There are a handful of moments in life where you are supposed to be the expert at something and the universe just wants to let you know who is in control. In July of 2021, the universe decided I could use a break. Unfortunately, that break was my ankle.
As many of you know, I run a training program for physicians who are wanting board certification in Sports Medicine. Part of my role as a Sports Medicine Doc is to cover various sporting events and train others how to do it. My background in sports is mostly centered on skateboarding, BMX, surfing, and snowboarding. This is why I love my job so my much. I run the only program in the country that focuses on action sports as of this writing.
At the start of our academic year I had recently hired an Associate Director of Sports Medicine, Dr. Ellexis Khan MD. We had also just hired our new Sports Medicine Fellow, Dr. Justin Mauser MD. The 2021 summer X games was to be their first day on the job. We had a great team, as always, but this year we were overstaffed with physicians that I had personally trained. Mauser was my prior resident and had spent 3 years with me. Khan was a prior student of mine and had just completed training under Dr. Andrew Nobe. Nobe was a prior Sports Medicine Fellow of mine and was also present at X games with us.
The venue for BMX was located at Pat Casey’s house in southern California. The ramps were impressive and they had a great flow to them. Once our EMS crews arrived on-site, we did our typical venue walkthrough. This involves inspecting the course and evaluating access points or points of failure. During the course walkthrough, it was decided that one section of the ramps was difficult to access if someone were to have an accident on them.
At the very back of the venue there was an elevated flat section located behind a large quarter pipe. On one side of the flat you had a roughly 15 foot drop off and on the other you had the roughly 12 foot quarter pipe. There was simply no easy way to get a spine board up to it and no easy way to get someone off of it. I made the executive decision to do a practice spine boarding session on this ramp so we could figure out how to safely move an athlete in the event of an emergency.
We decided to immobilize Dr. Nobe because he was the smallest of us. Our team climbed up to the ramp and began to strap down Nobe onto the board as I stood on the deck of the ramp directing them on what to do. Once he was strapped and secured in place, the ramp team lifted him and handed him to the team waiting on the deck of a nearby 8′ quarter pipe. The initial team then climbed down to the flat section at ground level, while I continued to direct the movements of the team around a couple obstacles.
We placed the board on the deck of the ramp and began to slide it towards the ground team. The ground team was reaching overhead to grab the edge of the board and began to pull him off the deck of the ramp. I moved to reposition myself on the ground level flat section, so I could direct the team around a few more obstacles to the final exit point.
The Moment of Truth
Sitting down on the coping of the quarter pipe, like I have done hundreds of thousands of times before, I proceeded to push off and slide down the ramp. When I hit the transition at the bottom, my left shoe got caught and hung up on the ramp surface. This caused my left foot to forcefully rotate externally, plantar flex, and evert all at once.
The sound was deafening, like a shotgun going off with a sharp bang. It was the type of sound you hear and needed no other information as to what just happened. I tucked my shoulder and began to roll forward as I carried my momentum to the bottom of the ramp. I landed flat on my back staring up at the sun. The venue was dead silent for a few seconds. I could feel something was off with my left foot.
Gently grabbing my leg, I lifted it off the ground and looked. I don’t think there is any amount of mental preparation that could have helped the visual image of what was laid out before me. Sitting there on the ramp, leg in hand, staring at inevitability, I felt like I had failed my team. My foot had successfully dislocated from my leg and the top of it was now touching the back of my calf. I was essentially kicking myself in the back of the knee.
I slowly lowered my leg back to the ground and laid back down. The spine board, with Nobe strapped to it magically appeared next to me. Dr. Khan made eye contact with me and the look on her face confirmed the obvious. Looking up at her with a smile on my face, I was secretly enjoying the irony of what just happened. I said to her “I just broke my ankle, didn’t I?”
At that same moment Dr. Joel Buzzy MD approached my side and offered words of hope reminding me that it could just be dislocated. I looked at him and laughed while saying “We all heard it.”
Looking over to my right side, where Nobe was patiently strapped to the board and waiting, I said “sorry brother, I have to take your ride.” A few moments later our medical team had removed Nobe from the board and placed me on it with my ankle in a SAM splint. They lifted me up and began to exit the venue. I was placed in the back of the ambulance and carted off to the hospital.
Irony is a funny thing. There I was, onboarding a new faculty member and a brand new Sports Fellow and I explode my ankle. I suppose this is where I claim how serious I take education and wanted to make it a really memorable experience for them. Unfortunately, humor doesn’t make it hurt less; the pain doesn’t make it any less funny though.
I texted my wife a photo of me on the gurney in the back of the ambulance. She didn’t respond. I later found out that she thought it was just me doing another training thing with everyone. It took her roughly 4 hours to figure out there was an IV in my arm in the photo. She knows I absolutely hate needles and would never volunteer my arm for training.
I ended up having surgery on my ankle the next day. It took 18 screws, 3 plates, and 2 wires to put it back together. Timing for any injury is almost always bad. This one could not have happened at a worse time. Trying to on-board a new faculty plus a fellow while simultaneously organizing college physicals for two schools was nearly impossible. All things considered, I only missed two weeks of actual work.
Clinical Outcomes and Return to Work
I spent a full week on inpatient in the hospital. This could be a story on its own given the rough experience I had with a very particular nurse but we will save that for another day. They discharged me to home and I spent the next week trying to balance sleeping, tv, and pain management. By the end of that week, I was pretty burned out and couldn’t wait to be somewhat mobile again.
I borrowed a scooter from a colleague at work just so I could move around. We managed to get all the college physicals done while I laid on the exam table with my leg elevated and reviewed all the paperwork for the Fellow. I am still not sure how we made it work but somehow the whole team rallied and we were able to get both schools completed and running before our deadlines.
Life Changing Moments
The big point in this story is that “shit happens” and it can change your life instantly. There was a point in time where I was stuck upstairs watching through the window at the birthday party for my daughter going on in the back yard. I could hear them singing and blowing out candles. There was a moment of despair as I realized I had failed my family. I was unable to be present for a birthday party because of my injury. It was almost a soul crushing experience to feel trapped and knowing I couldn’t be there for them.
Just when all hope was fading, my daughter came in to the room. I choked back the sadness and buried it with a smile that only us parents know how to do. My daughter had left her own party to bring me a piece of cake. Its hard to to maintain appearances as a parent. Kids, in the lack of wisdom often do remarkable things. Things that show depth of character that we as parents fail to give them credit for.
My daughter knew I couldn’t be there but she wasn’t upset at it. She understood what was happening. She had the empathy and understanding that I wanted to be there but physically could not. Her solution was to bring me a piece of cake so we could have that one moment of sharing her birthday together. It made me proud to have such an amazing child.
The Take Home Message
It is strange to think how these tiny gestures of empathy and understanding can change your life. I had been burning that proverbial candle at both ends for quite some time with work. We all were. It was an unintended consequence of COVID as a physician. The few years of covid leading up to this event I had been contemplating the purchase of a Sprinter van. I had a hard time pulling the trigger on the purchase because of the price point. It wasn’t until this injury slowed me down enough to realize the time I was missing out on.
Working like we all do as parents is exhausting. Then we add in the extras like kids sports, music recitals, and other school functions. It doesn’t leave much time for experiencing the “family” for what it is. Lily was smart enough to know that even though her birthday was going on around her, she needed to make sure I felt included. This is the gesture that pushed me over the edge. I wired the security deposit and signed the purchase agreement the next day for our Sprinter Van. It has been the single most expensive purchase of my life, and the time spent with the kids has made it worth every penny. My ankle injury may have been the best thing that could have happened to me because it drastically changed my perspective on things.