The Fall

April 29th, 2007 was a sunny, beautiful day at Smith Rock State Park. I was paired up with one of the climbing club's strongest climbers for an instructor, a middle-aged fellow who had climbed, let's just say, "a lot of impressive stuff." I'll call him John.

Right out of the parking lot, I gave my usual disclaimer: I was primarily interested in learning to place gear well, I was not looking to push my climbing technique on lead. He wondered why. The conversation went something like this:

"Because I don't want to fall."
'Have you ever fallen before?"
"Not outside, only in the gym."
"Then there's no reason to be afraid of it, right?"

I didn't grasp his logic there. Confused, I didn't push the point.

For the morning, I led strongly. I was feeling good. John climbed up to investigate my gear placements on my first two climbs and was quite satisfied. He showed me a less common but effective way to place nuts: rather than placing them so that they were getting the most surface area contact on both sides, if I found the right sized notch, I could slip the nut behind that notch and use the entire head of the nut like a stopper. There was no surface area contact happening this way, other than with the very top of the nut being pulled against the rock, but regardless, with the right placement and slinging, there was no way that the nut could be pulled from the crack

The next climb of the day was Carabid, a 5.6 trad route that John suggested, partially as a way to get out of the hot sun. After scrambling up to the start, he pulled out the guidebook and read me the description, explaining that there may be some areas where it would be hard to protect. He offered to lead it if I wished. I considered it for a moment, but was feeling good and ready enough to take a shot at it, saying, "If I get sketched, I'll just come back down."

As the guidebook puts it, Carabid would be a good beginner lead if it weren't for run-out sections and as I found, some navigation issues towards the top.

The first part of the climb went well. I placed gear quickly and regularly along the route, making sure that at least every second piece of passive protection was "backed up" by a cam here and there. I recall looking down once and thinking, "this would be a bad climb to fall on," because of how many ledges and blocky things there were that could cause what climbers like to refer to as the "cheese grater effect" (the way that on some lower grade climbs, because of the angle, you tend to tumble down them rather than fall straight down). Immediately following the first voice, another voice in my head said, as if to coach myself into the right space, "but you aren't going to fall on this."

When I was almost to the top of the pitch, I found the difficult part: a bulge which also happens to be the crux, close to the anchors (although I couldn't see the top yet). It was difficult to know whether to go right or left to get past this area. I climbed up to the left first and didn't like what I saw so I went back down and off to the right. I liked what I saw there even less so I decided to try left again.

Meanwhile, this bulge was not protectable (there is nowhere to place gear). I had looked around for any little pocket but the bulgy, cruxxy area was slabby and without any holes or pockets or cracks. The closest place to put in protection below this bulge was about 7-10 feet down: that is where my last nut was- a small nut about the size of my thumbnail which I had placed in the "new" way that John had showed me.

My second time trying to go left up this route, I took quite some time looking at it, trying this way and that. I recall the urge to just commit myself to it and go for it, which I did. When I got about few feet up this bulge, I realized I was stuck: I couldn't find a handhold, I couldn't move up it. At the same time, I realized I couldn't really back down to where I'd been either because of the angle of the slope; I definitely *was* committed to this move. All of this mental processing took place within a couple of seconds: "Crap- I can't go up OR down."

And then I felt myself losing my ability to hold onto the bulge, being slightly overhung. I felt myself peel away from the rock.

As loud as I could, I yelled, "Falling!"

I don't remember if I screamed after that, but I'm guessing I didn't. Probably because of the slightly overhung quality to this bulge, I inverted, flipping over and falling head first. That was the worst part: not being able to see what was coming as I fell. Because I was left of the rope trail, as I was falling, I was swinging right like a pendulum. I remember my left elbow and arm hitting something on the way down but I honestly don't remember if I felt any pain; I just remember registering that I'd hit something and then my thinking, "okay, what next? when will the pro catch?" I continued to fall for what seemed like several more seconds.

Finally, I felt a significant jolt when the rope caught and my back and head hit the wall; I was still upside down.

(My nut had caught me, only I didn't realize it yet. I actually hadn't even remembered what the last piece of pro was that I had placed- I thought maybe it had been a cam. But I would find out later that, in fact, my entire bodyweight, on what was about a 25-30 foot fall, was held by this little tiny nut. I have wondered many times if John had not showed me this other way to place nuts if that little nut would have held. Regardless, I am deeply thankful that the little nut held. The next piece of pro was another 7 feet below or more.)

John hollered up to me, "Are you okay, Tamara?!"

I checked myself out and saw my disfigured left elbow, bulging out in a sickening way.

"I broke my arm!" I shouted down.

"Can you turn yourself right side up and I'll lower you down?"

Slowly- and I don't remember how I did it entirely- I got right side up again and he slowly lowered me down to the start of the climb.

I had taken mountaineering first aid the previous spring and interestingly enough, was "with it" enough mentally to know what to do as the patient. I sat down immediately and leaned against the rock. Within a minute or two, I felt hot and cold chills filling my body and the world started spinning.

"I'm going into shock- you'd better cover me up or something," I said to John.

Within a few minutes, several guys arrived at the base of the climb. They had been climbing near me and had seen my fall. They introduced themselves as Wilderness First Responders and started asking me questions. I noted that they never checked me for head or back injuries but I was fairly certain and reassuring to them that I was fine in that regard- although in hindsight, they really should have insisted that I be checked over. One of them began to splint and swathe my arm with my clothing and climbing slings while John and one of the others tried to decide what to do next.

As I sat there with my back leaning up against the rock, trying to process what had just happened, an understanding came into my head, more or less in the form of a voice:

"You need to relax now and breathe deeply. Stay relaxed. The pain will be more bearable if you can relax. Just let these guys take care of everything, take care of you. Your job now is to relax and breathe."

With single focus and every ounce of courage I could muster, I willed myself calm. I continued to talk to myself and remind myself to breathe and relax, focusing only on that and not paying attention to anything the guys around me were doing.

I had honestly always wondered how I would handle a medical emergency or trauma, should anything ever happen to me. Would I be one of those screaming patients, freaking out and panicking? When I'd taken mountaineering first aid, I certainly felt like I was going to faint several times just *hearing* about and imagining particular injuries. In fact, a classmate of mine told me once that I looked so green during some of the lectures that he hoped nothing bad would ever happen on any future climbs I would go on.

But here I was, breathing deeply, only speaking to answer questions, just focusing all my energy and attention on staying calm and keeping my arm still. Something in me took charge and coached myself through the next few hours.

Since the start of the climb was 30-50 feet above the actual trail, up on a ledge, I would either have to scramble down (without hesitation, said no to that), they would have to carry me down the ledge (another definite no- was not going to risk getting more hurt or dropped) or they could build an anchor and lower me down off the ledge: yes, that was the option of choice. In hindsight, had I been the giver of first aid, I would have rappelled down alongside the victim to make sure they got down okay.

So I was lowered down off the ledge, asking several times for them to go more slowly, as I kept getting jostled by bumps, rocks and bushes I would have to navigate past- and every jostle sent a wave of pain throughout my arm and body.

When I finally reached the trail, there was a 4x4 waiting for me. I opted to walk a little further before getting on since the trail at that spot was uneven and I didn't want to risk falling off the thing. Then I rode the 4x4 through the park, back to the base of the hill, across the footbridge, slowly, being partially held onto the four-wheeler by the class organizer, Jill, who had arrived at the base of Carabid when she received the cell phone call from John- a call I don't remember being made.

Burned into my head is the memory of looking up at the rocks as I rode out, telling myself that my elbow had only been dislocated and wondering out loud if someone could just pop it back into place. This is where being in serious denial is a true blessing in an accident: had I known the true state my elbow was in or what I would face in years to come, I would not have been able to stay calm.

After the 4x4, I was driven up the dirt road up to the parking lot. In my "stay calm" state, I was carrying on a conversation with the driver of this park service truck that was wheeling me up this dirt road full of boulders and struggling to make it uphill. "So, if my arm is dislocated, how long do you think it will be before I can climb again? Will I miss the class next weekend?" He laughed.

