Delicious Ambiguity: Update on Erik's shoulder

Again, I have to start by expressing my sincerest gratitude for the incredible amount of support we’ve received. Friends from work continuously offer help in whatever way they can, Kara’s friends from her Bible study group (Side by Side) have provided some fabulous meals, and my residency program has been tremendously accommodating during the past two months. I only wish I could adequately express how much the support, prayers, and words of encouragement have meant to us.

Now onto an update…
(Here's the background in case you missed it the first time.)

Over the six weeks after my injury I had been looking forward to the EMG, which is a much easier way to say electromyogram. An EMG measures the electrical conduction through the nerves. They do this by sending electrical shocks through the skin and measuring the velocity and also by inserting needles into the muscles to measure the electrical activity directly in the muscle. If you are thinking this does not sound terribly comfortable, you have just confirmed your understanding of this tortuous exam. In saying that, you might wonder why I would be anticipating it for a month and a half, but it is certainly difficult to sit around without any idea of the prognosis and not being able to do anything to help the situation. There are no therapies, no exercises, and no foods or pills that I can do to be actively participating in my own welfare. Just waiting and praying.

Well, that day finally came last week when I would be brought down to the dungeon and tied up like Westley in the secret tree near Prince Humperdinck’s castle. Leading up to the EMG, I had hopes that even though I couldn’t will my arm to move with a mere thought, perhaps the needle would pick up some electrical activity in the muscle that was present, but too weak to contract the muscle and maybe just needed more time to heal. Unfortunately, I don’t have any great news after the EMG. The simplest way to say it (and actually what the neurologist wrote in my official medical record) is “there was no activation of the left triceps, deltoid, and infraspinatus muscles.” On a lighter note, however, I didn’t feel anything when the needle was inserted into my deltoid.

After the EMG, I had an appointment with “The Brachial Plexus Guys”. That’s what I call them. The brachial plexus clinic is made up of two orthopedic hand surgeons and a neurosurgeon who are truly experts in this field – traumatic brachial plexus injuries. In fact, after the appointment, one of their several minions (a hand surgery fellow) wrote down the title of THE hand surgery text (Green’s) and several chapters that they wrote on traumatic brachial plexus injuries. I went online to find it and discovered there are well over 1,000 publications between the three of them! I cannot take for granted the mere fact that I have access to the world experts!

OK, getting back to the appointment. I met with the neurosurgeon first and the rest of the team followed. We had a discussion about my career and how it is extremely frustrating to work so hard and for so long toward a goal that is now more of an uncertainty. I still have one good arm and a brain, and I’m optimistic that I will still practice emergency medicine despite the potential need for adjustments in practice style, though I am also praying that I won’t have to make any adjustments at all and that I’ll eventually heal. On that note, we also talked about how this injury will probably not heal completely on its own based on the EMG results. While my career absolutely is important to me, my active lifestyle is even more so. Most of you reading this know me and know that I was the guy on every intramural sports team, in addition to several city and church leagues, simultaneously (sometimes to my wife’s chagrin); I was the guy willing to try anything, especially if it pushed the limits of physical toughness (also to my wife’s chagrin, which is why I purposely did not using the term “dangerous” here J); I was the guy who would temporarily forget he was a dad and often behaved as the trouble-making cousin with his kids, constantly throwing, flipping, and wrestling with them. So as I pray for a complete recovery, I try to keep the potentially realistic perspective that I won’t be able to do everything that I could do prior to January 22, 2012. (I realize the previous sentence might contradict Mark 11:24, but I can’t pretend to know the will of God and I find that I need to prepare for all possible outcomes and that I cannot ignore the undesirable possibilities.)

(Click on any of the pics for better viewing.)

As I was sitting in that office, there was a picture on the wall of a cliff out over the sea and as we were having these discussions I pointed at the picture and I said, “I want to be able to climb that.”

That’s what every little boy thinks when they see a mountain or a cliff. The reply was something like, “Unfortunately, there’s a very good chance you won’t be able to hang from that cliff like you could before.” I had just undergone the EMG a few hours earlier with somewhat depressing results. So did I feel like crying when that sort of long-term prognosis was mentioned? Yes. Did I? No. But I did start thinking about what I might and might not be able to do. Things like riding carelessly on aggressive mountain bike trails, adventure races and high ropes obstacle courses in the Army, play softball on the church softball team, throw my kids in the pool, and the list goes on. After my internalized pity party was over, I realized that there has to be a way to continue doing some of these things – just look at Jim Abbott.

(Ignore the words -
this is the general concept)

Despite trying to stay optimistic and trusting that God has a plan in all of this, it sure is difficult to think about what the future might hold when it has yet to be written. A common phrase I kept hearing at the appointment was, “It’s still early.” This was good to hear as a reminder that there is still the possibility for some nerve regeneration – nerves grow about 1 mm per day – but it was still mildly annoying since there had been no improvement in function yet and it sure didn’t seem like it was “early” to me! I have another appointment on April 18^th and then another EMG about a month later and this journey will very likely lead to nerve grafting surgery where they will essentially transplant a nerve from somewhere else near my left shoulder or my leg and bypass the injured section. Then the journey starts again with rehab and the long road toward getting ready for next ski season. ;-) Stay tuned. (Season passes are cheaper if you get them before March 31st.)

I wrote everything above this paragraph about a week ago, closer to the appointment, and you might have noticed that the theme so far in this post has been disappointment and uncertainty, and maybe a little fear secondary to that uncertainty. If I broke my arm, it would heal and I’d go back to my normal life, but the difference in this injury is that there is no crystal ball and even if I do need surgery, would that lead to 80% of the strength and range of motion that I had before? Only 20%? I don’t know. I think it is appropriate to be disappointed with the EMG results, afraid of not knowing the extent of recovery and not having any control over it, and even sad that this has happened to me, but I also believe that I have a choice about how to respond to those emotions. I try to stay positive as much as I can and right now I am choosing just to take it one day at a time and take it as it comes.

It’s not always easy to see the rainbow through the storm, but I am surprised at how many things I have to be thankful about! For one, I could be dead - literally - or much more severely injured if I was only a few more inches toward my head and neck. I have pretty good function of my wrist and hand. We still have our minivan (“man van”) that we tried to sell last summer, which is good because my car has a manual transmission. Kara will tell you it’s a blessing that my chances of ever having a motorcycle in the garage have dramatically decreased. I have disability insurance, which is huge! Another positive note is that I also had an MRI two weeks ago to evaluate the rotator cuff, and while it seems the report showed many problem areas and didn’t comment on anything being “normal,” there is nothing that requires surgical repair.

I truly am in the best place to have an injury like this and couldn’t ask for better friends and colleagues! Please keep praying for a full recovery!

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