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by Ben Best
Not long after 7 p.m. on the evening of Tuesday, December 9, 2008 I drove from Clinton Township, Michigan to the Taubman Medical Library at the University of Michigan in Ann Arbor, Michigan. It was wet & rainy when I left, and there was every indication that conditions would be freezing upon my return. I intended to drive with extreme care to prevent an accident.
As is typically the case when I go to the University of Michigan medical library,
most of my initial time was spent on the computer taking advantage of electronic
privileged access to biomedical journal literature, whereas closer to closing
time I was in the stacks accessing articles too old to be available electronically
so that I could photocopy them. Taubman normally closes at 11:45 p.m., but
was open later for the benefit of students preparing for final exams —
closing at 1:45 a.m. Wednesday morning.
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I departed Ann Arbor shortly before the library closed, and drove back toward Clinton Township on Highway 14. The road was snowy, so between Ann Arbor and Livonia (on 14) I followed about five car-lengths behind a slow-moving (40-45 mph) car ahead of me.
From Livonia I drove north on Highway 275, leaving a large cushion of space between myself and other traffic. I was driving roughly the same speed (50-55 mph) as most other vehicles.
Not far north of 9 Mile Road I found myself suddenly, unexpectedly sliding. I spun counterclockwise on my left front tire, which I had replaced earlier in the day. I had been in the lane immediately to the right of the leftmost lane, and I observed a dark sedan barreling toward me in that lane — with no indication of slowing or swerving. I imagined that I was hit by that vehicle, but I have a poor memory of the event — and the police report did not indicate that I was hit by a northbound vehicle.
My next memory was of going into the ditch between the northbound and
southbound lanes. My brief feeling of safety was followed by my horrified
awareness of spinning onto the road into the southbound traffic as I moved
with a seemingly diabolical certainty into the path of an oncoming
semi-trailer. The semi-trailer only sideswiped me, however, but I was
struck by two other automobiles. The driver of one of those vehicles
did not remain at the scene of the collision ("hit and run"),
but the other driver was a woman who was hospitalized. At last report
the woman's injuries were not serious. I would estimate that the
collision took place at about 2:30 a.m., but I did not look at
my watch.
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My silver 2002 Saturn was "totaled", but the extent of the damage shown in the photos I later took at the towing company somewhat exaggerates the effect because of additional damage during towing. Immediately after the collision, the driver's side door was crushed, but mostly intact and inoperable.
A man came to my window and told me that I would be safer if I unhooked my seatbelt and moved to the passenger seat while awaiting the ambulance. I did as he suggested, noting that I only had use of my right hand because my left hand was quite deformed. I was able to extract my keys from the ignition and stuff them into my coat pocket. I was able to pull my backpack — full of valuable photocopies of medical papers — onto the front seat.
After a while the ambulance personnel arrived. Attempts were made to stabilize my spine as I was removed from my car. I believe that I was placed on a board and that my head and neck were immediately placed in a hard plastic rack intended to restrict movement. I was moved to the ambulance and driven to the hospital.
As happened so often during the next few days, I was quizzed about the date, my birthdate, the name of the US President, etc., as a means of assessing my level of consciousness.
The ambulance attendants removed all of my clothes using a sharp razor, ruining a favorite shirt and coat. My wallet had been in my coat pocket, and I confirmed that information found there applied to me. My watch and CI necklace were removed, but my CI bracelet was left on my wrist. I confirmed that I "wished to be frozen" if I died.
When I was asked about being given analgesics, I said that the pain was tolerable and that I did not want any medication. I told them that I do not smoke or drink or take any drugs, but that I do take many nutritional supplements (which I confirmed meant "vitamins"). I said that I have no history of drug abuse, and that my preference not to be given pain-killers was not because of a history of past addictions. When I was asked if my left hand had always been deformed, I told them that it had been a normal hand.
I was taken to the emergency department of the Royal Oak branch of Beaumont Hospital, which is the largest inpatient hospital in the United States.
I don't have much visual memory of the proceedings, but it seems to me that I was swarmed with emergency staff — probably the most physical attention I have ever received from so many people at once in my life. Most of what they did was taking X-rays and running me through scanners.
At one point a physician arrived who took my left hand into his hands. My middle finger & ring finger had been knocked-out of their joints, but this physician was able to manipulate them, and force them back into their joints. Later, the two fingers were taped together as a attempt to keep them from being knocked-out of their joints again.