I refused the ambulance waiting in the parking lot, not knowing if my insurance would cover it, and asked Jill to drive me to the hospital in Redmond. Heck, it was only a 10 minute drive and I didn't think the extra 10 minutes of being on morphine (the only real advantage to the ambulance) was worth whatever I would have to pay out of pocket.

The primary pain I was feeling was from the intense cramps going up my arm. I didn't understand the pain at the time, but in hindsight, since I had not simply dislocated my elbow as I had thought, but had fractured the ulna, radius, olecranon and had torn off all of the ligaments, the muscles were cramping because, with still being attached to the bones which were going every which way, they were all out of whack, likely being stretched and pulled in strange directions.

Getting in and out of the car was surprisingly painful. I had to suck in big deep breaths and move like a 90 year old granny. Once I got out of the car, there was a wheelchair waiting and I was whisked inside the Redmond Medical Center where they got me started on filling out paperwork.

"You've got to be kidding," I thought.

Still thinking my elbow was simply dislocated (oh, that denial!), and having learned in first aid how important it is to reduce a dislocation (put it back in joint) as soon as possible after the injury or risk further damage, I recall asserting myself with the nurses and staff, saying something to the effect of,

"Look, I think my arm is dislocated here and it needs to be put back in joint as soon as possible- can we just skip the paperwork and get to it?"

But of course, everyone but me could plainly see that there was more going on with this arm than a dislocation.

"We'll need to get some x-rays before we can do anything," I was told.

I was taken into the back, into a curtained-off room where the process began of getting x-rays. We found out with those x-rays that I was less than an inch away from having an open fracture- where the bone punctures the skin from the inside out. Those kinds of fractures are dangerous: one can die quickly from infection.

So, thus began the experience of The First Surgery.... starting off with my Redmond Medical Center extravaganza...

Climb On

Maybe it wasn't the best way to approach it, but my first trip back to Smith Rock since the accident was also the first time I really attempted climbing again.

The morning of the first two days of climbing, Saturday, as I waited in the parking lot for my group and instructor to gather, the rumbles of anxiety in my gut started spreading from butterflies in my tummy to an electric buzz in my head; I was starting to feel rattled just seeing everyone else suiting up and gathering ropes.

I began to think that maybe I wouldn't even tie-in that weekend; perhaps I should just observe.

I comforted and coached myself internally: "Tamara, you don't have to do anything you don't want to. You don't have to explain or justify anything. You don't even have to put on your harness if you don't want to. Only you understand everything you're feeling and everything you've been through, so don't worry about what anyone else thinks..."

As our group started down the path into the park, the instructor began asking me about my accident. In trying to relate to me, he began to talk about climbing falls in general and the kind of head spaces people are often in when they fall.

"How were you feeling when you fell?" he asked me.

The dreaded question. I understand why people ask it but I honestly resent that question.

In previous rock climbing classes, I'd heard many a lecture on overcoming fear; I'd heard so much about "just breathe and smile," about how to not let your head get the best of you.

But I find that mindset painfully simplistic for a situation that can be very complex. And for having gone through all that I have, for someone to ask how I was feeling- well, aside from it slightly implying that I fell because I was afraid I was going to fall or that I fell because I wasn't thinking about the right things at the right moment (in a sense, it was my fault), it's a minimizing (and somewhat insulting) question that doesn't take into account the entirety of a situation or the three-dimensional nature of a person.

But I answered his question truthfully.

"I was actually feeling pretty good. I'd had a really great day up until that point and was leading strongly. I was feeling like challenging myself. I remember thinking that this would be a bad climb to fall on because of all the blocky ledges everywhere, but otherwise, I felt pretty strong."

No, I hadn't been freaking out or panicking or looking down a lot or thinking I was going to fall.

If I did anything wrong just before I fell, it was in being over-confident and taking for granted the fact that I was on lead, was a beginner at placing gear, and that I was on a run-out route which was difficult to protect in places.

However, just hours previous to my fall, I'd told my instructor that day that I wasn't interested in pushing my climbing skills, I simply wanted to improve my skills at placing gear. He asked why.

"Because I don't want to fall."
"Have you ever fallen before?"
"No."
"Then why be afraid of it?"

Strange logic, yes.

I had never been interested in taking unnecessary risks, in falling on lead. I'd been extremely careful for the entire class, backing off of things when I felt doubtful. So it was poignantly ironic that I did end up falling in a moment of feeling strong and that I ended up paying a pretty big price for it.

And lord knows, I have been analyzing and overanalyzing my fall since the day it happened. So for someone to ask me, "how were you feeling right before you fell?" as if perhaps it had never occurred to me, makes me roll my eyes. I've tortured myself relentlessly about that moment of judgment- and all the moments leading up to it.

I've tortured myself about the fact that only hours previous to my fall, I was expressing a need to be careful (was it a premonition?). I've anguished over the fact that I felt like that concern was being minimized by my instructor (what if he'd not minimized it? would I have done anything differently?). And then after his consistent encouragement all morning I started to feel strong and confident. And then that afternoon, I fell. That strange reversal has haunted me quite a bit.

So, for someone who's never had a serious fall, for someone who's never had to grapple with the fact that they may never climb or kayak or have the active life they live for again *because* of a fall (and the arduous PT and rehab and three surgeries, and...), it's all too easy to simplify an accident as being due to the wrong head space.

And I don't blame the guy for asking but there was a voice inside of me that was whispering, "You have no idea. How can you ask me that?"

So that was how the first day of climbing began.

However, perhaps it wasn't such a bad thing. His questions put me a little on the defensive regarding all I'd been through, and it caused me to realize again that there was really no way I could ever explain it to someone; therefore, I had no reason to adjust my climbing or lack of it according to what anyone else had to say. If I couldn't bear the thought of putting on a harness that day, so be it.

So for the rest of the day, I didn't feel guilty saying no.

For once, I didn't push myself.

I didn't tough it out, I didn't feel much need to explain, I didn't care what anyone thought. I refused to scramble up a low 5th class ledge without a rope. I took my own sweet time on my first rappel (and then found that the carabiner the rope was through had been left unlocked). I climbed only half way up a 5.7 sport route then asked to be lowered down when the waves of anxiety were protesting loudly. I respected myself, I respected my fear, I honored the fact that these first steps were going to be the hardest. "For christ's sake, Tamara," I thought, "you need to be patient with yourself."

I needed to be as compassionate and caring for myself as I would be with a scared child needing comfort and reassurance.

Interestingly, the following climbing day, I worked with an instructor who asked me nothing about my accident or my mindset but only said, "You just do whatever you feel comfortable doing today. There's no pressure. If you want to take a walk, fine. If you don't want to climb at all, fine." So not surprisingly, I climbed two routes that day. I still only made it half way up a 5.7 sport but this time, I was first in line in our group to jump on it. I was feeling ready to process this whole ordeal. And I was still able to back off the climb when the anxiety voices became significantly louder than the compassionate voices.

I found that what really got to me was the height. It wasn't so much just being on rock again. The higher up I got, the louder the protesting in my gut. This probably doesn't sound surprising, but I had honestly expected that just being face to face with rock, to begin with, was going to be an issue. But that part wasn't too bad. So after that sport climb on the second day, the one I just jumped right on first thing in the morning, I gave myself a few hours to decompress and volunteered to be a belayer.

While doing so, a guy from the class I was taking when I fell showed up to help out. He was surprised to see me and with delight in his voice he said, "Wow, it is *so* good to see you back on the rock, Tamara."

His comment surprised me in a curious way: I hadn't put myself in someone else's shoes, looking at me from the outside. It hadn't occurred to me that others would be surprised to see me out there. Throughout the months, as I started doing mountaineering again (not so much pure rock), I did receive comments like, "It's great that you're not letting this get you down- some people would just stop climbing entirely, rock or snow. Some people would just quit."

