Keeping myself nourished is already proving to be something of a challenge. I’ve been taking in two kinds of liquid food: canned soups pureed in my blender and smoothies. I like soups, but they aren’t that filling. Having more than one can of soup raises concerns about excessive sodium intake. I may have to find some low sodium soups. As for smoothies, I’ve been making them with soymilk, soy yogurt, soy protein powder, bananas, and sometimes frozen fruit. Here my concern is taking in too much soy. I certainly don’t buy the anti-soy propaganda that’s out there, but I do tend to try to avoid consuming too much of anything. With the yogurt, protein powder and milk, one of these smoothies could easily have three or four servings of soy in it. Even with all that soy protein, I seem to need more than three meals a day, so it could come out to quite a few servings of soy each day. I did buy a few individual serving packets of rice and hemp protein powders, so I’ll have to try those out. I also have a little bit of rice milk in the refrigerator, so I can use that instead of soy milk in a smoothie or two, but I always find rice milk to be less filling than soy, so that won’t necessarily help the problem at all.
My insurance situation
7 AprWhen it comes to insurance, I happen to be very lucky. I have dual coverage for both medical and dental insurance. I get one set of coverage through the university. The fee is waived because of my job as a Graduate Student Instructor, but the plan is the student plan, which is most likely not as good as the plan that faculty and other employees have. I also have coverage through my father’s health and dental insurance plans, thanks to the Massachusetts healthcare reform law. While the main effect of this law was to expand coverage to almost all Massachusetts residents, it also contained a provision that required healthcare plans in the state to cover children for two years after loss of dependency (or until a certain age, which I think is 25). Since my parents are insured in Massachusetts through my father’s work, I’m covered under their plan. If I get through this situation in decent financial shape, I may just have to send Mitt Romney (who signed the healthcare reform law as governor) a letter of appreciation.
Getting around
7 AprI decided in the hospital the other day that I would stay off the bike while I’m recovering from my injuries. I might be walking some shorter distances, but for the most part, I’ll be taking buses. Most trips I take will require longer than they would take on a bike. My commute, for example, has taken almost three times as long since the accident. The nearest bus stops to my home are just under a third of a mile away, so my walk to the bust stop will be almost as long as my usual commute by bike (about 10 minutes). Many of the bus lines run infrequently (some every half hour on weekdays and every hour on weekends), so arriving just a little bit too late can cause major delays. Furthermore, when I get to a bus stop (with a few exceptions), I have no way of knowing whether the bus I’m looking for has already come. Sometimes buses come a few minutes early, but more frequently the run late. On some occasions, a bus doesn’t come at all. When the line runs only every hour or every half hour, that’s a pretty big deal.
So, yeah, I’m certainly not looking forward to being dependent on buses, but I’ll deal with it.
A failed experiment
7 AprI had some kale and about a third of a block of tofu in my refrigerator, so I tried steaming the kale and adding it and the tofu to a smoothie last night. The result was pretty unpalatable, so I ended up dumping it and making a more conventional smoothie.
Monday shopping
6 AprI made a quick stop at the Safeway across the street from my dentist’s office after my appointment so that I could buy some full-sized straws. I also ended up buying some bananas for smoothies and some chocolate soymilk, which was on sale.
After a brief stop at the office to arrange a ride home from the oral surgeon’s after my procedure, I went to Walgreens. There I acquired a Water Pik (I opted for a cordless model since my bathroom doesn’t have any outlets), a two-pack of children’s toothbrushes, and a package of little brushes, called Brush Picks and made by a company called DenTek. Although nobody had suggested this last item to me, I bought it because the brushes reminded me of some brushes that I used to use when I had orthodontic braces. They came eight to a package, and each one has a small brush at one end and a flexible pick at the other end. Eight is more than I’ll probably need, but this was the only size package I could find.