Not long thereafter I experienced an extremely intense urge to defecate, and I made my condition known. A bedpan was put in place. I felt like I cleared not only my bowels, but some of my intestines — and I felt like the volume of my defecation surprised at least some of the staff. It was the last bowel movement I was to have before 6 p.m. Saturday.
When the X-raying process was complete, I was taken to
a curtained-off cubicle in the emergency ward. Needles were
placed in the armpits of both my arms, and I was given a saline
drip. I continued to reiterate my desire not to be given
pain-killers, and thankfully, my wishes were respected.
Electrocardiogram (EKG) electrode
leads were taped to my chest so that my heart could be continuously monitored.
| EKG Chest probes | EKG Electrode |
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A nurse told me that a catheter would be inserted into my penis, which she said would be initially a little painful, but would be the best thing in the long run. I said nothing, but after some contemplation decided that I did not want the catheter. When I think about the possible injury & infection it could have caused — and the lack benefit — I am horrified that I even momentarily considered having the catheter.
My lip had been badly cut. A large piece of my lip was still hanging from my mouth. A physician said that he would sew my lip and a gash on my forehead. Although I did not want any analgesics, I approved the use of local anesthetic. I watched him sew my forehead and my lip.
I was later informed by a physician that my X-rays/scanning had revealed a small laceration in my kidney and a small subdural hematoma. I was not to have any food or drink while there was a prospect that I might have surgery. The saline drip was my only source of fluids, intended to prevent dehydration. The physician told me that I would probably see some blood in my urine. I was peeing into a pee bottle, and I never saw any blood in my urine.
I spent most of my time in emergency trying to cope with pain and trying to keep warm. The emergency ward was cold, and I lay naked on a table covered by a few blankets. I was continually readjusting my body to minimize pain, although no position was painless. My squirming would displace the blankets. I was often asking for more blankets and for blanket readjustment. I was often miserably cold, and was aggressive in trying to alleviate this condition. Some of my back pain was the kind of pain I feel when I am too cold and my back muscles spasm in response to the cold.
CI Facility Manager Andy Zawacki phoned me. Someone in emergency services had left him a message at around 4 a.m. or so. I believe that I had given the CI phone number to the ambulance personnel. I gave Andy a brief synopsis of my collision and physical status. I told him that he could pass this information to the CI Directors, but that I did not want further announcements at that time.
Wednesday evening a room became available in the Intensive Care Unit (ICU), so I was moved from the emergency ward to a room of my own in the ICU. The greatest and most noticeable immediate benefit to me was the fact that the room was reasonably warm, and that I could request that the temperature be turned-up. The bed was softer and more comfortable. The noise level, however, was at least as bad as it had been in the emergency ward. There was a relentless broadcasting of announcements, requests and pagings.
Greg — the male nurse responsible for my care on the shift in which I entered the ICU — asked me a question I was to be asked many times: on a scale of 1 to 10, what was my level of pain, if 10 was the worst pain I ever felt. The question is subjective and somewhat arbitrary. I can't really say what the worst pain I have ever felt was, and Greg certainly could have no knowledge of my pain history. Nonetheless, I answered "7", which at least established that my pain was not trivial. I also reiterated that the pain was manageable, and that I did not want to be given pain-killers. Moreover, given the relationship of inflammation to the immune system, I did not want any anti-inflammatories. Greg seemed to think that my "level 7 pain" was a very serious matter. Greg was the only hospital staffer who attempted to argue with me very seriously about my desire to avoid pain-killers. Part of his argument involved scare tactics which I cannot remember very well, but which did not make much sense to me. He implied that I might have breathing problems if I used no pain-killers. I pointed-out that morphine is a respiratory depressant. Greg said that my sentient awareness would not be compromised by morphine, which I doubted. Greg finally relented, and I will say to his credit that he did not force any unwanted medication onto me — an appreciation I have for all of the hospital staff.
