Sunday, February 17, 2008

Gisborne Hospital. International Orthopedic Surgeons. Titanium Plate.

My stay here at the Gisborne hospital has been interesting. The hospital is pretty modern and very up to date. It is pretty fully staffed, but also not extremely busy, which means that you get pretty close attention. I'm in Ward 9, the orthopedic ward. The first two nights, before my operation, I had a single room, but after the operation, they switched me to a four-bed room, where I am currently the only patient. It seems that many of other patients in the ward are pretty elderly, with injuries from falls, although the nurses said that they do a lot of hip, knee and shoulder replacements here. Being in a more rural area, it's probably a pretty hard life on those farmers. I think that they probably get better attention and care here than at the big hospitals in Auckland.

My operation went well. When I first met the surgeon, he was considering putting on an external frame to hold the bones in place, but after looking at the later set of x-rays, decided that putting in a plate would achieve a better result, since they could fix all of the broken bone pieces in the right place, and was less likely to have any danger of infection or injury, although it was slightly riskier as they had to open my arm at the wrist and move a nerve out of the way. I agreed with his assesment.

This meant that my operation was delayed a day since the titanium plate had to be shipped from Auckland. Friday morning they did the operation. I thought I was going to be able to see it, but I slept through the whole thing. It was a pretty international surgical team. The primary surgeon was from South Africa and he was assisted by surgeons from India and Somalia. The anesthesiologist (called an anaethsetist here) was a woman from Wisconsin. She did a really careful job of explaining what she was going to do, essentially blocking the nerves in my arm and giving me a sedative (which I had also been given in Te Puia, when I was first treated). She said that since I was an American, she'd give me the long list of possible risks and side-effects, since that was what they had to do in the US now.

Anyway, the operation took about an hour and a quarter and I missed the whole thing, waking up in the recovery room. The nerve block was quite effective as I couldn't move my left arm at all, but it all came back in a couple of hours.

It was quite painful last night and I'd get pain relief every three hours or so, when I'd wake up with the wrist really hurting. The nurses were a little careful in their treatment. Although I was cleared to get morphine, they would come in and first give me Panadol and codeine and then come back about 5 minutes later and ask if it was any better. It wasn't, so then they'd give me morphine, the pain would go away and I'd sleep for another three hours or so.

I also had to keep the arm raised all night, which was a bit of a pain to get comfortable with and I had a lot of swelling on the back of my hand and around my thumb. They actually cut away part or the bandage to relieve the tightness (I have pictures). Rather than a full cast, they use a partial cast called a backslab. It essentially goes around half of my arm an wrist to immobilize it. but they fasten it in place with bandages. This also means that they have access to the stitches.

It felt a lot better today and they have put my arm in a sling. The swelling has gone down and all my fingers seem to be back to normal. My thumb is still stiff and sort of numb, but the surgeon says that is normal. It is connected to a nerve the they have to stretch out of the way during the operation, so it takes a while to recover. I haven't lost any feeling, but it is just stiff and sort of numb feeling. He said to keep exercising my fingers and thumb, even in the cast.

They had me get up and get dressed this morning, fortunately, I had my dry bag with some clothes other than my rather torn jersey and shorts. Taking a shower with one hand is a bit tricky though. Actually, it is the drying that is a bit tricky. During the week, I had a male nurse who would help me out (he also had to rub me down with some kind on antibacterial solution when I showered prior to the operation), but I was on my own this morning. The nurse did put a plastic bag over the arm though, to keep it dry.

I should be here until Monday. My friend Tom Hepburn is driving down from Auckland, a favor above the call of duty, to pick me up on Tuesday morning.

Wednesday, February 13, 2008

Seven Hills. One Bad Descent. Tour Over.

The bicycling part of today's tour

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The Ambulance part of today's tour

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This entry was going to begin: After 90km, 7 hard hills, 7 bottles of water, two bottles of juice, a big sandwich, two peanut slabs and a chocolate afghan, I finally made it to a bed in Tokomaru Bay.

Instead, it begins: After 85km, 7 hard hills, 7 bottles of water, two bottles of juice, a big sandwich, two peanut slabs and a chocolate afghan, a broken wrist and a 100km ambulance ride, I finally made it to a bed in Gisborne hospital.

