get one. The “hat” was a bedpan I knew was near my sink in the bathroom. Why I remember this and nothing else is a great question, but the fact that it was photographed is even better.
March 26th
We are hoping to know this week where we’re going for rehab. We’re trying to get into a specialized brain rehabilitation program at Craig Hospital in Denver. It’s a process, but will be worth it if we can get accepted.
The good news is that his personality is 1000% there. He can hold entire conversations, make real jokes the same way he could before, and remember events and ask you relevant questions about your life based on memories he has and the relationship. To be honest, it’s mind boggling. His long-term memory is so good that he can trick you into thinking he’s ok… until he tells everyone he’s excited for his race in Oceanside this weekend and asks me if he has his flights booked for Park City. It’s a weird black void in the brain, but typically prognosis can be good for recovery with brain healing and the right rehab. It makes my head spin.
This brings up another story that is funny to me now. My coach visited me, and I was coherent enough to ask how his long ride to Death Valley was. The reason that is relevant is because the only reason I did not go with him is because we were going to be in Park City the same weekend. Yet, I followed this up by asking him if he wanted to join us in Park City again not realizing that date had come and gone already. The not so funny part of this timeframe to a lot of people is I was determined we were going to still go to Oceanside and at least be by the beach instead of a hospital room.
March 29th, many people have been working behind the scenes to get me into a rehab facility and Judy Smart, the Critical Liaison from Craig Hospital, visits us in person.
It’s official - on Monday, April 3rd, David will be transferred from UMC Hospital to Craig Hospital in Denver, CO. Craig is the #1 specialized inpatient brain rehabilitation facility in the country.
March 30th, the day before the race I was training for I received a very nice photo from some of my Las Vegas friends.
April 3rd, we’re finally allowed to leave UMC! We are transported via ambulance from UMC to the North Las Vegas Airport where we boarded our plane with three very nice flight nurses.
April 4th-15th, it’s officially rehab time. My doctor, Dr. Maerz, visits me every morning and I’m introduced to a team of specialists in addition to the nurses and techs that continually check my vitals. My team consists primarily of an OT (Occupational Therapist), PT (Physical Therapist), SLP (Speech Language Pathologist), and a neuropsychologist. A big highlight for me is that I can leave my room to eat at the bistro cafeteria on my floor. I’ll give a "brief" example of my experiences over the first two weeks with my incredible inpatient team.
My initial OT was Dane Kawamoto. One of the first things we did together was a scavenger hunt to get acclimated with the four-story building that was now my home. It was a cognitive test where I had to follow rules and not forget tasks but done in a manner that also required pre-planning and was therefore informative for how my brain was functioning. I had to find places I had never seen or heard of. This was the first test for problem solving and organization. I figured out that I could use a directory and somehow knew that one should be near an elevator. Some of the tasks included finding out how many beds were on the 4th floor, finding two red college pendants in the gym, learning about the Peak gym and Gift Shop hours, and locating the Community Reintegration office. This last one was a big eye opener for me. I had no idea what that office was and what they did. Dane filled me in and let me know that they help with returning to work and driving. I had no idea I wasn’t allowed to drive at this point as I still had a license, but it made sense that it should be tested based on cognitive and physical changes that had been documented.
* During another meeting we assessed my shoulder and evaluated for potential rotator cuff injuries. Dane was able to convince my Doctor to schedule an MRI to inspect the shoulder.
* On our second week we did a really cool exercise where he asked me to plan my next race and prepare to cook a meal. The next race task brought up a lot of conversations on whether or not there ever would be one, but he wanted to see if I could find a location, plan lodging, date, travel, etc.; it was a fun task. The cooking exercise would be an occurring theme for the next two days. Below are Dane’s notes about this task – the short version is I didn’t burn the hospital down and none of us got sick, so it was successful.
4/12/23: Patient navigated to grocery store within community, using his phone for directions. Walked in community without AD with supervision, demonstrating good safety awareness when crossing streets. Independently performed grocery shopping task in novel store.
4/13/23: Patient completed hot meal prep this session and made chicken, vegetables, and croissants. Utilized 3 burners on stovetop and oven in a novel kitchen. Performed all tasks with supervision for safety with patient demonstrating good alternating attention and safety awareness when completing tasks. Patient also with good sequencing throughout activity and cooked meal efficiently. No LOB noted throughout activity.
My initial PT was Emma. This was definitely a challenge. When I was still at UMC I felt OK, but Emma immediately made me very aware that was not the case. There were a lot of physical tasks to measure balance and coordination that I am pretty confident that I wouldn’t have excelled at before my accident and really made me feel clumsy. A lot of the testing was then focused on strengthening my vestibular system (sensory system that creates the sense of balance and spatial orientation) which included single leg tasks, tandem walking (heel to toe) as well as doing these tasks with my eyes closed while rotating my head diagonally.
Working with Emma was the first time that I walked down a flight of stairs in weeks. It was amazing how unconfident that I felt just being asked to do the task. However, I learned quickly that the more I did them the more my confidence would return even when asked to do new exercises.
* In addition to these physical tasks, we also worked in some cognitive exercises. We walked up and down the hospital hallways while I would toss a ball up, catch it, and transfer to my other hand over and over while avoiding any obstacles in the hallway AND naming animals based on alphabetic order.
* My Speech Therapist was Megan. She was fantastic and very patient with me. We had a lot of sessions that varied from just talking about things to doing an auditory test to taking a huge number of Woodcock Johnson Tests of Cognitive Abilities. These blue books became my nemesis and I swear I’m going to buy a copy and torture my friends and coworkers with it. I really don’t like taking tests that I didn’t prepare for, especially after a full day including OT and PT sessions all without a morning coffee or an energy drink. I understood the reason for the tests, and I never felt overwhelmed, but they definitely weren’t easy. Overall, it was a noticeable challenge that measured my cognitive health. For me, just doing something technical versus laying in a hospital bed watching TV helped get my brain back on track.
* In addition to all the sessions at Craig with the practitioners, there were also several trips to the neighboring hospital for imaging that included CT scans, x-rays, ultrasounds, and MRIs. I was wheeled between my room and the imaging section of the hospital in a wheelchair by several very nice porters.
* About one week after arriving, I was moved from the east tower to the west tower, which has larger rooms for more independent patients, but I did get to keep my gurney bed. 😀
* I was lucky to be scheduled for multiple sessions in the Peak gym therapy pool for some water aerobics and aquatic PT. During our first session, we met another couple that was from out of state who were maneuvering a more extreme version of my journey due to a spinal cord injury from a fall while cleaning snow off their roof. It was also the first time Frank had been in the pool which was amazing to see as it just seemed to bring a sense of normalcy and joy. We were all impressed with the quality of the facility.
* After my shoulder MRI, I received a referral to an Orthopedic Surgeon. His PA met me in my room one morning and gave me the good news that the broken bones were healing well and besides some expected bursitis and edema, everything looked good and there would be no surgery required. He then gave me a cortisone shot to help me push through painful PT and said we will continue to monitor for improvement.
* I will let Dr. Maerz do a final summary for this part of the journey:
As above, Mr. David Lehrner is a male who suffered polytrauma including traumatic encephalopathy and a bicycling accident on 3/12/2023. After his acute medical care, David was admitted to Craig Hospital on 4/3/2023 for ongoing medical care and for a comprehensive brain injury focused rehabilitation program. David's overall progress was rapid both prior to admission and through his Craig hospital length of stay. He is therefore able to discharge on 4/15/2023 to the outpatient setting for ongoing treatment. In addition to this document, please reference outside hospital medical records in the Craig Hospital admission history and physical as needed for greater detail.
The primary admission diagnosis was the patient's traumatic brain injury. CT scan imaging was completed on 4/4/2023 and MRI studies were completed on 4/7/2023. As below, the MRI study revealed thin subdural hemorrhages of 3 and 5 mm in the right cerebral convexity and left temporal region respectively. Also seen were evolving contusions in the right temporal and parietal lobes. A number of images were seen throughout the bilateral hemispheres consistent with diffuse axonal injury. A likely contusion was also seen in the right frontal region. Left mastoid fluid was incidentally noted. An EEG study is scheduled for completion on 4/14/2023.
In addition to imaging studies, assessment by neuropsychology and other therapy disciplines plans was provided for David for his primary diagnosis of moderate to severe traumatic encephalopathy. Summaries of these assessments appear below. In addition, please reference full therapy notes in the chart as needed for greater detail. Again, David made rapid progress, such that he is safe for transition to the outpatient setting on 4/15/2023 to continue his therapy sessions and recovery before returning home.
Overall, Mr. Lehrner has suffered a significant injury, but is making very rapid early progress. He is ready to transition to the outpatient setting for further therapy on 4/15/2023. We have discussed on several occasions the timeline associated with recovery from this type of an injury as well as precautions to be taken to allow for the greatest recovery possible.
April 15th-17th, it’s officially checkout day from inpatient and outpatient starts next week! My sister flies in for the weekend and since we’re all staying in a hotel now, we can easily go to a normal restaurant for meals and get a pedicure.