Greg seemed to be genuinely concerned about my discomfort. He ordered a more comfortable head brace for me than the hard plastic model that was pressing against my head, face and chest. The new padded brace was still very confining, but it was not as abrasive or hurtful. Greg told me that he had paid for the expedited hospital courier delivery out of his own pocket. I thanked him and expressed the hope that he was going to be compensated. (It was a somewhat awkward and confusing exchange.) Greg asked me if I would like a flu vaccination, to which I readily agreed. He told me that I did not qualify for the pneumonia vaccination because I was not over 65 years old. Hospital-acquired pneumonia is the most common cause of death in intensive care units.
I will now digress to give my thoughts, feelings, opinions and personal background concerning pain and pain-killers. I acknowledge that my attitudes are very idiosyncratic, and that my exposition has a large intuitive component, rather than being the product of directed research (although I do have a very scientific background and I have done related studies).
As a child I enormously disliked the effect that local anesthetics used in dentistry had upon my mouth. I did not like being unable to feel my own mouth. At the beginning of my teens, when my father told me that he did not used local anesthetics when visiting the dentist, I took that as inspiration to adopt the same policy. I had lots of deep drilling as a teenager and well into my 20s without the use of local anesthesia in dentistry. (Now I am less concerned one way or the other.) There may be some truth to the accusation that there was a pseudo-macho aspect to my stoicism, but I also think that there is something to be said for my willingness to face and master pain. During drilling I would attempt to psychologically adapt to the pain, and not allow myself to get upset about it.
I have long aspired to be a survivor. In my 20s I took the Outward Bound course in British Columbia, Canada in an effort to harden my ability to survive. The course was based on the philosophy that survival endurance can be trained. I was with an all-male group, and the focus was on building endurance.
When I attended pharmacy school, if there was one message that was pounded into us it was that all drugs have side effects, and that there is rarely no "price to pay" for drug benefits. I took this message to heart far more than most of my classmates, so far as I could tell. I mostly avoid drugs as much as possible. I was already a teetotaler when I entered pharmacy school, mainly because of my concerns about damaging effect of alcohol on the brain. I was very much against the idea of using alcohol to relieve my anxiety in social situations — I preferred to experience such anxieties with full consciousness, and to deal with them accordingly.
A significant number of my friends and associates (intellectual and otherwise) that I had when I was attending pharmacy school were doing recreational drugs. There were intellectual justifications given for the use of psychedelics, and I attempted scientific/philosophical refutation of these claims. One of my essays had the memorable title "Psychopharmacological Psychoepistemology". My more recent studies of alcohol have been more scientific than philosophical, but still lead me to believe that alcohol is likely harmful to brain function (see my essay Alcohol — Health Benefit or Hazard?).
All of the above digression can be viewed as "background bias", but now I want to explain why I believe that my avoidance of analgesics during my hospitalization was the right thing to do.
Although an argument can be made that some forms of pain — particularly chronic pain — can be pathological, none of the acute pain I experienced in the hospital was what I would call pathological. Pain is nature's warning signal that tissue is being damaged. Pain itself is not a disease, although too often pain is treated as if it is a disease. For many people their fear of pain is greater than their fear of death — a pathological attitude, in my view. Those people entreat their physicians to treat their pain rather than the disease, insofar as that is what is most concern to them. I think that it is far better to face painful realities and deal with them, rather than to try to run from them. (I have been told that I think about things that most other people would rather not think about.)
The best treatment for pain is to reduce the cause of the pain rather than to pharmacologically nullify the pain. In my case, I was covered with bruises and tissue injuries. Continued pressure on many body areas can result in ischemia, which results in pain. A person conscious of ischemic pain can shift body weight off the affected area, but a person who is drugged unconscious of pain will not move, and can quickly develop ulcerations in the ischemic area. Certainly, the maintenance of pressure will delay healing.
During my stay at the hospital, particularly during my first day in the emergency ward, I was squirming continuously — trying to shift my body weight to minimize pain on my injured body. I believe that this was of great value in reducing tissue injury. If I had been under the influence of analgesics, I would probably have been more passive, and worsened tissue damage. I may not have noticed if I had rolled on some of the needles in my arm — which could have resulted in greater injury and potential infection. My sensitivity to pain also made me very aware of how cold I was. My body weight is less than that of most Americans, and I have less fat to protect me from cold. Hospital staff did not seem very aware of these distinctions, and I had to continually request more blankets and better coverage. Had I been more oblivious to cold as a result of analgesics I could conceivably have gotten pneumonia (the number one cause of death in ICUs, as I mentioned earlier).
Psychological reactions to pain are very subjective — associated with anxiety & upset over the fact of pain. ("Pain is physical, suffering is mental.") Many people cause themselves a great deal of harm by their hysterical, panicked reactions to pain and their unwillingness to experience it. Analgesics, particularly opiates, are directed against the psychological components of pain as well as the pain sensations themselves. Pain is associated with a stress response, which elevates heart-rate & blood-pressure, along with plasma cortisol.
I am not a masochist. I do not seek pain and — aside from avoiding analgesics — my efforts are centered on reducing pain and the effects of pain. My tools for dealing with the psychological aspects of pain are themselves psychological — and are probably similar to what yogis accomplish when they demonstrate mastery over pain and reduction of blood pressure. I been doing this kind of "meditation" since I was 21 — and it is entirely self-taught. I have never seriously studied yoga.
My basic "mantra" is the word "relax". Once I have placed myself in a position that (for the time being) minimizes my pain, I try to concentrate all of my attention on my pain, while at the same time attempting to feel and cause relaxation. In this way I believe that I dissipate stress & upset associated with pain — and even lower my heart-rate & blood-pressure. In the hospital, it was my full-time job. My every waking moment not spent physically attending to myself was devoted to this task of psychological pain reduction. (I did not get much sleep.) I feel very pleased with my approach to pain during my hospital stay, and I believe that I am actually a stronger person as a result of the experience. As President of a cryonics organization, many people dearly wish to hurt & humiliate me, and I am now all-the-more prepared to face the social challenges to cryonics — which I expect to become more harsh before they get better.
After I was released from the hospital, a friend of mine who is a Registered Nurse who specializes in working in Emergency Rooms ("ER Nurse") commented on this write-up of my hospital experience.
She pointed-out that although my focus was entirely on maximizing my recovery, most hospital patients are as concerned (sometimes more concerned) with pain management than with recovery. She said that patients have a right to be relieved of pain and that hospital staff are made very conscious of their responsibility to patients in this regard. I am convinced that analgesics would have seriously reduced my ability to optimize my recovery, but the nurse pointed-out that circumstances could have been different. If I had a fracture in my neck, my squirming in the cervical collar could have been dangerous. Hospital staff would be responsible to warn me of the danger, but even under these circumstances it would be equivalent to criminal assault for hospital staff to administer analgesics (or any medication) without my consent (as long as I am conscious).
I was less impressed by the arguments the nurse gave that a urinary catheter would have allowed better assessment of my kidney function, and was advisable in light of my kidney failure. Attentive staff should be able to evaluate the volume and quality of urine in a pee bottle as effectively as urine obtained through a catheter. Sterile technique may be used during catheter insertion, but with my requirement to continually reposition myself I think that there would soon be ample opportunity for injury and infection. At minimum, my movement would have been restricted at a time when I believe that continual repositioning was an important means of minimizing tissue injury.
My having been deprived of any oral fluid since my entry into the hospital had left my mouth almost painfully parched. Another feature of the ICU which allowed for greater patient comfort was the availability of some drinking water — which I could only put in my mouth if I promised to suction it out with the suction device on my bedstand. I did relieve my mouth dryness in this way, with only a few precious drops of water leaking down my throat. Also on my bedstand was a lung exercise device, which I was encouraged to use hourly. The device was challenging for me to use, and underscored the severe drop in lung capacity I was experiencing during my hospitalization.
At the foot of my bed was another technological innovation: mechanically inflatable leg pads intended to prevent blood clotting in the lower limbs. The device would inflate slowly in an upward direction with the intention of moving blood from the legs to the upper body. Nonetheless, after about fifteen minutes of operation it would stop working and begin to beep annoyingly until someone turned it off. The device was actually counterproductive, because after it stopped working my legs would still be bound in the "leg irons", thereby restricting my mobility until I was able to get someone to release me.
There was no rest for the weary in the ICU. Aside from the ongoing noise, a blood pressure cuff was permanently attached to my upper arm. Every hour it would inflate to an uncomfortable tightness, and then slowly deflate to measure my blood pressure. Every few hours someone would visit to take blood samples, usually from veins in my left hand. The saline drip to my arm was a constant annoyance. The line restricted movement, and if I happened to lie on it the machine would beep until someone came to reset it.
