For the relentlessly adventurous, learning the deeper lessons of injury starts with a tough rule: You break it, you own it.

May 1, 2005
Outside Magazine
Dealing with Injury

Illustration by Matt Groller

I'M FALLING. HORIZONTAL IN MIDAIR, my face seeing the empty sky, my back toward the rocky ground 20 feet below and, 700 feet below that, the bottom of New Mexico's Rio Grande Gorge. Nothing comes from my mouth, but my mind is electric, hurtling faster than my body. This can't be happening.

What takes place next I don't remember, exactly—like sinking into a deep sleep while watching a violent movie, dreaming, waking, the movie still playing. I will only piece it together later from the accounts of the six friends who were climbing with me on Dead Cholla Wall that bright October day.

Midflight, I curl into a ball as if doing a gymnastics maneuver, hit the ground on my back—somehow missing the jagged rocks all around me—roll ten feet backwards into the sagebrush, bounce to my feet, and ridiculously ask my belayer if she's all right. Her face is as white as marble.

"I'm OK," I tell her. "My wrist is broken and I need to get to a hospital." I follow her eyes and look down at myself. My left hand is facing the wrong direction, the wrist unnaturally lumped.

"I have to walk out," I say.

I don't remember how I got my climbing harness off. I remember cradling my left arm in my right hand and determinedly scrambling up a large boulder and down the other side. Five feet along the trail, I'm flooded with nausea and know I'm about to pass out. I drop onto the dirt path and try to put my rushing head between my legs, but it's already swirling away. Lightning explodes behind my closed eyes and everything is flying off inside me. If this were the first time, I would think I was dying. Instead, at the very center of the maelstrom, I recognize what is occurring: I'm going into shock. Later I will be told that my body was convulsing.

The next thing I remember, Rob is looking into my face, but I can barely see him. His face is at the end of a long, black tunnel, talking to me. I can't make out the words. They sound like glue. I study his face and can see he is worried and I try to unstick his words.

"Mark, stay with me. Mark, stay with me. Mark."

I know I have to respond, but I don't have a tongue. So I grow one, like a plant in my mouth.

"I'm OK."

"Mark, you may have a head injury."

I am burning up and shivering uncontrollably, hot cold sweat draining from my flesh. I know this is shock and that it will pass.

Two things will stand out above all else. The first is Rob holding my head in his hands, talking to me, reassuring me. Rob, I'll learn later, is a certified wilderness first responder. He knows what to do, and though gravely concerned, he does it with the stoic composure of a natural leader. He feels the back of my head and neck with his fingers, dribbling water into my parched mouth. He removes the sharp rocks from under my ribs and thighs. Calls for the ropes and lays them over my legs; covers my chest and arms with fleece jackets. Tells Gordy to run to the top of the cliff with the cell phone. But I don't recall these acts. What I remember is this: Rob right there talking to me, his voice calm as a warm eddy, circling back again and again. "You're gonna be fine, just fine."

Then Janine is by my side, holding my good hand, and Ki is on the other side, stroking my head, and they both look so scared I try to tell them a funny story about a past wreck, but I can't tell if I'm doing a decent job of it.

The EMT helicopter comes into my slice of sky, and somehow a moment later the flight nurse has a morphine IV in my right forearm and an air splint compressing my left arm. I don't have a head wound after all; it's just a badly broken wrist. Do I think I can walk out? I can try. The chopper disappears over the dusky gorge without me.

Walking turns out to be difficult. The steep, switchbacking trail is loose underfoot, and I have to concentrate on each step. I have no balance. I am moving very slowly, the paramedics and a parade of climbers behind me. It is cool in the shadow below the cliff. The far rim is flaming, with ebony depths below. The sky is the color of blue you see only in dreams. I understand that everything is the way it should be.

It takes me half an hour to walk half a mile. I'm being helped into the back of an ambulance. Evening sunlight, warm and quiet as air, is cutting across the red desert. Friends encircle me. Hal shakes my good hand and says Katie is going with me, and I have to smile.

The jeep road is rutted and I groan when we hit bumps, but none of it really matters now, because we're on our way across northern New Mexico. This is the second thing that will stand out above all else: Katie knowing it is not necessary to speak, only to be at my side.

It is dark outside the ambulance windows now. The EMT is trying to get my medical history, which makes me laugh.

I'VE HAD MORE WRECKS in my life than I can count. A bad concussion from a rockslide while climbing a mountain in the Black Hills when I was five years old. A broken collarbone fighting with my grade-school nemesis atop a fence. Multiple concussions and a broken back in gymnastics, Mom always there, nursing me through some rough nights. Broken toes in karate. Broken hand and cheekbone bicycling across South Africa, my brothers surprised at the pumpkin sound my head made when it hit the pavement. Broken ribs alpine-climbing. Broken leg telemark-skiing, which required a plate and six screws to put back together. A torn biceps tendon ice-climbing. A triple hernia from carrying heavy packs in the Himalayas. A shattered shoulder mountain-biking, two bones sawed off and cobbled back together.