I then caught a bus to Whole Foods Market, where I purchased soy protein powder, antibacterial soap, natural mouthwash (Tom’s of Maine brand) and a couple of Amazake smoothies. I bought some frozen fruit with the dual purpose of adding to smoothies and icing my jaw on the bus ride home. I also looked for a calcium supplement, which proved to be harder than I thought. The supplements were organized by brand, so I had to look through each brand separately (rather than finding all of the calcium supplements in one place). I couldn’t find one that was specifically labeled as being vegan, and eventually an employee came over and asked if I needed any help. I told her what I was looking for, and she told me that calcium citrate should be vegetarian. I didn’t have the energy to explain the difference between veganism and vegetarianism, but I was baffled that somebody working in the supplement section of Whole Foods in Berkeley could lack that knowledge. She started pointing out different supplements to me, but I had already decided that she wasn’t going to be much help. Eventually, she left to check on something else (for which I was relieved), but she told me she would come back. I managed to find a supplement whose ingredients looked vegan (although it was only labeled as “Suitable for Vegetarians” and free of dairy). It seemed good enough, especially given the circumstances, so I took it to checkout and paid.
An insurance form
6 AprThis afternoon, I completed an insurance form for the cycling club. I don’t really understand what it’s for. I don’t see why there would be an insurance policy that would pay anybody other than me (the club didn’t incur any costs from the accident), but I’ve already signed a waiver freeing the club from any liability.
The form wasn’t particularly remarkable except for two things. First, it had checkboxes for 21 body parts, and I was to indicate which had been injured. I ended up checking just under half of them (10). However, most of the injuries were very minor, such as light scratches on the front of my neck and my right ear. The second thing was that I was asked to indicate whether my injuries were minor or serious, and I wasn’t sure what the answer was. While a broken jaw certainly isn’t fun, plenty of people recover from it, and relatively quickly. I assumed that there was some serious legal definition of “serious injury,” and I looked around and found that I was right, at least in the State of New York. A Google search turned up a page on the New York serious injury threshold:
“Serious injury” means a personal injury which results in death; dismemberment; significant disfigurement; a fracture; loss of a fetus; permanent loss of use of a body organ, member, function or system; permanent consequential limitation of use of a body organ or member; significant limitation of use of a body function or system, or a medically determined injury or impairment of a non permanent nature which prevents the injured person from performing substantially all of the material acts which constitute such person’s usual and customary daily activities for not less that ninety days during the one hundred eighty days immediately following the occurrence of the injury or impairment.
I’m nowhere near New York, and neither is the insurer, but this was good enough for me. While most of that wouldn’t describe any of my injuries, I definitely have a fracture.
Monday doctor visits
6 AprI called the oral surgeon’s office as soon as they opened at 8AM. They were able to make an 11AM appointment for me, but they told me that I should get a referral from University Health Services (UHS) so that my student health insurance plan would cover treatment. I called UHS, and they told me that I should come to urgent care to get my authorization.
I very much resented being required to get this authorization. It seemed ridiculous that they couldn’t just trust the emergency room doctor’s word that I needed to see an oral surgeon. I spent the better part of an hour waiting at UHS before seeing a nurse and then a doctor. The nurse took my temperature and my blood pressure (both were normal) and asked me a few questions about my accident and the injuries. She showed me a piece of paper with faces showing various levels of discomfort and had me rate my pain according to the numbers labeling the faces. However, there were two sets of labels, one from 1-10, and one from 0-5. I didn’t ask which one she wanted me to use, but I said my pain was about a 2. For the most part, my injuries have been a bit uncomfortable, but not particularly painful. The doctor looked at my various injuries and had another nurse bandage my scrapes. This actually made me rather glad to have come in because I had so many scrapes and not enough energy to bandage all of them. The nurse also gave me material for dressing my wounds for the next five days before I go back to get my stitches removed. I left with a bill of $15.60 not covered by insurance. Most of that was for the bandages the nurse had given me, which were $55 before insurance (and $11 after).
