Fused: A Patient's Story

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Powerful account of one medical student's experience with injury and recovery

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Fused: A Patient’s Story by Molly Kearney
 
The Incident
It was a typical morning at my collegiate diving dryland practice, which meant trampoline drills, conditioning, and dry diving board skills. My coach had me do front doubles on the dry board, a relatively new drill for me but not uncommon for divers. After a few successful attempts, I moved to the trampoline for an additional challenge. I had one more before being excused from practice so I could make it to my Anatomy 101 exam on time. The take-off was less than ideal, so I came out early thinking I was only at one flip. Having misjudged my rotation speed, I saw the ceiling when I came out, thought “oh no”, and landed on my head. Immediately, I curled into a ball while shocks went down both my arms and continued for about 30 seconds.

After a few minutes, I slowly sat up and tried to move my head the slightest bit, and the worst pain I have ever felt shot down my neck and back. I laid back down and tried to stay very still and keep myself calm. As a multisport athlete throughout childhood and high school, I had suffered various minor injuries that I could play through. At this point, I wasn’t convinced that I had injured myself bad enough to go to the emergency room. In my mind, I could move, albeit painfully, and I was pretty sure nothing was broken. My coach and teammates were all in shock, but I insisted that I would be fine after a few more minutes. Half an hour later, my coach and the facility manager convinced me to go to the hospital. I slowly stood up and walked hunched over trying to keep my upper body and head as still as possible and was driven to the hospital by a teammate. Upon arrival, I was immediately put in a wheelchair and strapped into a neck brace.

The Emergency Room
The next thing I remember is having my shirt cut off and a frenzy of nurses moving quickly about the room. I mentioned that my chest hurt and not five seconds later I was completely exposed to with EKG pads placed. I remember feeling like my brain was working slowly and had some trouble recalling my parents’ phone numbers. I asked the staff not to contact them yet because they were in a different time zone and it would have been very early for them. I did not want my parents to be woken up by a phone call that their daughter was in the hospital. Instead, I texted them and gave them updates.

I had an X-ray soon after arrival, followed by a CT. The next time a physician spoke with me, I was told (rather bluntly) I would need an MRI and would probably never dive again. That crushed my spirit and was the first time I had cried during this experience. My whole identity was being a diver; being told that I could not be who I was, was devastating. A few hours later, my MRI revealed C5-C6 instability with disruption of the disc posteriorly. I would need surgery to fuse the vertebrae (specifically, a C5-C6 anterior cervical discectomy and anterior stabilization), most likely later that day. It was a lot of information to process in a short amount of time and a rollercoaster of emotions. Throughout my stay in the ED, I was sending updates to my parents, with each text message getting progressively worse. Later I learned that my neurosurgeon had contacted my parents and spent many hours discussing my case, my treatment options, risks of the surgery, and so on. I am so appreciative that he did this and greatly admire him. It was decided that surgery would not take place until my mom arrived the next day on an emergency flight. 

My neck had a constant dull ache that became an intensely sharp and shooting pain if I managed to move my neck within the neck brace. My coach was with me all day until he had to leave to go to afternoon practice. I remember being so exhausted, drifting in and out of sleep. The staff was great, they tried to make the room dark for me and not have the monitors glaring to allow me to sleep. When most people would talk to me, they would lean over the bed so I could see their faces since I was lying flat on my back until after surgery. This gesture may seem small, but it meant a great deal to me to see them putting in the effort to make me feel heard. Upon admission, I was brought to a room with cartoon fish on the walls; this turned out to be pediatrics and even though I was a freshman in college, I was only 17 years old and therefore, technically, a pediatric patient.

In preparation for surgery, I was informed of the details of the procedure, but I don’t remember by whom. I was told during surgery I would have “pins” in my wrists and ankles, as well as multiple electrodes attached to my head to monitor my nerves during surgery.

The Day of Surgery:
I really don’t remember how the night went, though it definitely wasn’t restful. As soon as my mom arrived, between 9 and 10 o’clock in the morning, I was brought down to preop. I felt a mix of emotions; so happy to be with my mom, but very sad seeing how upset and worried she was. I felt terrible that I had put her through this. My surgeon quickly reviewed the plan with her, explained why it was so critical to be done now, and the risks of anesthesia. His candor and concern about the seriousness of the injury and confidence in the surgery helped to put my mom at ease.

In preop, I was still exhausted and really needed to use the bathroom. I was given a bedpan, which I had had to use since arriving at the hospital. Urinating in a bedpan while laying down is very difficult. It probably took close to five minutes for me to finally be able to go; at that moment I envied little kids that wet the bed. After relieving myself, I finally felt relaxed and the exhaustion took hold. I fell asleep as I was being wheeled to the OR.

Post-surgery:
My whole body was very sore and fatigued, and I had band-aids all over. Before being brought back up to my room, the nurses tested my strength and sensation: point and flex my toes, squeeze their hands, can I feel their touch, etc. A couple of friends were then able to come visit me. At this point, I had only been in college for three weeks and didn’t have many good friends yet, so it meant a lot that they came by. Some of my teammates and coaches also visited. The teammate that drove me to the hospital the day before very generously bought me a zip-up hoodie from our campus store that I greatly appreciate and still often wear. That evening I was finally allowed to eat, though I didn't have much of an appetite.