Not to mention all the frostbite, altitude sickness and diseases, the punctures, incisions, and stitches, the number of times I went too far in northern Burma, eventually splitting my mind into unidentifiable pieces. The truth is, physical injuries can often be less devastating than mental injuries. When your mind is broken, it is impossible to recognize that the pain and terror you are experiencing are surmountable. Sometimes this can be too much to bear. Hope is healing. Without it, everything goes unspeakably black.

Now: a mangled wrist.

I deserved it all. In every case, I was inattentive to something critical. I realize this is a failure of character, but I have not been able to correct it.

Most people do not deserve their afflictions. The daughter with AIDS. The mother with Alzheimer's. The brother crippled by a drunk driver. The father with inoperable cancer. The 16-year-old girl in Iraq, legless from a smart bomb. They are all victims of the unfathomable cruelty of fate.

But me—I've deserved every accident that's felled me. They have been good for me, every single one. An accident is a cryptic message. Your body is just the messenger. And it's up to your heart to decipher the meaning.

THE DISLOCATION is reduced at the hospital in Taos, but there are so many broken bones that I'll need surgery. I fly home to Laramie to have orthopedic surgeon Michael Wasser nail me back together. He's done it before. The carpentry takes three hours—anchoring down ripped ligaments, tweezing out bone fragments, running in a long screw. My wife, Sue, calmly reads in the waiting room, as she has many times before—worried, but you'd never know it. Her faith in my indestructibility is a fathomless ocean that buoys me upward.

General anesthesia and I have long-standing animosities, and I take time to come to. The post-op nurses will say I was kicking so hard I rammed my legs through the hospital-bed rails. When I at last return from this expedition of the mind, Sue gets me home and in bed. She patiently spoon-feeds me a bowl of soup while my daughter Teal reads me her report about African elephants: "Did you know that elephants poop 80 pounds a day?" With narcotics paralyzing my insides, I'm just hoping to go at all.

I awake at night in agony. My wrist feels as if it's being smashed in a vise. At 4 a.m. I finally admit that this can't be right, and Sue bundles me off to the emergency room. Dr. Wasser is there in minutes. I have the beginnings of compartment syndrome—pressure from the stitches is restricting circulation and could permanently damage the muscles and nerves in my hand. He gives me two options: go back into surgery immediately or snip the deep sutures without anesthetic so I can relate whether the pressure has been relieved. He suggests that Sue leave the room. I almost puke when he starts cutting, but it works.

"You're getting your M.D. the hard way," he says after finishing up. "One limb at a time."

I am readmitted to the hospital and intravenously plugged into a bag of Dilaudid—hospital heroin. I depress the self-administering plunger over and over. Soon I'm surfing my hospital bed like an out-of-control ten-year-old. Nurse Jeff is grand. I believe the other nurses rotating through the night to be the most beautiful women on earth.

I'm quite certain it would be best to spend another month or two here; alas, after two days I'm released upon the shoulders of my wife. My surefootedness is gone, and Sue must support me. She already has our bedroom set up for my recovery, a bouquet of sunflowers, cattails, and red berries blossoming from atop the dresser. Both daughters start to cry when they see me. They have made get-well cards. Addi's is poster-size and double-sided, a poem of word-pictures: "whenever you want a huge scoop of ice cream let me know . . . you are somewhat free, so lean back and have fun . . . this accident is just another one of your memories. . . ."

Janine sends me a bouquet of sunshine: brilliant yellow daisies, lilies, and roses. Katie mails me a new world of music in CDs and poetry. Megan leaves a mountain of date cookies in the house. Sarah makes us a spinach quiche, and Craig cooks us spaghetti and meatballs. Ken drops off a gyroscopic wrist rehabilitator/torture device. Pat pulls me out of the house and we drive up to the mountains to photograph the snow-rimed walls we intend to climb together.

I need protein to heal, so Sue is making the most magnificent sandwiches for lunch: grilled pastrami, turkey breast, and provolone on black rye. Yogurt full of fresh fruit. My mother comes over with a book about fathers and daughters. Alyson drops off two volumes of short stories and a novel.

I've done nothing to deserve all this kindness. Getting hurt is like dying without having to go that far. Those you care about unself-consciously show how much they care about you.

Tomorrow, next month—sometime— someone close to me will be hurt. Then it will be my turn. Will I give back all that I have been given? But why wait for an accident? Why can't I develop the humility to show compassion without pretext?

EVERYBODY ASKS ABOUT the pain as if it's a bad thing. Actually, I made friends with it years ago, and now Ms. P. and I have an intimate relationship. We don't see each other for a while, then we meet again and it's like no time has passed. I have learned so much from her. She shares truths I prefer to ignore. For instance, I have a tendency to live as if I were not mortal. She won't put up with such arrogance and sets me straight. And when I forget how many people are suffering all over the world, she reminds me. With her help, after every accident, I am humbled. Without her, I would be a compassionless ass.

Spending time with Ms. P. is just one gift of an injury. There are many.

Any injury worth the time will slow you down. Precisely what we all desperately need. An injury will make you do one thing at a time. You'll re-remember that multitasking only means you're doing several things poorly. Injured, you must focus on one thing for it to happen at all. With this singularity of focus comes happiness, for you have been released from distraction, the most corrosive disease of 21st-century life.

With only one hand, it takes me minutes to button up my jeans. Try it yourself. For the first few days I can't do it at all and have to wear sweats around the house like an incontinent old man. I can't squeeze toothpaste onto my toothbrush; instead I squeeze it onto my tongue. Like a kindergartner, I can't tie my shoelaces; my daughters do it for me, giggling.

I start using my mouth again, like a dog. To pull on my shirt. To pull it off by the sleeve. To unscrew a ketchup cap. To lick food off the side of my face. Our tongues, lips, and teeth are so useful and yet so underutilized.

By necessity, I learn how to do two things surprisingly quickly: popping open the childproof bottles of painkillers with one hand and typing swiftly, without pecking, with that same hand.

If challenge is something we all need—and I believe we do—then all this has been good.

One morning about a month after surgery, I decide to remove the splint, snip out the sutures from the three incisions, and try moving my fingers. First just wiggling them, then little thrusts. The swelling has gone down, and I can almost cup my fingers.

My wrist, however, is rigid as wood. It's swollen, deformed, and still faintly yellow. Any movement at all makes me jump. Doc Wasser is concerned that it might not be healing properly. My first second opinion recommends another surgery, a radical procedure that involves slicing me open from little finger to elbow, sawing off bones, drilling holes—a surgeon's wet dream. My second second opinion thinks that advice unwise and pronounces that I can expect 80 to 90 percent recovery of mobility and strength, plus serious arthritis. Given that my physical life is not only my passion but my livelihood, this doesn't exactly set my one hand to clapping. My third second opinion comes from a hand surgeon who also happens to be an accomplished climber and kayaker:

"No surgery and no predictions," he tells me. "Mark, do your rehab like your life depends on it. Expect recovery to take six to 12 months."

I know the drill, and it's going to hurt. Rehabilitation, conducted with religious fervor and monklike discipline, is the only way to get back to doing what you did to get hurt in the first place.

I already have every wrist rehabilitator ever made: two sets of grips with different tensions, two individual finger grips with different tensions, two different rubber webs, a set of small weights, a climber's rubber squeeze ball, a golfer's twistable grip stick. They are strewn about the house—in the office, in the bathroom, in the bedroom, in the kitchen.

My physical therapist says, "Compliance is usually the problem. It hurts, so patients don't do it. You have the opposite problem." She tells me to do only one session a day. I do my best to keep it down to three.
I use the whirlpool at the gym every other day. I hold my injured appendage under the hot water and slowly twist, rotate, spell the alphabet with my fingers. It is not tedious; it's therapy. Another chance to calm down, take time, breathe.

Some days my wrist appears to be improving and I'm exuberant. I see myself in the future, rock-climbing again, jamming big, strong hands into wide cracks, swinging ice tools into frozen waterfalls, pushing my girls on the tree swing, hugging my wife. Some days I know I've overtrained and must stop exercising, and doubts about my recovery emerge from the shadows like boxers I can't possibly beat with just one hand.

These are the emotional ups and downs of rehab. I try to accept it. Acceptance is one of the greatest lessons a serious injury can teach. Unfortunately, it will probably take a few more wrecks before I learn it. My mountaineering partner, John, and I have had to cancel our climbing expedition to Tibet. That's fine—the mountains won't go anywhere. In lieu of Tibet, he's invited me to do the Eiger with him this summer, slyly giving me a rehab goal.

Pat has gotten me over to the indoor climbing gym. I can barely hang on, of course, so we work the wall for only half an hour. Then we do hundreds of sit-ups to prepare for a route we hope to climb when the weather gets warm.

In the first month after the surgery, my neighbor Reed took me out walking almost every day. We do this whenever either one of us is injured: a fast clip for an hour or two to get the blood pumping. We talk about everything under the sky.

Over the winter, we skate-skied together in the Medicine Bows, without poles. We'll keep doing that right through May here in Wyoming. I may have twigs for arms, but I'll have Apolo Ohno thighs.

Sue is running stadium stairs with me. She talks, and I try to keep up.

And I'm back to bicycling to school with Teal and Addi. Simply riding beside them is a joy.

They say it's the circulating blood that causes the healing, but I believe it's the flowing love.

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