About an hour after getting out of UHS, I had my appointment with the oral surgeon. He seemed nice and friendly without being intrusive (and, as a somewhat shy individual, I’ve found a lot of medical professionals to be intrusive). He showed me my x-rays, and explained my fracture, a condyle mandibular fracture. I was mildly disgusted when he told me that the model skull on which he was pointing out the condyle, a thin part of the mandible near the joint, was a real human skull, and I became altogether horrified when he removed the jaw from the skull and asked me to hold it. He told me that the condyle fracture was a common type of fracture, which usually was treated without open surgery. The usual treatment was to anesthetize the patient, prod the bone back into place, and wire the jaw shut for a few weeks. In a small proportion of cases, however, this doesn’t work, so an open surgery is necessary. He added that there was a small number of cases in which it isn’t necessary to wire the jaw shut; sometimes the bone will stay in place well enough that it is sufficient to keep the patient on a liquid diet. He didn’t specify any time frame for the liquid diet, so I asked if this liquid diet would be for the rest of the patient’s life. “No, just a few weeks.” he answered, laughing.
In my case, the surgeon said, it will be necessary to wait a few days until my face is less swollen to do anything. He wasn’t sure whether it will be necessary to wire my jaw, and he won’t know until he has me asleep in the office. He told me he would have his receptionist call me in the afternoon to set up an appointment.
The oral surgeon also expressed concern about my two chipped front teeth. I told him that I was planning on having them fixed, but I thought that the broken jaw was a more pressing concern. He agreed, but said that I should have a dentist put a temporary seal on it. He said that since I had only lived in the area for seven months, he couldn’t imagine that I would have had any reason to find a dentist by now. I was more than a little bit amused by this, having long been told that I should have a dentist clean my teeth every six months. I said, that I had, in fact, found a dentist, and I told him who it was. The oral surgeon told me that my dentist was a great dentist, and then made an appointment with the dentist for me that afternoon.
I also asked the oral surgeon if he had any suggestions for keeping my mouth clean if my mouth were wired shut. He suggested getting a children’s toothbrush and Sensodyne toothpaste. I wasn’t crazy about the Sensodyne suggestion, but I decided to get a children’s toothbrush to use with my usual Tom’s of Maine toothpaste.
I had plenty of time to get to the dentist’s office, but somehow I still ended up running to catch the bus to get there. This certainly wasn’t a good thing for me to be doing with broken jaw, but I didn’t fall, and I did catch the bus. When I got to the dentist’s office, he put a seal on one of the teeth, which he said almost had a nerve exposed. He said that both of the teeth were only chipped in the outermost layers, and he expects that they will be fixable. However, we’ll have to watch them carefully, and they may end up needing root canal work.
I repeated the question about keeping my teeth clean to the dentist, and he suggested a Water Pik, so I added that to my shopping list, too.
About twenty minutes after I got out of the dentist’s office, I got a call from the receptionist at the oral surgeon’s office. She told me that the next two appointments available were Wednesday of this week and Tuesday of next week. She added that she’d have to check with the surgeon to see if Wednesday would be too soon and call me back later. She also told me I’d need a friend to drive me home from the procedure, so I headed into the office to find somebody who could do that for me.
I was relieved to learn when the receptionist called me back a couple of hours later that the surgeon will be able to do the procedure on Wednesday. Although I’m not in pain most of the time, there are enough positions that are quite painful, that I’d really like to get it done as soon as possible. After scheduling the appointment, the surgeon transferred me to another member of the office staff, who told me that their office didn’t contract with either of my health insurers, and she told me the cost of the service, which was just under $3700. I knew that my insurance would cover some of the costs, even if it was out of network, but I wondered why I was referred to an out-of-network doctor in the first place. I know I’ll be able to afford whatever it costs, but of course I’d rather pay for as little as possible.
