A World of Hurt
Injury, pain, the psychology of recovery, and getting back on the trail
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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?”
LET’S SEE. Before the torn rotator cuff it was a triple hernia caused by carrying too many ridiculously heavy expedition backpacks. Before that, separated ribs from an unexpected slip on an ice-coated, thousand-foot wall. A torn biceps tendon while mountaineering in Mexico. A broken leg (shiny six-inch plate with six long screws) telemark skiing. A smashed patella, a crushed cheekbone, a broken hand. They’re considering naming a wing after me at Gem City Bone and Joint.
There may be some serious outdoor athletes who have never been hurt, but I don’t know any. All my friends have scars and the stories to go with them. If you’ve never hurt yourself, you’ve likely never pushed yourself. Climb enough mountains, mountain bike enough miles, kayak enough rivers, and you will get injured. This is not a probability; it’s a money-back guarantee. Wrecks come with the territory. The world is one giant garden of cliffs, canyons, and cacti, and if you’re out there exploring it for any amount of time, you’ll discover that flesh is softer than stone, weaker than water, and highly vulnerable to velocity.
Hence we veterans of the outdoor life all have our proud lists of injuries, which of course make for some fine tales of struggle and heroism. But don’t be fooled. Injuries are mistakes made manifest. Rare is the accident not due to pilot error. You can’t blame the world—it is what it is. The nature of nature is fundamentally merciless. You can’t blame ice for being itself, transient, capricious, unfaithful; nor rock for being existentially rock-hard and immobile; nor water for being fluid, fast, and reckless.
This is the first lesson of injury: to take the blame.
THE NURSE was right. I came out of the operation looking and feeling like someone had tried to cleave my shoulder from my body with a broadsword. For the first week I could do nothing more than lie in bed and moan. Any movement was excruciating. Even in sleep I was sheathed in agony. I am still doing my best to forget every second of that first week.
(A note about the difference between doctors and nurses. Doctors do not care about your pain. Don’t expect them to. They know pain will pass, eventually. Doctors care about the ends, not the means. If you are capable of getting back to the life you had before you messed yourself up, they have done their job. Nurses, on the other hand, care about the means. Listen to them closely. Heed their advice.)
It is common to curse the thunderstorm of pain, but it often brings forth that most rare and delicate of flowers: humility. It is difficult and peculiarly unbecoming to be puffed up with pride when you are too weak to sit up. Arrogance evaporates when you need help going to the bathroom. Machismo melts with pain. If it hurts bad enough, you will break. This is extraordinarily useful self-knowledge.
To become an invalid is to pass through perhaps the most important veil of life, the veil of compassion; to be just like the people you might ordinarily ignore, the old, the weak, the disabled, the sick. All those gray-faced people, thin and fatigued, suffering some imperious malady that you, purely by the whim of the gods, do not have to face. One twist of fate and you’re just like them. Hurt, hurting, in need of help.
A serious injury doesn’t affect you alone. What about the person who steps up to take care of you? My wife fed me that first week, put ice packs on my shoulder and a damp cloth on my forehead, helped me to and from the toilet.
This is the second, albeit greatest, lesson of injury: to be humble.
THE SECOND WEEK, friends began dropping by and leaving gifts. Ed, a philosophy professor, my bicycling compadre and intellectual foil, left It’s Not About the Bike, by Lance Armstrong, and Seven Pillars of Wisdom, by T. E. Lawrence (the redoubtable Lawrence of Arabia). Wade, my climbing partner, left Camp 4: Recollections of a Yosemite Rockclimber, by Steve Roper. Ken and Carol, skiing companions, gave me a glossy dream-book of photographs of Patagonia. Richard, my college mentor and also a philosophy professor—a Woody Allen humor omnibus. Bill, an old history professor—the obscure and brilliant works of Patrick Leigh Fermor. Annie, fellow scribbler and tough thinker—The Immortal Class, by Travis Hugh Culley. John, colleague and expedition partner—a bottle of Captain Morgan rum and the current issue of Playboy. My mother—a tape of a lecture, “Choosing the God Who Answers by Fire,” by the Rev. Dr. James A. Forbes Jr. Vicki came by with a vintage bottle of tequila. Rick slipped a six-pack of Guinness into the fridge. My daughters drew me entire books’ worth of get-well pictures.
Sometimes, all you have to do is fall off your bicycle—something seven-year-olds manage without getting hurt—and you find you are connected to the souls of others by a thousand invisible cords. This is lesson number two in reverse.
ON THE NINTH DAY after surgery I shaved, left-handed, almost taking off my head. Day 11, I typed the whole day, left-handed. Day 13, I walked three blocks, had a relapse into incapacitating pain, and spent the next 24 hours in bed.
The third week, the horror of rehab began. My physical terrorist was a man named Jim Scifres. Big Jim. He was soft-spoken and easygoing. Jim had once been a football player. He’d busted his own shoulder. He weighed 260 pounds and could have ripped my arm off. Instead, he bent it, bit by bit. He told me to let pain be my guide, which I found hilarious. If you walk through a physical therapy clinic you will hear people screaming behind the curtains. Were you to literally let pain be your guide, you’d never go to physical therapy. You’d stay home, eat popcorn, watch old movies.
If you want to get better, it’s gonna hurt. Big Jim serenely denied the validity of this philosophy, and then blithely proceeded to put the hurt on me. Before the end of our first session he showed me some stretching exercises I should practice at home. I did them more religiously, more rigorously than a Tibetan monk does his straight-backed recitations.