April 18th – May 4th, I’m now an outpatient! The only negative about this is I now have to meet another new team. I’ve said it before, but everyone throughout this whole journey has been incredible – from their personal interactions to their domain expertise. However, it is difficult starting over when you had built rapport with someone.
We were finally able to get on the schedule with the Community Reintegration team to start discussing a return-to-work program and the return to drive program. My liaison within the Community Reintegration program is also an OT and has many years of experience in assisting patients in their return-to-work journey. After we had a meeting to discuss the intricacies of my job, she continues to act as my consultant to coordinate directly with my employer for creating a successful return to work timeline and educating them on what can be expected and what has been successful in the past.
* We made a few more stops to the neighboring hospital during this time for testing and a consultation. We were able to get the EEG Dr. Maerz wanted to rule out seizures before fully discontinuing some medication and I was able to see an ENT that verified my hearing was still good for my age and removed some residual remnants from the ruptured tympanic membrane.
* My new Speech Language Pathologist was Kara. After reviewing my results with the previous SLP we moved on to new testing to evaluate my Executive Functioning. There were four tests where I had to read a story and answer a series of questions requiring me to make decisions based on the information I had. One was planning my pretend workday based on the information I read, one was deciding on an activity to take a family member to based on the story I read and evaluating two laminated newspaper clippings of available programs, the third was coming up with a plan to talk to an owner of a roofing company after my repaired roof was now leaking, and the final test was a simulation of being a game show winner calling my parents and telling them I won the grand prize and that I was going to buy them something with the winnings. These all sound easy but the stories all had their own unique intricacies that had to be taken into consideration. After doing each test I was asked what my answers were and how I came up with them.
In the final week at Craig, I met with yet another new SLP named Allison who is licensed in the state of Nevada so we can continue the program via telehealth.
* In order to be eligible for return to driving, I was first required to complete a series of pre-drive testing to verify I was safe enough to be behind the wheel, even with an instructor. The screening tests were required for all disciplines – PT, OT, speech, and neuropsychology. It was a lot:
* * PT was first in the morning and there were many tests. First was just tapping my toes to a timer followed by doing heels only to a timer. Then I was asked to alternate my toes then heels while simultaneously doing the opposite on my other foot, not my specialty. After that was a basic vision test reading from an eye chart. Once I passed, another tech came behind me and swiveled by head back and forth and I was supposed to read the same small line on a chart while my head was moving. We then flipped the chair around and I had to look over each shoulder and tell her how many fingers she had out. We did this test again holding a fake wheel and finally we used a model gas/brake to react when a red or green light came up on a desk.
After this was finished, we did some actual PT where we did the Buffalo Concussion Treadmill Test (BCTT) on this very nice Woodway treadmill. It was a 20-minute test that started at a 3.5 mph walking pace. Every two minutes, the treadmill would incrementally elevate, eventually making it all the way up to a 15% grade. They then started increasing the speed. The final two minutes of this test were actually at a running speed up the 15% grade. Every minute I would have to give my perceived effort and they would compare that to my measured heart rate. It was nice to finally run again but I’m not planning to run up any hills anytime soon.
* OT was later in the day. First started with this red-light touching game. It’s a board with 100 dots in a star-like pattern and they light up randomly and you have to touch them. Many versions of this game. The first two times were just for speed. The following two tests I had to alternate touching with my right and left hand depending on what side of the screen it was on (right side illuminated, use your left hand, left side illuminated use your right hand). The last two tests I just had to alternate left right every time, while also paying attention to an LCD screen in the middle of the board and telling her what number was on the screen.
We finished our OT session by going across the street and doing a weird recognition test on a screen. It showed an animated car or a truck and then the screen flashed black and white like old school tv static, and you then asked you what you saw. There were three versions of that test. The second and third added a second item to the picture and you had to say where it was on a clock scale, 3 o’clock etc.
I then finally got to drive a video game simulator for practice. I drove through construction on busy city streets and back country roads. Thankfully, I managed to only hit one pedestrian who walked into the street from between two buses and get into only one head-on collision with a car that was driving on the wrong side of the road while attempting to pass another on a two-lane road. Somehow this was still considered “passing” and was told that there would be one more simulator test when I meet with the behind-the-wheel instructor before allowing me to hit the road in a student car where the instructor also has access to a gas and brake pedal.
* I also met with a neuropsychologist that had me do some additional testing. The first two tests were similar to tests I failed miserably at UMC that I never remember taking. The first version was connecting lines between consecutive numbers on a page. The second was similar, but also included the alphabet – so the number 1 connects to the letter A and the letter A connects to the number 2, etc. There was then a computer screen exam that measured my attention to detail and my reaction time. My goal was to press the spacebar as fast as I could when a letter appeared on the screen. However, if the letter X appeared, I was not supposed to press the spacebar. This was about a 15-minute test with the challenge being the speed in which the letters were displayed on the screen along with the frequency, but I was able to pass.
* Behind the Wheel Evaluation – in the end, I somehow convinced a panel of experts that I passed all the pre-screening tests and could now be scheduled for some real behind the wheel driving.
* * I met with Natalie, my instructor, and we started with some vision screening that was more difficult than anticipated. It was determined that my Lasik procedure is still good and I’m not color blind, but there were a few unique versions of this test that were more challenging than what the DMV normally does.
* Now that all of that was out of the way, it was time for one more simulator test. This time on the simulator I was successfully able to avoid all the cars driving at me on the wrong side of the road, the crazy pedestrians crossing the road in a 45 mph zone hidden between two parked semi-trucks, and the USPS vehicle crossing three lanes of traffic without a turn signal. That meant it was officially time to drive a real car.
* We went outside and situated ourselves in the student driver Honda Civic and started our first drive in the neighborhoods around Craig Hospital. Natalie has me call out if an intersection was a two-way or four-way stop, tested if I could remember a series of directions (next 3 lefts, etc.), and when we made it to the main street in Englewood, had me count any pedestrians I saw (how many and what side of the street). We then had a little fun doing two simulated emergency stops in a church parking lot before returning back to Craig Hospital to end our first session.
* We had a scheduled one-hour lunch break before testing was scheduled to resume. I met Jess and we headed to the downstairs Bistro and enjoyed our meal outdoors on a gorgeous sunny day. Afterwards, I headed back for the second driving session of the day.
* The second driving test was scheduled to be two hours driving on busier streets at higher speeds. I think we drove Southeast towards Lone Tree on wider roads before joining the interstate and then turning back to Englewood. Throughout both drives, Natalie and I discussed biking and running as her husband was training for a crazy ultra-marathon at extreme elevation and she had a long bike ride she was preparing for. This made it feel like a normal drive, rather than a test, and overall, she was pleased with my ability to multi-task and remain safe on the road. We finished this second drive slightly ahead of schedule and went back to her office where she let me know that I had passed and would not require the additional scheduled time on Friday. This was excellent news which meant Jess and I could return home a day early.
* Our first official team meeting occurred on May 4th. It was great to see the group together and hear them all confirm that they were pleased with the progress that I had made during outpatient. We spoke about the plan going forward and any follow-ups that would be required. The team agreed that I no longer needed to be in Colorado for outpatient sessions and we would conduct telehealth with Craig staff for SLP and OT with Community Reintegration. I received a referral for in-person PT in Vegas and was able to setup an initial meeting for the very next day
.
What I learned…
I just wanted to spend a minute and fill you in on a few of the things that I learned throughout this process besides all of the medical jargon that I have already mentioned. A lot of it will be focused on safety tips that I recommend, but I saved the best for last on the list.
First up is more of a recommendation to everyone reading this. No matter what sport you’re doing make sure you are wearing a helmet and make sure it is a good one. Virginia Tech has published their test findings in many sports including football, equestrian, hockey, snow sports and cycling. Please take a look and buy one of their highly ranked helmets for the sport you are doing. Here is a link directly to their cycling rating: https://www.helmet.beam.vt.edu/bicycle-helmet-ratings.html.
This will be focused specifically to Garmin users but I’m confident that Coros, Wahoo and others have a similar feature. Garmin has a feature called incident detection that works on their watches and cycling computers that will alert a list of safety contacts when it detects a potential accident. My wife was alerted on my accident automatically and she was able to see my specific location. For more information on it and how to set it up please see this link: https://support.garmin.com/en-US/?faq=RfaXahBWkH8Q7pVFLsuUmA
This item is focused specifically towards iPhone users but I know it also exists on Android phones as well. Please make sure you have your Emergency Contacts updated and update your Medical ID that includes blood type. Mine was setup and I’m not sure if EMS/Trauma used it or got the information from my wife but what if she hadn’t received the Incident Detection notice it was there and could have been used. Take a look at this link on how to configure it on your device: https://www.lifewire.com/set-up-emergency-contacts-on-iphone-5222039
This final one is a documentary movie that follows Kevin Pearce, a professional snowboarder that was a competitor to Shaun White, and his recovery from TBI he suffered in 2009 and includes some of his experience at Craig Hospital. It was released in 2013 and it is really a great way to learn about the severity of head injuries and see what is involved in the recovery process from the patient standpoint as well as the family and doctors. It is called The Crash Reel and it can be viewed for free on Amazon Prime Video at this link: https://www.amazon.com/dp/B0B8JWXS8W/
What have I been doing?