Sleep
6 AprSleeping is proving to be something of a challenge. I fell asleep three times last night, but for only about ninety minutes each time. There just isn’t any comfortable position for me to sleep in. I can’t tilt my head far enough back to lie down on my back, so I’m left with a choice of my badly scraped right side or my left side with the mandibular fracture. I’ve chosen to sleep on my right side since the scrapes are less serious than the fracture, but even that hasn’t gone so well.
The evening
6 AprAfter arriving home, I showered (carefully, to avoid getting my sutures wet) and called my parents to let them know that I had made it. I realized that, as it was Sunday, the pharmacies might close early, so I should go to pick up my prescription for Vicodin as soon as possible. While I’ve generally tended to avoid using painkillers (I didn’t use any when I had my wisdom teeth out), I decided that it would be good to have them on hand, just in case. Checking online, I found that none of the area pharmacies was open later than 6PM. I hurried to catch a bus to the nearest Long’s Pharmacy, arriving in the pharmacy line at 5:45PM. Fortunately, they were still able to fill my prescription.
I also looked for Fixodent, which an EMT recommended to me earlier to temporarily seal my teeth until I could see a dentist. However, I found that this product came in several different kinds, all of which were intended to be used with dentures, so I decided to wait until I could talk to a dentist to see what to do.
I arrived home to realize that I needed to buy straws so that I could drink without getting the sutures on my lip wet. Even without the sutures, drinking without a straw would be a challenge because my lower lip was swollen. I planned to take a walk out to Andronico’s, the nearest grocery store (and one I dislike very much), to buy a box of straws. This was complicated by the fact–for which I am very much appreciative–that the ride leader was planning on bringing my bicycle to my apartment from the fire station, and I didn’t have my cell phone, which was with my bicycle. When I managed to convince myself that I had enough time for the trip, I made the trek down to the store. I looked through what I thought was the entire store twice without finding any straws, so I settled on buying the cheapest package of juiceboxes that I could find. These, of course, come with small straws. I did find the straws after paying for the juiceboxes; they were along the wall at the end of the checkout lines.
I returned to my apartment and blended a can of Amy’s Lentil Soup and then drank it through one of the juicebox straws. I don’t generally find canned soups to be very filling, but I wasn’t very hungry, so this was enough.
The ride leader stopped by with my bicycle. He was very nice and apologetic about the accident, which I assured him was exclusively my fault. Along with my bicycle was my phone (in good working order), and my helmet, which doesn’t appear to have been damaged in the slightest (I will replace it out of caution nonetheless).
I’m going to go to bed soon. I made an attempt to brush my teeth not long ago, but it was not successful due to the level of swelling in my mouth. I also haven’t taken the Vicodin that I rushed out to buy, and I don’t plan to do so before going to bed.
The hospital
5 AprUpon arriving at the hospital, I found myself waiting in the hallway for an room. A man–whose position was not made known to me–asked me a number of questions about the accident. He also asked about my medical history. He asked if I’d ever had surgery, and I said I’d only had wisdom teeth removed, which he translated as a “no”. Somebody cut my shirt off of me, an act which rather annoyed me because I felt very much capable of removing my shirt myself, and I resented the loss of the shirt.
Eventually, they did find a room with space for me, and they proceeded to move me into the room and ignore me for a while. I found myself periodically whimpering, half because of the discomfort in my jaw and half because I thought it might make somebody pay attention to me. Lying on the bed, I had some time to examine my wounds–at least those which I could see. Both of my hands were bleeding: my right hand on the back side, and my left hand on both the front and back. I had scraped my right shoulder and both of my elbows, and it seemed like there was some blood on my face, but I couldn’t see my face. I also noticed that my top and bottom teeth weren’t lining up normally.
A doctor came in and introduced myself. He looked at my wounds briefly, and seemed particularly interested in my bleeding hands. He suggested, “Maybe you should wear gloves next time.” I half expected him to look at my bleeding right shoulder and suggest that I also wear a shirt next time, too.