Andy phoned me in the ICU and informed me that a couple of people had offered to visit me. I told him that the sentiment was appreciated, but that I wanted to minimize disturbances.
On Thursday afternoon, after less than 24 hours in the ICU, I was visited by a physician who removed the brace that had been confining movement of my head & neck to protect my spine. She probed various spots on my neck with her fingers, and asked me to report on the pain. I experienced no pain on the spine itself, only on the muscles and tendons. She concluded that it was safe to remove the neck brace. Moreover, there appeared to be no issues with my small kidney laceration or subdural hematoma — so I could be moved from the ICU to the trauma ward. She told me that I would probably be released from the hospital on Friday. Not long thereafter I was wheeled from the ICU to the trauma ward.
In the trauma ward I was separated from another trauma victim by a curtain. Whereas my main concern was still to adjust my body to minimize pain, reduce psychological stress, and generally achieve peace & quiet — my neighbor was more interested in watching TV, chatting on the telephone and visiting with people. I adapted to the noise, partly by soaking some tissue in water and using it as makeshift earplugs.
I was again warned about the dangers of leg clotting and urged to use the leg inflation device on my bed. I agreed, but the device worked no better than the one in the ICU, and I had it removed permanently from my legs. Possibly it is sometimes of benefit to drugged persons who are more immobile than I was.
Now that it had been established that I would have no surgery I was allowed food & drink. My first meal was typical North American diet: loaded with sugar & fat. I was able to eat the turkey and drank the milk. There was a form for indicating meal preferences, but I was only able to get this through to the kitchen for my last meal at the hospital.
I did very much avail myself of my ability to drink water. I had a call-button on my bed, and I kept the staff busy bringing me water and dumping my pee bottle. Nonetheless, they refused to remove the saline drip from my arm — probably due to hospital policy of not trusting patients to hydrate themselves.
Robert Ettinger phoned me. He seemed somewhat obsessed with trying to convince me to use pain-killers. I know he meant well, but it quickly became evident to me that he was did not appreciate my point of view. I simply told him that I was in no mood for arguing, and he relented on that basis. Andy had told me that Robert had told him that morphine was the greatest thing ever invented. Morphine may well have been appropriate for Mr. Ettinger's war injury.
I must admit that I became soft-headed and started getting curious about what morphine would feel like. I started thinking that a few hours of morphine might not be of much harm at this stage. When I asked a nurse if I could have some morphine she told me that this was no longer an option — that I was only to be given Vicodin. I had downgraded my subjective level of pain from 7-out-of-10 to 6-out-of-10 when I entered the trauma ward, but I don't know if this figured in the hospital decision. I told the nurse that I did not want any Vicodin. I am very pleased that I was not given any morphine. About a third of first-time morphine users experience nausea & vomiting — and I could easily have been in that group. Constipation & sedation is typical with morphine. Vicodin adds acetominophen to hydrocodone on the theory that overdosing increases nausea and stomach complications. I had enough to deal with without having to take medications intentionally designed to produce side effects as a means of protecting against drug abuse. Although my arguments against using analgesics are still the most important reason why I would not take Vicodin.
Despite the claim that I would be released on Friday, the staff at the trauma ward were in no rush to let me go. My main concern was that I had not walked, and did not know if I could walk. I expressed interest in various physical therapy programs they proposed, but I saw no sign of any preparation for me to get physical therapy. At one point I raised myself to sit on the edge of the bed (quite a feat for me at the time), but an alarm sounded, and a staff person rushed-in to tell me to get back in bed.
Later in the day on Friday the alarm on my bed was deactivated, and I was guided to walk to the washroom holding my IV pole. I shaved and washed my face somewhat, although my face & lips were still covered with scabs. I was given antibiotic ointment to apply. Robert Ettinger phoned me again and immediately began questioning me about pain-killers. I was fairly firm about not wanting to discuss the matter, and he quickly switched to expressing kind concern.
For the most part my pain was subsiding. At times I was able to assume a position on my right side that was almost completely painless when I did not move.
On Saturday I was increasingly inclined to get myself out of the hospital. The saline drip on my left arm was an increasing annoyance, and I knew that the only way to get it removed was to leave the hospital. The entire inside of my left arm was a leaking, bloody mess — ripe for infection. This was so obvious to my physicians/nurses that they removed it, although the needle on my right armpit was kept in place. The removal of the left arm needle provided an occasion for me to be walked (without the IV pole) to the washroom for my first (and last) shower. I expressed concern about showering when I was so covered with scabs, but the nurses thought it was for the best.