So, I finally made it to Gisborne--a little earlier than intended

First, the exciting part--if you consider falling down exciting. I'd just left Te Puia Springs, which is quite high up, and was heading down to Tokomaru Bay, where I planned to spend the night. It is downhill all the way. about 5km outside of Te Puia, I hit a bit of a bump where some recent chip seal started and my handlebar stem snapped off. The front wheel flipped sideways and I was thrown off while traveling about 35kph.

After skidding to a stop on the new, rough, chip seal, I was pretty well abraded on my right arm an shoulder. Then I noticed that my left wrist was not at a natural angle and I couldn't really move it. Fortunately, there was no traffic. About 30 seconds later, truck coming uphill stopped and helped me get the bike and trailer out of the road and very shortly thereafter, another pickup also stopped to help. The second fellow gave me a lift back up to Te Puia Springs, where they have a small community hospital. The first man loaded the bike and trailer on his truck and brought it up to the hospital.

It was around 5:30pm and the small hospital at Te Puia had only a nurse on duty, but she called in the doctor who was just next door. In about half an hour, they had given me a bit of morphine, put me on a saline drip, as they assumed I might be a bit dehydrated, cleaned and dressed my road rash, and splinted my arm. By then the local ambulance had arrived to transport me to the hospital at Gisborne, as it was obvious that I would need an orthopedist.

I think the paperwork took about as long as the actual medical work, but since I was an unknown patient, they seemed to be quite careful. They did a medical history and asked lots of questions about my current state, and, of course, they had to do the ACC paperwork, since it was an accident.

The trip to Gisborne Hospital took about an hour and a half, as it was about 100km from Te Puia Springs. I was admitted to the Gisborne Hospital ER, where I was the only patient. More paperwork, more medication, x-rays and the ER doctor anesthetized my arm, straightened out the wrist and put it in a cast. After a quick sandwich, since I wouldn't be able to eat after midnight, they put me back onto a saline drip and I was off to a room.

Comparatively, the rest of the ride was hardly eventful, just hard work. It was the longest day of my tour, unfortunately also the last, and had the most hills. After a stop in Te Araroa to fill up my water bottles, I tackled the three hills to Tikitiki. It was only 30km, but they were definitely as rated "hard". The Pedaller's Paradise guide accurately describes the section between Te Araroa and Tikitiki as "too many hills in too few kilometers".

I arrived in Tikitiki at about noon. The camp there was so rudimentary that it didn't even have a kitchen. It was actually more of a POP and even had an NZMCA sign. For a small village, with a well-known church, which I visited agin, and an RSA, it didn't even have a store. It had a small takeaway within the RSA, so I bought a sandwich and a drink, refilled my water bottles and headed off towards Ruatoruia, a much larger town.

After a couple of more hard hills and 20km, I found that Ruatoria had stores, the Ngati Pouru information center, and even a cafe, but no place to stay. I looked into the info center, where they had a display of very good local carvings in wood, bone and pounamu, and a fellow getting a traditional tattoo on his arm from the local Maori tattooist, a woman with a full moko, even the lips.

Since there was no place to stay at Ruatoria, I headed off towards TePuia Springs, where one of my guides said the hotel had a small camping area. It was uphill all the way including one more "hard" hill before the last hill into the town. I'm really glad that the stem didn't break as I was descending the last hard hill. As I neared the bottom, I looked in my rear-view mirror and ther was a fully loaded double lorry log truck right on my tail. I pulled over as far as I could and he whizzed by.

I trudged up the last hill to Te Puia Springs and stopped at the dairy for a snack. As I was coming out a young German cyclist was pulling in behind me. He had also ridden the same route as I, but started out at the East Cape lighthouse. After chatting a bit, I headed over to the hotel, one of those old Victorian hotels with pub, to find that they no longer had camping. I briefly considered staying at the hotel, but knew that there was both a campground and backpackers hostel at Tokomaru Bay, just 10km away, almost all downhill. So, I climbed the last short hill out of town, making my total climbing for the day more than 1000 meters and headed downhill.

Then, I fell dow.

Tomorrow, they will operate on my wrist. They plan to put the end of the radius bone back together with a titanium plate. It is curved to match the shape of the bone, and, if all goes well, it means that I will not lose the motion in my wrist. The two major possible complications are that there might be some nerve damage as they have to operate around the nerve going to my hand and the motion in my wrist might be reduced and I could end up with a stiff joint. They had to wait until tomorrow because the plate is a special order item, quite expensive and they have to courier one from Auckland.

Today's Photos: