This may end up being a massive, boring post, but I think it is somehow relevant to the "sometimes useful" nature of this site. There is a massive lack of information on the net about the surgery process and recovery of an open reduction internal fixation (ORIF) procedure to fix a broken tibia and fibula. Nay, there is a massive lack of information from a fit 35 year old. Anything Google would turn up was from people in their 50s, who probably live their day to day life like I have for the last couple months; sitting on a couch doin' nuthin. So, um, if you are a dude with a relatively healthy body who breaks your leg and needs ORIF in Japan, this post is for you!
Also, I'll talk about how the cops suck and how to get your Japanese national insurance to work for you.
The Crash. I should just lie about the crash. But it was nothing bad-ass, nothing glamorous. I wasn't on some twisting mountain road in scenic countryside Japan. I was just driving home from work, a few kilometers from my house, when the driver next to me, who probably didn't see me, changed lanes suddenly. I slammed on the brakes, he clipped my front tire, and I went down. It was a hit and run, though there is a chance he didn't even know it. My bike has stock exhaust. And though the engine is 999cc of pure power, it runs kind of quietly.
So I'm lying in the road. A quick body check reveals that the entire inertia of the bike crash went into my lower leg. The crash was probably 20kmph, but it was enough to snap the bone up something awful. I also fractured my accromion process, one of the bones that connects stuff on your shoulder. I think I night have broken my right wrist a little, but decided to just keep that one to myself.
I was only half dressed for riding. It was a hot day, so I left the proper motorcycle jacket at home. The jeans and boots were sanctioned riding wear, though the low speed nature of the crash meant that road rash wasn't a concern.
My Kevlar-lined riding jeans. Made by
Draggin Jeans, I recommend a pair. I will be wearing some armor under them from now on, though.
My armored jacket would have prevented the broken shoulder. Probably.
My knee-high off-road boots would have negated
any injuries, but you can't really wear those on the street.
So this is where the fun began. Lying in the street, some nice people helped me to the side of the road. Then the cops came. If you've read my site for a while, you'll know that the cops tend to ignore problems when a foreigner is related. I don't feel like going into great detail, but the dude who knocked me down got away clean. This is a busy Japanese road, with cameras somewhere down the line, but the cops would rather I just disappear. They weren't dicks about it, they just didn't really even try to help.
The ambulance. So, ambulances in Japan are basically just expensive taxis. They are not trained like the EMTs of other countries. They aren't allowed to give any sort of medication. They don't treat, they don't stabilize, and they don't run red lights. But they will phone all the hospitals in the area to find one suitable for you. We nixed the first available one, a pricey boutique place that only had single rooms. Fancy room fees are not covered by your insurance, and a single could easily cost $500 a day. The next choice was up in Asagaya, about 15 minutes away. Yes, we discussed my budget before deciding on a hospital.
Oh, my foot is pretty much dangling from my leg, bones and nerves playing a nice little game of tag every time the ambulance slams on the brakes to let a taxi merge. The pain was intense, though nothing like what was to come.
The hospital. I should preface this. I've never been in a hospital in my life. Never broken a bone, never needed something removed, never. My assumption of the way this exact type of accident should go down is this:
- Quick visual assessment by the doctors.
- Massive amounts of pain killers given. Morphine and what not.
- X-Rays, followed by emergency surgery that day, or maybe the next.
- Hospital stay of a week or less.
How it went down:
- No medication.
- The most horrific X-Ray / torture room, something I couldn't even imagine. They needed multiple angles of my leg, obviously. Instead of slowly and carefully getting me into different positions, the technician simply called in a few dudes to roll me, spin me, and flip me whichever way they felt. The pain was unexpressable. I know, even with my lack of medical training, that if they had gone a little slower, supporting my dangling-by-a-nerve foot, the pain would have been at about 50%.
- The severity required a CT-scan.
- Consultation time. I was informed that I would need surgery. They could do this the following Tuesday; 4 days time. But first they took some blood. I held out my arm. Nope, we're taking it from the artery on the inside of your thigh, by your nuts. I would need to be put in traction.
- Imagine, dear readers, a needle inserted into your heel bone, followed by a discharge of liquid magma. This was to dull the pain of what came next. The drill. Through my heel. For the wire. Memories of the medieval torture museum I went to in Germany years ago come to mind.
- Weights were hung from my heel-wire, 7kg to be exact, and I was wheeled up to my room.
The leg on the day of the accident.
Below you can see the fractured accromion process. It felt like something I would have walked away with if this had been the only thing wrong. Painful, but bearable. Hurt like a bitch to sneeze though!
The traction, aka torture device. When my foot was perpendicular to the bed, I could bear it. But it would naturally turn to the side. At about 45 degrees, the pain shot through me, and I would have to call the nurse to 治す it. Fix it. Rough.
Here you can see the wire through my heel.
The CT scan is freaky!
Insurance. The doctors were, once I had been stabilized, down to business. They matter-of-factly informed me that if I didn't have surgery, a costly endeavor, that I would never walk again. You do have insurance, right? Ummmmm. . . maybe. You see, I signed up for the National Insurance Plan, as required of everyone in this country, some years ago. Then I moved. Then I moved again. Three times, maybe four. In all the hustle, I lost my card, and they lost track of me. It turns out, in this country, that you are meant to re-register every time you move. So, ummmmm, let me get back to you about that surgery.
I was given a Monday deadline to sort it out (the accident happened on a Friday), and surgery was tentatively scheduled for Tuesday. I remained calm, quietly thinking of who I could ask for the un-insured cost if need be (as much as $40,000 I was told), and waited for the ward office to open on Monday, when I had a trusty friend, a long-time expat, was ready to go to battle for me.
While I lay in traction-induced agony, the battle was won, provided I pay the previous year's monthly insurance premiums, about $800. If you live in Japan and have National Health Insurance, the fees of which are based on your salary, then you will know how little I earned last year. But that doesn't matter! I'm insured!
I'll cut right to the chase about the cost. The National Insurance, for cases of very expensive procedures, has a co-pay of $800 + 1%. Otherwise they cover a straight up 70%. So for the month, with an un-adjusted bill of about $15k, I had to pay something like $1400. Not bad. And though I took a huge hit by being out of work for a month and a half (the life of a freelancer!), I won't have to sell the bike.
Here is the itemized bill. I was in the hospital for a few days in September as well, and that came to about 35,000 yen.
I'm curious how the costs compare to other countries. I know in the USA everything is dependent on your insurance; a good job means no hit to the wallet, no job means maybe you don't walk again.
The surgery. Pure bliss. As soon as they hit my spine with the nerve blocker, my lower extremities, if the entire lower half of your body can be called an extremity, went numb. They also gave me an IV of pain meds, against my wishes, that made me sporadically nap throughout the next few hours. The moments I was awake, watching the surgery on an overhead monitor, were fascinating. I know they put me under because some people might freak the fuck out at seeing drills and screws and blood, but once that leg was numb, I was as content as anything.
Two plate and about 20 screws.
The above is immediately after. Below is a month later.
After the surgery, I was wheeled back to my room and given an IV of pain/sleep meds. Thus began my 12 hours of hellish mind-fuckery.
It wasn't the pain coming back that was the main problem. It was all the factors of annoyance, things that kept me from relaxing in any way. I was thirsty beyond belief, having drank nothing for the past day. My back was sore, like I had been sleeping on an old mattress for a few days. And my brain was on another planet. If you ever want a good time, take ambien or eszopiclone or zaleplon or doxepin, and force yourself to stay awake. You'll be trippin' balls, son! Well, if you've just come out of major surgery, you don't want to be on a drug trip in any way.
For real, my brain had no control. I would try to form a thought, and then I would start thinking "purple bananas in space!" or "I can fly if I flap my hair", things that make no sense, but my brain was thinking they made sense. I've never had a bad drug trip before, but maybe it is something like this.
It was hella frustrating. I would have a crazy "I should paint the bedposts with razzleberry juice" thought, then my normal mind would kick in, trying to figure out why that was a good idea.
The nurses told me this was all normal.
No cast, just a bandage wrap for a few days.
The recovery. Skip the accident and traction and day after the surgery. On Wednesday I was pain free. Such is the magic of surgery. From then on, I can say that I felt totally fine, apart from the restlessness an active body feels when confined to limited movement. I even started stashing my pain meds. Laughingly weak, I figured they would serve me better in the future, after a night of clubbing or maybe the next time I do a really long motorcycle ride.
The recovery schedule was generic. One week and the bandages can come off. Two weeks in the hospital bed. Four weeks later and I can start bearing weight on the leg. I've read very mixed accounts of others with a similar injury, ranging from a couple nights in the hospital and leaving with an air cast, to months and months of bed rest. Not surprisingly, most information online is written by people with a negative story to tell, and most forum posts at medical websites are full of pain, and not something I recommend reading.
My friends are both awesome and jerks, at the same time.
Surgery scars just above my ankle. The wound the bottom, did my bone break out a bit there? I don't remember looking. This photo was taken about a month after the accident. Open wounds like this are of concern, as an infection here could seep into the bone and surgery, causing some horrific complications.
The feet, a month in.
The leg brace. After paying about $1000 for this thing, I showed it to my American doctor friend. She started laughing, quickly snapping a photo to send to all her doctor friends back in the States.
"I haven't seen something like this since our History of Medicine class! In a black and white photo!"
And there is a reason; this thing sucks. But it lets me walk. Remember, I broke my left shoulder, so the standard two crutch system wasn't going to cut it. I could go with a crutch on the right, and . . . this . . . on the left.
How does it work? Molded plastic pushes 100% of my weight onto the little divot below my knee. That tender little spot that is sometimes lovingly referred to as the funny bone. Funny because it feels kinda funny when you lightly tap on it. Not funny when rigid plastic jams into it with every step.
My friend giving it a try.
But practice makes perfect, and after a few weeks of use I can stand about 30 minutes with this before I need an ice pack.
Oh, and the guy who made this thing added a 2 inch heel to my Nikes. Dude, did you just ruin a pair of my favorite kicks!
I asked some American doctors, and they said that standard practice in the States is to stay off the leg, then start walking with a fracture boot. I didn't want to spend another $300 on another device, but these things are only about $40!
So that sums it up. I'm still not walking, though I was given the OK at week 5 to put 10kg of weight on the foot. Next is 25kg, then 40kg the following week. It really, really feels like I could walk unassisted, but you don't want to be ignoring doctor's orders.
Stay safe out there everyone.