After I had washed, I was walked back to my bed, which had been cleaned while I was in the shower. But there were no blankets on the bed. I asked the attendant to get me some blankets, but she evidently got distracted and forgot about me. For half-an-hour I paced back and forth along the side of my bed, waiting for the attendant to bring blankets. Finally, when I saw another attendant I requested blankets, and she brought them immediately. But my walking had given me confidence that I did not need physical therapy, and that the best thing for me was to get out of the hospital as soon as possible.
My doctors and nurses agreed that I could leave. The needle was removed from my right arm-pit. I phoned Andy to come and get me, telling him that I would repay him if he bought me an electrical blanket at a department store along the way. Most of all, I wanted peace, quiet and warmth — which I was able to achieve on the rest of the day Saturday and on Sunday.
I hope nothing that I have written gives the impression that I did not appreciate the doctors, nurses and attendants that attended to me at Beaumont Hospital. By and large I was fabulously impressed by the competence & caring of these people, and I am full of praise for them.
I count myself fortunate that there were no broken bones, spinal injuries or damages to my mental faculties. For that matter, I am fortunate to be alive. I have a fear of icy roads like never before. I am going to make very certain that I am as safe as I can be when I am driving in freezing conditions in the future.
Almost everything above (with the exception of "Response to an Emergency Nurse") was written a week after my release from the hospital. Initially I was unable to exercise more than five minutes without getting winded, but within a few weeks my ability to spend 40 minutes on my Stairmaster had been restored. My dentist removed the stitches on my lip, but my lip has still been slow to heal and will probably never be restored to normal without advanced medicine. Recovery of my left hand has been very slow, but I have been able to type despite pain & stiffness. I have a kind of headache that I never had before. Although the headaches are brief and not greatly bothersome, I find them very worrisome.
My "no fault" automobile insurance covered most of my hospital expenses — which were over $15,000. My health insurance covered most of the $500 deductible that the auto insurance would not cover, but I did have to pay some money to the hospital and to the Farmingham Hills Fire Department (ambulance service).
Very near the time of my release I attempted to contact the Michigan State Police to get more details on what happened in my collision. I was able to reach the officer who was responsible for the case, and who was at the scene of the collision. He provided me with some clarifying details of the collision (which I described above). He told me that he was issuing a "Careless Driving" citation. He acknowledged that he did not observe the collision as it happened, but said that the collision itself was evidence that I was not driving carefully enough for the conditions. He added that if I appeared in court and no one pressed charges that the citation would probably be dropped.
I appealed the citation and I went to court. I believe that I may have been naive about the dangers of the conditions, but it is untrue that I was driving without considerable care. I also planned to argue that I had already been punished enough by my injuries and that I had "learned my lesson".
I arrived at the courtroom a half-hour early and observed many other cases. I was reminded of the ancient conflict between justice and mercy, but in this case "mercy" was nearly always a somewhat reduced sentence agreed upon by the defendant (and typically involving a fine). It seemed like a racket to me designed to reduce fighting with defendants and bring in lost of money for the court. I expect that this system evolved after years of pragmatic experience concerning optimizing results and minimizing strife.
As it neared my turn I was approached by a police officer to speak with him outside of the court. His job was to get me to agree to a lesser charge of speeding 5 to 10 miles over the speed limit. He told me that the officer who had issued my citation was a very tough man, and that I would be wise not to fight the case. He was shocked when I told him I had spoken to the officer and he was surprised that I had been in the hospital.
Nonetheless, the officer in the court was not prepared to deal with something out of the ordinary, and I was coming to realize that it would be a waste of my time and energy to try to seek justice within this cynical system. I cynically agreed to the charge of speeding, despite the fact that I had not been speeding. I did not utter a word when standing before the judge and listening to him cite me for speeding — with a fine of $171, payable immediately. I did not get the impression that the judge knew much (if anything) about the case.
I made a careful study of the advantages and disadvantages of chains and winter tires, finally deciding upon winter tires — and trying to obtain the best. Changing tires twice a year has become a new ritual for me.
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