But the idea of willingly giving up on climbing without a fight was so far-fetched to me, for the kind of person I am, that it was an interesting perspective shift to stop and consider that others would have understood if I'd decided to do that. It was still a little difficult- though not impossible- for me to get my head around the idea that others were proud of me for being out there that day. From the view inside my heart and head, it wasn't a matter of "if"; it was a matter of "when." It was simply something that had to be done.

Soon after my accident, there was a fleeting moment where it had crossed my mind that maybe I would (peacefully) decide to never climb again, even if I was able to. After all, at first diagnosis, I was told that I'd never be able to flex or extend my elbow more than a range of 90 degrees, losing about 60-70 degrees. However, as I started to recover and as it became clear that I was going to surpass that expectation by a long shot, I knew I would have to at least top-rope again. Sure, maybe I'd never have "the head" to lead rock again but if it was in my heart to climb again, I'd find a way to do it.

(I'm incurably stubborn.)

And I knew all of this not because I have some sort of ego wrapped up in it or because I'm some sort of bad-ass or because I just "can't learn my lesson the first time." I knew that I'd have to eventually get back on the horse because I simply can't live in the shadow of something. I didn't want anything to have that kind of power over me. If I was going to stop rock climbing, I wanted it to be because I simply just (casually) decided I was done (irrespective of my fall) and not from being haunted by a past trauma.

So in my mind, of course I was back! Of course I'd have to return to take back a little bit of my power and get out from under the shadow of this whole ordeal.

Later that afternoon, I decided to do one more climb to see if I could make it to the top this time. It was a blocky 5.5 sport route which I had actually led the day I fell- but here I was following it, glad that it was easy climbing (and glad to be on a tight belay from above) because just getting up that high produced enough anxiety on its own.

As I set up my rappel to come back down, I felt a sense of relief mixed with pride. I hollered down at a friend to get a picture of me on rappel to document the fact that "Tamara is back."

I held out my left arm to wave at the camera, reminding myself to not take my right hand off the rope in my state of celebration.

It was good to be back.

Scary, but good.

Returning to the Scene of the Accident: Rising from the Ashes, Resurrecting Life From Loss

Returning to Smith Rock State Park for the first time since my climbing accident there was an event I had been anticipating and had been imagining in my mind over and over for the majority of a year.

(<--That's a picture of Carabid, the route I fell on. About half way up the spire is the top of the climb. I fell right before that.)

Some friends and I had driven down a day early, before our climbing class, and they went for a day hike while I ventured out on my own. There was some playful teasing in the parking lot beforehand about me bringing dynamite with me and showing that route just who was boss.

"We'll know that you've found Carabid when we hear the explosions."

"Carabid? Oh that route was blown up years ago by Tamara Turner.... "

The laughing and jokes were a welcome relief from the building nervousness inside of me- nervousness at the thought of finally being back, facing this place again. I had anticipated that it would be emotional and powerful but I didn't know exactly how I would react once I got to the base of the climb again, this time alone, in silence.

Every time I had imagined it in my head, tears would come.

I would mentally relive the whole ordeal: getting up onto the crux, realizing I had committed myself to the move because I couldn't back down, realizing I was not going to make the move and I was going to fall, the fall itself, flipping over backwards, hitting my elbow, the rope finally catching and the hours afterwards of shock, rescue, the hospital, the emergency surgery....

So after almost 11 months of anticipation, here I was- finally.

It took me a little longer than I anticipated to find the start of the climb. The start is tucked up above some ledges which require a bit of scrambling. I'd been wandering around the general area looking for the right place and kept seeing this lone Canadian goose sitting atop a ledge. It caught my eye several times. Too lazy to pull out my guidebook, I decided to go investigate the goose and sure enough, he was sitting right at the base of the route where we had dropped our packs and anchored.

Goose marks the spot.

Because it had already started to snow by that point, I decided not to risk scrambling up the wet rock to the base of the climb and stayed down below the ledge where I could still see the route. And the goose.

When I got there, I threw down my pack, pulled out my stick of sage and eventually got it to burn despite the wind and snow. I let the smoke of the sage wash over me (a Native American purification tradition I had been taught years and years ago).

After all this time, now it was just me and the rock.

Feeling somewhat empty at first, waiting for the emotion to hit me, I noticed I was almost holding my breath to see what would happen inside. I took some pictures of the route, even a couple videos. I took some self-portraits of myself with the rock in the background.

Then I sat down, staring out at the river with the climb at my back and recalled an email I had received from my mother that morning, encouraging me about my trip back to this place.

She had reminded me that I come from a lineage of incredibly strong women and that to her, I was like a phoenix rising from the ashes of this whole ordeal. She went on to tell me how proud she was of me but the words about the phoenix had lodged in my head.

Then suddenly, as if a light had just switched on, the realization flooded me that the name of the area where I had fallen is called the Phoenix Wall. The symbolism of that hit me in that moment and emotion rushed over me. Chills went up my spine. Tears came rushing in. I couldn't believe that it had never occurred to me before- the metaphor. After the many times I'd answered questions of where I had fallen, "The Phoenix Wall..." it had never clicked in my head how symbolic this was, considering all I'd had to overcome since then.

That was the moment I felt a mysterious and beautiful purpose to all of this. Something bigger than myself was in motion here.

Now, I wouldn't say that I'm necessarily a superstitious person but it is these sorts of moments in life that confirm for me that there is much more going on in our lives than meets the eye. It is these types of moments that make me continue to want to listen carefully and intently to the ways life whispers wisdom to us, whether through other people, animals, "coincidences" or whatnot. These are the sorts of moments that drive my own personal spirituality.

The moment I made the "phoenix" connection was the single most powerful moment of the experience being back there. From that moment forward, I felt a kind of peace and acceptance I'd longed for and had not yet felt. It was almost as if everything in my life was unfolding the way it was meant to. How much more encouragement could I possibly feel from the situation than to realize that I had fallen on Phoenix Wall- and I had succeeded at being a "phoenix"? Being a person who looks for and appreciates multiple levels of meaning and existence in life, this was inexpressibly heartening.

The moment that the phoenix symbolism hit me was the perfect timing. It registered just when I needed it most: within moments of being back. I could not have really fully appreciated it before that moment.

"You have risen from the ashes of this event.... "

I spent about 2 hours at the base of the climb, mostly just sitting there looking up at it, studying the route, trying to decide where exactly I fell, what I possibly hit on the way down, where I came to rest about half way up the pitch. Then I studied the ledge which I was lowered off after the fall and in one of the cracks of that ledge, I tucked a piece of crumpled-up paper.

On that piece of paper I had written the word "Loss" on one side and "Gratitude" on the other. I had so much to be thankful for and yet, had so much I had to grieve. It was necessary to embrace both.

A phoenix really isn't a phoenix without the destruction part. That's the beauty of it. There's a death/destruction of some kind. And then, there's the rebirth/resurrection. Both parts need to be there. So in making peace with the Phoenix Wall, with Smith Rock State Park, it was only appropriate that both elements be present in my process. Both Loss and Gratitude. Death and Rebirth.

Already blown away by the symbolism of having fallen on Phoenix Wall, having risen from some pretty overwhelming ashes, I decided to look into the meaning of the word "Carabid" when I got home. I didn't think my jaw could drop any further than it already had, but it did.

Carabid is the name for a type of beetle.

In Native American spirituality, as well as other traditions (such as Egyptian mythology), the beetle has tremendous significance. Because it rolls balls of dung and lays its eggs inside, it has long been associated with new life and turning "shit" into something useful. In addition to that, the beetle is a symbol of resurrection because of its dynamic metamorphosis from the grub stage to the winged stage.

The parallels just keep getting more intense...

Just weeks previous to me revisiting Smith Rock, but completely unrelated to it, my sister had sent me an email about the symbolic meaning of the beetle. And on top of that, my mother had been to Egypt in the recent past and had bought me a beetle bracelet, after having seen the beetle symbolism all over the Pyramids.

As I sat at the base of the climb that day, along with writing Loss and Gratitude on a piece of paper, I had taken another piece of paper and had written all sorts of other words on it that had meaning to me. Resurrection and Transformation kept landing on the page. This was before I learned the meaning of the word "Carabid."

So, I'll say it again: for something so unfortunate to have happened in my life, I am beginning to think that there is something bigger at work here- maybe even something quite beautiful unfolding. Considering where I've been, the emotional and spiritual and mental territory I have braved since my fall, I could not feel more cradled and cared for by life, the universe- whatever you want to call it- than I do since making these connections.

In my mind's eye, returning to Carabid had always been a kind of agonizing experience. When I would play it out in my mind, intense regret and sadness would come up. There was a lot of angst over it.

But being back there, although emotional, was actually incredibly freeing and releasing. I didn't feel angsty. Tears definitely came flooding over me, remembering the experience. But there was a feeling of acceptance emerging inside of me that I hadn't expected. They weren't hot tears anymore- they were cool tears. Tears of acceptance rather than tears of regret.

And although I would take back that fall, undo it if I possibly could, opt for not having had that experience if I had the choice, I feel a growing sensation inside that everything in my life is unfolding as it should- or at least as best and as beautifully as it possibly can.

Not only am I now a phoenix woman on Phoenix Wall who has risen from the ashes, but I am a winged dung beetle on Carabid who turned a big ball of poop into something promising, something hopeful, something transformative.

Balancing Both Loss and Gratitude: When Having Courage Means Surrendering

As I was packing to leave for my trip down to Smith Rock, my first trip there since my accident, a dear friend mine dropped by unexpectedly.

She told me that she had been thinking about me, about this trip, and all that would be going on inside my head and heart.

"So I wanted to give you this...," she said as she placed a small piece of metal into the palm of my hand and closed my fingers around it.

I opened my hand and studied this smooth, rock-like nugget in my hand.

Etched into the nugget was the word "Loss"

She explained that she knew I had spent so much of this last year mustering courage, being strong, fighting the odds. And yet, she wanted to remind me that it was important for me to just accept the pain of the loss I've had- that it is okay to just feel that loss and accept it, surrender to it.

What an incredible gift this was.

Though I have so much to be grateful for- grateful that my head, back, neck and life were spared, grateful that I came out of that accident as well as I did (all things considered), grateful for superb medical care and rehab, I really haven't given myself that much time to just feel the loss, to let the feelings surface and flood my body. I've only begun to let myself grieve.

And in order to fully release this experience, in order to really make peace with this place, I do, in fact, need to just accept the loss that I have experienced. I can't fight it. I can't push it away with courage and strength and determination. All of those qualities are wonderful but there is a certain point when you just have to let yourself experience the pain in your heart.

You have to breathe it in.

Loss.

It is a scary thing to totally embrace it. I don't really want to feel the helplessness or victimization feelings that come with that. Admitting to and feeling all of the loss I've had in the last year or so (physical, emotional) leaves me feeling vulnerable; it reminds me how fragile life truly is and how little control we have over so much of it.

But there is no escaping it. I can't- and shouldn't- try and mask that helpless, vulnerable feeling by powering through it.

Perhaps, I decided, it is more brave to admit vulnerability and loss than to rail against it with determination.

So as I was sitting at the base of Carabid, the climb I fell on, for the very first time since the accident, one of the things I did to make peace was to write the words, "Gratitude" and "Loss" on opposite sides of a piece of paper. Focusing on all I had to be grateful for as well as accepting all I had lost, I crumpled this piece of paper and tucked it into a crack at the base of the climb.

*******************************

PS: After having written this post, I learned later that the same morning I was at Smith Rock for the first time since my accident, writing the words Loss and Gratitude on that piece of paper, my mother had seen a rock in a store with the word, "Gratitude" on it and bought if for me with this particular trip back to Smith in mind. It was a word that had just come into my mind that morning as I'd been thinking about how to balance the feelings of loss. This "coincidence" definitely made me pause in awe about the kind of wavelength she and I share.

Anticipating A Reunion

Today, I am going to Smith Rock for the weekend with a climbing class. It will be the first time I've been back there since my accident. I'm going down a day early to have some "alone time" so that I can begin to make peace with myself and the place.

The last time I was there, I was being evacuated/rescued from my fall. I remember looking around the park as I was being hauled out, looking up at the rocks, still quite in shock and disbelief. My last impressions of the place were of pain, disbelief, and a slow-motion. surreal fog.

My plan is to walk to the base of the climb where I fell, sit there and see what happens inside of me.

I joked with some friends last night that maybe I would kick the rocks a few times.

"Take that!"

And wouldn't it be funny if I then ended up breaking my toe and coming out of there with a toe splint.

No, I don't think I'll be kicking anything.

It's peace I want.


In thinking about all of this, these words came into my head the other day and evoked some strong emotion, which I will try to remember this weekend....

"Tamara, you have suffered enough.... "

In my head and heart, I will be holding these words and feelings of compassion, of self-forgiveness, of peace.

It is time to let go.

Silver-plated and Screwed

This is the metal plate, about 3.5 inches long, that was removed from the under side of my ulna and the 8 screws that locked it into place.

Man, after 10 months inside my arm, it's good to have that thing out of me.

Before the surgery to have it removed, I said to my doctor, "I know this is going to sound weird, but when you remove the plate and screws, can I keep them? You know, for posterity. Maybe put them on my fridge, make a necklace out of them...."

My doc didn't look surprised or appalled at all and replied that it would be no problem. Perhaps me asking to keep the end of my radius bone, which was sawed off in my second surgery, had set a precedent for the kind of patient I was so that asking to keep my plate and screws was comparably "normal."

(Coincidentally, they didn't let me keep the end of my radius bone, unfortunately. Being human tissue, it was considered a bio-hazard or some such thing. It's just kind of weird to think that the end of my bone was just "thrown away" in a garbage can of sorts.)

I haven't decided yet what to make of the above hardware. I'm taking suggestions, however.

So far, the options on the table are:

-a bad-ass looking choker necklace (you know, all goth and stuff)

-a broach

-a crown ("I'm a princess!" a reference that perhaps only Curt will appreciate)

-a magnet for my fridge

Something needs to be done with it... Feel free to comment with any ideas.

A normal-looking elbow.

For the first time in close to a year, I have a fairly normal-looking left elbow.

Yesterday, in my boredom at work, after our server went down again, I peeled off the tape strips across my scar which were put on after the stitches were taken out, as some sort of backup I guess.

I got my first look at my unadorned , "new" left elbow. No pointy plate, no strange ridge along my ulna, no stitches, no tape, nothing.

Now, it's just me and my long pink scar, which over time, might fade entirely.

A normal-looking elbow.

I've never really considered myself all that vain but soon after the second surgery, I did have some struggles with the thought of having a freaky looking left arm. At that point in time, it was still swollen up, pointy and misshapen and with the stitches still in, fairly Frankenstein-esque. It took a couple months for me to really see what it was going to look like with the plate.

After I got used to the idea that it was just going to look funny, I didn't care so much anymore; I just wanted to get it working as much as possible.

Still, there is a definite feeling of relief settling in with the visual relative normalcy of my arm again. And in looking a little deeper- I am always finding a deeper meaning in everything- I sense that there is something bigger going on besides vanity.

Having that plate taken out, having a "normal" looking elbow again, except for some scars, symbolizes an ending.

So often, throughout this process, I found myself thinking, "I just want my normal arm back..."

So there's something about it that feels like an old friend coming home. "Ah, there you are, my real left elbow- not some robotic-looking thing..."

My elbow hasn't resembled anything like this since the accident. It's always been in a splint or in a brace, in a machine, or pointy-looking with its plate.

So that's the end of that. Just me and my scar. As normal as it can possibly look. And after all it's been through, it's pretty amazing.

I'm told that my elbow might be an ongoing project for the rest of my life, learning how to work with it and its new limitations due to the trauma it endured. But there's something about having as much as my arm back as possible that feels really good. Having that plate out is like having a bit more of normalcy, a bit more familiarity, a bit more of Tamara back.

Sure, on one level, it's just a darn elbow. Big deal.

And yet again, there's incredible symbolism in it. It is a metaphor for my life.

A little bit more of me is back.

The Month of Continuous Motion

The month of May 2007 was probably the most difficult of my entire recovery process to date.

Because of my elbow reconstruction, my surgeon/doc had the brilliant foresight to put me on a CPM machine. CPM stands for “continuous passive motion.” As soon as I had come out of the recovery room following my surgery, I was hooked up to this machine and it did not leave my side for a solid month.

It definitely became a complicated, crazy-making but miraculous love-hate relationship. The machine was a major factor in my exceptional recovery. So for all its miraculous gifts of motion and expedited recovery, I loved this machine.

At the same time, it was the biggest pain in my ass (and the elbow!)- more than any other single part of rehab.


The purpose of the machine was to keep my elbow moving continuously (didn’t see that one coming, did ya?) in order to reduce swelling and get blood flow to the area to speed healing.

Because I had broken a joint, which is much trickier than just a bone, it was imperative that the joint be moving as soon as possible. Just like parts of a car, joints need to move to stay healthy- things start going all screwy when you don’t move a joint for days at a time.

Up until this surgery, my arm had been in a splint for 10 days, immobilized from the previous and first surgery. So after 10 days of not being moved at all, and especially following such a high-trauma injury where scar tissue would be fiercely developing, it was even more crucial that this elbow be moved as much as possible, as soon as possible, despite the fact (especially because) it had just been reconstructed.

This is how the machine worked: My arm was strapped inside a v-shaped hinged cradle, with my elbow nestled inside the pocket of the “v” where the hinge was. The machine would move my forearm towards my shoulder and then extend it outwards, increasing the angle, as far as I could tolerate. It did this back and forth, back and forth 24 hours for the first three days, then 18-20 hours a day for the remainder of May.

While it moved up and down, up and down, I had an emergency button to stop the machine if I felt pain. I had a button to adjust the speed and a level to adjust the angle of my arm to my body. The white-noise hum of this machine, over the course 24/7 for a month, became a familiar buzz in my head and in my bones, leaving a strange kind of void when the thing went back to the medical supply guys.

(It was sort of like unplugging your refrigerator- suddenly, there’s this strange absence of an annoying hum!)

Each day I tried to increase the range of motion by a little bit. I set big goals for myself and tried to push myself every day just up to the point of pain. Right as I would wince, I would set the dial to go there. Usually after 5-10 minutes of being on the machine, I could crank up the dial just a touch more. Seeing as I was mostly home bound and mostly dependent on my mother, I needed something to keep my mind occupied so this became a sort of challenge or game. Only I had a lot of emotional investment in it, too. I worked desperately hard to get better. My ability to climb and kayak again- maybe even just feed myself again- depended on it.

I wish I had kept a record of my progress. If memory serves, I would make huge jumps over the course of a few days, then backslide, regain what I had lost, make another small jump, backslide again and so on and so forth, just enough to give me an emotional roller coaster ride of highs and lows, getting regularly encouraged then discouraged. However, after a month of being on this machine for the majority of every day, I could extend to about 30 degrees (zero is all the way extended) and could flex up to 115-120 degrees (165 is all the way flexed). This was close to the entire range of motion I was predicted to get back in my life, so to have achieved this after one month was exceptional.

Thank goodness my mother flew in from Colorado and stayed with me nearly the entire month to get me through this process. It’s a good thing she did, too, because we didn’t realize it until I actually brought the CPM machine home from the hospital that there was no way for me to adjust it myself or get it working without help. I didn’t have the arm strength to adjust it to my bed at night and then my desk during the day time (when I started working from home) and then the couch in the evenings. Each situation meant that the machine had to be tinkered with to fit the angle of my arm. Each time we had to adjust, it took 10-15 minutes to get it just right so that it wasn’t painful.

Until the last week of May, I slept with the machine running all night long.

Oh, the bedtime routine. That was the most frustrating part. It regularly underscored how helpless and dependent I had become, something that was incredibly difficult for me to accept and surrender to.

Because this machine could only lower to my arm level to a certain degree (they only come in one size and it didn’t fit me perfectly), I had to sleep on top of a stack of pillows in my bed to raise my arm high enough. So that I wouldn't fall off of the pillows and off the bed, we had to tuck blankets all around me to secure me into place.

Then there were the 20 minutes of my mother trying to adjust the angle of the arm cradle so that I could sleep with my arm in it, hanging off the side of the bed, all night long.

There was a narrow margin of comfort being in this machine. Trying to get situated in the cradle while lying down, when just the slightest motion one way could go from tolerable to painful, was endlessly frustrating. Eventually, we had to put tape strips on the floor and try to mark the machine ourselves in order to take some of the time off of the nightly experimentation that seemed to go on forever.

“Nope, that’s too far to the right. No, go back… now it’s too high. Now my fingers are going numb. My shoulder is being pulled too high, can you lower it more…? ouch!” That went on forever until I was ready to scream.

Hence, this routine had a way of making me emotional. I do believe I had my first real adult tantrum in my life. It was at these times when I would just break down.

…”Not only do I have to subject myself to sleeping in this machine all night long, but it’s going to be on the verge of painful AND a royal pain in the ass to set up every time!”

Being a supportive mama, she would do her best to console me in my helpless frustration. However, she too, on regular occasion, raised her voice at that damn CPM. I think I even heard a few cuss words come out of her mouth, directed at that “piece of…”

So After 15-20 minutes of struggling to find that “just right” tolerable position for my arm to be in all night long while I slept, mom would strap me into it and I was stuck there all night, without being able to move or roll over. If I had to get up to pee, I would have to call out to her to come help me.

In hindsight, I'm not sure how I did this- sleep all night long in one position without being able to move an inch while my arm went up and down, up and down to the sound of the CPM hum for 8 solid hours (or as long as I could sleep). Perhaps it was the pain killers?

Eventually, I found a way to unstrap myself in the middle of the night but I could never get back into the machine by myself once I was out. So I trained myself to not get up all night, as much as I could stand.

The last two weeks of May, I started working from home. Getting the machine set up at my desk as I typed one-handed while my left arm went up and down, up and down all day long was almost as difficult and frustrating as the bedtime routine. We layed down strips of tape in my office, too, in order to make the process easier each time.

“Let’s see, this leg of the machine goes here, that arm goes there…”

What a hassle. Obviously, the people making these machines have not had to use them. Not surprising. There’s no real way of marking settings other than the angle at which the cradle is moving. They are impossible to adjust on one’s own, if you have an injury- which you need to have in order to warrant using one.

When my mom had to leave, my dear friend Erik flew in to take over. He even had the motherly ‘tuck you into bed’ kisses that mom always delivered when we finally got the machine right (it never felt so good to be tucked into bed in my life). However, he and I didn’t have the same mother/daughter bickering back and forth. And I say that lightly and playfully.

While mom and I definitely got on each other’s nerves after being in close quarters (my small house) for four weeks with me so dependent on her, fighting with a damn, uncooperative machine, I could never thank her enough. There is nothing comparable to having momma there, even when you’re 32.

And Erik, a long time friend I’d known for 14 years, cared for me well, too. And my non-dramatic, non-family connection to him made for a good transition between dependency on mom and being by myself for the first time since the accident. When he left, the machine finally went back to its makers.

Being alone for the first time in about 5 weeks, while finally being free from this machine, was an incredible feeling of both freedom and emptiness, celebration and fear.

In that silence, the emotions really started to surface. Away from mom, away from any family dynamics, now finally being dependent on myself again- that’s when I really started feeling the gravity of the experience, now having to give myself all of the cheerleading and encouragement I had been drawing from others.

This was when the real test of compassion and patience for myself began.

Revisiting Old Scars

Today, I revisited some old scars. Literally and figuratively. And in a good way.

I got the stitches out of my elbow, stitches that had sewed up the same scar from two previous surgeries. These particular stitches were from my most recent elbow surgery- the one where I got the metal plate and 8 screws removed from my ulna.

My regular doc/surgeon, whom I'll call Mac, was out of town so I saw his partner (whom I'll call Rolf) and his partner's medical assistant instead. The MA commented on how fast I healed up, which was good to hear.

Rolf was someone Mac had consulted back in May of 2007 when I first came into the clinic with my elbow pinned closed, just after my first surgery (before the reconstructive surgery). Rolf had seen the x-rays of my elbow and unlike the Mac, he had recommended against having the reconstructive surgery.

I asked him if he remembered me; he said I looked familiar, which was nice of him to say but I doubted he actually recognized me because I don't even think we actually met face to face. I was actually asking more if he remembered my x-rays, since every doc or PT or nurse that I ever showed them to made such a big deal about how they had "never seen such a traumatic injury in all of their career..."

I didn't remind him that he'd given me different advice than Mac. He may or may not remember that.

And the only reason I even mention this is that I am convinced- totally convinced- that the reason I am where I am today is because of four reasons:

1- Mac's expertise and foresight

2- the reconstructive surgery (Mac was alone in recommending this)

3- the CPM machine

4- me working my ass off in rehab.

I firmly believe that had I not had that surgery, I would be much, much worse off today- maybe not even able to use my elbow.

Rolf was one of three (or maybe it was four) other orthopedic surgeons who didn't agree with Mac. Rolf's opinion, along with several other docs' "who had been in the field for awhile" was that to open me up again and disturb the tissues again, causing more scar tissue, was not worth the risks nor the uncertain potential for increased results.

But I am so deeply grateful for the decision I made. And now when I look back on those other opinions, it's actually kind of shocking that a doctor would recommend that I not have the surgery.

Anyhow, because of this history with Rolf, I was interested to meet with him today and show him my progress. The last time he saw me, my arm and I were a mess. And inside my head I was thinking, "I am so grateful I didn't take your advice, Rolf."

But I wasn't thinking that with any hard feelings at all. He is a really nice guy and a wonderful doctor, I'm sure. Yet, I still whisper thanks to my gut feeling, the voice that nagged me to have the surgery, regardless of the fact that Mac was voted down by three other surgeons.

So after showing him my elbow's current status, I was interested to get Rolf's take on some concerns I had.

I asked him about how my prosthetic radial head is moving around inside my radius (came up on my pre-op x-rays). Did he think that would eventually be a problem? "It's not a problem unless it causes pain." Did he think I would be more likely to get arthritis in my elbow because it's still a bit unstable on one side (Mac had discovered this pre-op, as well)? "No way of knowing." Did he think the metal prosthetic radial head grinding against my humerus bone might cause a problem at some point, since I don't have cartilage there anymore? "Maybe."

But he was very upbeat about all of this. He was impressed that I'd gained so much of my extension back. I reminded him that I was told, even by Mac, that I'd be permanently stuck with only being able to extend my elbow to 30 degrees (all the way out is zero) and only flex it as far as 120 (all the way flexed is about 165 for me). I told him how I'm only short about 5 degrees on both sides. He seemed very pleased all around.

There was a moment between when the MA took my stitches out and when he came into the room- maybe about 5 minutes- when tears started to fill my eyes. This happens to me every time I visit this clinic. It's become a familiar part of the visits, almost like a friend dropping in.

My friend, the tears.

What happens is that I flash back to early May of 2007 when I first came to this clinic. I flash back to the fear so intense that it made my whole body hot. I flash back to just how surreal it was to suddenly one day, not know if I'd ever be able to live the life I wanted to: an active life, a life with a working arm.

I flash back to the thoughts that haunted me for months, all those typical thoughts that are supposedly normal with any kind of loss: shock and denial thoughts. Why did this happen? Am I dreaming? Why did I have to...? If only I had... I just wish I could go back and...

Basically, I was torturing myself with whys and what ifs.

Then I flash back to all the repeated visits here, for all those dozens of x-rays that were, at first, painful to even get (turning my arm this way and that to get a picture). And then, there's just a general feeling that floods me. Instead of my life flashing before my eyes, it's like the last 10 months flash before my eyes. I see it fast-forwarded. And then suddenly, I'm sitting on that table again in the present moment, doing miraculously well but with a long road ahead of me still.

The tears are not sad tears. They are grateful tears. They are compassion tears. They are "thank god I'm here and not there anymore" tears. They are "holy shit, I've been through something big" tears.

They are part of that powerful feeling I've alluded to previously- when the strength within you to get through something blows your own mind.

Those tears, just like any good friend, are more or less saying to me, "We did it, Tamara."

The Power of Samba

There are plenty of articles and various kinds of testimonials that speak to the healing power of music. There are branches of science dedicated to the study of its effect on brain waves and many other physiological effects on the body, whether the music is throat singing of Tibetan monks or the intellectually-stimulating music of Bach.

This topic is not new to me. Having been quite interested in health, having studied nutrition, herbology and various forms of body work, as well as being a musician, there was a time when I saw myself going into some kind of field related to music therapy. Of course, I hadn’t thought much about how music could or would heal my life. It was always in the context of others.

So maybe it’s kind of ironic (and yet, should be shockingly obvious) that music ended up healing me; and perhaps, it’s even more ironic that it never even occurred to me to seek out music as part of my healing. It just happened to me. It fell into my lap.

Within a couple weeks after my big arm surgery, my friend, Dan, offered to pick me up at my house (I couldn’t drive yet) and take me to shows and rehearsals of the local samba batteria. I think he said something to the effect of, “We’ve got to get you out- getting you out drumming will do you good…”

We’d talked about drumming many times before. He’d mentioned this batteria to me long before my accident since I’d done a fair amount of drumming in my past. But I hadn’t really touched the drums in years, having gotten preoccupied with other things. Heck, with all the things going on in life, I hadn’t actually played music in ages, hadn’t composed in almost a year. I didn’t know it yet, but because of the lack of music in my life, I was desperately malnourished. I didn’t realize how starved I was until I caught a whiff of music again.

Conveniently, since I couldn’t really use my left arm that much, there were plenty of one-handed instruments I could play in this ensemble. And after a little coaxing, I finally decided to show up for a rehearsal.

Having not picked up a drum in years, but having been a musician all my life, it was a strange feeling, perhaps like running into your best friend from primary school, or maybe bumping into a lover who changed your life but whose last name you can’t remember. It was a combination of blissful familiarity and a foreign emptiness. It was a little surreal.

The leader of the rehearsal, Mehmet, a person Dan had referred to previously, was a talented drummer and Ph.D candidate in engineering. We seemed to connect right away- he wanted to hear about my experiences drumming in West Africa, I wanted to pick his brain regarding samba.

By the end of the rehearsal, I had a permanent smile on my face and the familiarity had overtaken the emptiness. Every cell in my body had started shouting, “Yes!”

An insatiable hunger to keep at it appeared in my gut out of nowhere. It was almost like a dramatic love scene (“where have you been all of my life?!”), only I knew that drumming had always been there for me, I just hadn’t made time for it.

How did I manage to forget how powerful this feeling was, how much my soul needed to play music? How did I somehow just run out of time for this? I found myself saying in my head, “I’ve got to remember how much I love drumming, how much I need this. I can’t forget this again.” I repeated this over and over to myself.

Up until the last particularly miserable year preceding the accident, I’d always had my hands in some kind of musical cookie jar. For the last 5 years, it had primarily taken the form of composing for film. But once I got a taste of drumming again, the hunger to remember and get reacquainted with such a love of mine turned my focus very much towards not only samba but also towards getting back into conga and West African drumming.

Playing the drums was an entirely different experience for me than most of my musical ventures, which had generally involved classical or jazz music to some degree. Drumming was something I saw as a side-project of sorts; it had been one of the ways I paid for my college (accompanying dancers) and it had taken me to Ghana for private study. Still, it was not my primary focus. Not until my “elbow adventure.”

