July 2, 2021 in Mass General ICU

There are many forms of trauma from psychological to emotional to physical. One cannot outweigh or place a different set of values from one to another. In this story, I will describe a horrible accident my husband sustained about 21 months ago, what we know about it and how very lucky we are that he recovered.

July 1, 2021 began like a normal day during the pandemic. I had a physical therapy appointment later in the day, as I had tendonitis in my left elbow, so dressed in appropriate clothing before heading downstairs to the computer in the kitchen, where I begin every day, reading political blogs, the news and stories online. I had suffered a badly sprained ankle at an out of state wedding six days earlier (not my first sprained ankle) so wore an old air cast, grabbed before returning to the Vineyard.

Dan always gets up later than I, had eaten his breakfast and gone back upstairs to our den with his cup of tea just to rest and hang out before his afternoon golf date with a friend. Overhead, I heard two big plunks, like he dropped something heavy, but I didn’t go up to check. He does not like to be fussed over. About 20 minutes later, I got a text on my phone, “Betty, please come upstairs, I need your help.” Oh no, this was bad. I knew that the text was dictated from his phone because Dan knows my name is “BETSY”, not “BETTY”.

I raced up our narrow, antique steps and found what looked like a crime scene, with a trail of blood outside the bathroom and pools of blood near where Dan lay, with his feet up on the toilet.

What I found when I went upstairs.

The two thuds had been Dan falling. As best we could figure it, he had gotten up to go to the bathroom, and, with no warning, collapsed in the hallway outside the bathroom, falling forward and splitting his head open. He claims that he wasn’t dizzy and felt like he did not have altered consciousness. He reasoned that he shouldn’t just lay there, bleeding on the wooden floor, so got up and moved into the bathroom, where he collapsed again, this time backwards, hitting the back of his neck and head on the tile floor. He was in tremendous pain, but pushed his body onto the bathmat, grabbed a towel for his head and got his legs up on the toilet. He’s been on blood thinners for about a dozen years for a different ailment, so he REALLY bleeds. Then he thought about how to reach me and came up with the bright idea to launch that text from from his Apple Watch (his phone was in the den, but within range to pick up the signal).

I told him I would call 911. He told me to call our doctor in Newton first (as if he could do something). I took a few photos to send to our doctor, but called 911. They came quickly; I began to clean up the puddles of blood, so it wouldn’t get tracked across the house as they got Dan outside into the ambulance.

The police and EMT blocked off our narrow street and told me to wait in the car to follow the ambulance. It was a hot day (as it had been the day before. I couldn’t get off my driveway to get to the hospital until all the emergency vehicles left the street). I never saw how Dan got out of the house or how the EMTs worked on him. Our dear across-the-street neighbors had just come back from a walk and saw the commotion, asking what was going on. At that point, I only knew that Dan had fallen and there was blood everywhere. During the course of the day, I texted with them and the friend who had the now-cancelled golf date. So those two close friends knew something about his accident. And I cancelled my PT appointment. She asked if Dan had another bike accident. No – this was different; he was forbidden to ride his bike after too many falls.

I raced to the hospital, but due to COVID precautions, wasn’t immediately allowed back into the ER. In fact, I was in the waiting room for an hour. When I finally got back, Dan’s forehead was stitched up; he had a 5″ laceration and his head was fully covered in a compression bandage to keep the swelling down. He was on an IV morphine drip, so he was in good spirits and happy to see me. They were about to take him for an MRI.

When the results came back, the image showed a broken C-1 vertebra (known as the Atlas vertebra, as it holds up the head) on his left side. He had a broken occipital bone at the base of his skull and a torn and clotted vertibral artery, also on his left side, but as soon as the doctor saw the broken vertebra, she knew she had to get him off the Vineyard, STAT. She called for the MedFlight, which was at Mass General (in downtown Boston) at that moment. She needed them immediately and began to prepare Dan for his journey. She urged me to run home and get what he might need to for a hospital stay. I didn’t know how long I had, so I raced home to pick up some clothing, his wallet, iPad, chargers, etc and try to get back before his flight. It is about a 20 minute drive each way.

I got back and Dan was still there. A storm approached and MedFlight couldn’t make it back to the Vineyard. The ER doctor called the Coast Guard. The Search and Rescue team arrived, along with the Oak Bluffs EMT crew. They did all sorts of other things (which, mercifully, Dan does not remember; we’ve talked about it subsequently) to prepare him for that flight in bad weather. The crew was amazing. We are both forever grateful for their calm professionalism. I kept watching Dan’s toes to see if he could move them and made mental lists of how our lives would change if he became paralyzed.

He was off. The hospital made a ferry reservation for me to leave the next morning (it did my heart a little good to see that even THEY had trouble getting through to the Steamship Authority; I was also given a special number to call to make my return reservation, only used for medical emergencies. When I finally knew when we’d return, they were kind and accommodating. I keep that phone number for true emergencies).

I got home late in the afternoon, dreading the thought of needing to now, after everything I’d been through that day, tackle cleaning up the bathroom, getting the blood out of the grout, washing all the towels and bath rugs. I was spent, emotionally and physically. I opened my door and caught the faint smell of bleach. I walked up the steps and entered my sparkling clean bathroom.

I couldn’t believe it. I called my neighbor. “Ed, thank you SO much for cleaning the bathroom. I can’t begin to tell you how much this means to me, what a relief it is. But I must ask, did your housekeeper do this, or did Joan?” And the response: “My angel wife spent all day going back and forth, doing the laundry. She got on her hands and knees, cleaning that grout herself. She wouldn’t send a stranger into your house.”

I cannot begin to tell you what it meant to me that my dear neighbor slaved away on her hands and knees so that I wouldn’t have to face that scene when I came home. Before I left the next day, I sent a thank-you email, and flowers, once I arrived home. Their kindness and generosity to me and our family goes so far beyond how I can ever properly express my gratitude. They were heaven-sent that day.

I heard from our primary care doctor. We had joined a concierge practice a year earlier. Boy, did it pay off this year. Our doctor coordinated all of Dan’s care and explained everything to me in terms that I could understand. He was truly wonderful, invaluable and reassuring. I called our children to explain what had happened.

The next morning, I drove home, dropped my stuff, turned the house on (we shut everything off when we are away for the summer) and headed down to Mass General Hospital where Dan impatiently awaited me. It was the start of monsoon season (it seemed to rain most of that month). The Featured photo was taken that day. Dan does well on morphine. We FaceTimed with each of our kids (as it happened, David and Anna were in the US, so in the same time zone, which was helpful). We reassured them that, despite how Dan looked, he would be OK. He received wonderful care, was seen by multiple specialists (neurology, orthopedics, cardiology). He remained there until the doctors had him stable, off the morphine drip and the wonderful nurses had taught me how to use the two collars he wore to stabilize the broken vertebra. He had to switch when he wanted to shower.

Home from the hospital after four days. The first photo I posted to social media. Now many people knew about Dan’s accident and the calls started coming. He couldn’t talk on the phone yet.

We left the hospital on July 4, not the holiday we had envisioned. No one ever mentioned “concussion”, but it was clear Dan had one. He had all the symptoms, which took quite some time to resolve. He couldn’t read for the strain on his eyes and concentration. He couldn’t talk on the phone – the sound hurt his left ear. Everything was too much for him. Eating with the collar on was problematic, as he couldn’t open his mouth fully, so we had to think a lot about food that was easy to chew and he didn’t have to open his mouth wide to access. He couldn’t lie down, or even rest comfortably on the couch. I brought lots of pillows to support him. He hollered in pain when I had to change from one collar to the other so he could shower. He couldn’t tolerate having his neck unsupported for even a moment.

David and Anna came back to Newton from their US travels for a day before leaving on July 10, so we had a chance to visit. Dan was so happy to see them again and it reassured them to see him. That was a bonus.

With David on July 9

I took him to see his primary care doctor later in the week, who went over a list of “do’s” and “don’ts”. Drink lots of water or Gatorade – stay hydrated. The doctors were trying to rule out what might have caused his collapse. He’s had a history of vasovagal syncope before – collapsing when standing too quickly, his blood pressure drops precipitously and he goes down. But each time he would feet faint or dizzy. He had no such feeling this time, no warning. He had played golf the day before, walking on a very hot day and not drinking much. He drinks Diet Coke, which is a diuretic, it does NOT hydrate. The doctor told him to drink water and lots of it while playing golf and after, and dial back the Diet Coke. He did this for a while, but only for a while.

His skin became very irritated from the collar. We tried cream and wearing various shirts all the time to keep the collar off direct skin contact. He saw multiple doctors and had Zoom calls with others. Two weeks later, the orthopedist told him he could stop wearing the collar 100% of the time; he only needed to wear it when in the car or other times when he could be jolted. That was a tremendous relief. We were off Martha’s Vineyard for 20 days and finally returned. He was not allowed to drive for three months (he couldn’t turn his head until the fracture healed).

At least back on the Vineyard, he could get out and walk slowly, see friends, go to our favorite restaurants. He came with me to my Pilates class (under a tent outside during COVID) and sit on the lawn, just to get out. A few times, I took him to meet up with his Friday golf group at lunchtime, so he could socialize. They were pleased to see him and he was SO happy to see them. Of course, golf at this point, was also out of the question.

Visit with golf buddies, early August.

His doctor checked in on his progress. He got occasional headaches, but he progressed. His final check with the orthopedist was October 6. We had left the Vineyard a few days earlier (I was done for the season). I drove him to Mass General for his X-ray, then his meeting with the doctor who gave him the all clear. I drove him straight to Woods Hole and watched him walk on the ferry (his car, clothes and golf clubs were still there). He was free to drive, play golf, resume his life.

His neck still hurts a bit when he tries to turn it to the left. He will never have full-range of motion, but given the alternatives, he is SO lucky that is the only lingering ill-effect. His life is back to normal. The doctors continued to think through all that happened and, for lack of better explanation (they did a test of his heart function, which came back normal), they concluded that it was an abnormal episode of vasovagal syncope and he has to be careful when standing, drink LOTS of fluids, and is on medication to RAISE his blood pressure (crazy, I know).

All things considered, he was one lucky guy.

Betsy Pfau
Retired from software sales long ago, two grown children. Theater major in college. Singer still, arts lover, involved in art museums locally (Greater Boston area). Originally from Detroit area.