The first person to see me for any significant amount of time was an x-ray technician (or whatever the person who takes the x-rays is called). He complained repeatedly that the doctor should have just requested a CT scan of my head because he wanted so many different angles. He did, at least, assure me that I was a good patient, although I don’t have any idea why he thought this to be the case. There was also apparently some problem with the equipment, and so some of the shots had to be retaken several times. I heard the technician talking to somebody else in the room where he controlled the x-ray machine, and it sounded like he was saying that something was far out of place. I didn’t know what he was talking about, but I suspected it had to do with my x-rays. The technician came back into the room and told me he just needed one more x-ray. He told me to lean my head back for the shot, but I found it too painful to my jaw to lean that far back, so he found an alternative position.
When I returned to the bed and waited to be seen by the doctor, it occurred to me that I had been carrying my iPod Touch on my bike at the time of the accident. This was only significant in that it could be confused for a phone. I found the bag of my possessions near the foot of my bed, and–sure enough–the iPod was in my shoe, and my phone was nowhere to be found. I knew that I’d get my phone back whenever I got my bike back, but I didn’t know when that would be. I figured I could probably take a bus down to the fire station to pick up the bike, but I didn’t know how long it would be before I’d feel up for the trip.
Eventually, the doctor came back and asked me how I was doing. It seemed like a strange question, given that the answer should have been apparent from my very presence in the emergency room (not to mention my appearance). I tried to be optimistic, answering, “Pretty well given the circumstances.” He answered, almost as if he was trying to undercut my optimism, “Well…you broke your jaw.” He told me that I’d have to see an oral surgeon as soon as possible during the week so that the surgeon could “fix [me] up.” He then explained to me how hitting the right side of my head had caused a fracture on the left side. He also started to tell me about “the other way to break your jaw”, which apparently involved hitting the front of one’s chin. When he finished explaining, I told him, “I guess I’ll have to try that another time,” attempting to sarcastically allude to my lack of interest in another way to break my jaw. He didn’t seem to appreciate my morbid sense of humor, answering, “No, I think once is enough.” He didn’t tell me how the oral surgeon would be fixing me up, but he said that I’d need to be on a liquid diet at least until I saw the oral surgeon. I couldn’t imagine chewing with my jaw feeling the way it was, so I wasn’t at all bothered by this restriction.
The doctor and a nurse then proceeded to clean off my various wounds. In addition to the ones I had seen, there was a cut on my upper lip, a cut on my chin, and a few abrasions on the right side of my face. The chin, I was told, needed to be stitched. As the nurse and doctor cleaned and stitched me, my thoughts turned to my teaching job. After a subpar fall semester, I’ve put a lot of work into teaching this semester, and I was concerned that I might not be able to finish the job with the broken jaw.
After my chin was stitched, the doctor raised the question of whether my lip needed to be sutured. I felt my lip with my tongue, and it felt as though something might have been stuck in the cut. I wondered if it might have been the fragments of my chipped teeth. The nurse and doctor proceeded to examine the cut, and sure enough, I heard the doctor comment that it looked like there was something in the cut before the nurse exclaimed, “It’s his tooth! His tooth shattered in his lip.” She seemed genuinely excited, as though she had never seen a case like this before. Within a few minutes, the fragments of the tooth were cleaned out, and the lip was sutured. The nurse mentioned that I was almost ready to go home, before leaving me to call my mother, who had called while the doctor was stitching my chin, on a hospital phone.
A short while later, a nurse told me I could leave as soon as I had clothing. Fortunately, my shorts weren’t damaged, but I’d need a shirt to replace the one that was cut off of my back. They found a black shirt for me, although I don’t know where it came from. A nurse gave me several sheets of paper with information about my injuries, a prescription for Vicodin, and a note that I should take three days off from school. I was more than a little bit surprised that they were releasing me without even bandaging any of my wounds, but I was glad to get out of the hospital and into the taxi that would take me home.
Shock and Jaw 