Over the course of the ten months from the time I fell until now, it absolutely became my best friend.

To risk stating the obvious, the simple ability to bang on something over and over- and loudly- was therapeutic in itself. It doesn’t take a musician to realize that. Secondly, an engineer could explain how the vibrations coming off of the drum being played also had healing qualities. Thirdly, giving my elbow and wrist a gentle workout by playing the drum (left hand muting the drum I primarily played with the right hand) also helped me recover physically.

But beyond that, it was something much greater than the catharsis of taking my emotions out on an instrument or getting side benefits from the sound waves and physical activity.

It was the gift of simply remembering something I was good at.

Slowly, happiness and satisfaction and pride started creeping into my life, subtly at first, but dependably. Remembering that I had an ear for this stuff allowed me to enjoy it, celebrate it and start celebrating the music in myself again. To remember and reacquaint myself with something I was good at- to follow that again- did wonders for my emotional healing.

And inside of reminding me of something I was good at, it did something even more profound. To put it succinctly, and at the risk of sounding trite, playing drums again simply reminded me who I was.

A feeling that powerful- to reawaken to yourself after having been so lost for so long in some deserted wasteland of depression, anxiety and complete mental and emotional exhaustion, having had severe identity amnesia- doesn’t come along often in life.

Reawakening to myself was a gift I didn’t take lightly.

And, just like so many other aspects of this journey, that always seemed to contain both the light and the dark, both the positive and the negative, both the rainy and sunny emotions, the depth and profundity of having remembered myself was surrounded ever so perfectly with lightness: I had made so many new friends. Among them, Mehmet, the rehearsal leader, had become a dear friend of mine. The way he tells the story is that by the second rehearsal, I was already correcting him and jumping in to point out inconsistencies. Being a fierce musician, that’s when he knew we’d have something to connect about.

So, after healing my body, my heart, my sense of self and my sense of purpose, on top of that, samba gave me a community of wonderful people. Through the simple power of music, I had gone from a barren, stripped down place of having lost so much to a place of awe-inspiring abundance overflowing with happiness, with a renewed sense of purpose and a new circle of silly, upbeat, musical friends.

Isn't there a saying about when a door closes, somewhere a window opens? Can I make up my own?

When life beats the crap out of you, then kicks you again while you're down, at some point, it's probably going to reach down, take your hand and somehow, try to make up for it.

Yeah. Something like that.

Intro to the Big Second Surgery and the CPM

Here I am, day 3 in the hospital, showing a little leg outside of my ever-so-thexy hospital gown. My left arm is inside the CPM machine, which I was strapped into immediately following surgery.

Unfortunately (?), this is the only picture I have of my CPM machine.

CPM stands for "continuous passive motion" and, like it sounds, the machine moves up and down, up and down with my elbow strapped inside. I could control the speed as well as (and most importantly!) how far down and how far up the machine went. The greater the degree of up and down, the more it stretched my range of motion. (At first, I could only move my elbow up and down a few degrees. The goal was to gradually increase the range with the machine, as much as I could tolerate the pain).

The purpose of the machine was to continuously keep my arm moving in order to reduce swelling, get the joint moving as soon as possible and get blood flow to the area to speed healing. Because I had broken a joint, which is much trickier than just a bone, it was imperative that the joint be moving as soon as possible.

Up until this surgery, my arm had been in a splint for 10 days, immobilized from the previous and first surgery. So after 10 days of not being moved at all, and especially following such a high-trauma injury where scar tissue would be fiercely developing, it was even more crucial that this elbow be moved as much as possible, despite the fact that it had, just hours previously, been reconstructed in terms of bone and ligaments.

For three days in the hospital, I was hooked up to the machine for 24 hours. Those three days in the hospital, alone, require several blog entries.

So yes, I slept with my arm going up and down, up and down. The only perk was that the hum of the machine was somewhat like soothing white noise.

In order to endure the pain of the machine, I was not only on some of the best narcotics known to mankind, but had a nerve block going to my left arm, which was, in and of itself, kind of an odd and creepy thing. There was some flexible kind of wire that was poked into my skin, just below my collar bone and then shoved through the muscle tissue until it was touching the brachial nerve (as memory serves). There was some kind of button I pushed on my IV as well to help monitor the pain but it would only give me doses every half hour so I couldn't OD. In my mental state, I can't quite remember all the details, but let's just say all of these attempts didn't quite cut the pain.

Far more painful than the actual fall and breaking of my elbow was the first night I had to sleep with this machine moving my arm. Because moving my arm inside the machine could change the pressure points on my arm from tolerable to excruciating, it meant I couldn't move in my bed all night long. At one point, I did. The pressure point changed and was suddenly rubbing something wrong and that was, by far, the most intense pain I'd felt in my life.

So I'm not quite sure why I'm smiling in this picture. Habit, I suppose. Despite the pain meds, I wasn't "blitzed out," unfortunately.

And the viking hat? That was brought to me by my dear friend Carol Joy- it was a great start to getting this recovery off to the right start.

So this CPM machine, which first became attached to me immediately after surgery, also went home with me from the hospital and remained attached for me for a solid month.

The month of CPM. That calls for its own entry as well.

Shame and Triumph

So I've begun to think more about why I've been blaming myself for the accident.

These days, I think I can sum up my emotional state as:

"I'm still not proud of how I got there, but I am proud of how I got out of it. I'm still somewhat ashamed of how diminished I had allowed myself to become at that point in my life, but I'm intensely proud of- even moved by- the strength, hard work and determination I somehow drew from in order to not only beat the odds, but to break medical statistics and records." 

In this entire process, this 10 month ordeal, it is these two spectrums of thought that make me the most emotional. 

Shame and triumph. 

Let me elaborate a little. 

When I injured myself so greatly, and when I think about the possibility of how much worse it could have been, I just honestly and simply feel like I really failed myself. I feel like I really let myself down.  A part of me really believes that I never would have gotten injured if I hadn't lost myself to such a degree, if I hadn't allowed myself to become so diminished.  I could just have easily hit my head or back in my fall that could have paralyzed me, even killed me.  So, even though I recovered way beyond what anyone predicted, I still feel like I failed myself by getting hurt in the first place. 

However, with the same intensity of emotion with which I hold myself responsible for how miserable I'd become, for how lost and crushed I'd become- and I've always been a person with an intensely rich inner life and emotional landscape- I found equal, if not greater, determination and belief in myself. 

Somehow, maybe out of nowhere?, there was a fire that began to burn in me again. Maybe it was my survival instinct. Maybe I was just so sick of feeling like crap. Maybe I just wouldn't stand for it any longer and so I sure as hell wasn't going to let this accident keep me from realizing parts of my life I dearly loved. Maybe it's *because* I was in such a low- and frankly, shitty- place in life, that I was finally able to say, "That's it.  I'm not staying in this place. It's only going to be uphill from here, I don't care what they say."

However, it certainly wasn't as simple as just setting my mind to success and everything after that was a bowl full of cherries. Not only did I have serious physical healing and rehab ahead of me, but I had unprecedented emotional healing to do as well.  The process was arduous, physically and emotionally-painful and it tried every ounce of resolve and patience in my being. 

But, as I've come to see it, the magical thing this predicament did do for me was to turn my attention completely towards myself. Suddenly, my body needed every shred of care, love, attention, patience, compassion and understanding I could muster. These were precisely the sentiments I could not summon for myself previously. 

So maybe my arm is what showed me how to love myself again. Perhaps it was shattering my left elbow that allowed me to put my heart back together. 

And it was a long, long road with lots of tears and reflection. But cradled by love, love from family and friends and love- finally- for myself, I was able to slowly crawl out from my dark hole and into the light. 

...which brings me to a metaphor that hit me awhile ago.... 

When you hit bottom, say like the bottom of a swimming pool, then you have something to kick off from... you've got that solid surface under your feet, because you sure as hell can't go any lower. From that solid surface (of hell) under your feet, you squat down and take one giant leap- like a springboard. From the bottom of the pool, you can only go up. 

So that's what I did. 

TT-Terminator

I must describe this photograph first. I took home a film from one of my x-rays, held it up against the window in my office and took a picture of it with the camera in my cell phone. This is why you see green foliage and some hands in the reflection, behind the x-ray. Now that we have that clarified....

With all the metal that was surgically implanted in my left elbow, I took on many new names.

Terminator.
Robo-girl.

Robo-Radius.
(for those who know what the radius bone is).

And one of my friends joked that as long as they were putting such hardware inside my arm, couldn't they at least give me something cool in the process? You know, like a retractable Swiss Army knife? A wine bottle-opener? Something Inspector Gadget-like?

While that metal plate and 8 screws came out a little over a week ago, that thing that looks like half of a dumbbell is the metal prosthetic radial head and will be there for life. Or until it wears out.

Now, I've had enough x-rays by now that I glow in the dark. If I had to count how many times this poor arm has been photographed, I'd say it's a serious contender for Britney Spears. Oh, that's right, it's like my elbow has its own medical paparazzi.

There were the x-rays right after the fall ("could you please bend your shattered elbow this way so I can get a picture?") then there were the x-rays taken during surgery to see if the radial head was lining up properly (it was being a real "bugger," I was told), then the x-rays right after that surgery. Then there were at least another 20 taken for the second surgery, post-surgery, all during rehab, then before my third surgery. And I'm sure next week, when I get the stitches out, there will be more photographs.

I guess I need to come up with a special autograph for the "Terminator Elbow, most photographed body part this side of the Mississippi...."

The Snowshoe Brace

Ah, the snowshoe brace!

The snowshoe brace got its name from one of my coworkers, PR, who shows up in other posts on this blog. Because of the metal loop going around my hand, she described it as looking like my arm was trapped inside of a snowshoe.

This was a custom-made brace my OT (occupational therapist) made for me so that I could regain my palm supination and pronation (palm up, palm down motion).

After six weeks of only moving my elbow like a hinge, with extension and flexion, I started working on trying to get palm supination and pronation back. After surgery, my arm had been "frozen" in the position of thumb pointing up. I could turn my palm down a little bit but could barely move the other direction so that my palm was facing up. It took about 4-5 weeks for me to be able to get my palm down enough to begin to use my hand for typing, although my hand was still at an angle, just barely turned down enough to reach the keypad with my fingertips. I became fluent at one-handed typing since I do quite a bit of writing for my job.

So the snowshoe brace was a uniquely grueling stage of the process. I was told by several hand therapists, "Don't expect to get back all of your range. You'll probably never be able to turn your palm all the way up again."

I'll never forget my first appointment with my OT, a peppy middle-aged woman whom I really came to adore. She asked me to set some goals for myself for regaining movement. Granted, this was after I'd spent a month being on a CPM machine ("continuous passive motion", explained in another post) and now was going to be given more exercises for extension and flexion, before the snowshoe brace came into being.

When asked what I'd like my goals to be, I started throwing out things like, "I'm going to sea kayak again, I'm going to climb again." She gave a boisterous laugh and said, "how about, for now, something like being able to put your earrings in?" I chuckled back, "Okay..." feeling a little embarrassed. It was true- at this point, I had so little range of motion, I could not reach my ears to put earrings in, nor could I wash my hair, feed myself or brush my teeth with my left hand because I simply couldn't bend (flexion) my elbow enough to bring my hand up to my face or head. For a long time, I could only get my elbow at 90 degrees down to about 45 degrees.

But yes, my mindset going in was not simply to one day be able to put earrings in again; I was going to set my sights as far as possible.

In terms of numbers, it had been guessed or estimated by my OT that at most, I might only get back about half my range, meaning that my palm would never turn completely up, but only half way between thumb pointing towards the sky and palm all the way up. As a pianist, drummer, climber and aspiring sea kayaker, this would pose a problem.

As I understand it, these sorts of custom braces are rare. Few OTs know how to make them. Most people in my position, with serious reconstructive surgery, end up struggling on their own to regain range of motion (ROM). Being blessed (or cursed) with a trusty stubborn streak, when a particular OT told me that I would probably only regain half my ROM, *if* I was lucky, I looked him in the eye and literally said, "You don't know me very well, do you?" He smiled and walked away.

While I understand that there's a point where a PT or OT is trying to prepare a patient for the worst and not build up false expectations, I deeply wanted a more positive outlook, something closer to, "we'll do everything we can to get you back as much range as possible!" So I became that cheerleader for myself, once again. It's really the only way it works, though- you've got to believe it yourself, that you can do it, no matter how many people are cheering you on.

Here's how the snowshoe brace worked, since the photo is from only one angle: There was a hard pocket which my elbow sat in. Attached to the hard pocket was the metal looped shape bar. Then I had a separate hard "sleeve' which I slipped over my hand and which went up my forearm. Attached to this sleeve were velcro straps which could then attach to the outside of that curved metal bar. Using the velcro straps, I could slowly twist my thumb outwards, forcing my palm to turn up. I could tighten and loosen the tension with the velcro straps within my pain tolerance. I tried to sleep with this thing on but it was too uncomfortable so I committed myself to wearing it 5-8 hours a day.

To recap from other posts, the reason I needed the snowhoe brace was because I'd had complete ligament reconstruction surgery on all the ligaments that surround the radial head. I also had a prosthetic radial head inserted into my radius bone because I'd crushed my own. Since I had a prosthetic radial head as well as all of the ligaments constructed around that, the palm movement was extremely stiff. My surgeon did not want me working at this range of motion for the first 6 weeks after surgery because working on it would stretch out the ligaments he had recontructed and we needed to make sure everything was healed well before working the arm that way. That meant that after 6 weeks of really hard work at extension and flexion, exhausting in and of itself, now I had an entirely new challenge starting from ground zero.

Within the first month to six weeks, as I recall, I think I was gaining about 10 degrees a week with the snowshoe brace. After that, progressed dropped dramatically and it was very challenging to stay positive, especially when I kept hearing each week, "yep, that's probably about all you're going to get." It took 5-6 months to get back the majority of my range; after the initial spike in progress, I think I was averaging only 5 degrees of gain every 2-3 weeks. I remember the regular, sinking feeling when I would go in for my appointments, be measured and find that even in wearing my brace 5--8 hours a day, I'd gained nothing.

I used the snowshoe brace for about 3 and a half months, total. At the time I stopped using it, I believe I still had about 15-20 degrees to go in each direction, both on the supination and pronation end. Eventually, using my arm in everyday activities helped me gain more and more.

As of January 2008, about 9 months from my fall, I had regained all but 5-7 degrees of range on both palm supination and pronation, depending on the day, how cold it was outside, etc.. This was extremely exciting, since again, all the "experts" warned me I would probably lose about 20-30 degrees on both sides. I just can't capture through words how grueling the process was... the emotional highs and lows, wearing this ridiculous-looking, awkward thing around town, trying night after night to sleep with it on, knowing that the more I could tolerate it and keep it on, the better long-term results I would have. But wearing it was fairly uncomfortable and when I really worked hard at it and really cranked down on those velcro straps, it could be unbearable.

This is one of the places in my journey where my patience was tested over and over. I wanted to excel, to be an overachieving patient, to prove them all wrong, to work my butt off- and I did. And at the same time, I had to be patient with my body and be careful not to cause further injury by pushing it too hard.

As uncomfortable as strange as it was, the snowshoe brace was crucial to my recovery. It did me well in the end. After months of using it, the therapy and exercises didn't end there. Right about the time I was finishing up using the brace (mostly because I just couldn't take it anymore and because I couldn't get enough tension on it to really stretch my arm), I started hearing more of, "that's probably going to be it for your progress." So I found another PT and then another OT and then after that, a final PT whom I really felt like gave me the right combination of hope and practicality....