The fourth week I showed up for my second appointment barely able to move. Jim asked me what I’d done, and I admitted I’d tried to do a push-up.
“Time somebody told you the truth,” he said. “Four to six months for 75 percent recovery, a year to full recovery. You won’t be doing push-ups anytime soon.”
The next time I saw him I was almost paralyzed. He put my shoulder in one of his Greco-Roman holds and asked me what I’d done this time. I admitted I’d done 200 reps for each exercise. He shook his head and suggested I try 20.
And so it went. Jim would put the hurt on me, then I’d go home and hurt myself on my own. All those years of mountaineering, the most masochistic of endeavors, stood me in good stead. Jim complained that I was the most noncompliant patient he’d ever had, but I don’t believe it. I did everything he said—every stretch, every exercise—500 percent.
Thus the third lesson of injury: to be patient.
Except that I don’t think I really learned it. I wanted to, I tried to, I fully recognized this wreck as my propitious opportunity to work on one of the outstanding inadequacies of my character. And I gave it my best shot—but in the end I think I was mostly pretending. I don’t think the true ennobling nature of patience really sank in. Every time I had a slight bit of improvement, I’d idiotically come to the conclusion that I was healed, go out and scrabble up an easy pitch or two or enter a bicycle race, then pay for it.
AFTER TWO MONTHS I couldn’t stand it anymore. I had to do a trip. I couldn’t yet come close to doing a pull-up. I couldn’t do a push-up. But what of it? All that meant was that I couldn’t climb or kayak or mountain bike or ski or carry a heavy pack. I still had legs. I could still hike. A mountain with maximum elevation gain but minimal technical requirements would be just what the doctor ordered. (Ha!)
It occurred to me that if injuries are little clues that we are mortal, there’s at least one mountain in the world that mortals were once not permitted to ascend: Mount Olympus. In Greek mythology, Olympus was the exclusive abode of the immortals—Zeus, the forever philandering god of the sky; Hera, goddess of marriage, his jealous and cruelly conniving wife; the ugly but good-hearted Hephaestus, god of fire; Aphrodite, goddess of good sex; and the rest of that fractious pantheon. Nothing pleased the Greek gods more than good, old-fashioned adventure (consider the struggles of Prometheus or Hercules). For a recovering invalid, climbing Mount Olympus seemed an appropriately hubristic first foray back into the backcountry.
Not any partner would do. It had to be someone who had suffered as much as I from his own stupidity, preferably more. Stephen Venables—friend, colleague, renowned British alpinist, and author of humorous books about Himalayan climbing—came immediately to mind. Stephen had lost most of the toes on his left foot after bivouacking high on Everest in 1988, and yet claimed that “losing the little piggies wasn’t really an injury at all, just occupational wear and tear—or, shall we say, unfortunate erosion.” In 1992, at the end of an otherwise safe, successful expedition to the Indian Himalayas, a piton popped during a rappel and he took a 300-foot fall, breaking both legs. In his book A Slender Thread, Stephen describes this episode with such characteristic British understatement and wry comedy that you almost forget he nearly died.
Stephen responded to my first e-mail with “sounds like good fun” and to the second with “deification imminent.” A week later we met in far northern Greece on the shore of the unbelievably emerald-blue Gulf of Salonika.
Mount Olympus rises 2,917 meters, 9,570 feet above sea level. We started our hike in the village of Litóchoron, some distance up from the topless beach, giving us a healthy 9,000-foot ascent. Penetrating the Enipeus River gorge, which cleaves the eastern flank of the massif, we passed through terrain seldom associated with Greece—a deep, mossy forest of giant beeches, walnuts, and holly oaks, matchless terrain for Artemis, goddess of the wilderness and the hunt.
Not one hour into the woods I knew the gods were with us. We had stopped for some bouldering on a pristine block of limestone. I set my sunglasses aside and they promptly vanished. After 45 minutes scouring the hillside, we abandoned the search effort. Kneeling to shoulder my pack, I spotted them, crushed into the gravel underfoot in a spot I had probed ten times. Hermes, the mischievous god of thievery, was up to his old tricks.
High in the cleft we passed the ruins of the Monastery of Saint Dionysus (splendid to think of the god of wine and debauchery transformed into a chaste Christian icon), switchbacked through Balkan pines with trunks four feet in diameter, and spent the night in the Spilios Agapitos hut.
Zeus was out carousing well into the wee hours, bellowing with lecherous laughter, tossing thunderbolts left and right, apparently chasing every virgin nymph and maiden this side of the Acropolis.
We set off for the summit at dawn, passing beyond the timberline into jagged alpine country. Stephen, formed of equal parts madness and wisdom, stopped so often to admire, name (“Campanula oreadum, Jankaea heldreichii“), and photograph the alpine flowers that I took to calling him The Gardener. The night before, Zeus had left an inch of new snow on the last thousand feet of the climb. It was no more than a steep scramble up into dark shrouds of mist, but the snow made the limestone slick and treacherous, giving my rebuilt shoulder a good test.
Aeolus and his four chiefs of the cardinal points—Boreas, Zephyr, Notus, and Eurus—were wrestling ferociously when we reached the sharp summit, throwing us one way, then the other. Clouds were springing to life on the leeward side of the peak, obscuring the view down, but off in the distance the Aegean Sea shimmered like the Golden Fleece. We humans are not immortal—we fall, we break, we die—and yet, to fulfill our own mythic dreams, we must live as if we were. Stephen and I shook hands, two gimps at the top of Greece.