Throughout the day and every few hours during the night, someone would come in to test my strength and sensation. I remember thinking “I’m fine, just let me sleep.” The next day, I was allowed to sit up, get out of bed, and use the bathroom. Before I was discharged, they had me walk down the hall and up a couple of stairs. Again, I thought, “I’m fine, this is silly, I’m just tired”. At some point, my mom attempted to wash and brush my hair; that is the most tangled and matted my hair has ever been.

Every person I came across while in the hospital was wonderful. The nurses in the Peds unit were very sweet and cared about how my mom was doing just as much as how I was doing. I very recently learned that my surgeon had contacted my dad multiple times during my stay to give him updates and discuss what to expect going forward. I remember one of my nurses showing me the scar on her neck from the same surgery I just had. She told my mom and me that she was still able to do everything she loved; this was very reassuring.

Short-term Recovery:
I went home for one month to recover. To shower, I needed to switch to a waterproof neck brace which had to be done laying down so that I wouldn’t move my neck. I was still so tired and sleeping while in a neck brace was extremely difficult. I was constantly uncomfortable and my neck had a dull ache. My skin started to peel and flake from the constant friction against the brace. When I started to feel stronger and slightly more energetic, I visited friends and family while I was home, all of whom were so happy surgery went well and told me how worried they had been. I tried really hard to study and keep up with my classes, but sitting upright for an extended amount of time was difficult, tiresome, and painful.

My dad flew back to school with me to go to my one-month follow-up appointment. The night before the appointment, I was alone in my dorm room and became incredibly emotional, the most emotional I had been through this entire process. Even though I felt great and had not had any issues while at home, I was still terrified that I would be given bad news the next day. The only thing my silly, naive, teenage brain was concerned about was being able to dive again. At the time, I had no idea just how close I had come to becoming paralyzed from the neck down. Prior to surgery, my neurosurgeon told my parents that this was a potentially life-changing event and that I was extremely lucky, and had this happened to the general population the outcome would have been much worse.

Thankfully, at the appointment, the surgeon told us the X-rays looked great and I could take off the neck brace. I had that thing off before he even finished the sentence. He explained that while the surgery was a success, there was now one less joint in my neck and that made it more vulnerable. Going forward I should avoid certain positions and activities, specifically painting a ceiling or holding a phone on my shoulder. I was cleared to start light conditioning, but no diving or trampoline activity for about a year.

Long-term Recovery
Following my one-month follow-up appointment, I fell back into the routine of going to classes and to every practice for only conditioning, as well as added physical therapy. Physical therapy seemed great and I think it could’ve been very helpful, but my insurance only authorized 12-15 sessions because I was receiving it out-of-state. I went to the school’s athletic trainers frequently which helped, but they did not really know what to do with me, so we focused on managing symptoms as opposed to helping the healing process along.

The next season, I tried to act as though nothing had happened. I was not scared of diving nor the trampoline, though I never did doubles again. An effect that I don’t think anyone could have prepared me for was my realization that I am not invincible. As an active kid involved in many sports, I had endured minor injuries, but none that threatened my well-being. While I was able to continue to dive, my outlook had shifted. In the back of my mind, I was thinking about what another surgery could mean, how long I would be away from practice, how I could legitimately lose the ability to walk or even breathe. Overall, I didn’t let my injury prevent me from progressing as a diver, though it did make me a more cautious person, on and off the pool deck. There were a few dryland drills I did not do, and on days I felt particularly exhausted from school, I would not train my more difficult dives. I was able to compete and do very well all four years.

About a year and a half after surgery, I decided to make an appointment with the surgeon to get X-rays and check up on everything. The appointment was very quick, and although it was all good news, I didn’t feel very reassured. At this point, I would have liked to know what to expect long-term. Fatigue, pain, and stiffness were all symptoms I had been dealing with but hoped that eventually, they would resolve (which it all probably would have had I been able to receive the appropriate amount of physical therapy). It was not until very recently while shadowing a radiologist, that I learned patients with vertebral fusions are likely to get arthritis and bone spurs above and below the operation site.

Now - Almost 10 Years Later:
Thankfully, I do not have constant neck pain every day. However, I do experience muscle fatigue and stiffness rather quickly. To combat this, I change positions and stretch very frequently and am very mindful of my posture. Studying for long periods of time and taking long exams is difficult and can be painful. Most nights, neck pain will wake me, but usually resolves quickly upon changing positions. Occasionally, I experience sudden, sharp, painful “twinges” in my neck when my head is turned that lasts less than a second.

Maybe it is because I was young and naïve, but I had complete confidence in my surgeon and the team that they would fix me. It didn’t cross my mind that something could happen during surgery that would prevent me from walking or breathing. Having completed my master’s degree in Biomedical Science, and currently being a first-year medical student, I’m actually happy I didn’t know then all that I know now. With complete confidence in the surgical team, I did not worry or fear the surgery at all which allowed me to have the unwavering belief that I could heal. As a future physician, I know this experience will help me treat my patients. I will not forget how important small gestures can be and will strive so do the same for my patients.