A lot of people have asked what I have been doing for the last two months. It’s actually pretty boring. I haven’t been binging any streaming shows and I’m actually quite behind on the shows I was watching. While I was in both hospitals, I ended up just watching a lot more local news than I used to and became very aware of the Denver broadcasters and their nuances. Once the Stanley Cup playoffs began, Jess and I watched a lot of hockey from our hotel, which was a nice way to wind down the day as the first round could have three back-to-back games.
Once I was discharged to outpatient, we did get to explore the Cherry Creek/Denver area. There was a nice little walking path along Cherry Creek where I was able to try and catch up on some Vitamin D. When my sister and friend came for the weekends, we explored the area restaurants, got a pedicure, and stopped at the Wings over the Rockies air museum. Jess and I made a trip to the iconic Red Rock Amphitheater to see it in person and one day we made it to the Garden of the Gods in Colorado Springs for a little hike. That hike was beautiful and was on a very accessible path.
In addition to eating and TV, I spent a lot of time reading. I read all of the handouts provided to me by the staff at Craig and finished a book Jess bought for me. Now that I’m back at home, it’s a little bit back to normal where we’re walking the dogs twice a day and going to Sunday family dinners including Mother’s Day this weekend. Overall, we both really feel like it has been a time warp where we can’t remember what we did and how it is already bedtime most days, which is a bit different than our normal scheduled routines.
How do I feel?
Overall, I’m feeling pretty normal. Like I said before, I got very lucky physically to avoid needing any surgeries and not having spinal injuries. The thing that I feel the most has been my shoulder. Putting on a coat (it was cold in Colorado), or drying myself after a shower, reminds me that my left side is still healing. It has been feeling better overall after the Orthopedic Surgeon gave me the cortisone shot. I meet with a local PT next week and am confident with time and work it will be back to normal soon.
A typical side effect of TBI is both physical and cognitive fatigue. From what I can tell it has been getting a lot better over the last few weeks. Most days I feel pretty normal, but intermittently it will pop up throughout the day. It feels like normal fatigue where concentration and motivation are limited. I sometimes have issues recalling words – they are on the tip of my tongue but I cannot place them. I also find I am more easily irritated by small things but working on recognizing when it happens.
To me the most accurate answer to the how do I feel question is: I’m ready to start contributing to life again, I’m tired of being a burden on people.
What’s next?
Now that I’m back home, the big question is what is next and what is and is not allowed? The easy question to answer is what is not allowed as it is a surprisingly small list. I have been told no alcohol for one year from the time of the accident to allow the brain to heal and no helmeted sports for six months from the time of the accident. I will work with my new PT to safely return to running.
I think the no helmeted sports will be the hardest as I really do enjoy being outdoors and group bike rides early in the summer mornings to avoid the heat. However, on the bright side there are plenty of alternatives available including riding indoors at Lifetime or Zwift online at home with other people avoiding the heat. I don’t know when and if there will be a next race, but my family was nice enough to set the bar really high and send me this amazing story of Rachel Foster that was able to complete the Boston Marathon six months after her accident. All that said, the real answer to what’s next is just returning to a normal routine that includes returning to work.
My coach (and friend) met for lunch on his birthday, and he had a great assessment for this entire situation. He said that I got to witness the good in humanity that most never get to see as it usually only happens when someone dies. It is very true, so many acquaintances, neighbors, customers, coworkers, bosses, friends, family, and strangers all reached out to me and Jess. That has been both a blessing and a curse as I am truly humbled by the outpouring of support received, while also finding it difficult to reconcile how I can I feel so normal, yet caused so much pain and grief to others just trying to do something I liked to do.
I’d like to finish by again thanking everyone that was part of this journey. Thank you to Jessica’s mom who made the trip from Naples, FL to stay with Jess immediately after the accident. Her dad joined us for my last week at UMC and my first week at Craig. Thank you to my mom and stepmom who joined us daily for our first 10 days in Denver, staying with family that doesn’t live too far away. And to my dad who came to experience my first off-hospital campus adventures since the accident. If it were not for everyone’s love, support, and your expertise, I’m confident we would not be celebrating my return home.
Update
Congratulations! You made it to the end! As a reward, I'd like to invite you to check out my update of what happened after I returned home that I published a few months later.
